OUTLINES 
OF THE 
INSTITUTES OF MEDICINE. OUTLINES 
OF THE 
INSTITUTES OF MEDICINE: 
FOUNDED ON 
THE PHILOSOPHY 
OF 
THE HUMAN ECONOMY, 
IN 
HEALTH, AND IN DISEASE. 
IN THREE PARTS. 
Should we build facts upon facts until our pile reached the heavens, they would 
tumble to pieces, unless they were cemented by principles.-Rush. 
BY JOSEPH A. GALLUP, M. D. 
Author of Sketches of Epidemic Diseases in the State of Vermont; late Professor of Theory and Practice in 
the Vermont Academy of Medicine, and of the Clinical School of Medicine ; Ex-President of the 
Vermont Medical Society ; Hon. Member of the Medical Society of the State of 
New York, &c. 
VOLUME II. 
BOSTON: 
OTIS, BROADERS, AND COMPANY. 
1 8 39. Entered according to Act of Congress, in the year 1838, by the Author, 
in the Clerk's Office of the District Court of Massachusetts. 
TUTTLE, DENNETT AND CHISHOLM, PRINTERS, 
No. 17 School Street. PATHOLOGICAL ILLUSTRATIONS 
IN REFERENCE TO 
S E M E I 0 T I C E . 
SECTION XLII 
SEMEIOTICE. 
However " dark and difficult " the subject of semeiology 
may be esteemed, some attempts must be made towards its 
illustration ; for, unless a view of the correspondence, or 
catenation of cause and sequence can be traced by, and be- 
tween the externa] tokens, and the internal changes, these 
manifestations are lost, and we profit nothing by them. 
Again, if the manifestations of the suffering tissues are not 
rightly apprehended, but misconstrued, there may be a fear- 
ful train of consequences as connected with the therapeutical 
applications. It behooves us, therefore, to proceed with 
caution in exploring the concealed conditions of the internal 
affected tissues, by their external indicators. 
1. Preliminary Remarks. 
2. Harmonies existing in Disease. 
Our expositions must chiefly have reference to the com- 
mon morbid habit, and not so much to any particular state of 
disease ; nor, indeed, to any isolated order of diseases. It 
is only by reviewing the phenomena of the common morbid 6 
SEMEIOTICE. 
habit, that just conceptions can be obtained of the character 
of disease universally. The modifications emanating from 
this are numerous, and depend, 1st, on the character of the 
hurtful agents ; 2d, on the severity of the impressions made ; 
3d, on the personal condition of the subject affected. 
Each of these specifications admits of many varieties, both 
in kind and severity. Notwithstanding, we find many things 
in common, and a parallel of harmony existing in and run- 
ning through all diseases of excitation. There are very 
striking analogies existing between what are called acute, and 
chronic diseases, and a similarity of phenomena are constant- 
ly presented, although differing in severity. The discoveries 
made by investigations in the living subject, in tracing the 
phenomena in a physiological manner ; or, by inspections of 
the ravages of disease in the lifeless, all conspire to prove an 
affinity of morbid changes, and that they are produced by 
agents having similar impressions and sequences, with trains 
of phenomena of much resemblance ; and yet, they have 
their peculiarities, as modified by time, and a greater or less 
degree of morbid force. 
Not only a difference in the severity of the antecedent 
agents modify the phenomena, but they are varied by the 
locations in different tissues, on which the determinations may 
concentrate. Often in attacks of acute disease, and some- 
times in chronic, the concentrations pass in rapid succession 
from organ to organ, and simulate the form of disease pecu- 
liar to such organs. So, a common attack of what is called 
gout, may migrate from one tissue or organ to another, and 
assume as many names as the number of organs it affects. 
The same of the various conditions of fever ; the local af- 
fection may migrate in its forming state, or after it has lost a 
part of its severity ; every place the concentrations fall upon, 
they alter the condition of the organ, excite a new train of 
phenomena, and in a nosographic description the affection 
requires a new7 name. The same circumstances attend what OUTLINES OF PATHOLOGY. 
7 
are called localinflammations. Indeed, the harmonies exist- 
ing in disease are so numerous, that if we are not warranted 
in speaking of the unity of disease, we may be justified in 
dilating on the affinity existing between all diseases of excita- 
tion ; and, again, we scarcely know what constitutes disease, 
without a state of excitation. 
The phenomena are liable to be irregular, and admit of 
many modifications. This has been so much the case that 
no invariable definition of fever, for instance, has ever been 
made out by the most scrutinizing pathologists. There is 
not a phenomenon in the groups attempted, but what may 
singly be absent, whilst yet enough are present to show its 
existence. 
This has been a source of perplexity, and caused much 
speculation ; and yet, admits of easy explanation on the sug- 
gestion of its depending on the readiness of the repulsive sus- 
ceptibility, existing at the time, to be excited. The three 
alleged phenomena of Boerhaave, shivering, frequent pulse, 
and heat, may, or may not be present, according as the re- 
pelling energies are free and intense, or otherwise. These 
phenomena may all be present ; yet, if the embarrassments 
are so severe that the recuperative force cannot be brought 
into exercise, they may be absent, or some of them only 
present. It is useless to attempt to establish an invariable 
series of phenomena in any disease, or any order of diseases; 
only the most common need be noticed. 
Notwithstanding, more or less of the phenomena of fever 
are present at the commencement to establish its existence, 
and others are soon developed ; and it may be insisted, that 
they very constantly indicate the condition of the internal tis- 
sues, when diligently examined, and by keeping the physio- 
logical derangements in view. On the subject of the anoma- 
3. Anomalies of the Phenomena. 8 
SEMEIOTICE. 
lies of disease we must make reference to Sect, xxxvi., and 
particularly article 5, on the subject of alternations of heat and 
cold as exciting disease, and with anomalous symptoms prov- 
ing suddenly fatal. The cause, although plain to any one 
who will observe, is almost constantly overlooked as too fa- 
miliar, and the relation between cause and effect on predis- 
posed tissues, is not always duly appreciated. 
The term fever is of very questionable import ; it is liable 
to mislead the mind from the real condition of the morbid 
economy. It had its origin in one of the most imposing phe- 
nomena, the presence of heat; and yet, this is often wanting. 
It has been applied to a large proportion of the affections of 
excitation, whilst they ought not to claim the appellation any 
more than other states of disease specified by other names, 
in which heat may be present as one of the phenomena. 
They all have their local affections somewhere, in common ; 
but the term fever seems to be applied to the internal, diffus- 
ed, membranous inflammations. The terms fever and in- 
flammation must be employed at present in conformity to 
universal usage; yet, it would be a gratification to use syno- 
nyms more expressive of facts. 
4. Contingent Phenomena. 
The phenomena attending disease may be very numerous 
on account of the ready susceptibility of the nerves of ex- 
ternal relation, so freely interwoven with the tissues of the 
nutritive organs, in greater or less proportion. The nerves 
of sensation and motion, with their organs, are often affected 
in a secondary manner, and give occasion to many casual 
phenomena, which are not really necessary to the progress of 
the disease. 
In Sect. xvi. 2, we have already attempted to show, that 
disease is seated essentially in the tissues destined to nutri- 
tion ; and although the nerves of external relation may be af- OUTLINES OF PATHOLOGY. 
9 
fected, yet it is in a secondary manner. Their increased 
sensibility may be very useful by indicating the progress and 
amount of disease, yet not very essential to its existence, or 
course. 
• a. Convulsions may attend at the commencement and pro- 
gress of disease, or not. Although often excited, they are 
not necessary to the character of the disease, and yet they 
aid the responding actions in re-establishing the lost balance 
of the circulation, between the centripetal and centrifugal ca- 
pillaries. They often are a part of the responding pro- 
cesses, and assist in establishing an equal action ; but the dis- 
ease will progress whether they appear or not. 
b. Syncope, and even an absence of pulse, acrotismus, are 
sometimes present. These, as well as many other phenom- 
ena, are dignified in nosographic arrangements as isolated dis- 
eases. Their presence is accidental, arising from a depriva- 
tion of vital force from changes in the nutritive tissues, which 
may or may not occur. They may manifest a sudden col- 
lapse, and yet not cause it. However, the restorative pro- 
cesses oftener prevail, and the disease keeps on its course as 
though they had not happened. The same of many of the 
erratic pains and spasms, which occur at the commencement of 
disease. 
c. Vomiting is often present at the onset of disease, and 
may commonly be considered an accidental phenomenon, ex- 
cited in harmony with the repulsive powers to restore the 
lost balance of circulation. It may occur whether any ex- 
citing cause exists in the stomach, or not. 
Many other phenomena may occur casually, and attend 
more or less the progress of disease, which are extremely 
liable to deceive the medical attendant. It will be acknowl- 
edged as difficult to draw a line of distinction between the 
casual and constant phenomena, in a general review of the 
morbid habit ; and the difficulty seems increased, on consid- 
ering there are few but which may be absent, under particular 10 
SEMEIOTICE. 
circumstances. Yet, pathologists have uniformly noticed 
certain trains of phenomena as attending what are styled 
fevers and inflammations, and our attention may be directed 
more particularly to these. 
5. Three Series of Phenomena. 
Semeiotice admits of three divisions of phenomena, the 
primary at the onset; the more developed at the acme, and 
the resulting. The first comprises the constitutional and lo- 
cal phenomena, at the onset of disease, whilst the functions 
are changed and attended with an inability of action, yet soon 
showing an excess of action at the acme of disease. The 
last comprises those which arise after disease has continued 
some uncertain length of time, and made structural changes 
of greater or less extent in the organism, and connected, 
more or less, with exhaustion of vital force. We need to 
review but a part of them. Although we may remark on 
the acme of disease, still it is a mere development of the 
first stage. 
6. Reflections on the first Series. Predisposition. 
The condition of predisposition is most commonly a state 
of excitation, above the ordinary state of health, from the 
stimulations of remote causes. The acumen of intellect, and 
activity of the organic actions are increased ; the muscles are 
energetic ; floridity of countenance, and increased or dimin- 
ished appetite, show a state of energy and excitation. How- 
ever, as soon as some changes take place in the nutritive tis- 
sues, lassitude, weariness, and dulness of intellect intervene ; 
it now approximates more to disease. OUTLINES OF PATHOLOGY. 
11 
7. Shrivelled Aspect, Paleness and Faintness. 
These phenomena, with the erections of the papillae, clear- 
ly indicate a rigid, tonic state of the dermoid tissue. The 
same condition prevails in the internal tissues, and the blood 
meets with a constrained passage in the capillary arteries, and 
still more in the capillary veins. The centrifugal circulations 
suffer delay, and the centripetal more or less of stasis. The 
aspect therefore becomes shrunken, with anaemia on the sur- 
face, and hyperaemia internally. The cardiac motions at this 
time are feeble, and irregular, like all the other functions. 
The alterations in the nutritive tissues impede the nervous 
force, and the functions become vacillating. 
The stomach having sensitive nerves of external relation, 
reports its uneasiness, and inability of natural function, al- 
though its tunics are distended with blood, and its cavity with 
food. By and bye it may be provoked into abnormal efforts, 
with vomiting ; or this may be absent. 
8. Chills and Rigors. 
The exsanguious state of the capillary circulations suspends 
the process of calorification, whilst a large proportion of 
blood is delayed in the great internal veins, in the spongy di- 
latable organs, and at the origins of the capillary veins form- 
ing congestions. (Sec. xxi. 4.) The temperature of the 
surface is below its ordinary standard, especially in the most 
severe conditions of disease. From the deficiency of the 
capillary circulation, the cuticular nervous expansions have 
their sensibility impaired or lost ; and the surface may be 
burned by heated substances, without the subject being con- 
scious of it at the time. In some extreme conditions, as in 
cholera and intermittents, there is a deficiency of calorifica- 
tion in the internal tissues, so that warm intestinal injections 
will be returned cold. The repulsive force is not brought 12 
SEMEIOTICE. 
early enough into action, so all the functions cease without 
chills or rigors, as there is no renewal of circulation on the 
surface to elicit heat. 
The ordinary conditions of disease, both acute and chronic, 
exhibit very different phenomena from those just sketched. 
In the chronic state, for the most part, the chills are very 
irregular, and sometimes absent, whilst there are certain ac- 
cessions of depressions, lowness or faintness, occurring either 
casually or periodically. Some have a more settled coldness, 
continuing a long lime from the beginning of the illness ; 
whilst others have alternations of chills and flushes, but sel- 
dom rigors. 
It is in the more common conditions of acute diseases, that 
chills and rigors appear at the attack. Soon after the other 
phenomena become manifest, and often simultaneously, the 
subject experiences a lively sensation of cold and heat, ir- 
regularly thrilling over the surface, and sometimes slight 
rigors. A sensation of coldness is often perceived at the 
stomach. These sensations invite the seeking for external 
warmth, and hot aromatic cordials internally. 
In these instances, the instinctive susceptibility is readily 
excited, and the inordinate stimulations provoked to severe 
impulses, so that the capillary circulations begin to be restored 
on the surface. The cutaneous nerves of sensation have soon 
an increase of perception, and they transmit the mixed sen- 
sation of heat and cold to their centre. The contrast of the 
warmer blood of the interior, and the cold state of the skin 
gives the mixed sensation of heat and coldness. So a well 
person, who has been exposed to cold, on coming into a 
warm room, is liable to feel slight chills. 
Again, there are certain states of paroxysmal fevers, called 
intermittents, in which the morbid condition appears to be a 
latent st^te of predisposition. The instinctive restorative 
powers become excited soon after the attack, and hold out 
a severe contest with the pathological derangements. The OUTLINES OF PATHOLOGY. 
13 
preservative energies excite the external muscles into convul- 
sive efforts or tremors. The internal accumulations of blood 
and precordial distress are great, the stimulations solicit the 
entire repulsive powers to action, and the whole muscular 
system becomes associated in convulsive movements, con- 
stituting the repeated rigors, which often continue several 
hours, apparently holding a doubtful conflict before the cir- 
culations obtain a full ascendancy. The centrifugal impetus 
now being considerable, sweats flow quite freely, and the pri- 
mary cause, or latent state of predisposition, appears to be 
essentially removed, and yet manifests its existence on the 
approach of another paroxysm. In continued fever it is only 
very partially overcome. 
It has long been remarked, that whenever chills and rigors 
arise, the paroxysm will not prove fatal. In such cases the 
repulsive powers have been partially excited, and when this 
is the fact they will prevail, although the contest may be 
severe before the derangements be restored ; yet, only so 
far as to admit a free and general action. After the circula- 
tion becomes established, the intensity of capillary action 
continues in such fevers as have no remissions ; but, in peri- 
odical fevers sweat soon flows and terminates the paroxysm. 
Sometimes the morbid changes are so great, that the repul- 
sive force cannot be excited in season, and the paroxysm 
proves fatal. . * 
The sense of feeling of patients is often very deceptive, 
with regard to either cold or heat at the commencement of 
fever ; and even also, during its progress. They seldom feel 
pained by the sensation of cold until they have had chills, 
and are then liable to be greatly deceived. They sometimes 
correctly feel cold, when the surface is actually so, the ther- 
mometer indicating about 94° or 96° of F. Yet, they will 
often complain of being cold when it indicates the heat of the 
surface to be 102° or 104° of F., and when there is a strong 
sensation of heat perceived by a bystander. On the other 14 
SEMEIOTICE. 
hand, sometimes they feel intense heat when the thermome- 
ter indicates in the mouth, far less than the natural standard 
of 98°. When the heat arises to 104° or 106° F. they 
sometimes become greatly pained by the feel of heat. The 
function of the nerves of feeling seems to be vitiated, an- 
swering to the parapsis expcrs, and acris of Good. This 
might not be considered very extraordinary, since the nerves 
of volition are, also, in a pathological state, as shown by the 
convulsive movements of the'muscles, in the rigors. Or, might 
these phenomena be explained on the principle of the relative 
effects of cold and heat, the previous sensation deceiving the 
judgment, like changing hands in cold and warm water ? Per- 
haps the effect on the nervous expansions would be the same, 
that is, a pathological state. 
9. Paroxysms, and their Periodical Return. 
Perhaps there is no thesis in semeiotice more abstruse, 
and difficult of illustration than this. Expositions of the 
subject have commonly been evaded in this age of rigorous 
induction ; whilst some think we have no data sufficient to 
argue from. We approach it with diffidence. 
Paroxysm implies a sudden accession of disease, and a 
train of phenomena resembling the cold, hot, and sweating 
stages of fever ; yet terminating in a short time, leaving the 
subject in the interval as well as before. It may be a fever 
of a few hours, or of a day, called an ephemera. An exacer- 
bation is an aggravation of the phenomena of continued dis- 
ease, resembling a paroxysm, yet soon subsiding into a state 
of remission ; when the disease continues as before. Both 
may return at stated periods, or causually. 
The following propositions in relation to the contingencies 
of paroxysms, in both the acute and chronic states, will be 
advanced. 
a. In every habit subject to paroxysmal attacks, there exists OUTLINES OF PATHOLOGY. 
15 
either a permanent state of predisposition ; or, the actual 
presence of disease in the involuntary nutritive tissues. 
b. In paroxysmal attacks of pain, and of convulsive agita- 
tions, the subsequent local concentrations fall upon some tis- 
sues receiving their nervous susceptibility from the spino-en- 
cephalic mass ; but in the instances of periodical hemor- 
rhages, &c., the concentrations will be in some of the nutri- 
tive tissues, and without muscular agitations. 
We will begin our illustrations by some familiar instances 
of paroxysmal pain. Suppose a subject has a carious tooth, 
which, however, gives no'trouble until he finds himself indis- 
posed from, perhaps, exposure to cold, or some other cir- 
cumstance. He has merely acquired a state of predisposi- 
tion. Soon some accidental excitation may be offered to the 
dental nerve of the carious tooth, which has now received 
an increase of sensibility ; it will rise into a severe paroxysm 
of pain, and even associate all the muscles of the trigeminal 
nerves into the same state, producing nervous, or paroxysmal 
toothache of perhaps five minutes continuance. This may 
be repeated occasionally, as long as the state of predisposition 
continues, and when this subsides the toothache will not be 
readily excited. 
c. Again, in every state of neuralgia there exists a hidden 
state of disease, or predisposition. The local nervous affec- 
tion cannot be removed as long as this state remains, and it 
always forms a concentration in some of the neurilema of the 
nerves of feeling, by which their sensibility immediately be- 
comes increased. 
Under the above circumstances the most trivial excitations 
induce a paroxysm of exquisite pain. A paroxysm, in the 
instance of neuralgia facialis, associates all the muscles of the 
face into the circle, and indeed often more extensively. In 
periodical hemicrania, the same circumstances exist, a state 
of latent disease, or predisposition ; and a point of increased 
susceptibility to which the morbid energies are directed. 16 
SEMEIOTICE. 
In case of periodical epilepsy, there is always existing 
some point of irritation in some portions of the neurilema of 
the nerves of external relation ; it may be a tumor, or an 
alteration of the osseous texture, or even congestion, acting 
as a local stimulus on the cerebellum, liable to excite epilep- 
tic convulsions ; or, it may be some kind of alteration, or 
permanent excitation in the tissues of the cerebrum, liable to 
produce insanity. In these instances, on the accession of 
some disturbing circumstances, altering the economy, the 
concentrations will most certainly affect the focal points of 
former irritation ; and then a train of phenomena will be ex- 
cited, and run through a course of harmonies of action pecu- 
liar to the organs most affected ; producing epilepsy in one 
case and insanity in the other. 
d. Passing by many similar affections, we will review that 
condition of disease called intermittent fever, having distinct 
paroxysms and intervals. These consist of several, at least 
three important divisions of unequal paroxysms ; viz : quoti- 
dian, tertian, and quartan. It may be necessary to bring 
some of their characteristics into view. 
e. The quotidian commences, in its most regular form, 
twentyfour hours after the onset of the preceding paroxysm, 
usually in the morning, and ending in less than eighteen hours. 
It has the shortest cold stage, but the longest paroxysm. It 
approaches nearest to continued fever, and shows a temporary 
crisis by passing off with sweat, and sediment in the urine. 
f. In the tertian, the paroxysm commences about forty- 
eight hours after the preceding ; usually at noon, and ending 
in less than twelve hours. It has a longer cold stage, with 
shorter hot, and sweating stages. 
g. In the quartan, the paroxysm commences about seven- 
tytwo hours after the preceding, usually in the afternoon, and 
ending in less than nine hours. It has the longest cold stage 
and shortest paroxysm. 
The accession of paroxysms of unequal periods and severity, OUTLINES OF PATHOLOGY. 
17 
seems to arise from modified physiological states of the sub- 
ject ; for they may run the one into the other, or even into 
continued fever spontaneously, or by treatment, or by cir- 
cumstances which alter this state. A single dose of opium 
has converted a tertian into continued fever, with delirium, 
when given at an early stage of the paroxysms. 
In every instance of simple intermittent in either of the va- 
rieties, at their commencement, there previously exists a per- 
manent state of predisposition; and which had commonly 
been acquired by a residence in a cold damp atmosphere, 
whilst there is great disparity of temperature between noon 
and night. It may have been heightened by neglect of clothing 
and diet, adapted to defend the system against the atmos- 
pheric changes of cold and heat. This state of predisposi- 
tion, when once established, is very persistive; it often 
continues from autumn to spring ; and various anomalous 
affections may arise in the mean time, before the intermittent 
appears in its specific character. The general aspect is most 
commonly altered in this state of predisposition, together 
with many slight sensations in the praecordial region, and yet 
little heeded by the subject. 
The peculiarity of this state of predisposition consists in 
the circumstance of an irritation concentrating in the spinal 
cord, more especially affecting the motory nerves. The 
general muscular susceptibilities show this, before and at the 
attack ; so also, the vitiated sensibility of the nerves of feel- 
ing. Indeed, all the phenomena at the attack of a paroxysm, 
indicate more especially a local impression on the spinal cord 
and organs of external relation, whilst the entire system of 
the nutritive tissues is affected by the state of predisposition. 
h. The access of a paroxysm of intermittent is sudden, 
with chills along the back. The nerves of muscular motion 
and of feeling are depraved ; the patient feels great distress, 
especially in the prsecordia, but judges erroneously of his sen- 
sations of heat and cold. The muscular system is agitated in 18 
SEMEIOTICE. 
a convulsive manner, long continued, and very differently from 
what it is in simple fever, with internal membranous, conges- 
tive inflammation. The phenomena of the muscular system, 
in uncomplicated intermittents, would rather show, that this 
affection ought to be placed in a nosography, rather along 
with convulsive diseases than fevers. The mind is rather 
prostrated than delirious, and, as soon as the paroxysm is 
over, becomes sedate as before, and even sooner than in epi- 
lepsy. Indeed, all the phenomena soon subside, after equal 
circulation is restored, and sweatings follow ; and the patient 
soon appears as though nothing important had happened to 
him, as in epilepsy. It is not until the affection has con- 
tinued a long time, and a more distinct morbid habit has 
supervened, that changes are found in the internal viscera ; 
these may be considered as sequelae. • 
The reason, then, why intermittents do not continue, and 
show a succession of pyrectic phenomena, is, that no impor- 
tant morbid habit exists to support them, but merely a parti- 
cular state of predisposition, so that the healthy actions 
return. But, the paroxysm will be repeated when the cir- 
cumstances of excitation again occur. Still the phenomena 
will appear essentially of the nervous kind, unless a morbid 
habit becomes established, when it will progress much like 
simple fever, either acute or chronic, and injure the internal 
tissues. 
i. Intermittents and epilepsy appear to have many things 
in common, both as to the state of predisposition and pheno- 
mena. The most prominent phenomena of both appear in 
the organs of external relation. The muscular agitations, the 
disposition to sleep and sweat after the paroxysm, show a 
freedom from real disease ia the intervals, whilst a state of 
predisposition exists. Intermittents are sometimes followed 
by periodical epilepsy, at the stated times of the intermittent 
accession ; and both may have their paroxysms intercepted 
by the same remedies, viz., arsenic, opium, quinine, &c. OUTLINES OF PATHOLOGY. 
19 
Both have been excited by mental emotions, and both cured 
by terror, or impressive passion. 
Still the question in relation to the excitation, and subsi- 
dence of paroxysms remains to be examined. 
Whenever the nervous system of external relation obtains 
a high degree of susceptibility, it is liable to be disturbed by 
slight impressions ; and abnormal motions once excited in an 
organ, directly associate other motions in organs of the same 
apparatus at least, through their whole extent. When these 
organic commotions are considerable, the entire economy 
suffers more or less disturbance. 
There must always be some cause to excite paroxysms, 
but they may be often so slight as to be imperceptible. Indeed, 
they are in their nature not perceptible by our senses. Yet, 
sometimes they may be, and it is common for paroxysms of 
neuralgia, convulsions, chorea, hysteria, epilepsy, and inter- 
mittents to be excited by fatigue, passions of the mind, &c. 
In these cases a general commotion is raised, and the con- 
centrations instantly arrive at the point of greatest sensibility ; 
this becomes sufficient to excite the subsequent catenation of 
phenomena, which constitute the paroxysm. 
j. There seem to be diurnal changes taking place in the 
elements of our atmosphere, which affect the finer sensibility 
of the nervous tissues, although not always cognizable by our 
senses. These were descanted on in Sect, xli., on Etiology. 
These changes are rarely noticed by any one in health, 
although the subject may perceive some difference in his 
ability of action, or even mental exertion, either casually, or 
periodically. These insensible changes affect the morbidly 
sensible tissues in their peculiar way, or through the organic 
sensibility, as intensely as the eye is affected by light, when 
its internal coat is inflamed ; or the auditory nerves in cases 
when a remote whisper becomes painful. Valetudinarians, 
and hypochondriacs sometimes possess such exquisite sensibil- 
ity that they become good aerometers. 20 
SEMEIOTICE. 
It is under circumstances like these that diurnal and lunar 
influencies exert their greatest effects, or excite the nervous 
commotions, which begin a long train of consecutive pheno- 
mena. It may be found by accurate observation, that every 
twentyfour hours may be divided into quadratures of six hours 
each, at which periods disease is most liable to be excited by 
the diurnal changes, as it may be by the seven day quadratures 
of the moon. 
Aside from all exterior circumstances, there appear to be 
periodical changes in the human economy occurring every 
day, and perhaps every six hours of the day, in which it may 
be less able to resist extraneous impressions. This is most 
discoverable in the whole round of phenomena in relation to 
the external superadded nerves ; and especially in the neces- 
sity of the periods of repose, and activity. It applies, also, 
in a less obvious manner, to the nutritive tissues. Nature 
seems to have impressed a law, especially on the external 
system of nerves, and more obscurely on the internal, where- 
by their functions are performed in regular rythms, especially 
of repose and activity ; and it is highly probable, that certain 
of these periods render the economy more assailable to the 
exciting causes of disease. The inquisitive are invited to 
follow out these suggestions, in the details of investigation. 
k. With regard to the subsidence of paroxysms, it appears, 
that after the economy has become fatigued, and gone the 
rounds of associate actions, it subsides of necessity into 
rest. 'There is no positively fixed morbid habit, or state of 
nosodynamia in the tissues to perpetuate disease ; so a sub- 
sidence ensues as after any high stimulation, or violent exer- 
cise of the organs of external relation. The prostration of 
energy, followed by relaxations with the remaining internal 
excitations, give occasion to sweats, which terminate the 
paroxysm. However, when the system has again accumu- 
lated force, and the circle of excitations becomes renewed, 
the paroxysm will be repeated. OUTLINES OF PATHOLOGY. 
21 
10. Cold Sweats. 
Although the surface may be cold at the onset of many 
habits of disease, especially of fever, and destitute of red 
blood, yet the internal irritations being severe, and acting on 
morbidly tonic tissues, the thinner portions of blood are 
forced through the exhaling surfaces, and resemble the matter 
of sweat. They often, however, contain albumen showing 
some viscidity. They are more delayed on the surface on 
account of its coldness, and they accumulate in abundance on 
some occasions of severe disease, as cholera, &c. 
As soon as the reactive forces have eliminated action, and 
the surface becomes turgid and warm, the cold sweats cease, 
and they may now be warm. This is a favorable circum- 
stance ; yet, the surface is liable to become hot and turgid, 
when all sweats cease. False views of the character of the 
diseased habit, have raised the hypothesis of these cold 
sweats arising from debility ; yet nothing is more adverse 
to the facts, which the other phenomena teach us. They 
are forced through the straightened exhalants, by the severity 
of arterial impulse from internal irritations. 
In some severe attacks of malignant fever, a portion of the 
cruor of the blood is forced on the surface, along with the 
serosity, or matter of sweat. The most remarkable instance 
of this phenomenon on record, was-in the ephemeral epidemic 
called the sudor anglicus, which occurred about the beginning 
of the sixteenth century ; thus described. 
And soon the surface caught the spreading fires, 
Through all the yielding pores the melted blood 
Gushed out in smoking sweats. 
* * * » « * « 
Here lay their hopes, though little hope remained, 
With full effusion of perpetual sweats 
To drive the venom out. 
In such cases the pores yield to a superior internal force. 22 
SEMEIOTICE. 
Sweats at this Stage are not critical, unless long continued 
until the surface becomes warm ; and perhaps not even then ; 
for the fever is still liable to remain. In what Blundell called 
the hydrotic fever, although the sweats were profuse, they 
were not attended with a crisis. 
Ichorous effusions take place into the sacs of the pleura 
in epidemic pneumonia ; also into the aerial tubes, form- 
ing the bloody sputa ; also, into the peritoneal sac in severe 
peritonitis, &c. These are of a character similar to the 
bloody sweats ; in both instances forced from the exhalants. 
11. Diarrhcea Serosa. 
This is of frequent occurrence at the commencement of 
many varieties of disease ; and we may be excused, if we 
should rob it of its dignity as an isolated affection, as we have 
many others, and reduce it to an humble phenomenon of the 
morbid habit. 
The muco-intestinal exhalants being portions of the centri- 
fugal circulation, and arising from the terminations of arteries, 
probably have their functions accelerated by the force of the 
heart and arteries, above that of the centripetal series. A 
fluid quite similar to the cold sweat of the skin, and by a sim- 
ilar process, is forced out in abundance, and produces the 
diarrhoea. This is a common phenomenon at the access of 
disease both in cold and warm seasons ; it admits of many 
modifications by mixing with different substances in the first 
passages. The diarrhoea attending cholera consists in a mere 
extension of the same circumstances, which produce the 
sweats ; and both occurring together show a severe state of 
disease. In ordinary attacks of disease, only one of these 
phenomena occurs, and by increasing one of them the other 
is diminished. The natural remedy for serous diarrhoea, is, 
to divert the exhalant action to the dermoid tissue. 
A moderate diarrhoea relieves the relative plethora of the OUTLINES OF PATHOLOGY. 
23 
vascular system, which always occurs at the onset of acute 
disease, and often saves the local impression from more im- 
portant organs. However, it sometimes proceeds to excess, 
as in cholera, and deprives the blood of its fluidity, neutral 
salts, &c., rendering it unfit for circulation, and sustaining the 
necessary secretions. 
This might be called a casual phenomenon, like most oth- 
ers occurring at the onset of disease. It, however, is fre- 
quently present. It is always absent in cholera, for the sweat 
arid diarrhoea supersede it, and so effectually, that the kidneys 
suffer a paresis. As the kidneys form a part of the elimina- 
ting series, so certain personal, or special circumstances may 
invite a determination of morbid impression to these organs, 
in preference to other tissues. A strong functional effort is 
excited, and large quantities of urine are produced. This 
renal effort relieves the vascular plethora, and saves more 
important organs, or such as are not constituted to relieve 
themselves by an excretion, such as the cerebral organs. 
These organs are seldom in danger of important congestions 
when the kidneys act freely ; and many slight attacks of dis- 
ease meet with an early crisis, when a copious discharge of 
urine attends them. Such are the ephemeral attacks of dis- 
ease in movable and enervated habits. 
As the severity of disease increases, th'e flow of limpid 
urine diminishes, and scarcely any is voided ; and at the 
height of fever the kidneys often suffer a paresis of function ; 
and a stronger concentration might involve them in inflamma- 
tion, nephritis. In this event there is no secretion, and the 
tissues of the organs are in danger of being spoiled. How- 
ever, as the morbid condition abates, the organs resume their 
functions and become the eliminators of large quantities of 
heterogeneous and effete materials, at the crisis, to the great 
12. Diabetes Simplex. 24 
SEMEIOTICE. 
relief of the circulating mass. On other occasions, the se- 
verity of the morbid habit is so intense, that there can. be but 
little, or no secretion of urine at the onset. 
13. Inordinate Flow of Bile. 
A morbid habit of a milder grade gives occasion to a boun- 
teous secretion of bile, at such times as the irritations con- 
centrate in the liver. This is ascertained by the discharges 
partaking of a bilious aspect. Yet, in the instance of the 
more severe affections, this organ also, often suffers a pare- 
sis, when no bile is secreted. Thus it usually appears in 
those fevers called gastro-intestinal, whilst in typhus gravior, 
and cholera, it is wanting. Hence is discovered the impro- 
priety, in ordinary cases, of using repeated cathartics to dis- 
charge bile, as they increase the quantity by their stimula- 
tions. Its own cathartic powrer is commonly sufficient to ef- 
fect its discharge. 
If it should be inquired, why there is a deficiency of bile 
in cholera, whilst the exhalants externally and internally are 
so active, producing sweats and diarrhoea ? it might be sug- 
gested physiologically, that the same deficiency of nervous 
force exists in the liver, as attends the centripetal circula- 
tions. So, in the diseased state, the arterial series is more 
active than the venous ; and the hepatic series of secreting 
capillaries are all venous. Besides, the exhalants do not suf- 
fer so much as the secernants. 
It seems to be a law of the morbid economy in relation to 
all the internal secreting organs, that in mild affections they 
suffer irritations, in which state their functions are increased. 
In more severe degrees, they suffer what might be called a 
state of excitation ; in which their function is impaired, com- 
monly attended with paresis. In this state inflammation is 
liable soon to supervene, and to be attended, either by tissu- 
al effusions externally, as occur in what are called the phleg- OUTLINES OF PATHOLOGY. 
25 
matiae ; or, by interstitial infiltrations, constituting the phleg- 
monoid state of inflammation. We are compelled for want 
of more appropriate terms, to use those which have been es- 
tablished by long usage. The word sub-inflammation de- 
serves no place in pathology. 
14. Cardiac, and Arterial diction. 
The physiology of the heart instructs us, that its motions 
quickly harmonize with every pleasant, and every injurious 
impression made upon the mind, or the susceptible tissues 
of the body. Its responses are, also, lively and energetic, 
whilst unembarrassed. Being the centre of the circulations 
it often has much to suffer, and to repel in disease. Being 
liable to a deficiency of vital force in common with other or- 
gans, and again to an increased sensibility ; also, sometimes 
inundated with fluids, and then suffering from inanition, we 
need not be surprised to find its rytbms broken, the pulsatory 
actions sometimes irregular, often deficient, frequently pow- 
erful, and again, sometimes annihilated, suffering a paresis, 
called acrotismus, or even asphyxia, when fatal. 
In the incipient stage of severe fever, the exercise of all 
the organs is liable to irregularity, or there exists a state of 
ataxia. The heart and arteries partake a portion of it often- 
times, not only in reference to other organs, but as relates to 
their individual exercise. Sometimes the heart acts quite 
powerfully, whilst the pulsatory action is small and feeble. 
The pulse is therefore liable to deceive, unless the examina- 
tion is extended to the heart. A hand on the praecordial 
region may discover the disparity, but the stethoscope tells 
best. In this case venesection is safe and proper. On the 
other hand, when the cardiac action is small, whilst the pul- 
satory may be quite full and seemingly strong, as sometimes 
occurs, then venesection should be used cautiously, Or leech- 
ing substituted to remove more safely the' congestive, op- 26 
SEMEIOTtCE. 
pressed state of the heart. Small bleedings may be used, and 
repeated cautiously, until the disparity is removed, and then 
to the point of relief. If good attention is given, this pulse 
may be distinguished from the hard and strong pulse, free 
from cardiac oppression. Although pretty full, it wants the 
force and vibratility of unembarrassed action. 
A deficient, irregular, and yielding pulse is one of the first 
phenomena we discover on the access of disease, the chronic 
as well as acute ; they are most manifest in the severest forms 
of disease. The pulsations soon become frequent ; but, their 
future feeble, or energetic oscillations depend on the circum- 
stance, whether the morbid derangements, or the restorative 
powers gain the ascendancy. When the former prevail, the 
pulsatory actions more and more diminish until a paresis oc- 
curs. On the contrary, in the event of a triumph of the lat- 
ter they become strong, full, and vibrating, if all other things 
are equal. In this event, the heart and arteries play their 
part in all the salutary processes. However, one consider- 
ation should constantly be kept in mind ; that, the predomi- 
nant nervous susceptibility of the heart and arteries, incline 
them to an amount of force in the responding actions, so as 
to be in danger of producing lesions in the very tissues their 
instinctive motions are directed to protect. An excess of 
action restores not the functions, but destroys the tissues. 
15. Primary Coma. 
Several remarks have already been made in relation to the 
encephalic functions. (Sec. xvi. 3.) Coma often occurs at 
the onset of fever, especially in the order called typhoid. 
This is quite different from the lethargic sleep at the latter 
periods of disease. 
Primary coma arises from any cause that suddenly occa- 
sions an exhaustion of vital force, by stimulation; or from 
accumulations of blood in the venous radicles producing con- OUTLINES OF PATHOLOGY. 
27 
gestions in the cerebrum, in which event the nervous force 
of the intellectual organs is partially intercepted for a time. 
The same circumstances occurring in the cerebellum occa- 
sion lassitude and paralysis ; yet, if they should be of an irri- 
'fating kind, convulsions might attend. Even congestions in 
the cerebral tissues may induce the same results, when they 
are sufficient to produce a perpendicular pressure on the ce- 
rebellum. (Sec. vi. 14.) 
The cerebral functions are liable to suffer when the mor- 
bid force is directed to these organs, and there often arise 
new trains of phenomena called nervous, on account of inju- 
ries done the spino-encephalic masses. We may merely no- 
tice that the pneumogastric nerve is liable to suffer an inabil- 
ity of function by the same circumstances, and by which the 
functions of the larynx, of the lungs, and of the stomach may 
be essentially altered. Hence arises inability of speech and 
swallowing, laborious respiration, with sighing, and an inca- 
pability of the stomach to be excited by stimulants, emetics, 
&c. A state of paresis prevails. The blood is not properly 
depurated in the lungs ; it remains dark. 
If the morbid conditions are not removed, and the case 
continues, this state of the tissues will be followed by inflam- 
mation, with effusions of various kinds within or between the 
membranes of the cranium and spinal cord, according to the 
state of the diathesis, and severity of morbid action ; and 
these give occasion to secondary coma, or earns lethargus 
absolutus of Good. 
It may now be necessary to review some of the most prom- 
inent phenomena at the acme of disease. 28 
SEMEIOTICE. 
SECTION XL II I 
PHENOMENA ATTENDING THE ACME OP DISEASED MORBID 
HABIT. 
1. Preliminary Remarks. 
When the tissues are free from a state of paresis, and at 
liberty to act in the varied conditions of disease, there will be 
a very constant succession of cause and sequence ; or there 
will be successive changes in the organism, and these chan- 
ges are, for the most part, manifested by discriminating phe- 
nomena. The alterations are liable to terminate in destruc- 
tive lesions of the organs affected ; or so far injure their tex- 
ture as to spoil their functions. 
The phenomena become more distinct, as well as more 
intense as the disease progresses, until it has arrived at its 
acme. They then continue without essential variation until 
the organism is spoiled, or a salutary crisis takes place, by 
a removal of the primary morbid derangements in the tissues. 
The medical attendant should not be an idle, or indifferent 
spectator, contemplating the changes going on, merely to 
gratify curiosity in seeing what they may amount to. There 
is a time to act, and to act energetically too ; and this is as 
soon as the disease has become developed ; or, indeed, be- 
fore its entire development. 
A person who has studied and observed the morbid habit, 
can foresee by the early phenomena what must happen, if it 
is permitted to progress without restraint. It ought to be 
met at the threshold by suitable and efficient remedies, in- 
stead of seeking for some point of local irritation, and apply- 
ing slow and inert palliations. 
The phenomena are so diversified in different tempera- 
ments, and in the modified conditions of the different habits 
of disease, both acute and chronic, that they require separate OUTLINES OF PATHOLOGY. 
29 
considerations in the different diatheses and types, so that our 
general remarks may be but few in this place. 
2. Increased action of the Heart and Arteries. 
At the acme of disease the organic susceptibility becomes 
increased, the tissues are impatient of even ordinary stimula- 
tions, but now endure those of the blood, which has suffered 
changes, and become more irritating. The phenomena of 
the circulations indicate a more elevated state of physiologi- 
cal action. The heart vibrates with unaccustomed energy, 
and the arteries act in accordance, as is manifested by their 
pulsatory movements. These pulsations admit of very dif- 
ferent degrees of frequency, from ninety in a minute, to one 
hundred and twentyfive or thirty. The case may be consid- 
ered more important as the pulse is more frequent, if all other 
things are equal. 
The arterial capillaries, which had been contracted, have 
now become turgid, and venous absorption is better perform- 
ed. In the synochoid diathesis the absorptions are free, for 
they must first become so, or there cannot be an expanded 
state of the circulations. In those cases approaching the ty- 
phoid state, the arterial pulsations remain limited, the pulse 
is constrained, or partially suppressed, although possessing 
some force ; yet, the absorptions are not free, and cannot be 
so, until the relative plethora is removed, and chiefly by 
blood-letting. A portion of the blood still remains in the 
congestions, and there cannot be an expanded state of circu- 
lation until these are essentially removed. 
Many instances might be detailed of the treatment modify- 
ing the whole train of the phenomena, which yet had remain- 
ed from the attack for several days, partaking of the states 
called adynamia, typhoid, &c. In such cases the surface is 
still anaemic, and unequally hot and cold, with internal con- 
gestion® -oilse frequent, feeble, and vacillating. Caloric to 30 
SEMEIOTICE. 
the surface by warm water, or mild steam ; moderate vene- 
section, and a grain or two of tartarized antimony, whilst the 
patient is in a warm bed, will commonly change the whole 
aspect of the phenomena, induce equal circulation, a more 
expanded state of circulation, and render the case more man- 
ageable. 
If the remedies should be successful in establishing a free 
and equal circulation, the phenomena are liable to become 
more intense than those attending the synochoid diathesis from 
the beginning, for the tissues now have assumed a greater in- 
crease of sensibility. The arterial impulse is now liable to 
become excessive in a day or two, and in proportion to the 
preceding state of depression of the circulation. 
This state of the system is not peculiar to the acute forms 
of disease, but may clearly be noticed in many chronic dis- 
eases. Even in phthisis pulmonalis, many of the cases show 
for a long time paleness, small and frequent pulse, cold ex- 
tremities. A treatment quite similar at an early stage, chan- 
ges this state, so that capillary circulation diffuses warmth 
universally, and all the phenomena, especially by the pulse, 
are more distinct, and the way prepared for the use of other 
beneficial remedies. 
3. Relative Hyperoemich or Plethora. 
The condensed, tonic state of the tissues produces a rel- 
ative plethora between the vessels and fluids, in the first stage 
of disease. The fluids in the second stage have become ex- 
panded by the evolution of caloric, and gases, (Sect. ix. 13,) 
so that the vascular tissues are distended very considerably ; 
the pulse becomes full and vibrating, whilst all the phenom- 
ena of high action are aggravated. 
The state of hyperasmia may be so great as to impede the 
free exercise of the cardiac, and vascular actions, by inter- 
cepting the nervous force. The result will be an impeded OUTLINES OF PATHOLOGY. 
31 
action of the centrifugal circulations, attended by what has 
been styled a suppressed pulse. This is a condition more or 
less approximating the typhoid state of disease. Venesec- 
tion in such events, relieves the disparity between the solids 
and fluids, excites absorption, and uniform circulation. If 
used insufficiently it increases pain, by relieving the nervous 
oppression ; but to an adequate extent relieves all the de- 
rangements, especially any disposition to chills, pains, or de- 
lirium. 
Every phenomenon proves the existence of an exaltation 
of physiological movements in the diseased state, when the 
vital susceptibility is free from embarrassment. At the early 
stage, whilst impediments were opposed to the free play of 
the vital force, and capillary circulation, coldness existed. 
Now the excess of animal caloric is so considerable as to be- 
come painful. The free capillary circulation of blood affords 
an occasion for an increase of calorification. (Sect, xii.) 
The increase of caloric, however, is not in proportion to 
the sensation of the patient ; for as he possesses an increase 
of sensibility at this time, it becomes the more intolerable. 
It rarely exceeds 102°, 104°, or 106° of Fah. The sense 
of feeling is evidently depraved, especially in dying people ; 
with a surface as cold as marble, and even cold breath, they 
complain of great heat. The uneasy sensation of cold is 
believed by the patient to arise from heat, when it is the re- 
verse. False perception exists. Par apsis algor of Good. 
In the ardent state of fever, the turgid condition of the 
capillaries impedes the exhalations universally. Sweats are 
absent, and this gives occasion for a greater accumulation of 
heat. The dry constricted surfaces internally produce thirst. 
Absorption is now better performed than exhalation, for even 
large quantities of fluids are often taken up by the digestive 
4. Increased Heat. 32 
SEMEIOTICE. 
mucous tissue. As soon as the dynamic state is removed 
by the proper treatment, the exhalants act, heat diminishes, 
and thirst ceases. 
Heat acts as a stimulus ; so it sometimes may be absorbed 
by cold drinks, and cold water to the surface. Cold takes 
up heat, and diminishes the turgid state of the capillaries. 
There is a period in which it may be used to some advan- 
tage, and this is after the severity of the disease has been re- 
moved by the proper remedies, so that internal congestion 
and inflammation are essentially overcome, and there remains 
a state of vascular erethism. If used before the primary 
morbid derangements are chiefly removed, cold drinks, and 
cold water to the surface will increase the tonic state, and 
aggravate the case. The state of internal inflammation either 
in the head, or elsewhere, is increased by it, although it may 
give a temporary respite on its first application. 
5. Impaired state of the Exhalations and Secretions. 
At the height of disease the dynamic state is made very 
manifest ; the disease seems to accumulate both in the acute 
and chronic form; the capillary exhaling and secreting tis- 
sues cannot well perform their oflices. Some seem quite 
suspended ; no sweats ; fauces parched ; saliva deficient ; 
urine and bile scanty. These illustrations have already been 
sufficiently made. 
6. Tissual Inflammation. 
The varieties of these are numerous, and their distinctive 
peculiarities may be found in Dr Good's nosology ; class 
haematica, order phlogotica. 
To exhibit a synoptical view of 'inflammation in connec- 
tion with fever, as we would wish to have it understood, we 
will employ the division of Sauvage's phlegmatiae, into OUTLINES OF PATHOLOGY. 
33 
a. Exanthematous. 
b. Membranous. 
c. Parenchymatous. 
This is founded on the thesis of all the phlegmatiae being 
considered as sequences of the morbid habit. The divisions 
are necessary for the purpose of discriminating the eruptive 
diseases from those having local determinations to the inter- 
nal membranes ; whilst the parenchymatous include the 
whole order of internal local inflammations. 
a. The difference in a pathological point of view, cannot 
be very great between the external and internal membranous 
inflammations, although they may have many peculiarities of 
appearance. The exanthems seem to possess a special ten- 
dency to the skin, although the internal tissues are previously 
affected. The peculiarities of the eruption require differ- 
ent names, whilst in every instance the general state of dis- 
ease consists in what is called fever, and its intensity deter- 
mines the severity of the case. Erysipelas sometimes oc- 
cupies both surfaces at the same time. So, also1, many of 
the exanthems ; whilst in fevers strictly, it is internally. 
b. It is peculiar to all the extended varieties of fevers, 
strictly so called, that they are accompanied with internal in- 
flammations on either the serous, or mucous membranes. 
When very intense the fibrous fascia are also associated with 
them. This kind of inflammation is never circumscribed, 
but diffused, and erratic like erythema, and erysipelas. The 
tissue of a cavity is affected more or. less ; and the inflamma- 
tion often leaves one cavity, partially at least, and seizes on 
some other. In the malignant fevers traces of inflammation, 
on inspection, may commonly be found in the head, thorax, 
and abdomen, in cases of some continuance. 
The internal coats of arteries and veins are sometimes in- 
flamed, resembling erythema ; and they obtain an increase of 
susceptibility in many conditions of disease, especially in pro- 
tracted fevers. In the heart it produces palpitations ; in the 34 
SEMEIOTICE. 
arteries, or in sections of them, throbbings. Beclard as- 
serts, that these tunics are often inflamed in fevers. The 
very frequent irritative pulse indicates it, together with ap- 
pearances denoting a typhoid diathesis. 
c. The parenchymatous concentrations affect the interior 
of organs ; whether the interior fibrous membranes of the 
hollow organs, or the parenchyma of the secerning, it is very 
similar. The inflammation is confined or circumscribed ; 
effusions take place into the interstitial spaces of the tissues, 
compressing the vascular tissues, and injuring the organic 
function, and, if not removed, the texture also. The exter- 
nal serous tissues of organs become likewise involved in 
severe disease, whilst they may not in chronic. Tins' kind 
of local inflammation has given origin to the internal local 
phlegmatiae, the pathological character of which has been 
very generally considered ess'entially different, whilst the real 
difference consists in what has now been specified. The ge- 
neral phenomena are quite similar, except that more topical 
pain attends the local phlegmatise ; the treatment required is 
quite similar. 
The first pathological change, locally, is a concentration of 
the morbid energies to the part to become inflamed, most 
commonly, attended with more or less pain, or tenderness on 
pressure, which indicates its location when internally. It has 
now become a focal point of irritation ; yet without redness 
at first. The capillary circulation is now interrupted, and blood 
soon accumulates, distending both veins and arteries. A 
strong oscillatory action ensues, with redness and an increase 
of sensibility. If its progress is not intercepted, either mem- 
branous or interstitial exhalations follow of sero-albuminous 
matter, and in a synochoid diathesis of a portion of fibrin. 
The part tumefies, becomes hard, with an increase of heat 
and pain. Chemico-vital changes follow, and the effused 
substance becomes softened, and forms an abscess, if paren- 
chymatous. The purulent matter is discharged either exter- OUTLINES OF PATHOLOGY. 
35 
nally, or into, or between some foldings of the tissues 
internally. During this process, the constitutional disease 
becomes aggravated by the reflex action of the inflamed part ; 
but, the discharge relieves the system of a great portion of 
disease. 
d. The terminations are often different, all of which de- 
pend on the intensity of the constitutional diathesis, and 
structural susceptibility. The vital action of the part may 
suffer a paresis, and end in gangrene. Or, the severity of 
action may be partially intercepted after the effusions have 
taken place, and the softening process ceases ; the absorbents 
take up the fluid parts, and the residue obtains an inert solid- 
ity, ending in scirrhus. Again, in chronic cases, the process 
may not go so far as to produce effusions, but the part may 
assume the conditions of hypertrophy. The investing serous 
membranes of the internal organs are liable, when inflamed, 
to produce effusions and adhesions. 
The diffused, internal, membranous inflammations, which 
always accompany fevers both mild and severe, are liable to 
be attended with considerable pain at first. The severe fe- 
vers have the most pain at first, but in the course of a few 
days according to their severity, the effusions from their sur- 
faces take place, when the pain mitigates. This is liable to 
deceive. The disease may really be worse when the patient 
feels easier, if without being relieved by proper treatment ; 
and especially if the pain has only been smothered by opium, 
or any other narcotic. In mild protracted fevers there may 
be no pain, yet in the abdomen a soreness on pressure ; and 
the case may grow worse if it is not entirely removed in 
season. 
e. The membranes of the brain, thorax, and abdomen, 
may all be affected in the severest malignant fevers ; yet 
some one of these cavities more than the others. The force 
of the disease may be transferred from one to the other, and 
as this occurs, the local phenomena will be changed, although 36 
SEMEIOTICE. 
the constitutional character of the disease remains the same. 
When in the head, besides the phenomena peculiar to the 
organs, the pulse will be the hardest ; when in the thorax, 
the fullest and slowest; but, when in the abdomen, the 
smallest and most frequent. This smallness of the pulse in 
the abdominal inflammations, is liable to deceive the medical 
attendant ; he is apt to impute the smallness of the pulse to 
some irritative weakness, when it arises from physiological 
circumstances concealing the greatest severity of concen- 
trated inflammation, by affecting the nutritive ganglia. The 
attendant will be greatly deceived, if he should suppose the 
disease to arise merely from local irritation, for he has much 
more to do than to palliate this. The term irritation, is too 
liable to license the use of narcotics. 
So, also, in fevers of tardy progress, the case may pro- 
ceed from day to day with little or no pain, and with many 
placid appearances, whilst the disease is insidiously producing 
effusions, and destroying the tissues. Whilst the whole train 
of phenomena may be.esteemed, by a superficial observer, as 
merely manifestations of'a harmless debility, the disease may 
be making progressive strides in undermining the basis of the 
economy. 
In protracted fevers, the local concentrations merely oc- 
cupy a single tissue, and the effusions are very much of a 
simple character. But, in those of a malignant kind, there 
may be many tissues, and, indeed, entire organs involved in 
the inflammation ; whilst the effusions are various, and of a 
mixed kind. The functions of the organs may be speedily 
destroyed, and gangrene commence 
f. The long catalogue of chronic diseases bear some resem- 
blance to the protracted fevers they commonly arise from 
the same causes. In fact they are many times the mere se- 
quelae of such fevers. The same tissues may remain affected, 
and terminate in purulent, or in hydropic effusions ; or in 
hypertrophy ; insanity ; atrophy ; phthisis pulmonalis, &c. OUTLINES OF PATHOLOGY. 
37 
The morbid habit is suffered to remain unregarded sometimes, 
whilst, perhaps, the local irritations have received the entire 
compliments of the courteous adviser. 
In conclusion we may remark, that the fur upon the tongue 
appears to arise from something of a similar membranous ex- 
citation. Its peculiar structure produces from its exhalant 
vessels an exudation of sero-fibrinous matter, liable to suffer 
many modifications. It is not peculiar to any particular tis- 
sue internally affected, but indicates the general state of dia- 
thesis. The mucous tissue of the tongue and fauces is some- 
times affected with inflammation, in some measure similar to 
the internal membranes. So, again, in protracted fever the 
dothinentery and aphthae denote the condition of the intestinal 
mucous coats. 
7. Elevated orgasm of the Nervous Tissues of Sense, Intel- 
lect, and Muscular Power. 
As all these depend on excitations of the spino-encephalic 
system of nerves, they may be noticed together. The illus- 
trations have reference to the state of fever more particularly, 
but apply to any affection having a cerebral determination. 
It is supposed the embarrassments to free vascular action 
have been essentially removed, if any such had previously ex- 
isted, as is constant in primary coma, &c. Venous absorp- 
tion must have become active, and the congestive state es- 
sentially removed, before an elevated state of action occurs. 
The capillary circulation in both arteries and veins is now 
free, and the increased sensibility of the nervous tissues ren- 
ders them impatient of the stimulations of the passing fluids ; 
and the blood now proves more irritating than in health. 
The nervous expansions of the five orders of the organs of 
external sense, transmit vivid impressions to the .centre of 
perception, liable to be so intense as to misrepresent objects 
and produce hallucinations. 38 
SEMEIOTICE. 
A similar state of the tissues exists in the organs of per- 
ception, and intellect. Their functions are accelerated, the 
ideas are vivid and in rapid succession ; indeed, so much so 
that the perceptive faculties are liable to be imposed on by 
false images, and the reasoning faculties to erroneous judg- 
ment. In the more moderate orgasm, the reminiscences are 
vivid ; imagination on the alert ; the trains of ideas numer- 
ous, and uttered in quick succession, replete with imagery 
and poetic effusions. If a little stimulation be added, either 
by the external senses, by medicaments, or internal irritation, 
the pleasant catenations of ideas are severed, and delirium 
more or less furious ensues. The cerebral membranes are 
now liable to afford effusions, which by a compressing force 
induce a fatal coma ; unless, peradventure, the patient may 
escape with some kind of mental imbecility. Yet, the or- 
gasm often subsides without effusions. 
In many conditions of even mild fever, continuing with a 
location in some remote part from the head, and when the 
organs of this part have remained free ; there may be a sud- 
den determination to that part by some excitation, not of 
inflammation, but mere turgescence exciting an orgasm, and 
followed by delirium. It may continue a longer or shorter 
period, but may soon subside, by venous absorption remov- 
ing the turgescence, and then the mind may be as tranquil as 
before. Such paroxysm's may occur in a state of predisposi- 
tion, in hypochondriasis, in liabilities to . hysteria, producing 
alienations of mind, and sometimes insanity. Effusions are 
not made in the tissues in such cases. 
There is a milder state of cerebral excitation, which pro- 
duces vigilance, without any discernible turgescence, or un- 
easiness. It is liable to occur in a state of convalescence, 
and in the instance of moderate mental excitement in mova- 
ble habits. It occurs with an habitual turgescence in those 
who indulge in alcoholic drinks, or opium, unless under the 
narcotic influence of large quantities. OUTLINES OF PATHOLOGY 
39 
The free play of the capillary circulations on the very ex- 
citable nervous, and muscular tissues in exalted fever, affords 
the muscles a preternatural energy. The state of lassitude is 
now exchanged for great strength with delirium, and the for- 
mer weak patient is capable of prodigies of valor. The vital 
force of muscles exists in profusion, and the strength of sev- 
eral men may be required to restrain the morbid energy of 
one. Every exertion adds irritation, and when long contin- 
ued is liable to end in asphyxia, or total exhaustion. 
Delirium may exist at the onset of fever, but it shows a 
freedom from a severe congestive state ; and in the more in- 
tense degrees of fever with coma-vigil, it does not occur un- 
til the absorbing processes have essentially removed the con- 
gestive state of the tissues, not only from the membranes of 
the brain, but throughout the nutritive tissues. It is in con- 
sequence of this, that the heart and arteries in tonic delirium 
act with considerable force and freedom. The pulse is full, 
hard, and frequent ; whereas before it might have been une- 
qual and embarrassed. 
8. Changes in the Fluids. 
It remains to be noticed, in relation to the forming state 
of disease, that the movable animal matter suffers changes 
simultaneously with the solid matter. It is sometimes diffi- 
cult to ascertain which may have morbid precedence. This 
appears to be the fact both in the acute and chronic condi- 
tions of disease. We also, discover progressive changes in 
both ; and as the primary impulses arise from the vascular 
tissues, we infer these to be the more immediate agents of 
all the subsequent changes. 
Commonly when blood is taken from a vein in the state of 
predisposition, and especially as soon as the first actual phe- 
nomena appear, in either acute or chronic disease, on mere 
inspection it shows some physiological changes. It does not 40 
SEMEIOTICE. 
flow freely from the vein, and is of a more than ordinary dark 
color. It either forms a weak coagulum very quickly, or 
not at all. If coagulated the serosity shows an ichorous ap- 
pearance. This usually occurs in the most malignant forms 
of acute disease, yet is seen in the scorbutic habit, and other 
slow diseases. 
AH these phenomena may be imputed to two circumstan- 
ces ; a deficiency of free vascular impulse, and of oxygen. 
By following the chain of causation, we discover these to 
arise from an inability of vital force ; and that this is produc- 
ed by changes made by the noxious causes acting on the pri- 
mary tissues, impairing their integrity of function, through the 
agency of the nutritive nerves. 
As the disease proceeds to the second stage, if the func- 
tions of the vascular tissues remain embarrassed, as they 
sometimes do from the rapid succession of the stages in an 
ephemera, or by neglect of proper treatment in more pro- 
tracted cases, the same phenomena may appear in the blood 
as in the first stage ; and, indeed, these phenomena may be- 
come increased and more apparent. The case now becomes 
very dangerous, the crasis of the blood is spoiled, as there is 
an inability of vascular function, whilst the state of nosodyna- 
mia has increased. The crasis of the blood is deficient of 
cohesion, and said to.be putrid, and does not coagulate. 
However, the progress of disease is far oftener very differ- 
ent from that just stated. The recuperative powers by their 
own susceptibility, or as aided by science, obtain an ascen- 
dancy ; the vascular impulsions modify the fluids, and they ex- 
hibit a new train of phenomena, and that partaking • of the 
tonicity of the solids. 
So we discover in the second stage, when directed to a 
more favorable termination, the blood to have been decar- 
bonized, and to have assumed a florid appearance eyen in 
the veins ; it flows freely, and is projected from the orifice 
with force, and has more free caloric. It now clearly mani- OUTLINES OF PATHOLOGY. 
41 
tests an increase ot vitality, vv hen drawn it does not coag- 
ulate so quickly as in health, but is sure to become so as 
soon as cooled, and the coagulum is far more dense, with a 
white fibrino-albuminous crust on the surface. 
The amount of fibrin becomes quickly increased, in a free 
state of action. Mr Whiting demonstrated, that the fibrin of 
the blood in health might be as one in a thousand, whilst in 
acute rheumatism it was seven. The film on blood taken at 
such times by a free orifice in a vein, serves as a nosometer 
to measure the amount of the disease. The more free calo- 
ric, and fibrin that exists will afford a thicker film, and as it 
cools will contract with greater force ; the edges turn up- 
wards, and form a cup-like appearance in proportion to the 
density given it by the capillary impulse, with free caloric. 
When these changes have taken place, the blood reacts 
with greater force on the tissues, it proves too highly stimu- 
lating, and the fibrin is liable to suffer a stasis in the most in- 
timate parenchymatous and vascular tissues. As it circu- 
lates in the thin serous tissues in the vicinity of morbid con- 
centrations, sero-albuminous fluid is forced out upon their 
surfaces, of various degrees of density according to the se- 
verity of the general diathesis. Sometimes a portion of 
fibrin is-exhaled on serous tissues, which produces adhesions 
of the adjoining membranes. 
Fibrin is one of the most combining, and sustaining of the 
fluids, but now exists in a modified, state, and in too great 
proportion, as well as excess of tonicity. Its excess indi- 
cates that state of the system long known as the phlogistic 
diathesis, most apparent at the acme of disease. Yet, this 
particular state may exist to a very considerable degree, when 
the albuminous film of the extravasated blood may not be ve- 
ry manifest. This diathesis may be managed with much 
prospect of success, and it is a great desideratum to convert 
other states of the economy into it, in relation to their suc- 
cessful issue. There is a great accordance in the phenomena 42 
SEMEIOTICE. 
discoverable in the fluids, indicating the several diatheses, 
and which reveal the character of the disease, and its salu- 
tary, or its destructive tendency, when diligently investigated. 
The external phenomena, when traced to their origin, indi- 
cate the condition of the organs sufficiently for practical pur- 
poses, almost as clearly as open vision. 
When this phlogistic, or inflammatory diathesis exists, the 
secretions, and natural exhalations are either suspended, or 
imperfectly performed. There is heat, with a hard and fre- 
quent pulse. The appearance of hemorrhage, and flow of 
the exhalations and secretions, indicate a diminution of mor- 
bid tonicity, and are tokens of a favorable termination. Yet 
when once established, and the fluids changed as above, it 
takes a week or two, under favorable circumstances, for sal- 
utary changes to take place, to restore the fluidity of the 
blood, and effect the necessary depurations. In the chronic 
state of disease, a phlogistic diathesis may be perpetuated by 
bad treatment, not only from month to month, but from year 
to year ; provided, however, it be not so bad as to destroy 
sooner. 
With these scanty remarks, we must pass by various phe- 
nomena of minor importance, to the resulting phenomena of 
the morbid habit. OUTLINES OF PATHOLOGY. 
43 
SECTION XLIV. 
PHENOMENA ATTENDING THE RESULTS OF THE MORBID 
HABIT, IN THE THIRD, OR LAST SERIES. 
1. Pathological Remarks. 
Having made an attempt to trace some of the external 
phenomena of disease to their origin, and expose the state of 
the organism, on which they depend in the forming, and 
more active stages ; we must now re-examine the same tis- 
sues and organs, in pursuit of the alterations they may have 
sustained in the conflicts they have suffered. The changes 
are frequent, and progress in a ratio of the intensity of the 
diseased state. 
Although it is difficult to make out an unexceptionable 
definition of fever, yet in every instance of derangements 
made in the tissues by the numerous ledantia, there scarcely 
fails to arise a train of pathological movements clearly indi- 
cating a perturbed condition, sooner or later; and as this is 
always attended with some disturbance of physiological ac- 
tion, so, more or less heat appears along with other phenom- 
ena, which are sufficiently pathognomonic of pyrexy, for all 
practical purposes. The modifying circumstances may be 
numerous which vary the phenomena, whilst the internal tis- 
sues are suffering. 
The relation of the external phenomena to the condition 
of the organs is pretty constant, when the whole of them are 
taken into the estimate. So, if some of them should be ab- 
sent, as for instance, pain in a low state of fever, we fave no 
reasons to infer that internal inflammation does not exist, if 
other phenomena indicating such a state are present. For, 
it has been proved by all post mortem examinations, that tis- 
sual inflammation in some degree, constantly exists in such 44 
SEMEIOTICE. 
conditions, and is always more manifest in some one of the 
three cavities than in any other. This inference is sufficient 
for all practical purposes, as the true therapeutic remedies 
ought to be used to remove the severity of the constitutional 
disease, on which the local affection depends. 
In like manner, at an early period, if only a few of the 
leading phenomena of fever are present, the inference will be 
safe, that disease will be evolved, and tissual location must 
follow, and its intensity will be in proportion to the hurtful 
impression, the attending phenomena, and the idiosyncrasy 
of the subject. 
The phenomena are sometimes deceptive, or become so 
to an inattentive, or incompetent observer. Although a fre- 
quent pulse usually attends acute fevers at an early period, 
yet there are cases of oppressed cardiac action, with slow, 
or intermittent pulse, even whilst there is an immense ac- 
cumulation of disease, and the phenomena will yet appear 
in a terrific form. 
Disease will continue until the primary derangements are 
removed, and the necessary adaptations effected ; and after 
it has continued some length of time, a train of secondary 
changes may serve to perpetuate it in a chronic form. It 
becomes the duty of the attendant to obviate these as far 
as possible, and guide the pathological processes to a salutary 
crisis. 
2. Limitation of Diseased diction. 
The contagious exanthems require a definite period to 
effect certain changes, and pass through the system ; they 
cannot be shortened, otherwise than by regulating the econo- 
my so as to prevent unnecessary aggravations and delay. 
Again, when any pyrectic disease is fully formed, some 
indefinite period is necessary for the morbid changes to OUTLINES OF PATHOLOGY. 
45 
be removed, and the healthy adjustments to take place. 
Otherwise than these, we cannot discover any limitation to 
diseased action, either favorable or otherwise, by which it is 
bound by fixed periods of termination. 
It may rather be insisted, that disease, when once formed, 
must continue until the primary derangements are removed ; 
or, until the injury done to the solids and fluids spoils their 
integrity of composition so far, that the vital influence can no 
longer excite them. Disease does not always end when its 
career in one form ceases. Acute disease may be transform- 
ed into some chronic form of a tedious kind. If we are not 
greatly deceived, both acute and chronic diseases may often 
not only be made milder by treatment, but greatly shortened 
from what they would be if left to pursue an unmolested 
course. 
As the active treatment of diseases has prevailed over the 
dilatory, expectant methods, so the paroxysmal exacerbations 
and crises of disease have been intercepted and obscured. 
Fevers left to the regular physiological processes are liable to 
manifest exacerbations and crises ; and are often continued to 
a great length ; not so long, however, as under bad treat- 
ment. So in phthisis puhnonalis, the hectical paroxysms are 
exact and severe, either with improper treatment, or no treat- 
ment ; whereas judicious treatment mitigates, and often anni- 
hilates them, when seasonably employed. 
The ordinary epidemic, endemic, and sporadic fevers are 
not necessarily limited to any definite periods, before they 
can be eliminated from the system. Many are the instances 
of spotted fever, yellow fever, dysentery, and cholera, ter- 
minating in health, or in death within the first twentyfour or 
fortyeight hours ; or if otherwise, then in continued disease. 
If they sometimes terminate in health in so short a time, then 
they are not necessarily limited to one, two', or three weeks. 
In these sudden restorations, the paroxysm may have been 
met at an early period by some simple therapeutic manage- 46 
SEMEIOTICE. 
ment, suitably applied, and in a system ready to give lively 
responses to the first impressions of the disease, and by the 
recuperative processes suddenly restoring the absorptions, 
secretions, and exhalations ; and this before any secondary 
changes had riveted the morbid changes in the inmost tissues. 
The first changes will be found to be few and simple, when 
separated from the numerous contingent circumstances that 
soon follow. However, if the disease does not meet with 
such favorable results, it progresses in a continued manner, 
to its severity, until other changes take place of a physiologi- 
cal character, but not of a necessarily limited kind. 
3. Phenomena resulting from changes made in the Internal 
Tissues, and Organs. 
The great theatre of morbid conflict, in the largest proportion 
of diseases, either acute or chronic, is in the internal viscera. 
This is particularly the fact in relation to those more emphat- 
ically styled fevers. If locations in acute disease should be 
more exterior, yet the internal capillary tissues are essentially 
affected, especially the heart and arteries. It is in the inter- 
nal cavities that we find the most important lesions. 
The examinations of unfortunate cases have been so nu- 
merous, it seems scarcely necessary they should be much 
further repeated, so far as relates to acute pyrectic diseases. 
There is a striking uniformity of results in all the reporters 
of pathological anatomy, and which accord with our own ob- 
servations. Severe disease concentrated in any particular 
cavity or organ, and continued a suitable length of time, pro- 
duces certain results, which are sufficiently definite and uni- 
form for all practical inferences. The united phenomena in- 
dicate pretty clearly what the essential changes in the organs 
must be, if not controlled ; and it is not very essential, so far 
as relates to the protective treatment, to discriminate very OUTLINES OF PATHOLOGY. 
47 
minutely beforehand the identical lesions that may occur. 
The protective treatment ought to be aimed to the preven- 
tion of all lesions, and its extent must be estimated from a 
knowledge of the constitutional phenomena. No time should 
be lost in waiting to see what local changes may take place. 
The phenomena universally tell what is in clanger of taking 
place, and this is sufficient to excite to diligence. When 
destructive local changes have taken place, the subsequent 
phenomena, indeed, too clearly indicate them, and convey an 
admonition for unjustifiable neglect. 
We can only stop to make some general references to the 
resulting phenomena, and chiefly in relation to acute disease, 
mostly omitting the chronic. 
a. In the encephalon, every organ and portion of organs 
are liable to plus concentrations of fluids, and every grade of 
constitutional force, and local capillary impulsion urging 
lesions of the textures. The concentrations often occur in 
fevers affecting the cerebral membranes. When the dura 
mater is most affected, the diathesis partakes of the synochoid 
character, with a strong, hard pulse and considerably frequent. 
The effusions are fibrinous and dense between the membranes, 
cementing them by adhesions of different degrees of strength. 
The same may occur in the theca of the spinal cord. Other 
more fluid effusions sometimes accompany these affections, 
preceded by pain and delirium. 
The concentrations are sometimes more particularly in the 
arachnoid membrane and piamater, and radiating into the fold- 
ings of the brain, pursuing the tract of the piamater. Pain 
is less intense, with more frequent pulse, and the case be- 
comes full of danger. These yield serous effusions, and very 
early, especially in the arachnoid in children. The ventri- 
cles are more or less filled, producing hydrocephalus. The 
same often occurs in the spinal cord. These effusions are some- 
times complicated, sometimes an ichorous fluid ; in cases of 
some longer continuance a puriform fluid is discovered be- 48 
SEMEIOTICE. 
tween the tissues. In cases that soon terminate fatally, there 
is a mere infiltration in the arachnoid. At other times it is 
found in large quantities, to the amount of eight ounces,* and 
with thickening of the tissues. 
Finally, after some continuance of the* phenomena, with 
perhaps coma-vigil, all consciousness is obliterated, and never 
to be restored ; hydrocephalus, with the eyes turned upwards 
and inwards ; pupils irregular, &c. Sudden concentrations 
at the attack of fever, are liable to produce effusions of blood ; 
the consequence is apoplexy or hemiplegia. Morbid changes 
may commonly be expected in insanity, and other chronic 
affections, as hypertrophies, hardening and softening of tis- 
sues ; ossifications. We cannot follow out the minute de- 
tails, they may be learned from morbid anatomy. 
b. In the thorax we discover changes in the tissues quite 
similar to those of the brain, with the addition of other tissues, 
each yielding modified products in a state of excitation. The 
kind and quantity are also varied by the intensity of disease. 
The mucous tissue of the lungs produces modified products, 
according to the severity of the diathesis. Sometimes an 
increase of mucus, together with an increase of exhalation, 
giving occasion to a copious sputa. When the case is a little 
more severe, there may be a copious effusion, engorging the 
aerial cells, and proving suddenly fatal, much to the surprise 
of an inattentive, or ignorant observer. 
The state of excitation may be more severe, with but little 
excretion, and that of a fibrinous character, and adhering like 
the fur on the tongue. It is liable to be in more profusion in 
the larynx, producing a dense albumino-fibrinous exudation, 
altering the voice to hoarseness, and even accumulating so as 
to suffocate ; producing tracheitis, or rattles. The sound of 
the voice denotes its density and danger. 
Before the diathesis arises to its highest degree, there is 
* Dr Abercrombie, Dis. of the Brain, p. 281. OUTLINES OF PATHOLOGY. 
49 
liable to be in the lungs, some of the cruorof the blood forced 
from the capillary vessels, and affording a sanious mixture of 
the sputa. Again, in certain states of mild diathesis in pre- 
disposed idiosyncrasies, the capillary vessels of the bronchial 
mucous membrane become turgid, capillary action is increas- 
ed, and blood is thrown out in large quantities, producing 
haemoptysis. So, likewise, under circumstances very simi- 
lar, the effusion of blood may be into the cellular and aerial 
tissue of the lungs, producing what has been improperly called 
apoplexy of the lungs, although the term is quite expressive 
of the physiological fact. The lungs become dense or hepa- 
tized. A modification more frequently occurring in a phlo- 
gistic diathesis, is, a fibrino-albuminous effusion into the in- 
terstitial spaces of the lungs, producing dense circumscribed 
tumefactions of greater or less extent, which lay the basis of 
future imposthumations. 
So again, in some of the mildest and nearly imperceptible 
grades of morbid concentrations on the pulmonary tissues, 
there is slowly exuded a sero-albuminous matter into the mi- 
nute spaces of the interstitial cellular tissue.* The fluid matter 
is absorbed, whilst the hithei to suspended fibro-albuminous 
substances condense, in part by the heat, absorption, and its 
cohesion, into tuberculous formations. Their presence when 
not numerous, produce but little inconvenience. However, 
by the continuation, or a new accession of a mild morbid 
habit, its concentration is liable to be in the circle of their 
* M. Andral says, " The lymphatic ganglions are one of the parts which 
best exhibit the development of tubercle subsequently to an attack of in- 
flammation." (Path. Anat. Vol. 2. p. 282.) In p. 281, he alsosays, " Dr Boek- 
er, a German anatomist, states that he repeatedly injected 'with mercury 
lymphatic ganglions presenting different forms of morbid alterations, and 
that he invariably found the injection pass freely thiough all the convo- 
lutions of the vessels; whence he concludes that in the diseases of these 
ganglions, the lesion is, at least in the greatest majority of cases, confined 
to the cellular tissue that unites the convolutions of the vessels, or to the coats 
of those vessels, but that there is no obstruction of their cavity." 50 
SEMEIOTICE. 
irritation ; the tissue becomes excited, inflamed, softened, 
and the puriform matter finds a passage into the aerial cells, 
to be cast out by coughing and spitting; constituting one va- 
riety of phthisis pulmonalis. The disease is continued by the 
same causes producing new crops or series of tubercles. 
The serous membrane of the lungs externally, with its 
costal portion, affords exudations very similar to those of the 
brain. In the most severe diatheses, when the concentrations 
affect many tissues in the pneumonic inflammations, blood 
often passes along with the other exudations into the thorax. 
But, in a strong phlogistic diathesis, the effusions will be of 
the fibro-serous kind, in pretty large proportion ; and if the 
case continues, they often condense, and having still a vitali- 
ty of the first grade, blood vessels vegetate in them ; it now 
becomes a parasitic pseudo-membrane. Notwithstanding 
these effusions oftener suffer changes, and form a mass of he- 
terogeneous matter, occasioning empyema. 
In ordinary conditions, and of less severity, the effusions 
partake of the sero-fibrinous kind, and taking the filamentary 
form, the thinner part being absorbed, unite the surfaces of 
the costal and pulmonary tissues, producing adhesions. 
In a milder state of diathesis, there is often thrown out 
from these surfaces in a few weeks, a more strictly serous 
exudation, constituting acute hydrothorax. In a mild, pro- 
tracted diathesis, chronic hydrothorax may be produced. The 
same circumstances occasion hydrops pericardii. 
c. In the, abdomen, the effusions are very constant under 
like circumstances. In order for their production there must 
be a general state of excitation, with a fixed concentration in 
a tissue, or some contiguous organ. In a severe state of dis- 
ease, the peritoneum produces large effusions of sero-albumi- 
nous matter, with a portion of fibrin, sometimes in six hours ; 
and often tinged with blood. 
We rarely meet with simple peritonitis ; this affection is 
most commonly associated in the inflammation of some con- OUTLINES OF PATHOLOGY. 
51 
tiguous or subjacent organ. It is excited in acute hepatitis, 
enteritis, &c. It is, however, in acute metritis, as occurring 
in puerperal fever, that we are made witnesses of the most 
appalling results of peritoneal effusions. The pathological 
changes discovered in the peritoneum are often more mani- 
fest than in the uterus, or its appendages ; which has led 
many pathologists into the error of considering the disease 
to have its chief seat in this tissue. A little further investi- 
gation cannot fail to show, that the uterus is the organ which 
is most highly predisposed ; and the first phenomena are re- 
ferable to it ; but the peritoneum is a more readily excitable 
tissue, and liable to be totally as well as suddenly associated 
into excitation. Its effusions, also, suddenly appear, and 
before so manifest changes occur in the substance of the 
uterus. This seems to be the view taken of it by some pa- 
thologists, and particularly by Dr Lee, of London, very lately. 
Notwithstanding^ lesions are commonly found in the uterus-, 
especially a puriform fluid in its veins and absorbents ; as 
well as other signs of inflammation, and extending to its ap- 
pendages.* But, we need not pursue this subject any further 
here, only to observe, that nearly the same phenomena occur 
in the peritoneal sac, and about as suddenly in enteritis, as in 
hysteritis. 
In concentrated disease, in any cavity, the blood vessels 
become more or less prominent, and particularly so in the abdo- 
men, especially those of the mesentery and omentum. The ef- 
fusions sometimes cement all the viscera together into a mass ; 
and if disease mitigates, and continues, most commonly ter- 
minates in atrophy. The peritoneal sac is subject, in more 
protracted cases, like the pleura, to slow serous effusions, 
constituting acute and chronic ascites. (See Sect. vii. 4.) 
The mucous tissue performs very important offices in the 
* In 1829, at Paris, out of 222 fatal cases, 132 showed a " puriform fluid 
in the vbins and absorbents of the uterus." (Amer. Jour, of Med. Sci. 
No. 30. p. 414.) 52 
SEMEIOTICE. 
economy, both in health and in disease. (Sect. vii. 5.) It is 
more endowed with nerves of external relation than any other 
internal tissue, except a few feet above and below the coecum ; 
and the nerves of nutrition are, for the most part, thickly be- 
stowed upon it by the numerous arteries sent to it. The 
physiological condition of this tissue enables it to admit of 
extensive capillary distention in every determination to the 
internal viscera. As most commonly at the onset of disease, 
whether acute or chronic, there is a retrocession from the 
surface to the centre, so this tissue is often distended ; and it 
is at such times that hemorrhages of venous blood occur. 
At the time examinations are made, being usually several 
hours after death, the absorptions remove a great amount of 
the blood concentrated in this tissue during life. It is 
then rarely seen in its real pathological state. It is seldom 
we find as much of a dense adventitious film on the surface of 
this tissue, as on the serous tissues, for it oftener yields an 
increase of mucus than fibrin, or albumen, when excited. It 
does not admit of the adhesive process. In croup, however, 
it is found in the larynx, but more probably when the subja- 
cent fibrous fascia are associated in the inflammation, than 
from the mucous tissue itself. 
The deciduous tunics in the affection called diarrhoea tu- 
balis of Dr Good, as well as the uterine decidua, afford some 
evidence that fibrinous, or rather albuminous exudations may 
arise from excitations of the mucous surfaces. Still, how- 
ever, the question returns, whether they ever arise, unless 
the subjacent fascia are also associated ? It seems they nei- 
ther appear in the serous tissues unless the affection becomes 
severe, when probably the subjacent fascia are associated, as 
in pleuritis, &c. They otherwise yield serous discharges 
when excited, and the mucous tissues their mucus, together 
with the matter of arterial exhalation. 
Dr Horner of Philadelphia, has been laudably engaged in pa- 
thological and physiological researches on the mucous tissue of OUTLINES OF PATHOLOGY. 
53 
the intestines, in reference to cholera.* He appears to de- 
monstrate the existence of an adventitious membrane ; thus 
described in case 3d, p. 68 : " The mucous coat of the sto- 
mach and small intestines had a strong inflammatory tinge ; 
the latter were filled with sero-fibrinous fluid, and were lined 
in almost the whole extent by a layer of fibrin ; this layer 
was about half a line in thickness, and adhered to the mucous 
coat as a layer of fresh fibrin does to the pleura or peritoneum ; 
that is to say, with a degree of tenacity permitting it to be 
rubbed ofF with the finger or floated in water, so as to exhibit 
both its adhesion to the intestine and its distinction from it." 
This layer hardened by alcohol. It will, however, be 
suggested, that all these exudations may partake more of an 
albuminous than fibrinous' character. Alcohol hardens albu- 
men as well as fibrin ; and we do not find the proofs of their 
being exclusively fibrin. Although we are constrained to 
dissent from this writer in some of his pathological views of 
cholera, yet we fully agree with him in a state of orgasm of 
the intestinal mucous tissue, and will not even disagree in 
calling it inflammation ; yet, cannot consider it as the primary 
cause, but as secondary, or a result of a primary constitu- 
tional affection. We cannot discover an " atony," as arising 
from " a sympathetic condition produced by the extreme patho- 
logical actions of the mucous membrane of the alimentary 
canal." We rather discover a state of tonic rigidity, and an 
inability of the functions of the centripetal circulations. 
The proofs of a general primary affection are made plain 
in the fact of other phenomena being either previous or syn- 
chronous with the determination to the intestinal canal. The 
alteration of the general aspect is first discovered ; and the 
excessive and continued sweats appear about as soon as the 
diarrhoea ; they both show a similar state of the centrifugal 
circulations, even in their matter of exhalation. This disease 
* Amer. Jour, of the Med. Sci. No. 31 and 32. 54 
SEMEIOTICE. 
cannot be viewed with any justness, as an exception to all 
others of the group of what are styled ataxic, adynamic, or 
severe typhoid fevers ; it being one particular modification, or 
variety. Neither are the vomitings, diarrhoea, or sweats pe- 
culiar to it. (p. 438.) The "cholera vesicles," on the surface of 
the mucous epithelium, or " superficial venous layer," bear a 
strong resemblance to the sudamina which appear when great 
centrifugal exhalations take place, in other conditions of fever, 
on the dermoid surface, with external heat. But external 
heat is absent here ; morbid action concentrates in the mu- 
cous tissue! 
That the main force of the disease is constitutional, is 
shown by an universal deficiency of calorification externally 
and internally, as well as a stasis of blood in the venous cap- 
illaries in every tissue of the system. We might, further, no- 
tice the tonic state of the tunics, and particularly the activity 
of the arteries over the veins, (p. 308,) as we have 
constantly insisted prevails at the onset of all fevers. " There 
was no pulse at the wrist, but it existed about the middle of 
the brachial artery, and beat from 160 to 170 in a minute, 
almost imperceptibly." (p. 76.) Again as respects the 
arteries : " The femoral, anterior tibial, humeral, radial, 
ulnar, and all the other arteries examined, were contracted to 
one half of their common diameter, with the internal coat in 
longitudinal wrinkles." (p. 77.) It manifestly appears they 
force out the fluid parts of the blood, at the extremities 
of the arterial circle, by a convulsive effort; not debility. 
The phenomena exhibited above accord with all the views 
we have hitherto expressed, in relation to the pathological 
character of cholera, which will be further detailed hereafter, 
and in relation to other complicated fevers. Whilst the cen- 
trifugal circulations are in such a perturbed and nosodynamic 
state, the centripetal are suffering a constrained, universal pa- 
resis. There is no well grounded analogy in all the history 
of disease of a local irritation producing such astounding phe- 
nomena. The eruption in confluent small pox, alluded to by OUTLINES OF PATHOLOGY. 
55 
the writer, is a resulting phenomenon of antecedent general 
disease. 
The 3d thesis proposed, (p. 59,) admits of extensive ani- 
madversion ; but, we have already digressed beyond what was 
intended, and can only remark, that in our most liberal esti- 
mation, he has not made out the case. We do not under- 
stand how " denuded veins pour out serum." (p. 294.) Is 
it not the arterial exhalants? All demonstrations prove the 
veins to be absorbing tissues, and they form the strongest 
chain of centripetal circulation. The inaptitude of the veins 
to absorb in cholera is shown by the fact stated in p. 285, 
viz., "it requires five minutes in cholera patients for an 
enema of camphor to be perceived in the breath, whilst one 
minute only is requisite in other cases of sickness." The 
blue tinge of the surface, and tardy flow of blood in venesec- 
tion, prove the stasis of venous blood in cholera. We ac- 
knowledge, that aside from some too hasty inductions, Pro- 
fessor Horner has rendered important service to pathological, 
as well as the normal anatomy of the intestinal mucous tissue. 
In our hasty review of the results of disease located in the 
abdomen, it may merely be remarked, that the glandulae soli- 
tarise, (Brunner) and agminatse, (Peyer) are often found in 
a diseased state. They suffer excitation and inflammation in 
greater or less degree, in many conditions of disease ; mean- 
ing all such as tend to produce some degree of inflammation 
in the mucous tissue, in which they are imbedded. They 
become turgid, enlarged, and often of a bluish color in the 
cadaver. They appear often ulcerated in typhoid fever, 
phthisis pulmonalis, &c. The membranes of the intestines 
become thickened and dense. After much investigation of 
late by many pathologists, it appears that the pathological con- 
dition of these glands is the result of disease, rather than a 
primary condition of disease in the glands. In such states as 
these glands are found diseased, there is liable to be in any 
part of the mucous tissue of the stomach or intestinal canal, 
certain small ulcerations beneath this tissue, with elevated 56 
SEMEIOTICE. 
edges, and not quickly incarning. They sometimes produce 
a softening of the muscular coat of the intestine, and the se- 
rous tunic giving way, either by the same process, or by rup- 
ture, the intestine becomes perforated ; their contents pass 
into the peritoneal sac, and the case proves fatal in about 
twentyfour hours. 
The mucous coat of the stomach does not so often show 
traits of active inflammation in fever, or other disease, as 
other portions of this tissue ; yet, such traits are sometimes 
discovered. It is very common, however, to discover a 
softening of its mucous coat ; besides many other changes 
we must omit.* The liver is subject to many degenerations, 
but does not so often show pathological changes from fever, 
strictly so called, as many other of the abdominal viscera. 
According to the reports of many cadaverous inspections, 
the spleen shows mordid derangements in fever, the most of 
any of the abdominal viscera. This change consists most 
commonly in softening. This viscus is composed essentially 
of gelatin ; it is a vascular and erectile tissue ; and in all con- 
centrations becomes largely distended with blood ; and on 
these accounts it is disposed to ramollisement. It is usually 
found softened, and easily breaks before the finger into a 
black, pultaceous mass. 
The pancreas contains but little blood, and is formed chief- 
ly of albumen, which is liable to condense by heat and other 
agents. When once condensed it nev'er softens, but is liable 
to scirrhosity. It is usually found hardened in fever. 
The organ affected in the abdomen can commonly be de- 
* Without stopping to make many references on this controverted sub- 
ject, let it merely be remarked in general terms, that our own observations 
accord with D. S. Smith. (Treatise on Fever, p. 203. Phil. Edit.) " The 
uniform result of the most careful observation in London is, that the mucous 
membrane of this organ (stomach) is less frequently, less severely, and less 
extensively diseased than any other portion of the same membrane." We 
may, however, except the softening of its mucous coat. OUTLINES OF PATHOLOGY. 
57 
tected by pain, or soreness, on pressure. The pain is most 
severe the first three or five days in fever, and subsides on 
the taking place of effusion. When the other phenomena 
continue, on the cessation of pain and tenderness, the case be- 
comes more fearful, as it indicates a state of insensibility which 
is the precursor of gangrene. 
Our limits do not admit of extending this subject. Refer- 
ence may be had to Abercrombie on diseases of the head and 
abdomen; Andral's Pathological Anatomy ; Morgagni on the 
Seats and Causes of Disease; S. Smith's Summary, in 
Treatise on Fever ; et aliis. 
4. Two trains of Resulting Phenomena, as disease may ter- 
minate favorably, or otherwise ; Prognosis. 
Disease when once established in the economy, will con- 
tinue until the primary cause, which produced and sustains it, 
is removed ; or, until the tissues become so far injured as to 
be unable to support the vital susceptibility. The event is 
called a crisis, whether tending to health, or dissolution ; and 
it becomes necessary to examine the principal phenomena in 
connection with each of these trains. 
a. The salutary phenomena in the more manifest instances, 
are preceded by an universal effort of the united functions, or 
as it might be calk'd an exacerbation ; which is followed by 
a relaxation of the emunctories, succeeded by discharges and 
a mitigation of heat, pain, praecordial distress, and numerous 
reverberating sensations. If the disease has received the 
benefits of a proper treatment, it calmly subsides without any 
violent phenomena into ease, and repose ; or, only a mild 
diarrhoea, turbid urine, or warm sweat. 
Whilst abnormal actions and excitations are continued, 
having existed for some time, and the economy has suffered 
very considerably, and until the vital susceptibility becomes 
in danger of exhaustion, it appears, there is as it were, a final 58 
SEMEIOTICE. 
effort made, an intense orgasm arises, as if to remove the of- 
fending cause, or exhaust itself in the attempt. This effort 
is attended with phenomena resembling an exacerbation fol- 
lowed by relaxation, and it often prevails by exciting the 
functions of tissues, which have been embarrassed by the 
morbid changes. In this event the nosodynamic cause is re- 
moved, secretion, absorption, and exhalation are restored, 
and health returns. Or, if the effort fails of effecting these 
objects, the vital energies are liable to be exhausted, and for- 
ever cease. Or, again, the effort, instead of eliminating the 
disease from the entire system, may produce a metastasis of 
local affection to some other tissue, which may be favorable 
or injurious, according to the circumstances in connection. 
There may be several efforts, or partial crises before an 
entire solution is effected. This change may take place at 
an early period in unlimited disease, if the primary changes 
have not already produced too many consequential changes. 
After disease has arrived to its acme, some time may be ne- 
cessary for the preparations and adjustments to be made, be- 
fore there can be a solution, and subsidence of morbid action. 
After the nosodynamic force becomes fixed in the inmost tis- 
sues, the increased tonicity, and sensibility assume a more 
intense state, which requires changes in the fluids, and a re- 
laxation in the solids to be effected ; or it requires time for 
the internal stimulations to become diminished, which usually 
excite the repulsive powers in an inordinate manner. 
Whatever may be the conclusions in relation to the humor- 
al pathology, it appears evident, that after fever is formed, 
critical discharges cannot take place until the altered state of 
the fibrin and albumen, at least, is effected ; and it ought not 
to be expected any more than that these same substances 
should flow from a phlegmon before a change, or softening. 
The state of the pyrectic diathesis, and alterations of fluids in 
tissues, are in some degree similar to this. 
At the acme of disease, or pyrectic action, no hemorrhages OUTLINES OF PATHOLOGY. 
59 
occur, nor sweats, nor but little urine, and this is not sur- 
charged with the detritus of the blood. As soon as thenoso- 
dynamia of the solids and fluids has subsided, if the excess of 
morbid action has not destroyed the integrity of the organ- 
ism, the salutary processes resume their accustomed rounds ; 
absorption and secretion become active, and the fluids receive 
their depurations. The emunctories are relaxed, and a new 
series of local tendencies direct the particles of decomposed 
fluids through them, being urged on by the yet irritated cap- 
illary vessels. 
So great a weight of distention and stimulation being re- 
moved, all the vital actions subside even below their ordinary 
level in a few days. The weary tissues require repose. 
However, as absorption returns, the appetite increases, and 
the system is again replenished. 
In a mild crisis, warm, fluid sweats flow spontaneously, 
whilst the aspect assumes its natural appearance. Sleep soon 
becomes quiet and refreshing, free from disturbing hallucina- 
tions ; for now the cerebral tissues are relieved of abnormal 
excitation. 
On other occasions the new determinations may be more 
essentially to the kidneys, or urinary apparatus, purging the 
blood of a mass of heterogeneous substances, partaking partly 
of the common elements, and partly pathological. As the 
rigid tissues begin to yield, there is noticed some increase of 
urine, in which on standing some hours in a glass vessel, a 
cloud appears diffused ; as the favorable changes proceed, 
another parcel shows a dense nebula in the centre of the ves- 
sel, and as the solution of the viscid matter takes place, a 
reddish sediment is precipitated on the sides of the vessel, 
and therefore called lateritious. The particular composition 
of these depurations may be learned from animal chemistry. 
The salutary impetus may be to the intestines, producing 
copious discharges by the now pervious exhalants, mucous 
secretions, and emancipated liver, pancreas, and other sources. 60 
SEMEIOTICE. 
It is not very uncommon for the critical determination to 
be directed to the glands of the axilla and inguina, or to vari- 
ous parts of the surface and cellular tissue, in form of inflam- 
mations, which soon suppurate, and afford much relief by their 
discharges. 
The blood now being a little altered, may be determined 
to some of the various portions of the mucous tissues, al- 
ready turgid. The nosodynamia of the vessels being dimin- 
ished, or removed, it finds a ready exit by hemorrhage from 
the nose, lungs, kidneys, intestines, or uterus. Let no pre- 
sumptuous interference be attempted to suppress these salu- 
tary discharges, which now look frightful to those who can 
discover nothing but debility in disease. They are the her- 
alds of returning health, and the recuperative powers have 
taken charge of the case. The timid may be well assured 
these discharges will cease, as soon as the instinctive force is 
sufficiently avenged of the injury done by the obnoxious ex- 
citations. Only moderate, supporting measures may be ne- 
cessary ; for too much will add further provocation, and ex- 
haust. No physiological thesis is better established than this, 
that high stimulations may suddenly exhaust the vital force at 
such times. A waving of the hand often extinguishes a 
dimly burning taper. 
The local affections subside along with the constitutional 
disease ; and the congestions, inflammations, and tumefac- 
tions will be dispersed in proportion as the absorbing, centri- 
petal circulations prevail over the centrifugal. 
The time when these revolutions may take place depends 
much on collateral circumstances. 1st, partly as the disease 
might have received a cast at its onset by the treatment; as 
whether it was weakened, but not suppressed ; or whether it 
was aggravated by improper treatment. 2d, as the causes 
might have been more impressive, and in an irritable habit, 
which cannot be long borne ; or, as the phenomena might 
appear in the reverse state. As a medium suppose between OUTLINES OF PATHOLOGY. 
61 
one and three weeks in ordinary cases of pyrexia ; yet some- 
times sooner, and later. 
From remote periods, it has been observed, that crises 
take place on certain days of fever, reckoning from the attack, 
rather than on others. These have been called critical days. 
The observations of a very respectable portion of physicians 
result in the conclusion, that about three fourths of fevers, 
not much interrupted in their course by treatment, terminate 
by crises on the assigned critical days. These are the ob- 
servance of tertian periods to the 11th day, and of quartan 
thence to the 20th, and even after. The first division will 
fall on the 3d, 5th, 7th, 9th and 11th days. The second 
division will happen on the 14th, 17th and 20th. After this, 
some have insisted on hebdomadal periods ; say from 20th to 
27th, 34th, &c. Others have insisted on the 21st as the 
third critical day of this period. There is a determinate pe- 
riodicity in the economy observable, in many conditions, and 
it is well marked in hectics, and intermittents. These cir- 
cumstances, with the observations of a great proportion of 
physicians, serve to confirm the suggestion of crises happen- 
ing on these days, far oftener than otherwise. The fact of 
simple fever often showing exacerbations every other day, 
confirms it. The visible crises are more constant in warm, 
than in cold latitudes. Notwithstanding, a discreet treatment 
will almost uniformly protect the economy from the danger- 
ous and uncertain conflict of a perturbating crisis. 
Severe, or very manifest crises, are not so much expected, 
nor seen at the present time, as formerly under the expectant 
treatment; and for two reasons. One is, that a well timed 
application of the relaxing, and secerning treatment, super- 
sedes and anticipates the necessity of these convulsive efforts 
of nature. The other is, when the treatment has been on 
the thesis of debility, and of a tonic kind, or a mixture of 
opposing prescriptions, the combined excitations of the dis- 
ease and of the treatment, depress or exhaust the vital force 62 
SEMEIOTICE. 
prematurely, so that the recuperative powers are disenabled 
from effecting the necessary processes. All may be lost, 
with numerous attending anomalies. A mild case in a good 
habit so treated, may be protracted, and yet in the end be 
triumphant. 
The previous history will apply chiefly to acute diseases ; 
but the same analogy may be transferred to those of the 
chronic kind, as these consist of protracted fevers, with their 
several local tendencies. Manifest crises do sometimes oc- 
cur in these ; yet, the changes are more commonly in a si- 
lent manner. 
A hidden pathological state sometimes exists in the inmost 
tissues, which may be very persistive, and yet scarcely suffi- 
cient to provoke those pyrectic changes, which ultimately 
destroy the organism, if not removed. These secret tissual 
changes are sometimes removed by a well timed excitant and 
secernant treatment; and, also, they have often been remov- 
ed by powerful affections of the mind, as was mentioned 
(p. 265.) In these instances the tissues suffer an excitation 
which promotes capillary action, and especially absorption, so 
effectually, by a sudden crisis, that all the phenomena of dis- 
ease are suddenly changed for those of health. 
b. The second train of phenomena are of a more sombre 
cast. The instinctive and repulsive powers may have been 
suppressed at the onset, and the case prove fatal without much 
injury done to the tissues ; but commonly otherwise ; and in 
the conflict of disease these efforts have produced irremedia- 
ble changes in the organism, and nearly exhausted its force 
by its excessive efforts. The sequences of morbid action, 
now in their turn, have become the causes of a fatal repose. 
The functions of organs destroyed by an excess of action, 
can never be restored by excessive stimulation. The intel- 
lect frequently becomes darkened from cerebral changes. 
The senses no longer respond to their former impulses, and 
insensibility lends its soothing aid in mitigating the agonies of 
suffering organs. OUTLINES OF PATHOLOGY. 
63 
A great inequality of organic function prevails, some are 
excessive, and others dormant. The respiratory functions 
soon become oppressed, even if there is no immediate organ- 
ic restraint. The rale is heard ; the pneumogastric nerve 
has lost its force, and the external respiratory muscles are as- 
sociated into severe efforts to expand the chest. The con- 
trol of the voluntary sphincters is lost; deglutition is difficult; 
the faeces discharged involuntarily, as well as unconsciously ; 
the wavering coma-vigil, if it had been present, is exchanged 
for secondary coma. Muscular motion is paralyzed, except 
perhaps some involuntary jerks. A fetid breath, and the ca- 
daverous smell of the sick-bed, foretoken dissolution. 
The fallen countenance assumes the Hippocratic aspect; 
along with a faltering pulse, cold extremities, and viscid 
sweats, the eyes have lost their lustre, and sink in the sock- 
ets ; features sharpened and sunk ; the general contour of 
expression lost from a paralysis of the facial nerves ; the skin 
about the ears and temples contracted ; the nose sharpened ; 
face pale or livid. Little, except the first grade of vital 
force remains, and that is soon to cease ; whilst, indeed, the 
whole train of moribund phenomena show a persistive noso- 
dynamic state of the tissues. 
c. The prognosis of diseases depends on a careful exami- 
nation of the phenomena, and on observing whether they 
manifest more or less severity as the case proceeds. How- 
ever, certain phenomena at the attack, and during the pro- 
gress, indicate a tendency to dissolution rather than recovery. 
Some of these may be mentioned in order to show the weight 
of disease, and which may require early attention. 
Great prostration of strength at the onset, with muscular 
tremors ; deliquium in an erect position, and disposition to 
sleep, all show' the weight of disease, and severe impressions 
on the nervous system of external relation. Pulse small, 
tremulous and frequent, 120 to 150 in a minute ; either re- 
maining small, or becoming more full and strong, yet not 64 
SEMEIOTICE. 
abating in frequency. Or, again, a very slow and irregular 
pulse at the onset. Deep sighing, with oppressed respira- 
tion, and desire for fresh air. 
As the disease advances, the head is hot whilst extremities 
are cold ; or high universal heat, with a frequent, sharp pulse, 
and tendency to delirium at an early period. Loss of place ; 
ignorance of friends ; and desire to go away. Livid counte- 
nance, maculae, petechiae, and severity of local affection. 
These do not require any exposition in this place. 
SECTION XLV. 
1. On the Diatheses; particularly the Synochoid and Ty- 
phoid. 
In order to gain some view of the intrinsic character of 
different habits of disease, we are led into a consideration of 
circumstances in which they appear to differ. The various 
particular, constitutional conditions in disease, which we dis- 
cover, are called diatheses ; whilst yet we are not able on all 
ocas ions to determine satisfactorily, in what the disparity 
consists. Thus we speak of a scrofulous, cancerous, hy- 
dropic diathesis, &c., on account of noticing some discrimin- 
ating phenomena, although not able to explore the whole of 
their arcana. 
These specific diatheses may require particular remedies, 
which are only learned from experience. Notwithstanding, 
we discover in all these conditions certain modified states, 
which in a practical view merit attention ; and these we as- 
sign to be the opposing states of the synochoid, and typhoid OUTLINES OF PATHOLOGY. 
65 
diatheses.* Aside from any specific treatment, these 
states ought to govern the general treatment. Thus, there 
may be two subjects affected with scrofula, the general treat- 
ment of which may require to be considerably different. 
We have occasionally made allusion to the diatheses; 
(Sect. xv. 6, et aliis,) but as it may be esteemed one of 
the most obscure subjects in pathology, and at the same time 
of the deepest interest in a therapeutical point of view, it 
merits the severest inquiry. We cannot here enter into a 
review of all the specific diatheses ; our attention, therefore, 
must be directed to the two general states of the economy, 
which may prevail and preside in many habits of disease, and 
which have been called the synochoid, and typhoid diatheses. 
There are numerous intervening grades, which may be called 
simple fever, not approximating very near to either of these 
states ; or a simple pyrectic diathesis. 
Although these terms might be considered objectionable, 
they are continued in conformity to usage, and as familiar to 
every one in apprehending two essentially different, and seem- 
ingly opposite pathological states existing in the morbid habit. 
From the earliest history of fevers they have been distin- 
* We have no particular predilection for the use of these terms ; dynamic 
and adynamic, or sthenic and asthenic might have been used. We would, 
however, have it expressly understood, that these terms are here used 
to express particular states of the system, without any reference to the 
causes. These modifications of diatheses are discovered in different subjects 
from the same causes, as in variola, rubeola, epidemic pneumonia, &c. 
They are oftentimes convertible in the same subject, but not so suddenly as 
some might suppose from mere appearances of debility. We, therefore, take 
the liberty of dissenting from the views of Drs. Bancroft, Armstrong, 
Davidge, and Dewees, (Prac. Phys. p. 169,) even if it be " incorrect in 
logic as well as in language," in considering that those affections alone 
should be called " typhus," which arise from "a specific contagion." It 
remains yet to be demonstrated that typhus does so arise ; and if it does, facts 
warrant that it. does incline, in many instances, to the synochoid diathe- 
sis ; this is as fully demonstrated as that variola often verges to the typhoid 
state. 66 
SEMEIOTICE. 
guished by some qualifying terms of their intrinsic character, 
synonymous with inflammatory and malignant, as expressive 
of two seemingly opposite states, and for the most part read- 
ily distinguishable. 
In the different epidemics and endemics which have ever 
prevailed, it has been observed they commonly possess a 
predominancy of character inclining to one or the other of 
these states, and that they may in the same individual, change 
the one into the other. When the manifest contagious dis- 
eases spread, it has always been observed, that some partake 
of one diathesis, and -some of the other ; and the diagnosis 
has been esteemed essential in modifying the treatment. In- 
deed, from the same causes, one in a family may manifest 
distinctly a predominance of one state, whilst another as 
clearly shows the other. These facts are important in lead- 
ing to an investigation of their intrinsic characters. 
These states of the morbid economy are not peculiar to 
acute diseases of the severest grades. The same disparity 
in the features of the leading phenomena of these two diathe- 
ses may be observed in a minus degree, in the milder grades 
of fever, and even in chronic diseases. It may be sufficient 
to mention influenza, phthisis pulmonalis, and dropsy. Ty- 
phus mitior evidently shows sometimes one diathesis, and at 
other times a verging to the other ; and this accounts for the 
distracting views that different physicians have formed of its 
pathological character, and consequently of the treatment. 
The first stage of phthisis is often clad in a deceptive garb of 
debility, furnished by the typhoid livery. 
What are the Invariable and Necessary Circumstances 
which produce the Disparity of these Conditions ? 
In prosecuting the inquiry, we shall need to be reminded 
of certain pathological theses, which are well established, and OUTLINES OF PATHOLOGY. 
67 
we shall, therefore, not stop to prove them. One is, that 
every inordinate impression on the tissues, if even through 
the mind, which is capable of altering the functions, is di- 
rectly followed by a retrocession of fluids from the surface 
to the central organs and tissues. It is attended with anaemia 
externally, and hyperaemia internally. This will hold good 
from syncope up to apoplexy. Although the period may 
sometimes be very short, between the impression and the 
return of circulation in quick responding habits, yet the 
change has existed in some degree. 
The principal physiological force existing, which must 
give energy to the vascular tissues enabling them to restore 
the equilibrity to the surface, must be the visceral ganglia and 
their nerves, since they accompany the arteries into their 
dermoid capillaries. 
Let us now recall what has been amply proved, that early 
in every severe disease the internal capillary vessels are fully 
distended, and engorged, whilst anaemia exists on the surface. 
And, also, the physiological fact of the ganglia, and their 
plexuses being vascular ; together with the pathological fact 
of these ganglia being found engorged in the numerous exam- 
inations of fatal typhoid cases, and the proposition appears 
to be established, that the derangements have produced an 
inability in the capillary circulations, and this is the immedi- 
ate cause of the typhoid state. A similar derangement in the 
encephalon produces coma, paralysis, and perhaps apoplexy, 
attended with a failure of functions. 
We have now found certain derangements in the circula- 
tions, sufficient to account for the phenomena presented, and 
the circumstances which produce these derangements have 
heretofore been amply discussed. 
We will, however, concede, that what has been advanced 
may be common, in greater or less degree, to both the dia- 
theses ; and the inquiry must still be extended, viz. What 
makes the difference ? 68 
SEMEIOTICE. 
We assume it as a fact, that those cases which afford the 
clearest manifestations of a typhoid diathesis early show the 
most of an ansemic state of the surface ; and the inference 
must be, that these cases have the greatest burden of internal 
hypersemia also ; and this is in conformity to autoptical in- 
spections. 
We improve, also, another fact, that the causes are more 
impressive under some circumstances, than others ; and, 
also, that they make greater impressions on some less resist- 
ing subjects, than on others. 
What has been advanced may not only be considered as 
facts, but as universally so. With this assurance, we will 
introduce another entitled to equal credit ; which is, the live- 
ly susceptibility of some temperaments enables the tissues to 
respond more readily, and energetically than others to every in- 
jury offered them ; and in disease severe stimulations have been 
presented. These early responding actions restore circula- 
tion in some degree, both arterial and venous, if not per- 
fectly ; and in sufficient season to save the paresis of the 
ganglia, which must take place, if the enthralments at the at- 
tack are continued. The circulation will now be more free 
and intense, in proportion to the severity of the impressions, 
and vascular force of individual idiosyncrasy, if all other 
things are equal. 
It is supposed this state of things may take place sponta- 
neously, and without the assistance of art, which is often the 
fact, and most generally so. The pathological processes 
now go on exhibiting that train of phenomena, which indi- 
cates the condition called the synochoid diathesis ; viz. heat, 
pain, redness, thirst, hard, and often throbbing pulse, capilla- 
ry circulation free, wakefulness, with liability to delirium, 
fixed location with pain in some organ or tissue, blood on 
venesection quite florid, having a fibrinous crust, and cupped. 
In analyzing the other limb of our subject, we merely need 
to make the relative inferences from the principles advanced. OUTLINES OF PATHOLOGY. 
69 
The blood is not early restored to the surface, either by na- 
ture or art, it is not aerated in the lungs, nor is venous ab- 
sorption excited sufficiently. The ganglial nervous force, 
including the internal respiratory, is so far paralyzed, and the 
tissues held in such rigid durance, that the recuperative pow- 
ers of the economy cannot be excited to afford seasonable 
aid ; for, the primitive or first grade of vital energy of tis- 
sues holds the nervous force in restraint by its acquired, or 
nosodynamic influence. It may be held until all functional 
action ceases ; but this is supposing an extreme case. It 
most commonly falls out, that the responding impulses are 
drawn forth, but in an imperfect manner, and this gives occa- 
sion to the, typhoid state. 
The circulations, with all their relative associations, are 
but imperfectly performed, when compared with the expand- 
ed state of the synochoid diathesis, with arterialized blood. 
The congestive condition of capillaries internally and 'exter- 
nally still remains, at least in some considerable degree. 
The state of the ganglial, or as combined with other nervous 
force constituting the nutritive system, bears some resem- 
blance to that of the encephalon in hemiplegia, half active, 
half dormant. The circulations which do appear are wont to 
be irregular ; forcible in some organs, with heat; whilst in 
others coldness, and inactivity exists. The same disparity is 
seen in the nervous functions of external relation ; plain 
specimens of ataxia. There exists uncommon prostration of 
muscular power, with sometimes spasmodic jerks ; inability 
of mind, with coma-vigil ; pulse feeble, and frequent, say 
one hundred and twenty or one hundred and forty in a min- 
ute ; surface pale, or often dusky, sometimes with petechiae, 
vibices, &c., appearing, also, in the internal tissues ; blood 
dark, and mostly destitute of the fibrinous crust, and scarce- 
ly coagulating. This train indicates the typhoid diathesis, in 
its highest degree ; yet, it often appears with far milder phe- 
nomena. 70 
SEMEIOTICE. 
There appears then, to be a manifest difference in these 
two pathological states, and that they arise either from modi- 
fications in the appreciable causes^ or in the personal condi- 
tion of the subject, rather than from any specific virus with 
an agency to produce either of them. The virus of small 
pox may give origin to either of them in different subjects; 
and by different treatment. So of scarlatina, and perhaps 
all diseases more or less. * , 
There are constantly presented intermediate grades of dia- 
theses, between the two extremes. In fevers of a milder 
grade, a predominance of one, or the other of these states 
may be easily discovered. The simple synochus and typhus 
may be cited as specimens. Always supposing the causes 
producing the typhoid state have been the most impressive, 
with the least vital ability to remove the derangements. It 
remains to be noticed, that whenever the embarrassments 
connected with the typhoid state of fever, are fully removed, 
the resulting phenomena will indicate the severest conditions 
of the synochoid state ; and attended with accumulated tissual 
sensibility, and intensity of vascular action, with a hard pulse 
and florid blood. 
2. Diathetical Remarks. 
Having briefly recapitulated the distinctive characters of 
the synochoid and typhoid habits, we may offer a thesis on 
our own responsibility ; viz. that these conditions are some- 
times convertible, or changed the one for the other. This 
thesis cannot be fully examined here, as it rather belongs to 
therapeutics. Some references, however, may be made 
to it. a 
a. Suppose a subject exercised with a sthenic, or inflam- 
matory fever, of course having a synochoid diathesis, having 
pain, with a moderately full and hard pulse, say one hundred OUTLINES OF PATHOLOGY. 
71 
in a minute moderate heat, and slight propensity to delirium ; 
and in this condition should be treated with wine, brandy, 
quinia, opium, the arsenious solution, and perhaps some et 
ceteras. 
In such an event, a manifest change of phenomena will oc- 
cur in twelve hours, often less, and still greater in twentyfour 
hours. The phenomena may then quite well simulate, and 
even assume the characteristics of the typhoid state. Alrea- 
dy paleness, sweats, coldness of the extremities ; pulse fluc- 
tuating from one hundred to one hundred and thirty or more 
in a minute ; thirst; dry and tremulous tongue ; vertigo ; 
vomiting ; muscular tremors ; coma-vigil ; internal conges- 
tions, and prostration of strength. 
If these measures are practised at an early period of almost 
any pyrectic habit, which usually show's some inequality of 
functions, anc} depressions ; and yet, if left to the natural pro- 
cesses would soon develop a mild synochoid diathesis of 
easy treatment ; then, this artificial state will very certainly 
be produced ; attended with a tremulons pulse, and general 
prostration. Mild cases of fever when thus treated develop 
a factitious typhoid diathesis of very difficult management.* 
As this factitious train of phenomena is supposed to indicate 
a fearful debility, the adviser may be induced to increase the 
quantity of the stimulants and tonics ; and" yet it usually re- 
sults, that the coldness, inability, and every typhoid phenom- 
enon increases in proportion ; and the case is most certainly 
lost. 
There is but little difficulty in discriminating these factitious 
cases, by an experienced observer, although they may be so 
* In Dr Rush's Med. Inquiries, Vol. III. p. 45, he has given the following 
advice. " Even opium, in large doses, sometimes produces by its powerful 
stimulus the same symptoms which are produced by the stimulus of marsh 
miasmata. These symptoms are a slow pulse, coma, a vomiting, cold sweats, 
a sallow color of the face, and a suppression of the discharges by the urinary 
passages and bowels." 72 
SEMEIOTICE. 
frequent in particular neighborhoods as to become factitiously 
endemical. It is uniformly, but unfortunately the case, that 
those who advise such treatment, are ready to impute the 
forbidding appearances to the necessary results of the disease, 
instead of the treatment.* 
* As a specimen of the " incendiary treatment," we may insert an abstract 
of a letter from the late Professor N. Smith, of New Haven, in 1824. He 
gave it as he had seen it ordered in " a case of fever," at Middletown, 
Conn. The patient was ordered to take, in divided doses, the following 
quantities, every twentyfour hours, viz. 
Three pints of wine. 
Eight ounces strong Tinct. Cinchonae. 
Two hundred and eighty drops strong Tinct. Cantharides. 
One and a half ounces Aqua Ammoniae. > 
One hundred drops of Fowler's Arsenious Solution. 
One and a half pints of Decoction cf Capsicum. 
Four ounces Tinct. of Opium by injection. 
As, also, various dietetic stimuli. 
It appears by the above bill of fare, the correctness of which we have no 
reason to doubt, that it is a harder job, sometimes, to kill people with medi- 
cines when they are sick, than whilst they are well; for they continue oc- 
casionally, for several days under such regimen ; indeed, such an enormous 
quantity of high stimuli that they become poisons. It is probable the 
diminished sensibility, and scanty absorptions render them inoperative, in 
part. 
In the case of M. M. Leavenworth, aet. 25, (Dr Minor on Typhus Syn- 
copalis,) it appears he took daily on an average twenty grains of opium, 
and eighteen ounces of Tinct. of Bark, for about nine days before he died; 
as also, wine, brandy, arsenious solution, old spirit, broth; and a plenty of 
epispastics were applied. Also, frequently repeated enemas, with two fluid 
drams in each of tinct. opium. The patient had vertigo, vomiting, delirium, stu- 
por, wakefulness, aortal throbbings; pulse from eighty to one hundred and 
twenty in aminute; skin cool and sweaty; total suppression of urine, &c. Such 
treatment requires no further remark than to say, it is Brunonianism outdone. 
Similar misfortunes have attended other, and remote neighborhoods to which 
such treatment has been transferred. It might be supposed that the Thomp- 
sonians are more consistent, in applying a part of their combustibles to 
the surface, even supposing they sometimes parboiled and singed their pa- 
tients. 
It is cordially accredited, that the "incendiary " treatment has not many 
advocates at the present time amongst men of science M. Broussais, how- 
ever, accuses Professor Rasori, of Italy, of the use of extravagant stimulating 
treatment, of a modified kind. "It is my duty," he says, "to point out OUTLINES OF PATHOLOGY. 
73 
b. On the other hand, to convert a typhoid state of disease 
to the synochoid, in order for the safety of the case, and to 
render it of comparative security, with plain mitigating treat- 
ment, involves the aid of many of the profoundest princi- 
ples of pathology, and discriminating practice. , 
A view of the pathological condition of organs shows the 
embarrassments that require to be removed. The longer 
this enthralled state of functions has existed, its alteration 
becomes the more difficult, and uncertain ; and yet many 
cases not of the severest grade have been changed after sev- 
eral days continuance. In the most severe grades of adyna- 
mic, or malignant fever, there is a period that offers the 
greatest prospect of relief, and this is as soon as the heart 
and all the centrifugal apparatus first make an effort, after the 
subsidence of action at the attack has occured ; and before 
many changes in the tissues have taken place, or the pulsa- 
tory efforts become very frequent and small. The more se- 
vere the impressions of the causes have been, the shorter is 
the period of possible relief. In many instances it may be 
of only one, or two hours space, that the instinctive powers 
of reaction can be excited, and drawn forth in a manner to 
save the destruction of the functions of the vital organs. It 
is rare that opportunity is offered, or indeed improved in 
these hurried cases, in a manner to give the greatest possible 
relief. 
Many cases, however, of very considerable severity do 
continue twentyfour, or fortyeight hours under many threat- 
ening embarrassments, which are remediable with discreet 
these errors, because they serve to throw light, in place of experiments, on 
the mechanism and effects of vomiting; because they are connected as 
causes of disease, with the disorders of the digestive functions; and finally 
because it is high time to put a stop to the contagions of Rasorism, which 
threatens to seize on our schools, and to replace the system of Brown, of 
which our countrymen begin to be ashamed." Phy. applied to Path. p. 344. 
2d Amer- Edit. 74 
SEMEIOTICE. 
and energetic treatment. Although there may be a great se- 
dation of many of the most important functions, yet direct 
stimulants and tonics do not grant the needed relief; for the 
organism is, oppressed and suffers an inability of function, 
which cannot be removed until there is a returning freedom 
in the play of the nervous force. 
Every kind of stimulation, unless directed in a successful 
manner to promote secretion, and capillary circulation, 
co-operates with the causes, and adds to the enthralled con- 
dition of the nervous force. The design must be to dimin- 
ish the state of nosodynamia, relieve the paresis of the ner- 
vous tissues, promote secretion and absorption, and solicit 
the circulations from the centre to the surface. 
We cannot enter particularly on the methodus medendi at 
this time, but our own experience justifies the statement, 
that such changes have been effected in severe dysentery, 
spotted fever, pneumonia typhoides, scarlatina, &c. Refer- 
ence may be had to some cases in Treatise on Epidemic 
Diseases, &c. We have the testimony of many, eminent in 
the profession, of similar results in yellow fever, plague, 
cholera, and local fevers of the typhoid aspect. Some allu- 
sion to the treatment will be made in the next division, on 
therapeutics. 
The foregoing brief expositions of the phenomena of dis- 
ease, are all that can be offered at present. Yet constant 
allusions must be made to their seats, and attending phenom- 
ena in our further investigations. It would be irksome to re- 
view all the phenomena of the chronic habits, nor does it 
appear necessary, as they depend on a series of circumstan- 
ces very similar, or of much affinity to the acute forms of 
disease. OUTLINES OF PATHOLOGY 
75 
3. Concluding Remarks in reference to the Study of 
Pathology. 
The foregoing sections merely afford a bird's-eye view of 
the entire range that is necessary to be explored, in the 
study of pathology. If it can be conceded that any one de- 
partment of medicine claims a special regard, it is this ; but, 
how greatly neglected ! It has so happened in the course of 
our experience, that some students in answering to public in- 
terrogatories, would be able to describe the bones of the car- 
pus and tarsus, as well as the minutest muscles ; and like- 
wise give a good account of chemistry and botany ; but when 
interrogated on the maladies affecting the human system, 
could scarcely give a definition of common diseases, and 
were mainly ignorant of the character of the morbid habit. 
The excuse for this neglect has sometimes been the want 
of time, and that they had intended to bestow more attention 
to these subjects after they had got through, and gone into 
practice I Is not this an abuse offered to the community ; 
to visit the chambers of the distressed, to profer counsel 
with the badge of confidence, and yet ignorant of the indis- 
pensables of a practitioner ? By such things the public is 
wronged, and the profession degraded. Well might the 
keen sarcasm of a certain legislator apply in such cases, who 
in his remarks on a bill before the legislature, for the de- 
clared purpose of preventing quacks from practising without 
diplomas, observed, be was much in favor of the bill, 
and only wished it extended, so as to exclude quacks with 
diplomas also. 
Our desire is not to wound, but rather to heal, and we are 
whiling to provoke to good works. It is all important that 
the adviser should be able to decipher the state of the inter- 
nal organs, most commonly the seats of disease, by the ex- 
ternal emanations from those organs when oppressed in func- 76 
SEMEIOTICE. 
tion, and suffering structural changes, ihe external tokens 
are sometimes obscure from the want of intensity, but oftener 
from want of attention, or discernment. 
There is most commonly, a catenation of tokens revealing 
the morbid habit, and even the sometimes obscure seats of 
particular diseases, which scarcely falls short of arithmetical 
exactness. The medical adviser should learn to construe 
their language, before he can form a just diagnosis, or esti- 
mate the kind or amount of remedies. The radical phe- 
nomena resulting from lesions of the nutritive tissues, must 
be distinguished from the fleeting nervous disturbances often 
hovering about. The empiric combats these fugitive symp- 
toms with his specifics, and announces his patient to have 
as many diseases, as he discovers prominent phenomena. 
The tokens of acute disease are intrusive, and force them- 
selves upon the perception of the careless observer, whilst 
the instinctive energies are roused into manifest perturbation. 
The milder grades, and chronic forms of disease are more 
liable to deceive. Concealed as it were in ambush, in the 
inmost recesses, they prey upon the tissues of organic life. 
With slow and inappreciable changes the organism suffers a 
deterioration, and manifests its lesions by scattered light 
less vivid than a smothered coal-pit ; exhibiting phenomena 
alone to be discerned, whilst remediable, by the scrutinizing 
tact of the pathologist; and fortunate, indeed, is that patient, 
who has an adviser possessing the faculty of discrimination. 
Oftentimes, the slow movements of the torpedo outstrip 
the tardy progress of the ailment ; and before the slothful 
pathologist discerns the worm gnawing the delicate tissues, 
the crimsoned, hectical cheek, and unrebukable thrush deride 
him in scorn. Or, the attenuated capillaries, impatient of 
delay, disgorge their fluids in the form of hydropic intumes- 
cences, and serous bloatings. 
We may then be permitted to remark, that correct pathol- OUTLINES OF PATHOLOGY 
77 
ogy leads to the investigation of the character of disease, and 
the early ravages it is committing in the remote tissues and nu- 
tritive recesses. It is the concentration, as well as the com- 
pletion of all other medical studies. It should be considered 
the common centre around which all others are arranged, 
though at unequal distances. 
Anatomy and Chemistry, are the two supporting pillars in 
the temple of Medicine. They represent the basement and 
frame of the edifice ; but of how little use would these be 
without the finish, and without the endowments. As well 
might we expect the naked frame would defend us from the 
inclemency of the seasons, as that a physician should be pre- 
pared to compete with disease, without a correct compre- 
hension of the principles of pathology. 
We may then be suffered to observe, that however indis- 
pensable chemistry may be to the medical student, it merely 
prepares his mind the better to comprehend pathology ; and 
that, however important anatomy may be, not only to the 
surgeon, but to the physician also ; yet, it only portrays the 
form, location, and structure of animal bodies, without the vi- 
tal impulses, and without the secret, tissual movements. 
Physiology sets the car in motion, whilst pathology exhibits 
its reddened axle exciting combustion in the whole ma- 
chinery. DIVISION in. 
THERAPEUTICS. OUTLINES OF NOSOGRAPHY : 
OR AN 
ARRANGEMENT OF CONSTITUTIONAL DISEASES, 
ACCORDING TO THEIR 
MOST COMMON TISSUAL SEATS. 
If I may be allowed the expression, it is always the same individual, but in 
entering each system (tissue) it has a different appearance there, so that often 
you cannot recognise it.-Bichat. EXPOSITIONS. 
Agreeably to dur design, in treating of the physiological 
functions of the human economy, in the synthetic method, it 
appears equally proper, to begin at the simplest organization, 
in treating of the pathological states to which they are sub- 
ject. 
This appears to be in accordance with the fact, that a great 
proportion of diseases at their onset, have their seats in the 
simple tissues. Notwithstanding, in their progress, other 
contiguous tissues often become associated, and the event 
may show an injury done to every tissue of an organ. 
It will be granted, again, that disease in its most compli- 
cated form, and impetuous career, may primarily seize on the 
whole of some organs, composed of many tissues. So it ap- 
pears in the complex, or malignant diseases, attended with 
what might be called an exalted typhoid diathesis ; or, a tor- 
nado of the elements of disease. These are rather out of 
the*common course of acute affections, and altogether so of 
the chronic. They accomplish in a short time, what the 
ordinary habits of disease do in a long period of conflict. 
Dr Good, in his very scientific nosology, adopted the an- 
alytic method, and assigned the seats of disease, in toto, in 
the organs generally, and without descending from the com- 
pound to the simple organization. We will only stop to 
remark, that the course now pursued, is, in our opinion, 
most in accordance with the history of diseases. It was in- 84 
EXPOSITIONS. 
tended to have, followed up the pathological states in the 
exact order of the physiological, but farther reflection has 
convinced us, that this would not afford so good opportunity 
to illustrate the general character of disease. 
An apology may be due for adopting the simple plan of 
embodying all constitutional disease into one class. This 
appears to us the most agreeable to facts, and at the same 
time assists in exposing the real simple character of disease, 
as disrobed of mysticism. We have merely made an attempt, 
in the preceding pathology, to expose this simplicity of the 
elements constituting disease, and when followed out may 
resemble the simple numerals in arithmetic. The intention 
is, to show, that all diseases partake of a state of excitation. 
We can scarcely conceive of the existence of disease, 
when fully developed, and stripped of incidental contingen- 
cies, without a state of excitation, more or less intense ; and 
therefore conclude it to be the more simple and natural 
method, to group all constitutional affections under one head. 
The discriminations of diatheses may be partly shown in the 
different orders ; whilst the specifications of particular dis- 
eases are found in the genera, and their varieties. 
There may be various states of organs attended with a de- 
ficiency cf vital action, which, notwithstanding, arise from 
excitations, followed by paralysis, or inability of function. 
These should be considered as modified states of disease, and 
may require exciting remedies. The gangrene of a frost- 
bitten limb, and the dry gangrene may be of this kind. 
Syncope and asphyxy may need mild exciting treatment, al- 
though produced by excess of stimulation. Hemiplegia is 
connected with an excess of cerebral excitation ; and ramol- 
lissement is the sequence of antecedent abnormal excitation. 
Certain states of the diseased habit may, therefore, require 
exciting remedies, in the progress of abnormal changes. 
Disease being a general affection, constituting a common 
morbid habit, is subjected by a pathological law of the eco- OUTLINES OF NOSOGRAPHY. 
85 
nomy, to concentrate on some tissue, and form a local point, 
or focus. As soon as the special influences are altered, 
which directed the concentration to any particular point, and 
whilst the general morbid habit remains, the local concentra- 
tions, by other influences, may change to other tissues, 
requiring another nosographic order, and a new name ; and 
there modifying the character of the morbid habit, by its pe- 
culiar reflex action. 
Although we had retained a general knowledge of the 
opinion of Dr Rush, on the affinity existing in diseases, read 
many years past, yet we had entirely forgotten the following 
sentiment, and accidentally discovered it, after this arrange- 
ment was made out. We cordially accept its support. 
" However varied morbid actions may be by their causes, 
seats, and effects, they are all of the same nature, and the 
time will probably come, when the whole nomenclature of 
morbid actions will be absorbed in the single name of dis- 
ease."* 
It appears, that Broussais arrived to nearly the same con- 
clusion, rather unconsciously, by another process in arguing ; 
that is, by following out his notions of his favorite " irrita- 
tion."! " This proposition is one of the keys to physiolo- 
gical pathology ; it exhibits the secret tie which unites the 
slightest diseases with the most severe ; it fills an immense 
hiatus, which has existed in the science from the most re- 
mote antiquity ; it destroys this insulation of the different 
shades of irritation, which may be regarded as the source of 
medical ontology ; it connects chronic and acute affections, 
those of different ages, sexes, and places, with one another ; 
it shows the union of surgery with medicine," &c. 
In some respects it appeared desirable to have made a di- 
vision of the class into acute and chronic affections. But, 
on reflection, it was found difficult, and is indeed unneces- 
"Med. Inq. Vol. II. p. 234. 
t Commentary on Prop. 84, Prin. Phys. Med. 86 
EXPOSITIONS. 
sary ; for, acute diseases often become chronic ; and again, 
the chronic, by slight aggravations, become acute. It is, 
therefore, difficult to draw a line of discrimination. It is 
certain both will remain until the primary pathological 
changes are removed, as well as their results. 
The following summary is admissible of much improve- 
ment. Some affections may more properly belong to a no- 
menclature of local affections, and some no doubt are omitted 
which belong in this. 
We are aware that other tissues might be admitted as seats 
of disease ; yet, concluded to make an attempt at the most 
obvious, and leave others for consideration. The cellular 
tissue performs many offices, and the effects of disease are 
often found in it, as it is a universal tissue. How far it may 
be found to be the primary seat of disease may be doubtful. 
It is very often only the reservoir of the morbid effects of dis- 
ease in other tissues. 
The vascular is, also, an universal tissue, and associated in 
almost every malady. Great homage may be due to it ; but, 
still it may rather be considered as an organ, and composed 
of the very tissues which are brought into review. SYNOPSIS NOSOGRAPHIjE generalis. 
CLASSIS SINGULARIS. 
HABITUDO MOBBOSA PYRECTICA COMMUNIS. 
DEFINITION. 
The whole series of organic movements changed from their 
normal state, by the agency of certain causes impressing the vital 
susceptibility, producing a state of excitation. The phenomena 
manifest a perversion of the organic rythms, more or less, and 
other alterations of their functions. The general excitation is 
attended with local concentrations in tissues of different organic 
sensibility; the reflex actions of which modify the common dia- 
thesis. After uncertain periods of perturbed action, a subsidence 
ensues, often preceded by some unusual discharges ; or, a continual 
conflict prevails until the vital energies cease. 
ORDINES. 
I. 
Diathesis fervida fibrosa. (Habitus phlogisticus.-Sthenia.) 
IL 
Diathesis fervida mucosa. (Habitus pyrecticus mitis.-Synochus.) 88 
SYNOPSIS. 
III. 
Diathesis fervida serosa. (Habitus typhoides mitior.-Sthenia lenis.) 
IV. 
Diathesis fervida complexa. [Habitus typhoides gravior.-Ataxia, et 
Adynamia.) 
V. 
Diathesis fervida erupta. [Habitus phlogisticus.-Sthenia.) 
VI. 
Diathesis glandularis indurata, et imposthumosa. 
VIL 
Diathesis capillaris adstricta. 
VIII. 
Diathesis muscularis adstricta. 
IX. 
Diathesis spino-encephalica depravata. 
X. 
Diathesis ossea depravata. 
. XI. 
Diathesis specialis. DIATHETICAL SCALE. 
The following general scheme will assist in comprehend- 
ing the different states of the diseased system called Diathe- 
ses, which have been esteemed by most physicians, to exist 
in different conditions of fevers, and always considered es- 
sential in the diagnosis, as directing to modifications of treat- 
ment. The two most important adverse states may thus be 
illustrated, and considerably in accordance with the most ap- 
proved writers on the pathology of fever ; excepting their 
notions of debility. 
1. DIATHESIS SYNOCHOIDES. 
Synocha. Sthenia rigida. With exalted phlogistic dia- 
thesis. 
Synochus. Sthenia mitis. With mild phlogistic diathesis. 
2. DIATHESIS TYPHOIDES. 
Typhus gravior. Sthenia oppressa. With much inabili- 
ty of function ; irregularity ; enthralment; rapid. 
Typhus mitior. Sthenia lenis. With less oppression, 
and inability of function ; mild typhoid habit ; tardy. 
Other terms might have been used, but these are preferred 
at present, as being familiar. 
Some illustrations of these modified states of the system, 
were attempted in Section xlv. ; to which particular refer- 
ence should be made. They are farther specified in the Or- 90 
DIATHETICAL SCALE. 
ders. According to the present arrangement, the first and 
second comprise affections ordinarily of the synochoid dia- 
thesis ; the third and fourth in like manner, the typhoid. 
Some of these states of the general system are discovera- 
ble, in a modified manner, in every constitutional affection, 
whether fevers, strictly so called, or the exanthemata, or the 
phlegmatias ; and even in chronic diseases. 
The scheme admits of many subdivisions, or grades and 
shades of difference, which are better discriminated in prac- 
tice, than delineated on paper. ORDINAL ARRANGEMENT. 
The character of the common morbid habit may be mod- 
ified, 
1st Jis the principal local affection, emanating from the 
general habit, may concentrate on the fibrous membranes, 
attended with intense reflex actions. 
ORDER I. 
DIATHESIS FERVID A FIBROSA. 
(Habitus phlogisticus.- Sthenia.) 
FIRST SERIES. 
Genus 1. Synocha. Enecia cauma of Good; Inflam- 
matory fever. 
DEFINITION OF CHARACTER. 
A state of general high excitement, preceded by a sensa- 
tion of lassitude, and chilliness ; pulse full, hard, and mod- 
erately frequent; pain intense. Blood drawn usually cover- 
ed with a fibrinous pellicle. Skin dry, and hot ; tongue 
coated with a white fur ; urine high colored and scanty. Lo- 
cation of the disease, principally, in the fibrous or fibro-mus- 
cular membranes of any part of the body ; liable to produce 
effusions, adhesions, or suppurations, by associating other 
neighboring tissues in the series of morbid action.* 
'Itisto be understood, that the vascular systems throughout the body, 
act preternaturally, in all diseases of excitation. The fibrous tissues are 92 
FIBROUS TISSUE. 
Genus 2. Meningitis. Empresma cephalitis, G. 
Phrenzy. 
Commencing with the common pyrectic phenomena ; also, 
pain in the head ; redness of the face, and sometimes of the 
about as freely penetrated by vessels, as any other tissue, but not so much 
with red blood; however they become considerably injected when inflamed. 
All inflammations in this tissue from mechanical injuries, are found to be 
severely painful, and the same occurs from a concentration of disease, 
forming the local affection on this tissue. The dense and unyielding fabric 
occasions a divellication of nervous filaments, when only moderately dis- 
tended with fluids. The sympathetic influences radiating from such in- 
flamed parts, by their reflex actions on the general system, produce a free 
and high state of reaction, or fever, in connection with the general diseased 
impression. 
Bichat insists on the " vital activity" of the fibrous tissue; and " that it 
is the seat of pain, and of inflammation" ; that " all the kinds of sympa- 
thies are observed in it"; that "remote organs are excited into disease by 
it," and yet, " that it hardly contributes to the formation of pus." (Gen. 
Anat. Vol. II. p. 278.) He has said, that inflammation was little understood, 
yet, that " the periosteum seems to be affected by it." 
We insist that the chief seat of inflammation is in this tissue, in all the 
diseases of this order, and that the effusions, which are the effect of its ex- 
citation, are made on its surface, and of course into the adhering cellular 
tissues; yet, where the adjoining membrane is close and dense, it may be 
made on a free surface; as in pleuritis, &c. 
Bichat also admits that the fibrous tissues may be injected. 
Vicq d'Azyr says he has seen the dura mater red, and of a fleshy ap- 
pearance. 
Dr Dewees speaks confidently of this tissue being inflamed, " attended 
with a high degree of pain and irritation." He also says, " Inflammation 
may exist in the cornea, and proceed to the effusion of coagulable lymph, 
and even small ulcers occur, without any red vessels being visible either in 
this coat or in the sclerotic." (Prac. Phys. p. 289.) 
। Dr Eberle speaks of phrenitis seated in the dura and pia mater. 
Dr S. Smith speaks of the dura mater as more vascular than natural, and 
adhering to the cranium. 
Shaw in his Manual of Anatomy, speaks of the dura mater as " blood- 
shot." 
Andral says, " the serous membranes are much less frequently altered in 
1heir own proper tissue, than in the cellular layer that lines their external 
surface." (Path. Anat. Vol. II. p. 357.) This is what has been called the 
fibrous fascia. 
Reisseissen first demonstrated a fib tissue below the mucous in the OUTLINES OF NOSOGRAPHY. 
93 
adnata of the eyes ; intolerance of light and sound ; watch- 
fulness ; delirium. 
Genus 3. Sclerotitis. Ophthalmia taraxis acuta, G. 
Fibrous ophthalmia. 
Inflammation of the dense coats of the eye ; pain severe, 
and burning in the interior of the eye ; headache ; intoler- 
ance of light ; flow of acrid tears. 
Var. 1. Corneitis, of the cornea. 
Var. 2. Iritis, of the iris. 
Genus 4. Tonsillitis. Empresma paristhmitis tonsil- 
laris, G. Quinsy. 
Tumefaction of the tonsils ; heat, pain; difficulty of swal- 
lowing ; liable to suppuration. 
Genus 5. Parotitis. Empresma parotitis, G. Mumps. 
Pain, and tumefaction of the parotid glands, and adjacent 
parts; liable to a metastasis to the testes in males, and the 
mammae in females ; or in either sex, to the membranes of 
the brain. 
Genus 6. Otitis. Empresma otitis, G. Inflammation 
of interna] ear. 
Pain in the inner ear acute ; sometimes delirium, or coma ; 
liable to suppuration, often followed by caries. 
Genus 7. Odontitis. Odontia dolorosa, G. Inflam- 
mation in the dense membranes of the teeth. 
Pain acute ; inflammation of the investing membranes of 
the teeth, and jaws ; tumefaction. 
trachea, and extending into the bronchia;. When inflamed it furnishes the 
fibrinous exudations in croup, and pneumonia. 
Broussais, and others teach^ that the basis of the skin consists of " a fi- 
brous'^network" ; hence the effusions in phlegmons, &c. 
The fibrous tissue of the hollow organs, called sometimes muscular, and 
nervous, are most affected in phlegmonous, or circumscribed inflammation 
of those organs. 94 
FIBROUS TISSUE. 
Genus 8. Linguitis. Dysphagia linguosa, G. Inflam- 
mation of the tongue. 
Pain, tumefaction, deep redness of the tongue ; mouth and 
fauces compressed ; tongue thrust out; deglutition impeded, 
and danger of suffocation. 
Genus 9. Pharyngitis. Cynanche pharyngea. Inflam- 
mation of the pharynx. 
Inflammation of the pharynx ; tumefaction internally ; de- 
glutition prevented ; distress, and fever severe. 
Genus 10. Laryngitis. Empresma laryngitis, G. In- 
flammation of the larynx. 
Pain, and tumefaction of the circumjacent textures of the 
larynx ; cough ; liable to prove suddenly fatal from the tume- 
faction producing suffocation. 
Genus 11. Tracheitis. Empresma bronchlemmitis, G. 
Croup, Hives, Rattles. 
Inflammation of the fibrous and mucous tissues of the tra- 
chea ; inspiration attended with a sonorous, shrill sound ; fi- 
brinous exudation, often extending to the bronchia. 
Genus 12. Pneumonitis fibrosa. Empresma pleuritis, 
G. Pleurisy.* 
* SPECIMEN OF PNEUMONIC AFFECTIONS, WHICH MAY BE APPLIED TO SOME 
OTHER ORGANS, IN RELATION TO THE TISSUES. 
Pneumonia, Cullen. Inflammation of the lungs. 
Varieties. 1st, fibrosa. Pneumonitis. 
2d, mucosa. Peripneumonia notha. 
3d, serosa. Mild Pleurisy; liable to terminate in acute 
hydrothorax. 
4th, •-- cellulbsa. Phlogotic inflammation; liable to termi- 
nate in imposthumation. 
5th, tuberculosa. Tuberculous phthisis. 
6th, complexa. Pneumonia typhoides, or epidemic pneu- 
monia. Involving all the tissues. 
It will be unnecessary to notice the varieties in all the organs; they will OUTLINES OF NOSOGRAPHY. 
95 
Inflammation of the fibrous tissue of the lungs and exterior 
parts, and associating the serous ; pain acute, impeding res- 
piration ; dry cough ; pulse hard and tense ; fibrinous effu- 
sions and adhesions between the pleurae. 
Genus 13. Carditis. Empresma carditis, G. Inflam- 
mation of the heart. 
Oppressive pain referred to the region of the heart, in- 
creased by a recumbent posture ; frequent, hard and irregu- 
lar pulse ; forcible palpitations ; oftentimes a cough. 
Genus 14. Diaphragmitis. Empresma pleuritis dia- 
phragmatica, G. Inflammation of the diaphragm. 
Pain, with a sensation of constriction in the praecordial re- 
gion ; short, oppressed respiration ; often hiccup ; slight 
alienation of mind ; distortion of the muscles of the face, rep- 
resenting a grinning, or risus sardonicus. 
Genus 15. Gastritis. Empresma gastritis. G. Inflam- 
mation of the stomach. 
Oppressive pain at the epigastric region, aggravated by ev- 
ery thing swallowed, and by pressure ; vomiting, with a sen- 
sation of burning heat; pulse small, hard and frequent. 
Genus 16. Enteritis. Empresma enteritis, G. Inflam- 
mation of the fibro-muscular coat of the intestines. 
I . 
Acute pain in the umbilical region, increased on pressure, 
and by bending forwards ; tension of the abdomen ; frequent, 
small, hard pulse ; vomiting ; coldness of the extremities. 
Var. 1. Duodenitis. 
Var. 2. Colitis. 
Genus 17. Hepatitis. Empresma hepatitis, G. Inflam- 
mation of the liver. 
be developed in the general orders as we proceed. The general pathologi- 
cal character of the diseases will be shown by the definitions of the orders 
to which they are attached. 96 
FIBROUS TISSUE. 
Pain acute in the right hypochondrium ; slight tension and 
tenderness on pressure ; difficulty of lying on the left side ; 
often pain above the right shoulder ; pulse, heat, and thirst 
indicative of synocha.* 
Genus 18. Splenitis. Empresma splenitis, G. Inflam- 
mation of the spleen. 
Pain in the left hypochondrium, steady ; increased by pres- 
sure. 
Genus 19. Nephritis. Empresmanephritis, G. Inflam- 
mation of the kidneys.. 
Pain in the loins, and along the course of the ureters ; 
numbness of the thigh, and retraction of the testicle of the 
side affected ; micturition, or ischuria. 
Genus 20. Cystitis. Empresma cystitis, G. Inflamma- 
tion of the bladder. 
Pain, soreness, and tumefaction in the hypogastrium ; mic- 
turition, or ischuria. 
Genus 21. Prostatitis. Inflammation of the prostate 
gland. 
Pain, referred to the neck of the bladder ; suppression of 
urine. 
Genus 22. Urethritis. Inflammation of the urethra. 
Heat, pain and thickening of the coats of the urethra, with- 
out discharges ; urination frequent, difficult, and painful, or 
suppressed. 
Genus 23. Orchitis. Empresma orchitis, G. Inflam- 
mation of the testicles. 
Pain, tumefaction, and tenderness of the testicle ; nausea, 
and pain in the loins. 
* The capsule of Glisson, accompanying the portal ramifications in the 
liver, is a fibrous membrane. So also the middle tunic of the blood ves- 
sels. OUTLINES OF NOSOGRAPHY. 
97 
Genus 24. Metritis. Empresma hysteritis, G. Inflam- 
mation of the uterus. 
Pain, tumefaction, and tenderness in the female hypogas- 
trium; increased sensibility of the os uteri ; frequent, hard 
pulse ; pain in the loins ; not limited to puerperal patients. 
Genus 25. Mastitis. Inflammation of the female breast. 
Pain, swelling, hardness, tenderness, and at length redness 
in the breast ; liability to suppurate. 
Genus 26. Periostitis. Inflammation of the periosteum. 
Severe and incessant pain, referred to deep seated parts 
surrounding the bones ; liable to effusion and suppuration. 
Genus 27. Paronychia. Phlysis paronychia periostei, 
G. Felon, malignant whitlow. 
This is periostitis of the phalanges of the fingers, below the 
theca, or in it. 
Genus 28. Phlogosis. Phyma furunculus, G. Boil. 
Pain, tumefaction, heat, redness in the skin ; liable to sup- 
puration, with a central core. 
SEC ON D SERIES, 
As affecting the arthrodial fibrous membranes, and fascia of 
muscles. 
Genus 29. Rheumatismus. Arthrosia acuta, G. Rheu- 
matism.* 
Acute pain in the fibro-serous membranes of the large ar- 
ticulations, followed by a smooth, shining tumefaction ; not 
liable to suppurate ; immobility of the joints and muscles. 
Var. 1. Acutus. 
Var. 2. Chronicus. 
* It is understood that the pyrectic character of synocha, at the head of 
this order, attends all these affections. 98 
FIBROUS TISSUE. 
Genus 30. Lumbago. Jlrthrosia acuta lumborum, G. 
Rheumatism of the loins. 
Pains, affecting the loins, extending towards the crura of 
the diaphragm ; immobility of the body. 
Genus 31. Rheumatismus fascialis. Rheumatalgia. 
Rheumatism of the fascia and muscles. 
Severe pain, soreness, and sensibility of a whole limb, or 
some portion of the fascia and muscles ; immobility ; tender- 
ness, without tumefaction ; sporadic. Similar to the follow- 
ing genus, but without effusion, and liable to persist. The 
peculiarity of the diathesis, in this instance, is opposed to a 
morbid secretion ; in the other, effusion readily takes place. 
Genus 32. Phlegmatia dolens. Sparganosis puerpe- 
rarum, G. Swelled leg. Milk leg. 
Either sex, affected with an acute morbid diathesis, at- 
tacked with severe pain, and soreness in the groin, fascia, and 
muscles of the leg ; in a few hours followed by a tense, glos- 
sy tumefaction, extending over the whole limb ; not suppura- 
ting, but continuing several weeks or months ; pain mitigated 
by the swelling ; gelatino-albuminous effusion into the cellu- 
lar tissue ; most commonly occurring in puerperal patients ; 
yet in other instances, and in both sexes. 
Genus 33. Podagra. Arthrosia podagra, G. Gout. 
Arthritis. 
Pain, severe in the small joints, commonly in the toes, and 
ball of the foot; followed by swelling, not suppurative, but 
often followed by calcareous concretions ; occurring by par- 
oxysms and remissions, and occasionally with metastasis to 
the organic viscera. 
Var. 1. Larvata, G. Disguised, atonic, or wandering 
gout; local affection not yet fixed. OUTLINES OF NOSOGRAPHY. 
99 
Var. 2. Retrograda, G. Retrograde gout. After having 
attacked the extremities, the local affection becomes trans- 
ferred to some of the organs of the three visceral cavities ; 
attended with severe inflammation; this may occur even 
without going to the extremities first. 
Genus 34. Hydarthrus rheumatismus. Arthrosia 
hydarthrus entonicus, G. Rheumatic white swelling. 
Chronic inflammation, pain and swelling of the larger 
joints ; involving the dense membranes in the local affection ; 
swelling colorless ; tender on pressure ; slow imperfect sup- 
puration ; thickening of membranes. 
Var. 1. Strumatosus. Scrofulous white swelling. Pain 
deep seated and circumscribed ; slow inflammation, imper- 
fectly suppurating, and disorganizing the bone, and integu- 
ments ; irritative fever.* 
* Inflammation is not so manifest in the dense tissues as in the softer; in 
this instance the parts are more yielding, they are more susceptible, and show 
the traces of altered structure more distinctly than the denser. Notwith- 
standing, we find the fibrous tissue very much thickened, or affected with 
hypertrophy, as in the last instance, in scrofulous white swelling. The car- 
tilages of the acetabulum of the hip joint, for example, afford purulency in 
the disease called morbus coxarius, whilst no traces of inflammation are oth- 
erwise discoverable. The signs of inflammation were so entirely absent, 
that Mr Brodie supposed the inflammation was the effect, and not the cause, 
of the ulceration. It is probable no pathologist of the present time will assent 
to this, but will consider that the formation of purulency is the effect of in- 
flammatory action, notwithstanding the tissue does not develop the ordinary 
signs of inflammation in an eminent manner, on account of its density and 
incapability of receiving large engorgements. So the fibrous tissue may be 
severely affected in acute disease, without manifesting traits of disease like 
the soft membranes. 100 
MUCOUS TISSUE. 
The character of the general habit may be modified by the 
reflex actions, 
2dly. ds the local concentration may chiefly affect the mucous 
membranes, lining the hollow organs. 
ORDER II. 
DIATHESIS FERVIDA MUCOSA. 
(Habitus pyrecticus mitis.- Synochus.) 
The common diathesis, in the diseases of this order, is of 
a milder pyrectic grade than the preceding. Although in 
some instances, cases present of a very considerable intensity 
of vascular action ; yet, the common range of diseases of the 
mucous tissues, is of a milder grade than those of the pre- 
ceding order, although commonly of the synochoid character. 
When they are very severe, it is on account of the contigu- 
ous tissues being associated with the mucous in the local 
affection. The diseases may be acute or chronic. 
The grade of morbid intensity corresponds with the com- 
mon received opinion of Synochus, a grade of intensity below 
that of synocha. However, absolute precision is not ex- 
pected in these cases. For a synopsis of the physiological 
character of this tissue, see Section vii. 5. 
DEFINITION OF CHARACTER. 
Genus 1. Catarrhus. Catarrhus communis, G. Ca- 
tarrh, or coryza. 
Irritation, or inflammation of the mucous membrane of the 
nostrils, fauces, frontal sinuses, and trachea ; at first, thin 
acrid discharges, afterwards mucous ; sneezing and coughing. 
Var. 1. communis. 
FIRST SERIES. OUTLINES OF NOSOGRAPHY. 
101 
Var. 2. epidemicus. Influenza. Attack sudden ; 
pain in the forehead ; cough, and expectoration ; sneezing ; 
epidemical. 
Genus 2. Conjunctivitis. Ophthalmia taraxis mitis, 
G. Common sore eye. 
Redness, heat, irritation, in the tunica conjunctiva ; some- 
times pain ; watery discharge. 
Var. 1. acuta. 
Var. 2. chronica. 
Var. 3. purulenta. With muco-purulency. 
Var. 4. chemosis. Adnata turgid, with dark blood. 
Genus 3. Aphtha. Emphlysis aphtha, G. Thrush. 
Minute vesicles on the tongue, gums, and fauces ; at first 
transparent, soon of a pearl color ; often migrating through 
the eustachian tube, nostrils, and alimentary canal; terminat- 
ing in excoriating ulcerations. 
Var. 1. infantum. White thrush. 
Var. 2. maligna. Black thrush. 
Var. 3. diphtheritis. * 
f 
Genus 4. Tracheitis mitis. Mild croup. 
Respiration impeded ; hoarse cough ; soreness in the glot- 
tis ; discharge of mucus. 
Genus 5. Pneumonitis mucosa. Peripneumonia notha, 
G. Spurious pleurisy. 
Acute inflammation of the mucous membrane of the lungs ; 
pain obtuse in the thorax, and often in the forehead ; pulse 
moderately hard and frequent ; respiration oppressed, at- 
tended with cough, and frequent expectoration of mucus, or 
sanies, which is liable to accumulate, and suppress respira- 
tion. 102 
MUCOUS TISSUE. 
Genus 6. Phthisis mucosa. Marasmus catarrhalis, G. 
Consumption from an affection of the mucous membrane 
of the lungs. 
Chronic inflammation of the mucous membrane of the tra- 
chea, bronchia, or both ; coldness of the surface and extre- 
mities ; frequent, small, and hard pulse ; pain in the side, or 
some part of the thorax ; cough, dry at first; afterwards ex- 
pectoration, more or less copious ; shortness of breath on 
exercise ; fever ultimately assuming the hectical character ; 
emaciation ; sweats ; diarrhoea. (See Order vi. G. 5, 6, 
7, 8.) 
Genus 7. Pertussis. Bex convulsiva, G. Hooping 
cough ; chin-cough. 
Slight pain ; affection of the mucous membrane of the 
bronchia ; convulsive cough, occurring by paroxysms, ac- 
companied with a shrill, protracted sound in inspiration ; 
supposed to be contagious. 
Genus 8. Febris gastrica. Gastric fever. 
Irritation, or inflammation in the mucous membrane of the 
stomach, prevailing mostly in warm seasons ; pulse mode- 
rately hard, and frequent ; slight pain, unless extending to 
other tissues ; tenderness on pressure ; attended with emesis. 
Genus 9. Erythema gastricum. Erythematic 
blush. 
Irritation of the mucous membrane of the stomach, often 
extending to the fauces ; intolerance of food or drink ; sen- 
sation of heat, and tenderness in the stomach ; mucous tissue 
liable to become softened. 
Genus 10. Enteritis mucosa. Mild inflamma- 
tion of the intestines. 
Inflammation of the mucous coat of the intestines, not in- 
dicated by pain, unless other tissues are involved, but gener- OUTLINES OF NOSOGRAPHY. 
103 
ally by symptoms of mild fever; occasional diarrhoea ; intol- 
erance of emetics, cathartics, and stimulants ; tenderness on 
pressure. 
Genus 11. Gastro-en.teritis. Inflammation in both 
stomach and intestines. 
Similar to the above, only more extensive. 
Genus 12. Febris biliosa. Bilious fever. 
Same as gastro-enteritis, only the irritative state of the 
membrane extends into the liver, producing a morbid secre- 
tion of bile. 
Genus 13. Dyspepsia. Limosis dyspepsia, G. Bad di- 
gestion. 
Digestion impaired ; appetite unsteady ; eructation ; car- 
dialgia ; nausea ; chronic irritation of the mucous coat of the 
stomach ; occasional diarrhoea, or costiveness. 
Genus 14. Dysenteria lenta. Dysentcria simplex, G. 
Mucous dysentery. 
Inflammation, or irritation of the mucous coat of the rec- 
tum ; frequent dejections of mucus ; gripings, and tenesmus ; 
fever mild. 
Genus 15. Cholera infantum. Cholera of in- 
fants. 
Usually attacking children at the age of dentition, and in 
the warm season of the year ; some vomiting ; debility ; fre- 
quent intestinal discharges, of thin, watery, and occasionally, 
bilious materials ; sometimes a curded substance ; small, and 
frequent pulse ; tumid abdomen ; lingering fever, producing 
great emaciation. 
Genus 16. Erythema urethralis. Paruria ardens, 
G. Micturition. 
Necessity of urinating very frequently ; urine in small quan- 104 
MUCOUS TISSUE. 
titles, and bloody ; irritative state of the membrane, extend- 
ing into the bladder. 
i 
Genus 17. Diarrhiea. Diarrhoea, G. Looseness. 
Frequent alvine discharges of various materials ; more or 
less pipings ; absence of tenesmus. 
Var. 1. stercorea. Copious discharges of thin, fecal 
matter. 
Var. 2. mucosa. Discharges of viscid mucous mat- 
ter for the most part. 
Var. 3. chylosa. Discharges of a milky appearance. 
Var. 4. lienteria. Aliment discharged with little al- 
teration. 
Var. 5. aquosa. Discharges copious, and of a wa- 
tery kind. 
Var. 6. biliosa. Discharges containing bile. 
SEC OND SERIES. 
Attended with mucous discharges, or accumulations; also, dis- 
charges from organs connected zvith the mucous surfaces. 
Genus 18. Ptyalismus. Ptyalismus, G. Salivation. 
Discharge by spitting. 
Copious discharge of muco-salivary matter from the mouth 
and fauces. 
Var. 1. spontaneus. From local irritation, as preg- 
nancy. 
Var. 2. hydrargyratus. From use of mercury. 
Genus 19. Asthma humidum. Asthma humidum, G. 
Common, or mucous asthma. 
Expectoration of viscid mucus ; suffering exacerbation, 
preceded by dulness, lassitude, oppression of the praecordia ; 
laborious respiration, aggravated by a recumbent position. OUTLINES OF NOSOGRAPHY. 
105 
Genus 20. Diabetes mellitus. Paruria mellita, G. 
Flow of sweet urine. 
Copious discharge of urine, containing saccharine matter, 
iffbrding the smell and taste of honey ; thirst, and frequent 
julse ; dryness of the skin ; costiveness. 
Var. 1. simplex. Of limpid urine. 
Var. 2. excrementitius. Excrementitious dischar- 
charges in fevers. 
Genus 21. Leucorrhcea simplex. Leucorrhcea commu- 
nis, G. Fluor albus ; Whites. 
Discharge of mucous matter from the vagina, without in- 
fection; usually heat of urine; disappearing during menstrua- 
tion. 
Var. 1. acrior. Acrimonious and foetid. 
Genus 22. Blenorrhcea. Blenorrhcea simplex, G. Gleet. 
Mucous discharge from the urethra, without nfection. 
Genus 23. Blenorrhcea virulenta. Blenorrhcea luo- 
des, G. Gonorrhoea ; Clap. 
Copious discharge of vitiated mucus from the glands of the 
urethra ; burning pain in micturition ; from impure, or inor- 
dinate coition ; infectious. 
Genus 24. Syphilis. Lues syphilis, G. Pox. Lues 
venerea. 
A vesicular eruption, most commonly on the glans penis, 
terminating in ulcerations not inclined to heal, with ragged 
edges, called chancres ; for the most part tumors in the groin, 
called buboes ; copper-colored spots on the skin succeeding, 
with nodes on the bones, and deep seated pains ; ulceration in 
the throat, deep and ragged, affecting the cartilages, and des- 
troying them ; produced by an irritating infectious material, 
introduced through the mucous membrane of the glans penis, 
or by excoriation on any part of the body ; very persistive in 106 
MUCOUS TISSUE. 
& 
its character, and not readily eliminated from the system ; ir- 
ritative fever ; emaciation. 
ACCUMULATIONS IN MUCOUS CAVITIES. 
Genus 25. Hydrops uteri, G. Dropsy of the uterus. 
Tumefaction, with obscure fluctuation in the hypogastric 
region ; lower section of the uterus elastic to the touch. 
Var. 1. mucosus. 
Var. 2. hydatidosus. 
Genus 26. Hydrops tubalis, G. Dropsy of the Fallo- 
pian tube. 
An intumescence in the iliac region ; spreading transverse- 
ly ; with obscure fluctuation. 
Genus 27. Hydrops ovarii, G. Dropsy of the ovary. 
Intumescence in one, or both iliac regions, spreading grad- 
ually over the abdomen ; fluctuation obscure. 
THIRD SERIES. 
As the local engorgements may be attended with discharges of 
blood. 
Genus 28. Epistaxis. Hoemorrhagia narium,G. Bleed- 
ing at the nose. 
Discharge of blood from the nostrils ; commonly preceded 
by pain and heat in the forehead. 
Genus 29. Hjemorrhagia laryngis. Bleeding from 
the larynx, or trachea. 
Spitting of blood, not intimately mixed with mucus ; ab- 
sence of cough. 
Genus 30. Haemoptysis. Hoemorrhagia haemoptysis, G. 
Spitting of blood. OUTLINES OF NOSOGRAPHY. 
107 
Flow of blood from the mucous membrane of the lungs, 
with cough; commonly preceded by pain, or pressure under 
the sternum ; when scanty, mixed with mucus ; when pro- 
fuse, red and coagulating. 
Genus 31. H^ematemesis. Hcemorrhagia hamatemesisy 
G. Vomiting of blood. 
Large quantities of dark blood from the mucous membrane 
of the stomach, by emesis ; distress ; sinking. 
Genus 32. Hcemorrhagia intestinalis. Intestinal 
discharge of blood. 
Large quantities of blood discharged, per anum, from the 
intestines, or liver. Usually occurring in the latter stage of 
typhus, from the mucous coat. 
Genus 33. Hematuria. Hcemorrhagia hcematuria, G. 
Bleeding from the urinary passages. 
Discharge by the urethra ; preceded by turgescence, pain, 
and tension, in the region of the bladder. 
Genus 34. H.emorrhois. Hcemorrhagia proctica, G. 
Bleeding piles. 
Dropping of blood from the hemorrhoidal vessels, preced- 
ed by heat, irritation, tension of the part, and pain extend- 
ing up the back. 
Genus 35. Menorrhcea. Catamenia. 
Stilicidium of sero-cruor from the uterus, preceded by 
slight uneasiness, and sensation of heaviness in the loins ; oc- 
curring every lunation ; not coagulable. This is a phys- 
iological secretion, unless in excess, when it becomes coa- 
gulable. 
Var. 1. naturalis. 
Var. 2. serosa. Serous periodical discharge, 
usurping the natural. 108 
SEROUS TISSUE. 
Genus 36. ELsmorrhagia uteri. Hcemorrhagia 
uterina, G. Flooding. 
Immoderate flow of blood from the uterus ; coagulable. 
Var. 1. menstrualis. Excessive flow at the month- 
ly period. 
Var. 2. parturientis. Discharge of blood before, 
and during delivery. 
Var. 3. puerperalis. Immoderate flow after de- 
livery. 
The character of the common morbid habit is also modi- 
fied, by the reflex actions, 
3dly. Jis the local concentration may chiefly affect the serous 
membranes, with feeble and peculiar sympathetic asso- 
ciations. 
ORDER III. 
DIATHESIS FERVIDA SEROSA. 
(Habitus typhoides mitior. Sthenia lenis.) 
DEFINITION OF CHARACTER. 
The phenomena in the diseases of this order, exhibit a 
low grade of responding action, when compared with the two 
last. In the series of acute diseases, the chills are slight; 
lassitude considerable ; pulse small, compressible, and fre- 
quent, from 90 to 120 in a minute ; the general aspect fallen, 
with paleness ; a disposition to coldness and drowsiness ; 
sighing. In the progress of diseased perturbation, numerous 
phenomena are developed, which must be learned from its 
extended history. The diseases of this order are sometimes 
so procrastinated as to be called chronic. OUTLINES OF NOSOGRAPHY. 
109 
first series, 
Genus 1. Typhus mitior. Enecia typhus, G. Ty- 
phus, nervous, or slow fever : Dothinenteritis, or ty- 
phoid fever. 
Pains slight and erratic ; chills moderate ; pulse frequent, 
small, and compressible ; dull pain in back of the head 
and neck ; sighing ; despondency of mind ; lassitude ; incli- 
nation to sleep. Location in the serous tissues of the brain; 
as the disease progresses for several weeks, the phenomena 
become varied, such as coma-vigil, low muttering delirium, 
diarrhoea, sub-sultus, furred tongue, with brown list in the 
centre : in fatal cases, insensibility, with hydrocephalus. 
Genus 2. Pleuritis mitis. Empresma pleuritis, G. 
Mild pleurisy. 
Pains slight and persistent in the region of the thorax, in- 
creased during inspiration ; fever moderate and protracted ; 
location diffused in the serous tissues of the thorax ; liable 
to terminate by adhesion, or hydrothorax. 
Genus 3. Peritonitis mitis. Empresmaperitonitis, G. 
Inflammation of the peritoneum. 
Pain, and tenderness of the abdomen generally, increased 
on pressure, and an erect position ; location extensive in the 
peritoneum covering the viscera, and lining the parietes of 
the abdomen ; liable to effusion of sero-purulent matter, or 
adhesion, or effusion of serum, constituting ascites.* 
Genus 4. Arteritis. Inflammation of the inner coat of 
the arteries. 
Strong, sharp, and frequent pulsatory action of the arte- 
• When severe peritonitis exists, it stands connected with the subjacent 
muscular, or fibrous tissues. 110 
SEROUS TISSUE.. 
ries generally, but especially in certain ramifications more 
particularly affected ; when in the coeliac artery, it offers 
some resemblance to an abdominal aneurism. 
Genus 5. Phlebitis. Inflammation of the inner 
coat of veins. 
Signs of irritative fever generally ; pulse frequent, and ir- 
ritable ; sometimes arising from venesection ; having a red 
list along the course of the vein ; an effusion of sero-puru- 
lent matter often found in the veins. 
Genus 6. Delirium vigilans. Mania e potu. Tre- 
mulent delirium. 
Pulse moderately accelerated, sometimes more full and 
hard, commonly frequent and compressible ; mild delirium ; 
muscular movements feeble, and tremulous, sometimes con- 
vulsive ; watchfulness persistent for a considerable period ; 
restless anxiety, and inquietude ; aspect fallen ; occasional 
nausea and faintness ; fugitive pains, mostly in the head. 
Occurring in persons, who have ordinarily made too free use 
of alcoholic potations.* 
Genus 7. Irruptiones. Irruptions into the serous 
cavities. 
These have been ascertained to be pretty frequent; but 
their characters are not at present definable. They often ac- 
company malignant fevers, especially the exanthems, and are 
attended with much distress. Chronic irruptions have often 
been noticed in autoptic examinations. 
* We may here remark, that the seat of local tendency is m the serous 
membranes of the brain, as they have commonly been found surcharged 
with serum, and the ventricles filled, as in typhus; also the sinuses, with 
the veins, greatly distended. The nervous system has previously acquired 
a morbid susceptibility, and tremulously discharges its functions, when the 
common causes of disease are applied to the system. The diathesis com- 
pares the best of any with the present order. OUTLINES OF NOSOGRAPHY 
111 
SECOND SERIES . 
Serous effusions into cavities not having apertures. 
Genus 8. Anasarca. Hydrops cellularis, G. General 
intumescence. 
Accumulation of serosity in the serous cells of the cellu- 
lar tissue universally, especially in the lower extremities ; ob- 
scurely diaphanous ; pitting on pressure ; scantiness of 
urine ; frequent pulse ; dyspnoea ; inability to exercise, es- 
pecially in ascending heights. 
Genus 9. Hydrops darti. Dropsy of the scrotum. 
Soft, oedematous tumefaction of the cellular tunic of the 
scrotum ; often large, and obliterating the penis ; imperfectly 
diaphanous. 
Genus 10. (Edema. Hydrops cellularis artuum, G. 
(Edema. 
Intumescence of the cellular tissue of a part ; often the 
joints, but more commonly of the feet, in which instance it 
is increased by an erect position ; pitting on pressure. 
Genus 11. Hydrocephalus. Hydrops capitis, G. 
Dropsy in the brain. 
Headache; synochoid, or typhoid fever, followed by 
squinting ; torpidity of the body and intellect ; dilated pu- 
pils ; coma, An effect of previous inflammation, producing 
effusion of serum into the ventricles of the brain, and other 
tissues. 
Var. 1. internus. 
Var. 2. externus. Sutures separated, and external 
enlargement. 112 
SEROUS TISSUE. 
Genus 12. Hydrorachis. Hydrops spina, G. Spina 
bifida. Dropsy of the spine. 
Collection of serous fluid in the spinal column ; congen- 
ital ; tumor, commonly on the loins, from a deficiency of 
the vertebrae ; fluctuating, and diminished on pressure, in- 
ducing lethargic symptoms. 
Genus 13. Hydrophthalmia. Staphyloma, G. Dropsy 
of the eye. 
Ball of the eye enlarged, especially the cornea ; vision 
obscured, or destroyed. 
Genus 14. Hydrothorax. Hydrops thoracis, G. Drop- 
sy* of the chest. 
Dyspnoea, increased by exercise and a horizontal posi- 
tion ; countenance sub-livid ; urine red, and scanty ; sudden 
starting from sleep, with a sensation of suffocation ; oedema 
of the lower extremities. When extensive, an elevation 
and distention of the affected side, and difficulty of lying on 
the opposite side. 
Genus 15. Hydrops pericardii. Dropsy of the heart 
case.* 
Oppression, and distress in the praecordial region ; vibra- 
tory motion perceived in the action of the heart externally ; 
sometimes palpitation. 
Genus 16. Ascites. Hydrops abdominis, G. Dropsy 
of the abdomen. 
Intumescence of the whole abdomen, uniform and com- 
pressible ; fluctuation on percussion ; pulse frequent ; thirst; 
scanty urination. 
* It is most commonly an effect of excitation in the tissue, as associated 
with the adjacent tissues; sometimes idiopathic. Corvisart found eight 
pounds of fluid in an idiopathic case. Laennec frequently found air, 
(gas ?) along with a fluid. OUTLINES OF NOSOGRAPHY 
113 
Var. 1. hydatidosus. Sacculated dropsy of the 
abdomen ; from hydatids. A heavy, inelastic intumescence, 
destitute of the undulatory motion in ascites, on percussion. 
jrENUs 17. Hydrocele. Hydrops scroti vaginalis, G. 
Dropsy of the vaginalis testis. 
Heavy, elastic tumor of one, or both sections of the vagi- 
ial tunic of the scrotum ; diaphanous ; the spermatic pro- 
•ess distinguishable ; not diminished by pressure. 
The character of the common morbid habit may be mod- 
ified, 
4thly. As the localities may affect several, or all the thin 
tissues, and parenchyma of organs, attended with severe, un- 
equal, and perturbed association of actions. 
ORDER IV. 
DIATHESIS FERVID A COMPLEXA. 
{Habitus typhoides gravior.-Ataxia, el Adynamia.) 
DEFINITION OF CHARACTER. 
This order embraces the most severe and complicated 
forms of acute diseases. The causes act collectively on 
highly predisposed habits. Severeimpressions are made on 
all the system of the nutritive tissues, and immediately af- 
fecting the nerves of external relation, with their functions 
perverted. Some functions may suffer a paresis, whilst oth- 
ers have an excess of action. Great disproportion in the 
phenomena, and liability to change. The functions of the 
heart, arteries, and brain, liable to severe depressions, follow- 
ed by excess, and perturbation of action ; or suffering a qui- 
etus in death, soon after the attack. Many of the phenome- 114 
COMPLEX TISSUE. 
na developed from the suffering of the organs of external 
and internal relation, are mutable, whilst the organs are un- 
dergoing important pathological changes. Early in the dis- 
ease, or first stage, blood drawn appears highly carbonized ; 
great prostration of muscular and vital action. In the second 
stage, the blood shows a floridity in the more prosperous 
cases ; and if the responding actions become free, the dia- 
thesis makes an approximation to the character of the syno- 
choid. The organs chiefly impressed, are often despoiled of 
their functions, and liable to gangrene, hepatization, or ery- 
sipelatoides. 
FIRST SERIES 
Genus 1. Typhus gravior. Enecia typhusgravior, G. 
Severe typhus. Jail, camp, hospital, or putrid fever. 
" With rigor and heat alternating, with little or no perspi- 
ration ; pulse tense and hard, usually quick, but fluctuating ; 
pain over the forehead and crown ; urine alternating from 
limpid to turbid ; delirium, succeeded by stupor ; signs of 
putrescency." G. 
Genus 2. Pestis orientalis. Jlnthracia pestis, G. 
Eastern plague, or pest. 
Fever typhoid ; externally buboes, carbuncles, vibices, or 
vesicular erythema. 
Genus 3. Typhus icterodes. Epanetus malignus fia- 
vus, G. Yellow fever. 
Fever typhoid ; local determination concentrating to the 
stomach and liver ; occasionally, yellowness of the skin, and 
black vomit. 
Genus 4. Cynanche Maligna. Empresma paristhmi- 
tis maligna, G. Malignant quinsy. 
Inflammation of the fauces, terminating in ash colored OUTLINES OF NOSOGRAPHY. 
115 
..oughs, followed by ichorous discharges ; often an efflores- 
cence, or petechias on the skin. 
Genus 5. Pneumonitis complexa. Empresma pneu- 
monitis maligna, G. Pneumonia typhoides. Epidemic 
lung fever. 
Pain in the thorax ; pulse variable, often feeble ; impe- 
ded respiration; cough tedious, with sputa tinged with blood; 
prostration of vital action ; epidemic in cold seasons. 
Genus 6. Typhus petechialis. Ephemera maligna. 
Spotted fever. 
A malignant ephemera, occurring epidemically in cold sea- 
sons, but liable to be protracted into the character of slow 
typhus ; pains fugitive, yet usually concentrated under the 
frontal bone ; not preceded by rigors ; paleness ; sighing, 
and solicitude of mind ; pulse frequent, small, corded, and 
retiring, often 160 in a minute ; liable to become suppressed 
some time before death. The location is in the serous mem- 
branes of the head and thorax, involving the adjacent nervous 
tissues ; sometimes fixes with severity in the abdomen. 
Petechise in the serous membrane of the thorax, often in the 
abdomen, and frequently on the skin ; sweats, for the most 
part, readily excited. A protean form of disease, having a 
resemblance to the malignant epidemic intermittents, as de- 
scribed by Alibert ; and, excepting the transpiration of 
blood, to the Sudor Anglicus of Sennertius. 
Genus 7. Melina. Meloena, G. Black jaundice. 
Dark, sallow complexion of the adnata; also vomiting of 
black, viscid, bilious matter, sometimes mixed with grumous 
blood ; distress ; faintness. 
Var. 1. fiocculosa. The discharge, by vomitiiig, 
of a dark, flocculent appearance, compared to coffee grounds ; 
occurring in severe malignant diseases ; faintness, and pros- 
tration of strength. 116 
COMPLEX TISSUES. 
Genus 8. Cholera morbus. Cholera, G. Spasmodic 
puking and purging. 
Frequent vomiting,'and purging of a watery fluid ; spasms 
of the abdominal muscles, and often of the limbs ; anxiety, 
sinking, and cold sweats. As the disease mitigates, the em- 
esis is attended with bilious discharges, as mild cases often 
are from the beginning. 
Genus 9. Dysenteria maligna. Dysenteria acuta py- 
rectica, G. Malignant, or camp dysentery. 
Frequent, small dejections of bloody. mucus ; tenesmus. 
Prostration of vital action. Location in the rectum and co- 
lon ; paroxysms of pain severe ; pulse small and frequent ; 
dejection of countenance ; conjunctiva clear, and eyes sunk 
in the sockets. 
Genus 10. Enteritis maligna. Empresma enteritis, 
G. Severe intestinal inflammation. 
Intense pain in the abdomen, not relieved by cathartics ; 
pulse frequent and small; vomiting ; tension, and tenderness 
on pressure ; Countenance fallen ; vital action early pros- 
trated. . - 
\ < 
Genus 11. Hysteritis typhoidesi. Empresma hyste- 
ritis puerperarum, G. Child-bed fever. 
Commencing about the second or third day after delivery ; 
pain, and intumescence in the hypogastric region, extending 
over the abdomen, and often involving the peritoneum gen- 
erally ; tenderness on pressure ; small, frequent, and hard 
pulse ; suspicious alienation of mind. 
Genus 12. Erysipelas gangrenosum. Emphlysis ery- 
sipelas, G. Malignant erysipelas. 
External, local inflammation diffused, without marginal 
adhesion, and irregular ; burning heat; vesications inclining 
to a dark color, or gangrenous. OUTLINES OF NOSOGRAPHY. 
117 
Genus 13. Gangrtena. Gangrcena, G. Gangrene. 
A part, deprived of vital force by causes inducing extreme 
innervation, or enervation, loses its- tonicity and vital charac- 
ter ; becomes insensible, yielding, and livid, or assumes dry- 
ness and hardness. A dead part, surrounded by vital solids. 
Var. 1. sphacelus. Mortification. The dead part 
soft, and black ; decomposing ; separating from the sound, 
and affording a putrescent smell. 
Var. 2. ustilaginea. Mildew mortification. The 
enervated part, at first white, turns 'black, dry, and shri- 
velled ; then becomes separated, and cast off. Occurring 
chiefly on the extremities, with a general state of enervation ; 
spreading in limbs, sometimes until they lose their attachment 
to the body. 
Incarcerated hernia, intussusception, and other maladies 
destroying the vitality of all the tissues of a part, might be 
admitted into this order.* 
* It ought to be distinctly understood, that the above are not all the dis- 
eases that may find admittance into this order. There is scarcely a febrile 
complaint, including the exanthemata, internal inflammations, and even 
chronic diseases, but that appears in different degrees of intensity, and the 
degree of intensity will always indicate either the mitior orgravior diathesis. 
Small pox, measles, scarlatina, enteritis, peritonitis, &c. may be cited as ex- 
amples. The general morbid changes are more severe in the one instance 
than in the other, and each one impresses the tissues affected, according to 
their intensity. 118 
DERMOID TISSUE. 
The character of the general habit may be modified by the 
reflex actions, 
5thly. ds the local concentrations may affect the dermoid tis- 
sue, endowed with sensitive nerves of external relation. 
ORDER V. 
DIATHESIS FERVIDA ERUPTIVA 
(Habitus phlogisticus.-Sthenia.) 
The general character of the dermoid diathesis is inflam- 
matory, or phlogistic ; notwithstanding many cases present 
the aspect of the typhoid gravior, as particularly exemplified 
in the exanthems. So small pox, measles, and cynanche 
often assume this diathesis, on account of the eruptive irrita- 
tion having made strong impressions on the internal tissues, 
affecting the ganglionic susceptibility, before arriving on 
the skin. In such cases the viscera remain burdened, 
they are not relieved sufficiently by the eruption. The chro- 
nic affections of the skin are pretty uniformly of a mild phlo- 
gistic character. They sometimes recede to the internal 
tissues, and excite extraordinary commotion. The skin 
being essentially of the fibrous character, and supplied with 
the sensibility of external relation, renders it susceptible of 
transmitting free reflex action on the general habit. 
DEFINITION OF CHARACTER. 
FIRST SERIES. 
Genus 1. Variola.' Empyesis variola, G. Smallpox. 
Shivering ; pain in the back and head ; vesicles appearing 
under the cuticle, between the third and fifth day from the 
attack, rising into purulency about the eighth ; degenerating OUTLINES OF NOSOGRAPHY. 
119 
into scabs, and falling off about the sixteenth day, leaving 
scars, or pits ; contagious ; liability to secondary fever. 
Var. 1. discreta. Pustules pea-sized and distinct; 
margin red. 
Var. 2. confluens. Pustules irregular, and running 
together ; margin pale. • 
Var. 3. inserta. Inoculated. 
Genus 2. Varioloides. Variola simulata. Modified 
small pox. 
Occurring in spuriously vaccinated, and sometimes vario- 
lated persons, when exposed to the contagion of small pox ; 
symptoms similar to the mild small pox ; a full vesicle forms, 
but higher than small pox, with an indentation, and suddenly 
dries up, and falls off in thin, transparent, straw colored 
scales ; the skin appears now projecting above its level, or 
tuberculated ; no secondary fever ; contagious. 
Genus. 3. Vaccinia. Emphlysis vaccinia, G. Cow, or 
kine pox. 
One, or more vesicles, depressed in the centre, transpa- 
rent, and circular ; surrounded with a red areola ; hardening 
into a dark, mahogany colored scab, falling off about the 
eighteenth day, leaving a permanent smooth scar. Trans- 
mitted by contact. 
Var. 1. inserta. Inoculated. 
Var. 2. spuria. Vesicle irregular, and purulent; 
areola indistinct ; scab formed early, and rough. 
Genus 4. Varicella. Emphlysis varicella, G. Chicken 
pox. 
Vesicles thinly scattered ; not so large as variola ; transpa- 
rent, with a thin pellicle ; not maturating into pus ; but about 
the third day, oozing at the top, and forming small, irregular, 
dark scabs ; often successive imperfect crops of pustules. 120 
DERMOID TISSUES. 
Var. 1. lentiformis; vesicles flattened at the top. 
Var. 2. coniformis; swine, or water pox; sharp 
pointed. 
Genus 5. Rubeola. Enanthesis rubeola, G. Measles. 
Dry cough ; soreness in the fauces ; suffusion of the eyes ; 
rash appearing from the third to the sixth day of the attack, 
first in the fauces, then on the face, and breast; terminating 
in cuticular exfoliations about the tenth day ; contagious. 
Genus 6. ScarlatiNa. Enanthesis rosalia, G. Scarlet 
fever. 
Rash, or scarlet efflorescence, irregularly diffused over the 
body ; appearing about the second, and vanishing about the 
fifth day. 
Var. 1. simplex. Without inflammation in the 
fauces. 
Var. 2. anginosat Inflammation in th,e fauces, with 
fever of the synochoid character. 
Var. 3. maligna. With typhoid character ; cynan- 
che maligna. See Order 4, Genus 4. ' 
Genus 7. Urticaria. Enanthesis urticaria, G. Nettle- 
rash. 
c£ Rash, in florid, itching, nhttle-sting wheals ; appearing 
about the second day ; irregularly fading, and reviving, or 
wandering from part to part." G. 
Genus 8. Miliaria. Emphlysis miliaria, G. Miliary 
eruption. 
Small vesicular eruptions ; stinging sensation ; following 
profuse sweats, especially in puerperal fever ; attended with 
a sour odor. OUTLINES OF NOSOGRAPHY. 
121 
Genus 9. Erysipelas. Emphlysis erysipelas, G. St. 
Anthony's fire. 
An extensive, undefined, and irregular tumefaction on the 
face, or any part of the body ; skin of deep red color, and 
often partially covered with vesications. 
Var. 1. suppurativum. Solid, and liable to suppura- 
tion ; cells of the cellular tissue not united by adhesion ; 
matter diffused. 
Var. 2. (edematasum. Soft or compressible. 
Var. 3. gangrcenosum. Dark colored, liable to ter- 
minate in gangrene. 
Var. 4. erraticum. Migrating extensively over the 
skin. 
I 
Genus 10. Erythema. Erythema, G. Inflammatory 
blush. 
Superficial, turgescent redness on the skin ; burning sen- 
sation ; redness disappearing on pressure ; occasionally mi- 
grating in irregular trains. 
Genus 11. Pernio. Erythema pernio, G. Chilblain. 
Bluish, crimson color of the skin ; intolerable itching ; 
affecting the extremities in cold seasons ; liable to ulcerate. 
Genus 12. Pemphigus. Emphlysispemphigus, G. Ve- 
sicular fever. 
Transparent vesicles, the size of a filbert, scattered over 
the body ; edges inflamed ; fluid pellucid ; liable to ulcerate 
on breaking. 
Genus 13. Bullae. Ecphlysis pompholyx diutinus, G. 
Blebs. 
A large portion of the cuticle detached, containing a watery, 
yellowish fluid ; growing from small vesicles to the size of 
walnuts ; spreading over the whole body, and into the mouth ; 
forming ulcerations ; continuing several months. 122 
DERMOID TISSUE. 
Var. 1. quotidiance. With dark, red base, coming 
and going in twentyfour hours ; on the hands and legs. 
Var. 2. pompholyx. Tingling, followed by transpa- 
rent vesications, pea-sized ; difficult to heal ; reappearing on 
various parts of the skin. 
SECO.VD SERIES 
Chronic Eruptions. 
Genus 14. Plica polonica. Trichosisplica, G. Matted 
hair. 
Hairs of the head, sometimes of the beard, and pudendum, 
increased in vascularity, sensibility, and size ; issuing blood, 
and an agglutinating secretion ; the hair becomes matted, and 
entwined. Supposed by some to be infectious. 
A ' 
Genus 15. Impetigo. Lepidosis psoriasis, G. Scaly 
running tetter. 
Pustules continuous, terminating in scabs; skin often 
chappy. 
Genus 16. Lepra. Lepidosis lepriasis, G. Leprosy. 
Laminated scales of various sizes ; of a circular, smooth 
form. 
Var. 1. vulgaris. Scales smooth and large, whitish, 
with red borders ; covering the whole body. 
Var. 2. albida. Scales whitish, small, depressed in 
the centre ; on extremities. 
Var. 3. nigricans. Black leprosy. 
Genus 17. Herpes. Ecphlysis herpes, G. Tetter. 
Vesicular eruption in distinct clusters ; forming scabs ; 
tingling and itching. 
Var. 1. phlyctcenodes. Small inflamed vesicles. 
Var. 2. zoster. Shingles. OUTLINES OF NOSOGRAPHY. 
123 
Var. 3. circinatus. Ring-worm. 
Var. 4. labialis. On the lips. 
Var. 5. preputialis. On the prepuce. 
Genus 18. Psora. Ecpyesis scabies, G. Itch. 
Vesicular, or pustular pimples between the fingers, and 
flexures of joints, and spreading over the body ; intolerable 
itching ; terminating in scabs. 
Var. 1. papularis. Rank itch. 
Var. 2. vesicularis. Watery do. 
Var. 3. complicata. Complicated do. 
Var. 4. purulenta. Pocky do. 
Var. 5. exotica. Mangy do. 
Genus 19. Ichthyosis. Lepidosis ichthyiasis, G. Fish- 
skin. 
Hard, thickened incrustations on the skin ; hard, dusky 
rind, or scab ; sometimes nearly covering the body ; at other 
times more partial; resembling horn. 
Var. 1. simplex. Warty rind. 
Var. 2. cornea. Brown horny rind ; thickened skin. 
Var. 3. cornigera. Scabs incurvated, horn-like ; 
growth much elevated. 
Genus 20. Porrigo. Ecpyesis porrigo, G. Scali, or 
tinea. 
Yellow colored pustules, containing a viscid fluid, forming 
thin yellowish scabs. 
Var. 1. Crustacea. Milky scall. In patches on the 
face of lactescent children. 
Var. 2. galeata. Scalled head. Producing scabs 
over the head, affecting the roots of the hair ; occurring 
mostly during dentition. 
Var. 3. furfurucea. Dandery scall. Very minute 
pustules, terminating in scurfy scales. 124 
GLANDULAR TISSUE. 
The character of the general habit may be modified by the 
local irritations, 
6thly. As they exist in indurated glandular textures. 
ORDER VI. 
DIATHESIS GLANDULARIS INDURATA ET 
IMPOSTHUMOSA. 
DEFINITION OF CHARACTER. 
It may be suggested, that tuberculated states of glands and 
hypertrophy of membranes, rarely, if ever, arise without 
some fault, some pathological state of the general habit. 
Changes are often made in a gradual manner, in the organs of 
internal relation, without the subject being made conscious of 
them, until some secondary train of symptoms arises. A 
mild pathological state may exist, and be making very slow 
changes in tissues of location, even whilst the person is en- 
gaged in his usual concerns. These local changes are com- 
monly excited and modified primarily by the general habit; 
but when once formed, they produce a reflex action back on 
the system, according to their identical irritative character, 
and the physiological character of the part affected. Perhaps 
there is no structure more complicated, and less sentitive, 
than that of the glandular, and indurations of this structure 
are frequent. The pyrectic habit is mild and dilatory ; it is 
strictly chronic, and partakes of an irritative synochal charac- 
ter. Whenever changes have been made of a structural 
kind, they may not induce much disturbance in the gen- 
eral habit, until some adjunct cause excites commotion in 
the economy of the system ; whenever this proves to be the 
case, the local irritations will concentrate to the altered part, 
and inflamma ion be liable to become manifest. The reflex 
action now becomes more manifest; and if ulceration follows, OUTLINES OF NOSOGRAPHY. 
125 
the future fever, called hectical, receives its chief modifica- 
tion from it. 
By including imposthumations in this order, we are led to 
a review of the hectical habit. 
FIRST SERIES, 
Genus 1. Carcinoma. Carcinus vulgaris, G. Cancer. 
Irritative pyrectic habit, with dingy countenance ; hard or 
scirrhous tumor, commonly in the secernent glands ; of a 
leaden color ; knotted to the feel; attached to the skin, 
which is puckered, and to the muscles, making it fixed ; oc- 
casional darting pains ; intersected with ligamentary bands ; 
terminating in an ichorous phagedenic ulcer. 
Var. 1. vulgaris. As above. 
Var. 2. pullulans. Partially healing, then becoming 
aggravated. 
Var. 3. spongiosum. Having bleeding and fungous 
excrescences ; invading all the tissues of a part. The fun- 
gus hsematodes of Wardrop. 
< • • 
Genus 2. Scrofula. Struma vulgaris, G. King's evil. 
Indolent tumors of the glands of the neck, groin, armpit, 
&c. with but little pain ; slowly suppurating, and tardy in 
healing ; skin of the tumor retains its natural color ; tumor 
movable. The common habit delicate, skin smooth and flo- 
rid ; upper lip full. 
Genus 3. Goitre. Emphyma sarcoma cellulosum, G. 
Bronchocele. Swelled neck. 
Elastic tumor of the thyroid gland ; extending largely, 
and affecting the cellular tissue ; incident to young people in 
mountainous countries ; not liable to suppurate ; destitute of 
redness or inflammation. 126 
GLANDULAR TISSUE 
Genus 4. Tonsilla indurata. Swelled and in- 
durated tonsils. 
Liable to become indurated, and impede deglutition. 
Genus 5. Tuberculum. Emphyma sarcoma tuberculo- 
sum, G. Tubercle. 
Very small indurations, situated in the internal organs and 
membranes ; so minute as scarcely to be seen, but as they 
become enlarged, they may be of the size of millet seed, or 
larger. They are liable to suppurate in clusters, or in their 
envelopes, and afford an imperfect purulency ; rarely taking 
on the incarning process ; ending in a destruction of the res- 
pective organs or membranes, attended with hectic fever. 
Some may be named merely as varieties, from the tissues 
where they may be located. 
Var. 1. gutturis, of the throat. 
Var. 2. trachea, of the trachea. 
Var. 3. pulmonum, of the lungs. 
Var. 4. stomachi, of the stomach. 
Var. 5. hepatis, of the liver. 
Var. 6. splenis, of the spleen. 
Var. 7. mesenterii, of the mesentery. 
Var. 8. omenti, of the omentum. 
Var. 9. intestinorum, of the intestines. 
Var. 10. mem. serosa,, of the serous membrane. 
Var. 11. mem. mucosa, of the mucous membrane. 
et cetera. 
The cancerous, scrofulous tumors and ulcerations, to- 
gether with tubercles, and a carnified state of membranes, in- 
clude a considerable portion of the catalogue of diseases ; 
and especially, if we might add to these the various exulcera- 
tions and imposthumations occurring externally. It seems as 
proper here, as any where, to take some notice of these in a 
very general manner, as liable to be connected with a state of 
irritative fever, and producing various kinds of atrophy. outlines of nosography. 
127 
SECOND SERIES. 
Genus 6. Phthisis trachealis tuberculosa. Tra- 
cheal phthisis, or consumption. 
Pain slight and transient ; cough, with hoarseness, and loss 
of natural speech ; dry at first, followed by expectoration ; 
pulse frequent ; hectic fever. 
Genus 7. Phthisis pulmonalis tuberculosa. Mar- 
asmus phthisis tuberculosa, G. Tubercular consumption. 
Slight and transient pains in the side ; alternate chills and 
heats, especially in the afternoon ; often heat in the palms of 
the hands, and soles of the feet ; slight, ineffectual cough, 
sometimes attended with small haemoptysis, and eventually 
with a copious expectoration of muco-purulency ; shortness 
of breath, especially on exercise ; circumscribed flush on one 
or both cheeks ; pulse 100, or 120 in a minute, small and 
hard. Most liable to occur between the ages of 25 and 35, 
in habits slender, impressible, and easily fatigued ; having 
skin rather pale, and streaked with small blue veins ; teeth 
and adnata of a cretaceous whiteness. Fever chronic, de- 
generating into hectic ; emaciation. Towards the close, 
night sweats, diarrhoea, oedema of the feet. 
Genus 8. Phthisis apostematosa. Marasmus phthisis 
apostematosa, G. Apostematous phthisis. 
Dry cough ; obtuse pain in the chest at a fixed point ; in- 
ability of lying on the opposite side ; hectic fever ; at length 
a sudden and copious expectoration of purulency ; liable to 
repetition.* 
J 
Genus 9. Vomica. Jlpostema vomica, G. Internal abscess. 
A collection of purulency in some of fbe organs of the 
* See Pthisis mucosa, in Order II. Genus 6. 128 
ULCERATED TISSUES. 
great cavities ; preceded by more or less signs o f inflamma- 
tion ; discharged either by some natural outlet, or letained in 
natural cavities. 
Genus 10. Empyema. Jlpostema empyema, G. Purulent 
matter in the thorax. 
After more or less pneumonic inflammation ; rigors and 
heats ; short respiration ; expiration the most difficult from 
the accumulation of purulency in the thorax pressing the dia- 
phragm ; inclination to lie on the affected side ; elevation of 
the ribs of the oppressed side ; hectical symptoms. 
Genus 11. Apostema hepaticum. Apostema hepaticum, 
G. Hepatic abscess. 
Shiverings ; fulness, and tenderness in the right side, pre- 
ceded by more or less signs of hepatitis ; yellow counte- 
nance ; hectical symptoms ; liable to be discharged, 
1st, externally. 
2d, by the ductus communis. 
3d, into the thorax. 
4th, into the abdomen. 
5th, into the intestinal canal, by adhesions first formed. 
Genus 12. Lumbago apostematosa. Apostema pso- 
aticum, G. Lumbar abscess. 
Preceded by dull pain and tension of the loins ; shiver- 
ings ; impediment to an erect posture; commonly a tumor 
and fluctuation of matter below Poupart's ligament on the 
thigh ; diminished by a recumbent position, and by pressure 
Liable to be discharged, / 
1st, below Poupart's ligament. 
2d, on the loins. 
3d, exterior to the sphincter ani. 
Genus 13. Morbus coxarius. Jlrthropuosis. Hip dis- 
ease ; malum ischiaticum. 
Abscess of the hip joint, with caries of the acetabulum. OUTLINES OF NOSOGRAPHY. 
129 
Accompanied with hectical phenomena ; preceded by slight, 
obtuse pain in the knee, ancle or groin ; inability to use the 
limb, or maintain an erect position ; pain on moving the hip 
joint; shrinking in the size, and an elongation of the limb ; 
sometimes an acute disease, but oftener chronic ; frequent- 
ly a displacement of the head of the os femoris, with short- 
ening of the limb. 
Genus 14. Carbunculus. Phyma anthrax, G. Car- 
buncle. 
An imperfectly suppurative abscess, with a sordid gangre- 
nous core ; preceded by a vesicular, livid, flat, burning tumor, 
highly inflamed. 
Genus 15. Atrophia. Marasmus atrophia, G. A- 
trophy. 
Pale, emaciated habit; skin wrinkled ; muscles thin and 
weak ; synochula. Occasioned by deficiency or bad quality 
of nutriment, or from a deficiency of the assimilatory pro- 
cesses. 
Genus 16-. Tabes. Marasmus tabes, G. Slow wasting, 
or marasmus. 
Universal languor and depression of mind ; emaciation ; 
persistive synochula, often induced by extraneous irritating 
materials ;-as, 
Var. 1. venenata. From improper use of mercury, 
arsenic, opium, &c. Also, syphilis. 
Var. 2. strumosa. From a scrofulous diathesis. 
Var. 3. cachectica. From cachexy. 
Genus 17. Hectisis. Epanetus hectica, G. Hectic 
fever. 
An irritative fever, having a resemblance to a mild remit- 
tent ; two exacerbations every twentyfour hours, one corn- 130 
MORBID TISSUES. 
mencing about noon, the other about six o'clock in the even- 
ing, preceded by chilliness, followed with aggravation of fe- 
ver, a flush in one or both cheeks, and ending with free 
sweats. The noon exacerbations of about four hours con- 
tinuance, the evening the severest, of about six hours ; urine 
high colored, depositing a red sediment; in an advanced 
stage, the tongue free from fur, of a deep red color, and 
covered with aphthae; adnata of a pearly whiteness ; occa- 
sional diarrhoea ; oedema of the feet; emaciation ; always 
connected with a state of irritated, or of ulcerated surface, 
not incarning, but reflecting morbid sympathy to the involun- 
tary movements. 
The common habit may be sympathetically influenced, 
7thly. As the local impressions may constrain the secretory 
and excretory functions. 
ORDER VII. 
DIATHESIS CAPILLARIS ADSTRICTA. 
DEFINITION OF CHARACTER. 
Some of the varieties of diseases of this order, may be 
considered as having a local origin, in a particular manner. 
They, however, generally depend on a state of innervation 
and tonicity. The tissue affected receives an undue propor- 
tion of the general preternatural state of tonicity existing ; 
yet it may not, in the first instance, be sufficient to produce 
even much turgescence of vessels, although it may impede 
the secretion, or the excretion of a tissue. If it continues, 
a stage of turgescence follows, and sooner or later, a liability 
to inflammation. The reflex action will be different on the OUTLINES OF NOSOGRAPHY. 
131 
system, as modified by tissues of different sensibilities, and 
of greater or less importance to the general economy. It 
becomes difficult, therefore, to make much advance in rela- 
tion to any specific modification of character, collectively, 
of this order on the common habit. 
FIRST SERIES. 
Genus 1. Plethora. Plethora entonica, G. Fulness 
of vessels. 
Vascular system generally, distended beyond the physio- 
logical state, on account of the ingesta and egesta not being 
duly proportioned; or, as a sudden state of tonicity may 
have contracted the calibres of the vessels, and as the fluids 
may have become suddenly expanded. 
« 
Genus 2. Adiaphrosis. Obstructed perspiration. 
Dryness of the skin ; from a sudden state of innervation, 
diminishing the secretion ; or, a more permanent and inelas- 
tic state of the tissue, whereby transpiration is made difficult. 
Genus 3. Polydipsia. Dipsosis avens, G. Morbid 
thirst. 
Strong desire for drink, with a dryness of the mouth and 
fauces. The secretion by the mucous membrane is stopped, 
whilst absorption is active ; the part needs to be frequently 
moistened ; the same in the stomach. Restore secretion, 
and thirst ceases. 
Genus 4. Agalactio. Agalactia impotens, G. Scan- 
tiness of milk. 
Var. 1. tonica. A state of innervation, or of in- 
flammation. 
Var. 2. inanis. From defect of nutriment. 132 
MORBID TISSUES. 
Genus 5. Tussis arida. Tussis sicca, G. Dry 
cough. 
The mucous membrane of the lungs not affording its se- 
cretion, in consequence of a state of tonicity, excitation, or 
inflammation. 
Genus 6. Icterus. Icterus, G. Jaundice. 
The natural course of the bile perverted ; it becomes ab- 
sorbed or regurgitated into the circulation, and tinges white 
membranes and fluids of a yellow color ; most of the excre- 
tions are also yellow, except the fasces, which are whitish 
and tardy from its absence. 
Var. 1. • tonicus. From a state of innervation and 
erection, impeding secretion. 
Var. 2. phlogisticus. From extreme excitation, or 
inflammation of the liver. 
Var. 3. cholceus. From a viscid state of the bile, 
closing the passages. 
Var. 4. chololithicus. From gall-stones; or from 
other mechanical impediments. 
Genus 7. Ischuria. Paruria inops, G. Suppression 
of urine. 
A paresis of the function of the ^kidneys; urine not se- 
creted ; bladder empty. 
Var. 1. tonica. From a state of morbid tonicity or 
innervation, producing an inability of function, or paresis. 
Var. 2. phlogistica. From inflammation; far more 
obstinate than the last. 
Var. 3. vesicalis. When urine is retained in the 
bladder from any cause obstructing its passage through the 
urethra; tumor above the pubes ; tenderness on pressure ; 
desire to urinate. From inflammation, from stricture, from 
calculi, from paralysis, from narcotics, &c. OUTLINES of nosography. 
133 
Genus 8. Stranguria. Paruria stillatitia, G. Stran- 
gury. Dysury. 
Frequent desire to void urine, irresistible ; in very small 
quantities, often by drops ; attended with painful dysury ; 
urine often mixed with blood. From cold, from cantharides, 
&c. 
' ■ - 
Genus 9. Obstipatio. Coprostasis, G. Adstriction. 
Costiveness. 
Slow fecal movements, or a constipation. Often from a 
deficiency of mucous secretion, or an intense absorption of 
fluid matter from the intestines. From deficiency of bile. 
From an undue proportion of calcareous and albuminous mat- 
ter secreted into the intestines, forming scybalous substances. 
From mechanical hindrances, as strictures, inflammations, &c. 
Genus 10. Chlorosis. Chlorosis, G. Green sickness. 
Absence of menstruation at the expected period. Adstric- 
tive state of the uterine mucous tissue. 
Var. 1. irritata, (inops.) Countenance sallow ; 
muscular inability ; depraved appetite ; imperfect digestion ; 
dejection of mind; pulse increased. A mild state of toni- 
city ; excitants may overcome the paresis, and effect the 
secretion. 
Var. 2. plethorica. Pain in the head and loins; 
palpitations ; pulse full and frequent. The tonicity needs to 
be reduced by debilitating measures, before secretion can 
take place.* 
* For a membranous tissue, or a complicated organ to maintain its function 
regularly, it is necessary to have the natural impetus accurately balanced. 
If it suffers only a small degree of orgasm, it is liable to have its functional office 
increased, constituting that morbid condition called proflua. If the organ 
suffers a higher degree of orgasm, it is liable to have its function Suppressed, 
and a state of adstriction follows; of course an inability of functional exer. 
rise, even whilst a state of tonicity prevails. So sweat does not flow from 
the surface whilst the intensity of fever continues, although it might in the 134 
MORBID TISSUES. 
Genus 11. Amenorrhcea. Paramenia obstructionism G. 
Retention of menses. 
Menstruation obstructed in its course, after having been 
established. Pain in the head and back; languor; febrile 
symptoms. 
Genus 12. Dysmenorrhiea. Paramenia dijfcilism G. 
Difficult menstruation. 
Menstruation progresses with great pain, attended with to- 
nic spasms of the hypogastric viscera; suffering paroxysmal 
aggravation. 
SECOND SERIES 
Emphysematous tumefactions, with adstriction of outlet. 
Genus 13. Emphysema pulmonis. Inflation of the 
bronchial vesicles. 
Dilatation of the bronchial vesicles, by the pressure of 
confined air, or a rupture of several into the substance of the 
lungs ; or an infiltration into the cellular tissue, appearing in 
vesicles below the pleura pulmonalis from internal rupture, or 
secreted from the blood. Attended with dyspnoea ; cough, 
and surcharge of mucus ; lungs not collapsing, and the capa- 
city of the bronchia diminished. Often produced by hurried 
respiration. 
Genus 14. Pneumatosis cellularis. Emphysema cel- 
lulare, G. Cellular intumescence. 
An intumescence from gas, throughout the cellular texture 
over the body, giving a crepitating or crackling sound when 
pressed. 
commencement, and at length at the close, after the severity of the diathesis 
becomes diminished. Something similar occurs in numerous other instances 
in the morbid economy, although we may not be able, in the present state of 
pathological science, to explain all of them in the most satisfactory manner. OUTLINES OF NOSOGRAPHY. 
135 
Var. 1. a veneno. From poison. 
Var. 2. a vulnere. From a wound. 
Var. 3. a put ri dine. From putrefaction. 
Genus 15. Emphysema intestinale. Tympany of the 
intestines. 
Light and sonorous intumescence of the abdomen, from 
accumulation of gas in the intestines. When moderate and 
less extensive, it is called flatulency ; also, borborygmy. 
Var. 1. abdominale. Tympany of the abdomen. 
An accumulation of gas in the cavity of the abdomen ; sono- 
rous on percussion. 
Genus 16. Physometra. Emphysema uteri, G. Tym- 
pany of the uterus. 
Light circumscribed tumor in the hypogastric region, 
giving an obscure tympanitic sound on percussion ; flatus 
sometimes discharged per vaginam. 
The general habit may be influenced sympathetically, 
8thly. Jis the local concentrations from the morbid habit, 
may impress the expansions of the respiratory and gangli- 
onic nerves, distributed in either the voluntary, or invol- 
untary muscular organs, obstructing their movements by 
a spastic rigidity. 
ORDER VIII. 
DIATHESIS M U S C U L A R I S ADSTRICTA. 
REMARKS ON CHARACTER. 
In this habit of disease, the muscles suffer a morbid con- 
traction, and remain fixed an-indefinite length of time. Their 
motions seem to be influenced by the susceptibility bestowed 136 
MUSCULAR TISSUE!. 
by the branches of the trisplanchnic and respiratory nerves, 
plentifully distributed in their composition, especially as 
relates to the visceral muscles. Anatomy demonstrates many 
of the voluntary muscles, also, as being supplied with nerves 
of involuntary susceptibility, as well as of external relation. 
Where the latter have not been demonstrated, we argue their 
existence from analogy, which anatomy may reveal at a fu- 
ture period. ' When the morbid concentration is on the 
nerves destined to excite voluntary motion, their spasmodic 
muscular action is alternated with relaxations, in quick suc- 
cession, constituting the kind that is called clonic spasm ; 
whilst the contractions producing the present order, have 
been called tonic spasm. In both conditions, there is a state 
of morbid tonicity, yet variously modified by the physiologi- 
cal character of the different orders of nerves, and primitive 
vital force. With respect to the character of this diathesis, 
it may merely be noticed, that as the vital force is lavished on 
the muscular branches of the trisplanchnic, the vascular 
branches are deficient in vital force ; the responding febrile 
actions are, therefore, not well developed, yet laboring in a 
constrained manner. We may firstly consider the external, 
and then proceed to the several muscles particularly under 
the dominion of the trisplanchnic nerves. The former organs 
will be again brought into review, in treating of the morbid 
actions of the nerves of volition. It should further be ob- 
served, that this order of spasm is very persistive, sometimes 
continuing even after apparent death, whilst any irritability 
remains, as is shown in the case of priapism, and stiffness of 
joints, in some instances. 
The physiological movements of the organic viscera are 
more steady, uniform, and persistive, than those of the organs 
of external relation. The same leading character prevails in 
the morbid state ; hence the persistency of tonic spasm, and 
neuralgic pains. It will be suggested, that the primitive vital OUTLINES OF NOSOGRAPHY. 
137 
force, vis insita, assumes its prerogative in tonic spasm ; per- 
haps in aid of the ganglial nerves. 
FIRST SERIES. 
Effecting the muscles of external relation, through the 
agency of the arterial trisplanchnic nerves, and prim- 
itive vital force. 
Genus 1. Tetanus. Entasia tetanus, G. Stretching 
spasm. 
Permanent, tonic spasm in some or all the locomotive mus- 
cles ; subject to slight remissions, but not relaxation ; severe 
pain ; countenance distorted ; dyspnoea ; difficult deglutition; 
jaws closed ; pulse contracted, small, and hurried ; coldness 
of the surface and extremities ; blood when drawn shows no 
phlogistic pellicle. The disease often terminates fatally by 
some convulsive movements. 
Var. 1. anticus, or emprosthotonos. Body rigidly 
bent forwards. 
Var. 2. posticus, or opisthotonos. Body rigidly 
bent backwards. 
Var. 3. lateralis. Body rigidly bent sideways. 
Genus 2. Catochus. Carus ecstasis, G. Ecstacy. 
" Total suspension of mental power and voluntary motion ; 
pulsation and breathing continuing; muscles rigid ; body 
erect, and inflexible." G. 
Genus 3. Trismus. Entasia trismus, G. Locked-jaw. 
Painful, fixed, and rigid contraction of the muscles of the 
jaws ; mouth firmly closed. 
Var. 1. nascentium. Affecting infants soon after 
birth, from irritation of the funis, or in the alimentary pas- 
sages. 
Var. 2. traiimaticus. From wounds or ulcers, es- 
pecially in hot climates. 138 
MUSCULAR TISSUE. 
Genus 4. Hydrophobia. Lyssa, G. Dread of water. 
Rage. 
Dread of cold, or shining bodies, and for the most part a 
horror of liquids. When voluntary efforts are made to swal- 
low drink, an involuntary and painful spasmodic action of the 
muscles of deglutition prevents, with an exacerbation of the 
spasms of muscles of the throat and adjacent parts. Hurry 
of mind ; anxiety and horror ; supervening the bite of a rabid 
animal. These symptoms are preceded by pain, or uneasi- 
ness in the bitten part. Sometimes a desire of biting and do- 
ing violence ; at other times not. Occasionally priapism. 
Var. 1. canina. From the bite of a dog, and often 
fatal on the access of one or two paroxysms. 
Var. 2. felina. 11 The paroxysms periodical, and 
returning with the full moon ; produced by the bite of an en- 
raged cat." G. From the bite of wolves also. 
Genus 5. Globus hystericus. Dysphagia globosa, 
G. Hysteric globe. 
A suffocative sensation in the throat ; a tumefaction, from 
contraction of muscles ; sensation of a ball rising from the 
stomach ; deglutition hindered ; often attends hysteria, hypo- 
chondrias, and grief. 
Genus 6. Cephaloxia. Entasia loxia, G. Stiff neck. 
Fixed contraction of the muscles on either side of the 
neck, drawing the head to the side affected. 
Genus 7. Angina spasmodica. Laryngismus stridulus, 
G. Spasmodic quinsy. 
Painful, constrictive sensation of the larynx, attended with 
severe dyspnoea ; often attacking young persons in sleep ; 
having some resemblance to croup, but without inflammation 
or effusion ; access and exit sudden. outlines of nosography. 
139 
Genus 8. Pleurodynia acuta. Pleuralgia acuta, G. 
Stitch in the side. 
Sudden pain or stitch in the side, without manifest fever ; 
relieved by pressure. 
Genus 9. Priapismus. Entasia priapismus, G. Pria- 
pism. 
Painful and continued erection of the penis, without libidi- 
nous desires. 
Genus 10. Crampus. Entasia systremma, G. Cramp. 
Muscles, portions of muscles, or contractile membranes, 
suffering a sudden and very painful contraction, and remain- 
ing so an indefinite length of time, not very long ; yet until 
warmth and circulation restores them. 
Var. 1. stomachi. Of the stomach. 
Var. 2. intestinalis. Of the intestines. 
Var. 3. cruralis. Of the legs, &c. 
SECOND SERIES. 
As affecting the internal and external muscles, under the do- 
minion of the ganglionic and respiratory nerves ; also, the 
primitive vital force. 
Genus 11. Incubus. Ephialtcs nocturnus, G. Night- 
mare. 
Spastic stricture of the internal and external muscles of 
respiration ; inability of moving, or effecting respiration ; oc- 
curring during sleep ; intellect partly excited, or dreaming ; 
consciousness of a heavy weight on the breast ; ineffectual 
exertions to move ; distress of body ; trepidation of mind ; 
at length a severe, yet sort of despairing effort, excites the 
muscular movements ; and the heart is perceived, on awak- 
ing, to be acting with prodigious force and frequency. 140 
MUSCULAR TISSUE. 
Var. 1. " vigilantium. Produced during wakeful- 
ness ; the pressure severe, and extending over the abdomen ; 
respiration frequent, laborious, constricted ; eyes fixed ; 
sighing deep and violent ; intellect undisturbed. Found, oc- 
casionally, as a symptom in dyspepsia, hydrocephalus, worms, 
and hypochondrias." G. 
Genus 12. Adstrictio cordis. Corded pulse. 
The action of the heart constrained ; pulse frequent, small, 
corded, and retiring, as noticed in Order IV. Genus 6, from 
130 to 180 pulsations in a minute. Prsecordial distress ; 
sometimes of short duration ; at other times of some hours' 
continuance, ending suddenly and favorably ; or at other times 
fatally by a cessation of circulation. 
Genus 13. Asthma convulsivum. Asthma siccum, G. 
Nervous or convulsive asthma. 
A sudden spasmodic paroxysm of difficulty of breathing ; 
a sense of constriction, with a wheezing sound ; not of long 
duration ; cough slight; scanty expectoration at the close of 
the fit. 
Genus 14. Angina pectoris. Sternalgia, G. Breast 
pang- 
Violent and sudden constrictive pain under the lower part 
of the sternum, involving the heart and its appendages, also 
the respiratory muscles, and those along the left arm most 
commonly ; breathing constrained, with a sense of suffoca- 
tion ; occurring by paroxysms ; often excited by exercise ; 
frequently palpitation, followed by loss of pulse, sensation, 
and muscular motion, with cold sweat ; paroxysm usually of 
half an hour, often fatal. Chronic and irregular. 
Genus 15. Singultus. Clonus singultus, G. Hiccough. 
Sudden contractile snatch of the diaphragm, associating the 
respiratory muscles, especially the abdominal ; interrupting OUTLINES of nosographt. 
141 
every word, with a sharp sound on inspiration ; sometimes 
transient, at others a symptom in fevers, with irritation on 
the pneumogastric nerve ; and in a chronic state, continuing 
many months. 
Genus 16. Clonus epigastricus. Epigastric spasm, 
A single and sudden snatch or jerk of the diaphragm, and 
parts adjacent the solar plexus, soon after going to sleep ; 
resembling an electrical shock ; causing instant wakefulness, 
rising, distress, and perturbation. 
Genus 17. Emesis. Limosis emesis, G. Vomiting. 
Persistent spasmodic contraction of the muscular coat of 
the stomach, until its contents are evacuated by the oesopha- 
gus, assisted by the respiratory muscles ; recurring by parox- 
ysms. Sometimes by sudden snatches, with belchings, 
without much aid of the respiratory muscles, as in strictured 
hernia, and ganglionic irritations in fever. 
Genus 18. Pvrosis. Limosis sputatoria, G. Water- 
brash. 
Severe constrictive pain in the epigastrium, increased by 
an erect position ; the paroxysm is relieved by an eructation, 
or emesis, of a white, acrid, sometimes viscid fluid, in consi- 
derable quantity. 
Genus 19. Colica spasmodica. Colica ileus, G. Iliac 
passion. 
A sudden, spasmodic, and inverted motion of the aliment- 
ary canal, with vomiting of fecal matter; painful retraction of 
the umbilical region ; costiveness. 
Genus 20. Rhachialgia. Colica rhachialgia, G. Paint- 
ers' colic. 
Of slow access ; pain of the stomach, extending along the 
intestines to the umbilical region, which is drawn backwards, 142 
MUSCULAR TISSUE. 
towards the spine, with pain in the back and arms ; the whole 
region of the abdomen painful to the touch, and the muscles 
drawn into hard eminences ; frequent eructation and vomiting, 
with obstinate spastic costiveness ; ineffectual attempts at de- 
fecation. If the disease is not seasonably removed, it is 
liable to terminate in inflammation and gangrene, or in paraly- 
sis of the arms, and contraction of the fingers. 
i 
Genus 21. Tenesmus. Proctica tenesmus, G. Straining. 
Painful and very constant desire for defecation, with small 
discharge of mucus sometimes ; suffering frequent exacerba- 
tions. 
Genus 22. Proctalgia. Proctica simplex, G. Pain of 
the anus. 
Severe and unrelenting pain at the fundament, without in- 
flammation. 
Genus 23. Hysteralgia. Dolor uteri. Uterine pang. 
Severe spasmodic pains of the uterus, and its pelvic ap- 
pendages, spreading to the sacrum ; directed to the exclusion 
of its contents. 
Var. 1. parturientis. Severe, exclusory, spastic, 
uterine movements, during parturition ; occurring by parox- 
ysms. 
Var. 2. secondaria. Unrelenting, spasmodic pains 
succeeding parturition, directed in the same manner. 
Similar spasms occur in dysmenorrhoea, and some other 
affections of the uterus. OUTLINES OF NOSOGRAPHT, 
143 
The general habit may be affected sympathetically, by the 
reflex actions, 
Qthly. Jis the local concentrations, emanating from the com- 
mon morbid habit, may impress the spino-encephalic system 
of nerves of external relation ; altering their susceptibility, 
and the movements of their dependent organs. 
ORDER IX. 
DIATHESIS SPINO-ENCEPHALICA DEPRAVATA. 
REMARKS. 
It may be proper to make three series of the diseases that 
especially affect the nervous system of external relation. 
Firstly, as affecting the muscular nerves of volition, and their 
organs;-secondly, as affecting the nerves of sensation, and 
their organs ;-thirdly, as affecting the encephalic mass, and 
altering or modifying the intellectual functions. Each of 
these admit of two divisions, viz. as their functions may be 
exalted or depressed. 
The common morbid diathesis, as depending on the system 
of ganglionic influence, may be in very different states, during 
the existence of the diseases of the present order ; it would 
be useless, therefore, to attempt any definition of its char- 
acter. 
FIRST SERIES, 
FIRST DIVISION 
Diseases of Exaltation of the functions of voluntary mus- 
cular organs. 
Genus 1. Convulsio. Syspasia convulsio, G. Convul- 
sion fit. 
Alternate contractions and relaxations of the muscles of 
voluntary motion, generally ; reiterated in rapid succession 144 
NERVOUS TISSUE. 
for several minutes ; hands clenched, and teeth gnashing ; 
intellect obscured in severe cases, but not in mild. 
Var. 1. universalis. Affecting the whole body. 
Var. 2. partialis. Affecting portions of the body. 
Var. 3. parturientis. Uterine irritation metastatis- 
ed to the encephalon ; severe, reiterated clonic agitations ; 
no recollection of any thing that transpired. 
Genus 2. Epilepsia. Syspasia epilepsia, G. Falling 
sickness. 
Severe agitations of the whole of the system of voluntary 
muscles, without consciousness ; countenance livid, and hor- 
ribly distorted ; gnashing of the teeth, and often wounding 
the tongue ; frothing at the mouth; paroxysms commonly 
ending short of ten minutes ; involuntary emission of urine, 
and other excretions ; succeeded by coma. 
Var. 1. periodica. Returning at fixed periods ; 
often curable. 
Var. 2. organica. From organic changes in the 
encephalon ; incurable. 
Var. 3. sympathetica. Associated with some local 
defect in a remote part, and a sensation of coldness, or aura 
epileptica, slowly ascending to the encephalon. 
Genus 3. Hysteria. Syspasia hysteria, G. Hysteric-fit. 
Irregular and protean agitations of the voluntary muscles, 
repeated in successive paroxysms, most commonly of uncer- 
tain duration ; a sensation of flatulent uneasiness in the abdo- 
men, ascending to the throat, which becomes constricted and 
swollen, called globus hystericus ; followed by an abolition of 
consciousness, and spasms ; in the intervals, mind often in- 
coherent, with sighing, laughing, or crying ; copious limpid 
urine. Most commonly appearing in females, between pu- 
berty and the acme of life, having movable, sanguine temper- 
aments, and at catamenial periods. OUTLINES of nosography. 
145 
Genus 4. Chorea. Synclonus chorea, G. St. Vitus's 
Dance. 
Convulsive and irregular agitations of various muscles of 
the body, or limbs, when attempted to be moved by the will; 
sensation and consciousness not disturbed; occurring in 
young persons, and liable to continue some time. 
Genus 5. Subsultus. Chlonus subsultus, G. Jerking 
of muscles. 
Involuntary coptractions of separate muscles, thereby mov- 
ing their tendons ; reiterated at short and uncertain intervals ; 
a symptom of organic irritation. 
Genus 6. Paralysis tremula. Synclonus tremor, G. 
Paralytic trembling. 
Chronic, tremulous agitation of the head, limbs, and some- 
times of the whole body, especially when directed by the 
will; occurring in elderly persons ; and occasionally in ner- 
vous habits, from cold and the passions. 
Genus 7. Palpitatio. Clonus palpitatio, G. Palpi- 
tation. 
Irregular, convulsive, or vibratory motion of the heart, 
with corresponding irregular undulations of the pulse ; some- 
times severe, with precordial distress; at other times mild. 
Genus 8. Intermittens. ^.netus, G. Intermittent. 
Ague. 
A succession of paroxysms during its course, having a 
freedom from fever in the intervals. Commencing with lan- 
guor, yawning, corrugation, and coldness of the skin ; horri- 
pilation, and a sudden sensation of extreme coldness, espe- 
cially along the dorsal region, quickly followed by tremors 
and convulsive agitations of all the voluntary muscles, which 
continue for several hours ; countenance livid; precordial 146 
nervous tissue. 
distress ; thirst; insensibility to heat, whilst there is an in- 
creased sensibility to cold. At length, the convulsive agita- 
tions abate, and responding action is manifested by heat, 
pain, throbbing of the arteries, and at length followed by pro- 
fuse sweats, and an inclination to sleep.* 
Genus 9. Intermittens quotidiana. dnetus quotid- 
anus^ G. Daily ague. 
Paroxysm commencing twentyfour hours after the first, 
usually in the morning, and ending in less than eighteen 
hours. 
Var. 1. anticipans. When the paroxysm com- 
mences earlier, by about an hour. 
Var. 2. protracta. Paroxysm continued so as to 
leave a shorter interval. 
Var. 3. tarda. When the paroxysm is retarded, 
or delayed beginning. 
Var. 4. complicata. When assuming a febrile di- 
athesis, and having local determination, as to the kidneys, 
hips, liver, spleen, side, head ; changing into hysteria, or ep- 
ilepsy. 
Genus 10. Intermittens tertiana. Jlnetus tertianus, 
G. Tertian ague. 
* The phenomena of intermittents indicate very essentially an affection 
of the nerves of external relation ; however, the whole of the vital forces 
are truly impressed, but in a slight manner at the onset. The local concen- 
tration appears to be on the nerves of external relation, and the repulsive 
actions are hefe manifested almost as clearly as in convulsion; certainly as 
much as in tremor. Dr Hosack, in his lectures on Theory and Practice, p. 
63, states that a patient of his, upon the attack of an intermittent, was seized 
with convulsion. When the state of paroxysmal agitation is over, there is 
no greater appearance of febrile commotion, than there is in the intervals of 
epilepsy, nor so much as often occurs in convulsion. We mean in simple 
uncomplicated intermittents; for it is true, that a congestive state of the 
viscera is liable to take place, and may become the theatre of morbid de- 
rangement, attended with fever. (See. Path. Sect. xlii. 9. c.) outlines of nosography. 
147 
Paroxysm commencing fortyeight hours after the first, 
usually at noon, and ending in less than twelve hours. 
Var. 1. tarda. Having a short and imperfect in- 
termission. 
Var. 2. complicata. Giving rise to other diseases, 
as dysentery, syncope, lethargy, apoplexy, &c. 
Genus 11. Intermittens quartana. Anetus quarta- 
nus , G. Quartan ague. 
Paroxysm commencing seventytwo hours after the first, 
usually in the afternoon, and ending in less than nine hours. 
Var. 1. anticipans. Paroxysms beginning earlier. 
Var. 2. tarda. Delaying its usual period, com- 
monly two hours. 
Var. 3. complicata. Giving origin to numerous 
other diseases. 
Genus 12. Intermittens erratica. Anetus errati- 
cus. G. Irregular ague. 
The paroxysms irregular in point of time, as, whether 
they may be on the fifth, sixth, seventh, eighth, ninth, or 
tenth day, having an interval of more than seventytwo hours. 
Irregular in point of severity of paroxysm. 
Genus 13. Intermittens complicata. Jlnetus com- 
plicatus, G. Complicated ague. 
Paroxysms multiplied and intricate ; consisting of tertian 
or quartan periods. 
Var. 1. tertiana duplex. Double tertian. Par- 
oxysms of the one tertian, occurring in the intermissions of 
the other ; yet having a difference of severity and contin- 
uance. One paroxysm every day, yet a difference in sever- 
ity ; occurring at noon. 
Var. 2. tertiana triplex. Triple tertian. The 
double tertian ; yet one of the sets having two paroxysms on 
the day of its return ; the other but one. The two last va- 148 
NERVOUS TISSUE 
rieties differently combined, constitute double tertians, double 
and triple quartans, &c. 
It may be noticed in illustration, that the shorter the inter- 
mission, the longer the paroxysm will be. Again, the longer 
the paroxysm, the earlier it commences in the day. And, 
furthermore, the longer the cold fit, the less durable the other 
stages. The quotidian has the slightest cold stage, but the 
longest paroxysm. The quartan having the shortest parox- 
ysm, has the longest cold stage. 
Nature having impressed a law on the nervous system of 
external relation, whereby its functions are performed in reg- 
ular rythms, especially of repose and activity ; intermittents, 
as well as many other diseases of the nervous system, are 
bound to it, and receive their modifications from it. This is 
more particularly the case, when not complicated with a de- 
cided congestive location in the viscera, under the dominion 
of the ganglionic nerves.* 
SECOND DIVISION. 
Diseases of depression of the functions of voluntary organs. 
REMARKS. 
The phenomena of diseases of this division are consider- 
ably different from the last. In that, the functions of the or- 
gans are exalted, in this depressed. The pathological cir- 
cumstances of the involuntary organic system affect the en- 
cephalon and its appendages, essentially through the medium 
of the vascular system. So the heart, and all the organs 
under the dominion of the ganglionic influence, may be in 
* Should an objection be raised against exalting the species of intermit- 
tents to the rank of genera, it might be replied, that it comports with the 
other arrangements we have followed. The same objection might be made 
against all the phlegmatiae^ as well as the other spasmodic diseases. It need 
only be remarked, that it appears to be in unison with other arrangements, 
so to dispose of them. OUTLINES OF NOSOGRAPHY. 
149 
vigorous exercise, while the spino-encephalic, and its de- 
pendent organs, are quiescent. 
Genus 14. Apoplexia. Carus apoplexia, G. Apo- 
plexy. 
Suspension of the functions of sensation, motion, and in- 
tellect ; deep sleep ; sonorous breathing ; respiration slow ; 
pulse rather slower than natural, and full ; attack sudden ; 
attended with a general morbid habit. 
Var. 1. sanguinea. Occurring in plethoric habits, 
and attended with hemorrhage in the encephalon. 
Var. 2. serosa. Occurring mostly in leuco-phleg- 
matic habits, attended with serous effusion in the brain. 
Var. 3. congestiva. From sudden dilatations of 
the encephalic blood vessels, sometimes at the attack of ma- 
lignant fevers ; also, from narcotics ; from ebriety ; from 
passion ; from oppressive substances in the stomach ; from 
rigidity of cerebral capillaries in aged people. 
Genus 15. Paralysis. Carus paralysis, G. Palsy. 
Sudden loss of sensation, or of motion, or both, in a part 
of the body. 
Var. 1. hemiplegia. Affecting one half of the 
body, from the median line ; loss of sensation and motion, 
with weakness of intellect and articulation ; face contracted 
to the sound side ; acknowledging nearly the same pathologi- 
cal circumstances as apoplexy, only partial, and not attended 
with somnolency. 
Var. 2. paraplegia. Affecting the lower half of the 
body, from some circumstance impairing the function of the 
spinal cord. 
Var. 3. partialis. From inability of function of 
some particular nerve, as in paralysis facialis. 
Genus 16. Catalepsia. Carus catalepsia, G. Cata- 
lepsy. Trance. 150 
NERVOUS TISSUE. 
Suspension of motion, sensation, and intellect; pulsation 
and breathing not affected ; imos flexible, and retaining a 
given position ; countenance florid ; eyes open, and intently 
fixed, but without vision. 
Genus 17. Lethargus. Cams lethargus, G. Coma. 
Morbid sleep. 
Quietus of body and mind ; morbid sleep, of several de- 
grees of intensity, from which the subject cannot easily be 
roused. 
Var. 1. absolutus. Impossibility to excite sensa- 
tion, motion, or consciousness. 
Var. 2. cataphora. Short intervals of imperfect 
waking. 
Var. 2. vigil. - coma-vigil. Torpitude of sensa- 
tion and motion, but imperfect quietus of mind ; incoherent 
ideas, and disjointed talk, without consciousness of having 
slept, when thoroughly awakened. This variety is also called 
typhomania. They may all appear as symptoms in pyrectic 
disease. 
Genus 18. Vertigo. Dinus vertigo, G. Dizziness, j 
An apparent whirling round of objects, or swimming of the 
head ; often with dimness of sight; sometimes a sense of un- 
dulation in the ground ; loss of judgment and muscular bal- 
ance, and the subject is liable to fall; often followed by head- 
ache. Sometimes a chronic affection, attended with milder 
symptoms. 
Var. 1. illusoria. Imaginary objects before the 
sight. 
Var. 2. scotoma. Blindness and faintness; nervous 
fainting fit. 
The two following will be offered as affecting the two di- 
visions of the nervous systems, the external and internal; or, OUTLINES of nosography. 
151 
in other words, the whole of the nervous forces of the sys- 
tem. The first from causes irremediable ; the second from 
causes more transient, and less fatal. 
Genus 19. Asphyxia. Carus asphyxia, G. Suspended 
animation.* 
Total suspension of all the functions of the system, from 
causes paralysing the energy of nervous influence, both in the 
spino-encephalic and ganglionic systems. 
Var. 1. suffocationis. From hanging, and from 
drowning, or any cause hindering the circulation and respira- 
tion. Countenance turgid and livid. 
Var. 2. mephitica. Choke-damp. From carbonic 
acid gas, in wells, and other places ; or any other deleterious 
gas, damp, or exhalation. Countenance pallid. 
Var. 3. algida. From severe cold. Limbs rigid ; 
countenance pallid and shrivelled. 
Var. 4. electrica. From lightning, or a severe stroke 
of electricity. Limbs flexible; countenance pale; blood 
uncoagulable. In this variety the system seems to be totally 
exhausted of its irritable and contractile power. 
Genus 20. Syncope. Syncope, G. Fainting fit. Swoon. 
Circulation and respiration feeble, or imperceptible ; loss 
of motion, sensation, and consciousness ; eyes rolled up ; 
slight spasms, followed by a momentary quietus, resembling 
asphyxy. 
Var. 1. cardiaca. From affections of the heart; 
plethora ; polypi; ossification ; hypertrophy. 
Var. 2. inanitionis. From long fasting; debility; 
loss of blood, fatigue, diarrhoea, &c. 
Var. 3. doloris. From severe pain ; sudden shocks. 
Var. 4. pathematica. From sudden, overwhelming 
passion. 
* Asphyxia. The term signifies an absence of pulse. But custom has 
given it the extensive meaning we apply to it. 152 
NERVOUS TISSUE. 
SECOND SERIES. 
Affecting the nerves of sensation, and their organs. 
I. DISEASES OF EXALTATION OF THE SENSE OF TOUCH. 
Genus 21. Tactus acrior. P ar apsis acris, G. Acute 
sensibility. 
Feeling painfully acute, or sensible to impressions not gen- 
erally perceived. 
Var. 1. tcneritudo. Soreness. Painful uneasiness, 
or tenderness, local or general, on being touched with a mod- 
erate pressure. 
Var. 2. pruritus. Itching. Painful titillation, local 
or general. 
Var. 3. ardor. Heat. Sense of temperature, local 
or general, above that of pleasant and natural coolness. 
Var. 4. algor. Coldness. Painful sensation of cold- 
ness. 
Genus 22. Cephalalgia. Cephalcea nauseosa, G. Sick 
headache. 
An aching, strictured sensation over the head, with severe 
pain in the forehead, temples, or about the head; inability of 
bearing the light, or sounds, or bringing the mind to mental 
operations; occurring by paroxysms in the predisposed, 
when excited by slight causes, yet sometimes periodical; con- 
tinuing several hours ; often followed by vomiting, which, 
with sweating, gives relief. Commonly occurring in mova- 
ble temperaments. 
Var. 1. chronica. Chronic headache. Very sim- 
ilar to the above, only not so severe, but continuing in a 
chronic form for a considerable part of the time, with occa- 
sional remissions. 
Genus 23. Hemicrania. Cephalcca hemicrania, G. Pe- 
riodical head-ache. Megrim. OUTLINES OF NOSOGRAPHY. 
153 
Severe strictured sensation over one half of the head, with 
an intense pain in a small circumscribed spot over the parie- 
tal bone, or in the forehead ; occurring by paroxysms, and 
often periodical; sometimes connected with a carious tooth, 
or a sequel of intermittent fever. 
Genus 24. Neuralgia. Neuralgia, G. Tic doloureux. 
Acute, lancinating, insufferable pains, following the course 
of the nerves of sensation of a part, exciting spasms in the 
neighboring muscular tissues ; occurring by short and uncer- 
tain paroxysms ; excited by anything that lightly impresses, 
or moves the part; continuing a long time. Most liable to 
affect the face ; but no part where the fascia and muscles are 
supplied with sensitive nerves is exempted. 
Var. 1. faciei. Pains beginning in the terminations, 
more or less, of the branches of the fifth pair of nerves of 
sensation in the face, eradiating along their course with dis- 
tracting pains, and distortions of muscles ; no change disco- 
verable in the part, in the intervals. 
Var. 2. pedis. Intolerable pain about the heel of a 
similar character. 
Var. 3. pedis digiti. Affecting the great toe in a 
similar manner ; very persistive.* 
I ' 
Genus 25. Odontalgia. Odontia dolorosa, G. Tooth- 
ache. 
Acute pain in the teeth and jaws, without swelling., 
Var. 1. cariosa. Severe sharp pain, continuing an 
indefinite length of time, having exacerbations ; referred to 
the carious tooth, but extending into the jaw. 
Var. 2. nervosa. Severe sharp pain occurring by 
paroxysms, slowly spreading along the fifth pair of nerves 
* Almost all the diseases attended with severe pain, and without vascular 
turgescence, might be styled neuralgia, (pained nerves.) Indeed it appears 
very lately, that Mr Teale has embodied a large family under the genus neu- 
ralgia, including pyrosis, angina pectoris, colica pictonum, &c. 154 
NERVOUS TISSUE. 
from the teeth to the face, ear, and temples, and sometimes 
over the parietal bone ; then gradually subsiding ; simulating 
neuralgia. 
Var. 3. sympathetica. From general irritation con- 
centrating to the dental nerves, without caries, or any evident 
cause, as in the first months of pregnancy. 
Genus 26. Gastrodynia. Stomach pain. 
Oppressive, unrelenting pain in the epigastrium ; weakness ; 
tenderness on pressure ; very persistive, and rarely remitting. 
Genus 27. Pleurodynia. Pleuralgia chronica, G. Side 
pain. 
Fixed, permanent pain in the side, of long continuance ; 
not relieved by any position, but aggravated by lying on the 
affected side ; tenderness on pressure, and frequently along 
the course of the intercostal nerves to the spine ; breathing 
not affected. 
Var. 1. hypochondriaca. Similar pain and tender- 
ness, seated in the side below the spurious ribs ; or above 
the os ilium. 
Genus 28. Ischias nervosa. Jlrthrosia coxendicis, G. 
Sciatica. Coxalgia. 
Severe and persistive pain, with tenderness, seated in the 
hip and back part of the thigh, without swelling ; bearing 
some resemblance to chronic rheumatism, and involving the 
ischiadic nerve ; limb liable to numbness and atrophy, as well 
as emaciation of the whole body ; febrile habit ; often fol- 
lowed by a retraction of the hip from muscular contractions. 
DIMINUTION OF THE SENSE OF TOUCH. 
Genus 29. Anesthesia. Parapsis expers. Numbness. 
Total insensibility to objects of touch. 
Var. 1. simplex. Numbness confined locally or gen- OUTLINES OF NOSOGRAPHY. 
155 
erally to the sense of touch; sometimes accompanied with 
uneasiness. 
Var. 2. illusoria. Imaginary sense of touch, or gen- 
eral feeling in organs that have no existence, as after amputa- 
tions. 
II. DISEASES OF EXALTATION OF THE SENSE OF SIGHT. 
Genus 30. Retinitis chronica. Protracted inflamma- 
tion of the retina. 
Acute sensibility of the retina; vision indistinct; intole- 
rance of light, which, if permitted to strike the retina, pro- 
duces shrieks and agonies. Slight symptoms of irritative 
fever, with occasional headache ; often persisting for many 
years ; emaciation ; increased sensibility universally. 
Genus 31. Nyctalopia. Paropsis lucifuga, G. Night 
sight. 
Vision painfully acute in strong light; but clear and pleas- 
ant in a deep shade, or the dusk of the evening. 
DIMINUTION OF THE SENSE OF SIGHT; OR INDIFFERENCE.* 
Genus 32. Amblyopia. Paropsis noctifuga, G. Day 
sight. 
Vision dull and confused in the dusk ; but clear and pow- 
erful in broad daylight. 
Genus 33. Presbyopia. Paropsis longinqua, G. Long 
sight. 
Vision only accurate when the object is far off. 
* The future definitions of the organs of sense will be mostly copied from 
Good; omitting some, and varying the order of others. We freely grant 
that the most of these are local affections, and only secondarily disturbing 
the general habit 156 
NERVOUS TISSUE. 
Genus 34. Myopia. Paropsis propinqua, G. Short 
sight. 
Vision only accurate when the object is near. 
Genus 35. Dysopia lateralis. Paropsis lateralis. 
Skue sight. 
Vision only accurate when the object is placed obliquely. 
Genus 36. Phantasma. Paropsis illusoria, G. False 
sight. 
Imaginary objects floating before the sight ; or real objects 
appearing with imaginary qualities. 
Var. 1. musca volitantes. Dark spots floating in 
the way of vision. 
Genus 37. Caligo corner. Paropsis caligo, G. 
Opaque cornea; web eye. 
Dimness or abolition of sight, from opacity of the cornea, 
or spots upon its surface. 
Genus 38. Glaucoma. Paropsis glaucosis. G. 
Dimness or abolition of sight, from opacity of the humors. 
Genus 39. Cataracta. Paropsis cataracta, G. Cata- 
ract. 
Dimness, Or abolition of sight from opacity of the crystal- 
line lens. 
Var. 1. lenticularis. The opacity existing in the 
lens itself, and confined to it. 
Var. 2. capsularis. The opacity confined to the 
capsule of the lens. 
Var. 3. complicata. The opacity common to the 
lens, and its capsule. 
Genus 40. Caligo pupill®.. Paropsis synizesis, G. 
Dimness, or abolition of sight from contraction or oblit- 
eration of the pupil. OUTLINES OF NOSOGRAPHY. 
157 
Genus 41. Gutta serena. Paropsis amaurosis, G. 
Drop serene. 
Dimness, or abolition of sight, with unalterable pupil, 
usually black and dilated ; but without any other apparent 
defect.* 
Genus 42. Ectropium. Ophthalmia ectropium, G. 
Eversion of the eye-lids. 
Eversion of one or both the eye-lids ; and consequent ex- 
posure of the red internal tunic. 
Entropium, when the eye-lids are turned inwards. 
III. DISEASES OF EXALTATION OF THE SENSE OF HEARING. 
Genus 43. Auditus acrior. Paracusis acris, G. 
Acute hearing. 
Hearing painfully acute, and intolerant of the lowest 
sounds. 
Genus 44. Paracusis imaginaria. Paracusis illuso- 
ria, G. Imaginary sounds. 
DIMINUTION OF THE SENSE OF HEARING. 
Genus 45. Dyseccea. Paracusis obtusa, G. Hardness 
of hearing. 
Hearing dull and confused, and demanding a clear and 
modulated articulation. From organic defect; local debility; 
obstruction in the auditory passages, as mucus, wax, sordes, 
extrinsic bodies. 
Genus 46. Dyseccea organica. Paracusis surditas, 
G. Total deafness. 
From organic defect, local palsy. 
* Some cases admit a slight movement from the ganglionic nerves sent to 
the iris. 158 
NERVOUS TISSUE. 
IV. EXALTATION OF THE SENSE OF SMELL. 
Genus 47. Olfactus acrior. Parosmis acris, G. 
Acute smell. 
Smell painfully acute, or sensible to odors not generally 
perceived. 
DIMINUTION OF THE SENSE OF SMELL. 
Genus 48. Anosmia. Parosmis obtusa, G. Loss of 
smell. 
Smell dull, or totally lost. From organic defect, or par- 
alytic inability. 
V. EXALTATION OF THE SENSE OF TASTE. 
Genus 49. Gustus acrior. Parageusis acrida, G. 
Acute taste. 
Taste painfully acute, or sensible to savors not generally 
perceived. 
DIMINUTION OF THE SENSE OF TASTE. 
Genus 50. Ageustia. Parageusis obtusa, et expers, G. 
Taste dull, or extinguished. 
From mucus, aphthae, palsy, &c. 
third: series. 
^ffecting the encephalic mass, and perverting the intellectual 
functions. 
EXALTATION OF INTELLECT. 
Genus 51. Vesania. Ecphronia, G. Insanity. 
Diseased perception, with little disturbance of the judg- 
ment, occasionally shifting into diseased judgment, with lit- OUTLINES OF NOSOGRAPHY. 
159 
tie disturbance of the perception ; diminished sensibility ; 
irregular remissions.* 
Genus 52. Mania. Ecphronia mania, G. Madness. 
The discrepancy between the perception and the judgment, 
general; raving ; entony ; and impassioned emotion. 
Var. 1. --ferox. Furious and violent madness. 
Var. 2. exultans. Gay and elevated madness. 
Var. 3. despondens. Gloomy, despondent madness. 
Var. 4. demens. Chaotic madness. 
, * 1 ' 
DEPRESSION. 
Genus 53. Melancholia. Ecphronia melancholia, G. 
Melancholy. 
The discrepancy between the perception and the judgment, 
limited to a single object, or train of ideas, for the most part 
with taciturnity, love of solitude, gloomy fear or suspicion. 
Var. 1. attonita. Fixed, mute, immovable melan- 
choly. 
Var. 2. errabunda. Roving, restless melancholy ; 
having a constant desire to change the abode. 
Var. 3. malevolens. Morose, or mischievous mel- 
ancholy ; occasionally terminating in suicide, or the injury of 
others. 
Var. 4. complacens. Self complacent and affable 
melancholy ; occasionally rejoicing in a visionary superiority 
of rank, station, or endowments. 
Var. 1 
* We have presumed to borrow very liberally from Dr Good's order, 
Phrenica, or diseases of the mind ; indeed, pursuing him very literally, and 
only transposing to suit our Own mode of exhibiting the characters of the 
several affections. 
In this series we are under the necessity of abandoning the tissual phe- 
nomena, and to pursue the mental; and this must be so, until anatomy, and 
phrenology shall arrive to such precision, as to indicate the individual or- 
gans and functions, connected with the several mental processes. 160 
NERVOUS TISSUE. 
EXALTATION. 
Genus 54. Mania a pathemate. Empathema, Good's 
2d Gen. Ungovernable passion. 
The judgment perverted or overpowered by the force of 
some predominant passion ; the features of the countenance 
changed from their common character. 
Genus 55. Empathema entonicum, G. Ungovernable 
passion. 
The predominant passion accompanied with increased ex- 
citement, ardor, and activity ; eye quick and daring ; coun- 
tenance flushed and tumid. 
Var. 1. iracundice. Wrath. 
Var. 2. super biaz. Pride. 
Var. 3. giorice famis. Ambition. 
Var. 4. letitice. Joy. Transport. 
Var. 5. philautice. Self-love. Self-conceit. 
Var. 6. zelotypice. Jealousy. 
X DEPRESSION. 
Genus 56. Empathema atonicum, G. Despondency. 
The predominant passion accompanied with diminished ex- 
citement ; anxiety, and love of solitude ; eye fixed and pen- 
sive ; countenance pale and furrowed. 
Var. 1. desiderii. Longing. Eager desire for an 
absent object, whether place or person ; and hence equally 
including home-sickness, country-sickness, love-sickness. 
Var. 2. aurifamis. Avarice. 
Var. 3. anxietudinis. Preying care. ' 
Var. 4. mceroris. Heart-ache. Severe grief. 
Var. 5. desperationis. Despair. 
EXALTATION. 
Genus 57. Hallucinatio. Musia, 3d Gen. Good. Il- 
lusion. OUTLINES OF NOSOGRAPHY. 
161 
The judgment perverted, or overpowered by the force of 
the imagination ; the spirits permanently elevated or depress- 
ed ; the feelings of the mind depicted in the countenance. 
Genus 58. Alusia elatio, G. Mental extravagance. 
Romantic ideas of real life; ardent and exalted fancy ; 
pleasurable feelings ; frequent pulse ; great activity; eye 
keen, and lighted up ; countenance confident and animated. 
Var. 1. heroica. Chivalry. Romantic gallantry. 
Var. 2. facetosa. High spirits ; sparkling, ebullient 
wit, incapable of restraining itself; that often sacrifices a 
friend at the shrine of a jest. 
Var. 3. ecstatica. False inspiration ; visionary con- 
ceits. 
Var. 4. fanatica. Fanaticism. 
DEPRESSION. 
Genus 59. Alusia Hypochondrias, G. Low spirits. 
Gloomy ideas of real life ; dejected spirits ; anxiety ; dys- 
pespy ; languid pulse ; indisposition to activity ; eye oblique 
and scowling ; countenance gloomy and sullen. 
Var. 1. autalgica. Vapors. With visionary or. 
exaggerated sense of pains, or disease ; whimsical dislike of 
persons, places, or things ; groundless apprehensions of per- 
sonal danger, or poverty. 
Var. 2. -.- pertcesa. Weariness of life. Spleen. With 
general listlessness, or disgust; irksomeness, and weariness 
of life. 
Var. 3. misanthropica. Misanthropy. With gen- 
eral malevolence, peevishness, and abhorrence of mankind. 
Genus 60. Aphelxia, 4th Gen. Good. Revery. 
Voluntary inactivity of the whole, or greater part of the 
external senses to the impressions of surrounding objects, 
during wakefulness. 162 
NERVOUS TISSUE. 
Genus 61. Aphelxia socors, G. Absence of mind. 
Truant attention; wandering fancy ; vacant, vacillating 
countenance. 
Genus 62. Aphelxia intenta, G. Abstraction of mind. 
The attention wound up, and riveted to a particular sub- 
ject; and with sympathetic emotion of the muscles and feat- 
ures, connected with its general drift. 
Var. 1. a studio. From intense study. 
Var. 2. a pathemate. From overwhelming passion, 
as rapture, grief, despair. 
Genus 63. Oneirodynia. Paroniria, 5th Gen. Good. 
Dreaming. 
The voluntary organs connected with the passing train of 
ideas, overpowered by the force of the imagination, during 
dreaming, and involuntarily excited to their natural or accus- 
tomed actions ; while the other organs remain asleep. 
Genus 64. Somnambulismus. Paroniria ambulctns, G. 
Sleep-walking. 
The muscles of locomotion excited into their accustomed 
action, by the force of the imagination, during sleep. 
Genus 65. Nyctegersia. Paroniria loquens, G. Sleep- 
talking. 
The muscles of speech excited into their accustomed ac- 
tion, by the force of the imagination, during dreaming. 
Genus 66. Exoneirosis. Paroniria salax, G. Night- 
pollution. 
The sexual organs excited into venereal action by the force 
of the imagination, during dreaming. 
Genus 67. Amentia. Moria, 6th Gen. Good. Fatuity. 
Defect or hebetude of the understanding. OUTLINES OP NOSOGRAPHY. 
163 
Genus 63. Moria imbecilis, G. Imbecility. 
The defect or hebetude partial, or confined to particular 
faculties of the understanding. 
Var. 1. stupiditas. Stupidity.^ Dulness and indo- 
cility of the apprehension ; torpitude and poverty of the im- 
agination. 
Var. 2. amnesia. Forgetfulness. Febleness or fail- 
ure of the memory. 
Var. 3. credulitas. Credulity. Weakness and un- 
due pliancy of the judgment, with a facility of being duped. 
Var. 4. inconstantia. Fickleness* Instability and 
irresolution of the will. 
Genus 69. Moria demens, G. Wistlessness. Irra- 
tionality. 
Defect, or hebetude of all the faculties of the under- 
standing. ' • . 
Var. 1. stultitia. Folly. Shallow knowledge ; fee- 
ble judgment ; light frivolous fancy ; for the most part good 
natured ; sometimes with obstinacy. 
Var. 2. lerema. Dotage. Impotence of body as 
well as of mind, from natural or premature old age. 
Var. 3. ancea. Idiotism. General obliteration of 
the mental powers and affections ; paucity, or destitution of 
ideas ; obtuse sensibility ; vacant countenance ; imperfect or 
broken articulation ; with occasional transient and unmean- 
ing gusts of passion. , 164 
OSSEOUS TISSUE. 
The general habit may be affected by the reflex actions, 
lOthly. As emanating from the irritation of local affections 
seated in the osseous texture. 
ORDER X. 
DIATHESIS OSSEA DEPRAVATA. 
remarks on character. 
The osseous texture being composed of vital solids, although 
studded with crystallizations of saline carbonates and phos- 
phates, is liable to take on preternatural, or morbid action. 
The diseases of the bones, like those of other textures, may 
be acute or chronic. The hard hollow bones have been 
broken into fragments in six days' inflammation, with exul- 
ceration, reverberating severely on the general system, with 
high sthenic diathesis. At other times they slowly decay 
with little reflex action ; merely a reflected irritation. In 
the pathological state, the bones and teeth often assume a high 
degree of sensitiveness. Diseases of the bones often accom- 
pany constitutional idiosyncrasies, arising from scrofulous, 
syphilitic, scorbutic, or cancerous contaminations. 
FIRST SERIES, 
Genus 1. Ostitis. Inflammation in the outer or inner 
membrane of hollow bones. 
Pain severe and deep seated ; inflammation involving the 
surrounding soft parts ; synochoid fever for the most part; 
soon followed by suppuration, breaking the bone with exul- 
ceration, when internal. 
Genus 2. Osteosarcoma. Sideratio ossis. Spina ven- 
v tosa. 
Slow, internal caries of bones, involving the integuments ; OUTLINES OF NOSOGRAPHY. 
165 
elevating the skin in the form of a conical tumor ; discharge 
ichorous, corroding, and foetid. 
Genus 3. Exostosis. Emphyma exostosis, G. Node. 
Chronic inelastic tumor ; immovable, hard, and bony to 
the touch. 
Var. 1. ostea. Seated on the bone. 
Var. 2. periostea. From ossification of the perios- 
teum ; protuberant. 
Var. 3. pendula. Detached bony substances in jqints. 
Genus 4. Caries. Ulcus cariosum, G. Carious ulcer. 
An ulcer of the soft parts, connected with a death of the 
external lamella of a bone ; dark color ; foetid smell; exfoli- 
ation ; crumbling. 
Var. 1. arthrocace. When the defect extends to 
the medulla. 
/ 
Var. 2. necrosis. When there is an entire death of 
a bone. 
Genus 5. Ossificatio. Osthexia infarciens, G. Ossi- 
fication. 
Ossific matter concreting in masses in various soft parts. 
Var. 1. implexa. Ossific matter deposited in mem- 
branes, as in the aorta and pleura ; also, as in tendons, liga- 
ments, and sometimes uniformly over the periosteum. 
Genus 6. Rhaciiitis. Cyrtosis rhachia, G. Rickets. 
Deformity of the osseous system ; head bulky, with pro- 
minent forehead ; spine crooked ; ribs depressed, with pro- 
tuberances at the sternal junction ; sternum prominent and 
deformed ; epiphysis of bones enlarged, presenting a soft 
cellular structure internally, which may readilly be cut; de- 
ficiency of ossific matter; periosteum thickened; skin pale, 
and flesh flabby ; premature development of mind. 166 
OSSEOUS TISSUE. 
Genus 7. Cretinismus. Cyrtosis cretinismus, G. Cre- 
tinism. ' 
The skeleton short and deformed ; head large ; goitre ; 
enlarged abdomen; universal cachexy ; skin wrinkled ; va- 
cant countenance, and stupidity of mind ; hereditary. 
Genus 8. Mollities ossium. Parostiaflexilis, G. Soft- 
ness of bones. 
The substance of bones soft and yielding, liable to bend 
with small force and little pain ; deficiency in the deposit of 
phosphate of lime. 
Genus 9. Fragilitas ossium. Parostia fragilis, G. 
, , , . 1 Brittleness of bones. 
The entire osseous system of a friable nature, and liable to 
be fractured by slight force, and with little pain; deficiency 
of component gelatine. 
SECOND SERIES 
Genus 10. Lithiasis. Lithia, G. Gravelly habit. 
Superabundant secretion and deposition of calcareous neu- 
trals in various receptacles, forming crystallizations, which are 
voided with difficulty, or retained ; or depositions in mem- 
branes, as in arthritic concretions. , 
Var. 1. renalis. In the kidney. Severe pain in 
the. region of the kidneys, extending towards the testicle and 
thigh of the side affected ; vomiting, pyrectic habit. 
Var. 2. vesicalis. Stone in the bladder. Pain on 
walking or riding ; urgency to urinate often, and suddenly 
interrupted ; rigidity in the penis, and pain in the glans. 
When in the urethra, pain exquisite, and inability to urinate. 
Var. 3. chololitha. Gall-stones. Obtuse pain in 
the right hypochondrium ; sallow, or yellow complexion ; 
pale fasces ; urine of a yellow cast. When passing the ducts OUTLINES OF NOSOGRAPHY. 
167 
to the duodenum, exquisite pain at the epigastrium, fever and 
vomiting. 
Var. 4. pulmonalis. Calcareous deposits in the 
membranes of the bronchial vesicles, and occasionally loos- 
ened by suppuration, and discharged by coughing. 
Var. 5. enterolitha. Lithic concretions or crystalli- 
zations in the stomach and intestinal canal. 
Tjie general susceptibility may be sympathetically influ- 
enced, 
y * ■ 
llthly'. Jis the local irritations may be of a peculiar 
kind, affecting different tissues. 
ORDER XI. 
DIATHESIS S P E C I A L I S . 
G-enus 1, Scorbutus. Porphyra,G. Scurvy. Purpura.* 
Gradual approach of debility of body, and torpitude of 
mind ; bloated countenance ; anxiety ; difficult respiration ; 
frequent and small pulse; pains in the limbs ; petechiae, or 
vibices on the surface ; occasionally cutaneous exudations of 
blood ; often spongy, bleeding gums, and intestinal discharges 
of blood ; foetid breath. 
Var. 1. simplex. Numerous small flea-bite spots; 
lurid countenance. 
Var. 2. urticans. Tingling nettle-sting wheals, 
with flea-bite spots ; migratory. 
* Although this habit of disease affects the mucous texture very consider- 
ably, yet it does not seem to have a primary location in it. The sanguine- 
ous system appears to be essentially affected, as is manifested from the great 
changes taking place in >the crasis of the blood. It was conceived, most 
proper to have it stand in the specific diathesis for consideration. Both 
solids and fluids seem simultaneously to be affected. See Sect. xv. 5. 168 
DIATHESIS SPECIALIS. 
Var. 3. hemorrhagica. Land scurvy. Various 
sized and shaped patches. 
Var. 4. nautica. Sea scurvy. Spots of various 
colors ; teeth loose. 
Genus 2. Helminthia, G. Entozoa. Vermiparous 
habit. 
A disposition to produce worms, or nourish the larvae of 
insects in the alimentary canal, or extension of the mucous 
membrane* Producing various and anomalous symptoms, as 
emaciation, voracious appetite, or disgust of food ; gnawing, 
pungent pains, pale countenance, foetid breath, convulsions, 
irritation of the nostrils, and febrile excitations. 
Var. 1. Lumbricus teres. ^scaris lumbricoides, G. 
Long round-worm. Head incurvated ; mouth triangular ; 
yellowish, transparent color, with a faint line down the side ; 
gregarious and vivacious ; from twelve to fifteen inches long; 
commonly inhabiting the ileum, or the stomach. 
Var. 2. Tricocephalus. Long thread-worm ; about two 
inches long; head obtuse, and furnished with a retractile pro- 
boscis ; tail longer than its body, terminating in a hair-like 
point J residing in groups, and inhabiting the coecum of sickly 
children. * 
Var. 3. Tenia solium. Long tape-worm. Long articu- 
lations, with pores, by which it attaches itself to the intes- 
tines, one on each joint, generally alternate ; head with a 
terminal mouth, surrounded with two rows of holders ; a lit- 
tle below, on the flattened surface, two tubercular orifices, 
or suckers ; tail terminated by a semicircular joint, without 
any aperture ; from thirty to forty feet long, or even sixty ; 
residing at the upper part of the intestines, and feeding on 
the chylous materials ; rerrioved with difficulty. 
Var. 4. Tenia lata. Broad tape-worm. Articulations 
short and broad ; body broader in the middle, and tapering 
towards both ends ; head smaller than the last; inhabiting OUTLINES OF NOSOGRAPHY. 
169 
the upper part of the intestines ; usually in groups of three 
or four ; from three to fifteen feet long. 
Var. 5. Fasciola. Fluke. Gourd-worm. Body flattish, 
with an aperture at the head, and generally another beneath ; 
size and appearance having a resemblance to a gourd seed, 
and broader. More commonly infesting quadrupeds, and al- 
so other animals ; sometimes in the liver ; one kind white, 
another brown. 
Var. 6. Jlscaris. Jlscaris vermicularis, G. Maw-worm. 
Thread-worm. Inhabiting the podex, but sometimes wan- 
dering ; in groups ; about half an inch long ; bead divided 
into three vesicles, an aperture in each, which receives nour- 
ishment; tail terminating in a point. Exciting local imita- 
tion ; itching. 
Var. 7. Scarabcci. Larvse of the beetle. But little 
known. 
Var. 8. (Estri. Bots, or larvae of the gad-fly. Round ; 
pale green ; found in the human feces, but more frequently 
in those of the horse ; taken into the stomach. 
Var. 9. Gordii. Hair-worms, or seta equina. Found 
in stagnant waters ; from four to six inches long, twisted into 
knots ; pale brown color. Produced in Lapland especially, 
occasioning violent colics, attended with profuse ptyalism, 
and bloody urine ; called Colica Lapponica. 
Var. 10. Hirudo. The leech. Different species swal- 
lowed along with the muddy and stagnant water they inhabit. 
Var. 11. Musca cibaria. Larvse of the pantry-fly. 
Producing disturbance in the stomach. In danger of being 
taken in various media, especially in decayed cheese.* 
* We have drawn liberally in this genus from Dr Good's Nosology, as on 
many former occasions. Those who wish to pursue the subject more mi- 
nutely, may refer to his Study of Medicine, tind Brera on Worms. 
Perhaps the vermiparous habit might have had a location amongst the 
affections of the mucous membrane. But worms have been found in all 
tissues, and may be considered to arise from constitutional circumstances. 
We have the history of a case furnished by Dr L. Emmons of Lower 170 
DIATHESIS SPECIALIS. 
Genus 3. Incendium spontaneum. Catacausis ebriosa, 
G. Spontaneous combustion. 
Combustion of the human system ; spontaneously arising, 
or easily excited ; occurring in females for the most part, 
who are advanced in life, and who have made an immoderate 
use of alcoholic liquors ; occurring in the night, and in soli- 
tude. The body has been found with a flickering flame up- 
on it, but oftener with a smothered heat, producing a foetid 
smoke ; the flame increased by water ; the fabric becomes 
reduced to a black, oily, and sooty mass. 
Canada, of a vast number of the filiaria taken from the breast of a woman, 
at various times. They made way with their heads through the skin, and 
were thence pulled out. 
M. Andral makes this notice in his Path. Anat. "Only two kinds of en- 
tozoa have as yet been observed in the nervous centres of the human sub- 
ject, namely, acephalocysts, and cysticerci. The former has occasionally 
been observed both in the substance of the brain, and in that of the spinal 
cord. INDEX TO THE NOSOGRAPHY. 
Adiaphrosis, 131. 
Adstrictio cordis, 140. 
Agalactio, 131. 
Ageustia, 158. 
Alusia elatio, 161. 
Alusia hypochondrias, 161. 
Amblyopia, 155. 
Amenorrhcea, 134. 
Amentia, 162. 
Anasarca, 111. 
Anaesthesia, 154. 
Angina pectoris, 140. 
Angina spasmodica, 138. 
Anosmia, 158. 
Aphelxia, 161. 
Aphelxia intenta, 162. 
Aphelxia socors, 162. 
Aphtha, 101. 
Apoplexia, 149. 
Apostema hepaticum, 128. 
Arteritis, 109. 
Ascites, 112. 
Asphyxia, 181. 
Asthma convulsivum, 140. 
Asthma humidum, 104. 
Atrophia, 129. 
Auditus acrior, 157. 
Blenorrhcea, 105. 
Blenorrhoea virulenta, 105. 
Bullse, 121. 
Caligo corneae, 156. 
Caligo pupilloe, 156. 
Carditis, 95. 
Carbunculus, 129. 
Carcinoma, 125. 
Caries, 165. 
Catalepsia, 149. 
Cataracta, 156. 
Catarrhus, 100. 
Catochus, 137. 
Cephalalgia, 152. 
Cephaloxia, 138. 
Chlorosis, 133. 
Cholera infantum, 103. 
Cholera morbus, 116. 
Chorea, 145. 
Clonus epigastricus, 141. 
Colica spasmodica, 141. 
Conjunctivitis, 101. 
Convulsio, 143. 
Crampus, 139. 
Cretinismus, 166. 
Cynanche maligna, 114. 
Cystitis, 96. 
Delirium vigilans, 110. 
Diabetes mellitus, 105. 
Diaphragmitis, 95. 
Diarrhoea, 104. 
Diathesis capillaris adstricta, 130. 
Diathesis fervida complexa, 113. 
Diathesis fervida eruptiva, 118. 
Diathesis fervida fibrosa, 91. 
Diathesis fervida mucosa, 100. 
Diathesis fervida serosa, 108. 
Diathesis glandularis indurataet impos- 
thumosa, 124. 
Diathesis muscularis adstricta, 135. 
Diathesis ossea depravata, 164. 
Diathesis specialis, 167. 
Diathesis spino-encephalica depravata, 
143. 
Dysmenorrhoea, 134. 
Dysecoea, 157. 
Dysecoea organica, 157. 
Dysenteria lenta, 103. 
Dysenteria maligna, 116. 
Dysopia lateralis, 156. 
Dyspepsia, 103. 
Ectropium 157. 
Emesis, 141. 
Empathema atonicum, 160. 
Empathema entonicum, 160. 
Emphysema intestinale, 135. 
Emphysema pulmonis, 134. 172 
INDEX TO THE NOSOGRAPHY. 
Empyema, 128. 
Enteritis, 95. 
Enteritis maligna, 116. 
Enteritis mucosa, 102. 
Entropium, 157. 
Epistaxis, 106. 
Epilepsia, 144. 
Erysipelas, 121. 
Erysipelas gangraenosum, 116. 
Erythema, 121. 
Erythema gastricum, 102. 
Erythema urethralis, 103. 
Exoneirosis, 162. 
Exostosis, 165- 
Febris biliosa, 103. 
Febris gastrica, 102. 
Fragilitas ossium, 166. 
Gangraena, 117. 
Gastritis, 95. 
Gastrbdynia, 154. 
Gastro-enteritis, 103. 
Glaucoma, 156. 
Globus hystericus, 138. 
Goitre, 125. 
Gustus acrior, 158. 
Gutta serena, 157. 
Haematemesis, 107. 
Haematuria, 107. 
Haemoptysis, 106. 
Haemorrhagia intestinalis, 107. 
Haemorrhagia laryngis, 106. 
Haemorrhagia uteri, 108. 
Haemorrhois, 107. 
Hallucinatio, 160. 
Hectisis, 129. 
Helminthia, 168. 
Hemicrania, 152. 
Hepatitis, 95. 
Herpes, 122. 
Hydarthrus rheumatismus, 99. 
Hydrocele, 113. 
Hydrocephalus, 111. 
Hydrophobia, 138. 
Hydrophthalmia, 112. 
Hydrops darti, 111. 
Hydrops ovarii, 106. 
Hydrops pericardii, 112. 
Hydrops tubalis, 106. 
Hydrops uteri, 106. 
Hydrorachis, 112. 
Hydrothorax, 112. 
Hysteralgia, 142. 
Hysteria, 144. 
Hysteritis typhoides, 116. 
Ichthyosis, 123. 
Icterus, 132. 
Impetigo, 122. 
Incendium spontaneum, 170. 
Incubus, 139. 
Intermittens, 145. 
Intermittens complicata, 147. 
Intermittens erratica, 147. 
Inlermittens quartana, 147. 
Intermittens quotidiana, 146. 
Intermittens tertiana, 146. 
Irruptiones, 110. 
Ischias nervosa, 154. 
Ischuria, 132. 
Laryngitis, 94. 
Lepra, 122. 
Lethargus, 150. 
Leucorrhoea simplex, 105. 
Linguitis, 94. 
Lithiasis, 166. 
Lumbago, 98. 
Lumbago apostematosa, 128. 
Mania, 159. 
Mania a pathemate, 160. 
Mastitis, 97. 
Melaena, 115. 
Melancholia, 159. 
Meningitis, 92. 
Metritis, 97. 
Menorrhoea, 107. 
Miliaria, 120. 
Mollities ossium, 166. 
Morbus coxarius, 128. 
Moria demens, 163. 
Moria imbecilis, 163. 
Myopia, 156. 
Nephritis, 96. 
Neuralgia, 153. 
Nyctalopia, 155. 
Nyctegersia, 162. 
Obstipatio, 133. 
Odontalgia, 153. 
Odontitis, 93. 
Oedema, 111. 
Olfactus acrior, 158. 
Oneirodynia, 162. 
Orchitis, 96. 
Ossificatio, 165. 
Ostitis, 164. 
Osteo-sarcoma, 164. 
Otitis, 93. 
Palpitatio, 145. 
Paracusis imaginaria, 157. 
Paralysis, 149. 
Paralysis tremula, 145, 
Paronychia, 97. 
Parotitis, 93. 
Pemphigus, 121. 
Periostitis, 97. 
Peritonitis mitis, 109. 
Pernio, 121. 
Pertussis, 102. 
Pestis orientalis, 114. INDEX TO THE NOSOGRAPHY 
173 
Phantasma, 156. 
Pharyngitis, 94. 
Phlebitis, 110. 
Phlegmatia dolens, 98. 
Phlogosis, 97. 
Phthisis apostematosa, 127. 
Phthisis mucosa, 102. 
Phthisis pulmonalis tuberculosa, 127. 
Phthisis trachealis tuberculosa, 127. 
Physometra, 135. 
Plethora, 131. 
Pleuritis mitis, 109. 
Pleurodynia, 154. 
Pleurodynia acuta, 139. 
Plica polonica, 122. 
Pneumonia, 94. 
Pneumatosis cellularis, 134. 
Pneumonitis complexa, 115. 
Pneumonitis fibrosa, 94. 
Pneumonitis mucosa, 101. 
Podagra, 98> 
Polydipsia, 131. 
Porrigo, 123. 
Presbyopia, 155. 
Priapismus, 139. 
Proctalgia, 142. 
Prostatitis, 96. 
Psora, 123. 
Ptyalismus, 104. 
Pyrosis, 141. 
Retinitis chronica, 155. 
Rhachialgia, 141. 
Rhachitis, 165. 
Rheumatismus, 97. 
Rheumatismus fascialis, 98. 
Rubeola, 120. 
Scarlatina, 120- 
Sclerotitis, 93. 
Scorbutus, 167. 
Scrofula, 125. 
Singultus, 140. 
Somnambulismus, 162. 
Splenitis, 96. 
Stranguria, 133. 
Subsultus, 145. 
Syncope, 151. 
Synocha, 91. 
Synochus, 100. 
Syphilis, 105. 
Tabes, 129. 
Tactus acrior, 152. 
Tenesmus, 142. 
Tetanus, 137. 
Tonsilla indurata, 126. 
Tonsillitis, 93. 
Tracheitis, 94. 
Tracheitis mitis, 101. 
Trismus, 137. 
Tuberculum, 126. 
Tussis arida, 132. 
Typhus gravior, 114 
Typhus icterodes, 114. 
Typhus mitior, 109. 
Typhus petechialis, 115. 
Urethritis, 96. 
Urticaria, 120. 
Vaccinia, 119. 
Varicella, 119. 
Variola, 118. 
Varioloides, 119. 
Vertigo, 150. 
Vesania, 158. 
Vomica, 129. THERAPEUTICS. 
ORDER I. 
SECTION XLVI. 
PRELIMINARY REMARKS. 
It is expected the antecedent illustrations in the two former 
divisions, will assist in exposing the characters of the mala- 
dies incident to the human economy, and thereby shorten 
what might otherwise be necessary in this division. 
It is not so necessary for us to dwell long on the external 
tokens, called symptomatology, after giving the most charac- 
teristic phenomena, as to explore the external connections 
with the oppressed organs. This has been already attempted 
in part, and frequent allusions to the subject will be made as 
we proceed. The histories of the distinctive phenomena of 
isolated disease, have been so repeatedly made out, that it is 
unnecessary to repeat very minutely. 
The preceding nosography teaches the leading, and most 
distinctive phenomena ; and for a more full enumeration ref- 
erence may be made to many systematic writers, and of late 
to Doctors Dewees' and Eberle's systems of medicine. The 
phenomena constantly vary with the state, and stage of dis- 
ease, and they are modified by numerous incidental circum- 
stances. A very minute enumeration of phenomena, is liable 
to lead to a view of the independent existence of isolated dis- 
ease, a circumstance to be greatly regretted. It has been 
our province to harmonize the general principles of medicine, 176 
PRELIMINARIES. 
to trace the analogies of particular diseases, and expose erro- 
neous inductions, which direct to improper treatment. 
The arrangement of diseases into orders, according to 
their tissual seats, is offered with much assurance of utility ; 
as assisting the memory, exposing the affinity and intrinsic 
character of diseases, as well as the simplicity of treatment. 
Not that all diseases of any order possess, at all times, the 
same diatheses, and demand the same remedies, but they 
generally do ; subject, however, to many modifications. 
The diathesis even in the same case may become altered, and 
require a modified treatment. 
The first order comprises a group of affections, although 
of much intensity of pathological action, nevertheless of sim- 
ple character ; and the remedial agents are very well agreed 
on in kind, if not in degree. We begin then with the plain- 
est mode of treatment, and proceed to other groups more 
complicated and difficult. The general treatment of the dis- 
eases, in this order is so similar, it cannot be necessary to 
repeat it in all of them, neither have we time. 
Neither can we dwell on all the minutiae of treatment. As 
brevity is our director, we will pass over many things, which 
although of much importance, need not to be repeated, being 
already before the public. We refer the student directly to 
the advice given by Dr Dewees in his first volume of Prac- 
tice of Physic from page ninth to page sixtythird ; on the 
subjects of the qualifications of a nurse, and the faithful dis- 
charge of duty ; on drinks and nourishment; cleanliness ; 
ventilation ; temperature ; dressing of blisters ; injections ; 
management during convalescence, &c. These subjects are 
there well advised, and demand primary attention. We may 
merely remark, that he may be over cautious in the dietetic 
part ; but, this may be accounted for by the great alarm so 
vehemently reiterated by our transatlantic coadjutors in rela- 
tion to irritating the stomach by food. However, a small OUTLINES OP THERAPEUTICS. 
177 
medicament may contain a severer goad, than a large mess of 
panada. 
Our limits rather compel to the aphoristical method of 
writing, and excludes, for the most part, the details of par- 
ticular cases. We think time better employed in offering 
reasons for what is proposed, as we understand the nature of 
the subject. Nothing is therefore concealed, or taken upon 
prima facie evidence. 
1. Synocha. Cauma of Good. 
The qualifying terms used to express the character of this 
grade of the pyrectic habit, have been various ; it has been 
called continued, sthenic, dynamic, and inflammatory fever. 
It proceeds with considerable regularity, and without any 
great depressions. It has some slight aggravations often- 
times, from about six to nine o'clock in the afternoon ; and 
again, slight remissions from three to about six o'clock in the 
morning. When it occurs in low, cold, and damp situations, 
it often partakes some of the intermittent type, and shows 
more evident remissions. 
This habit of fever has its location diffused principally on 
the dense fibrous tissues of the body, either externally, or in- 
ternally ; as may be seen in rheumatism, and the internal 
phlegmatise. In the latter event the fibrous fascia of the or- 
gans are involved in the local affection, whether all the other 
tissues are, or not. (See Nosography, Order I.) 
There is no necessity of making reference to causes, as 
these have been already considered. It may be noticed that 
cold is usually an accessary agent. We have now to contend 
with the primary physiological cause, the effect of the remote 
and exciting causes. 
a. In addition to the phenomena of this grade of fever giv- 
en in the nosography, it may be observed, that the depres- 
sion at the attack is quite inconsiderable ; there is commonly, 178 
SYNOCHA. 
however, paleness, lassitude, shrinking of the surface, some 
irregularity of cardiac action, with running chills, especially 
over the back. Responding action soon takes place ; for, 
although there are some internal congestions, the primary 
changes are not so great as to embarrass the capillary circula- 
tion so extensively, but that it is continued rather freely, and 
a vigorous expanded action soon obtains ; and this is attended 
with more or less universal distress ; sensibility is increased, 
with pain in some part, commonly diffused through the head 
and back, if not more immediately directed to some particu- 
lar organ, which is to become the seat of future inflammation. 
Although there might be some partial, cold sweats for a 
short time, the surface soon becomes hot, and red, especially 
if external warmth has been applied. All sweating soon 
ceases and the skin is dry and hot; as is the tongue also, and 
covered with a white fur, which after a few days becomes 
thick, and brownish; loss of appetite, nausea, and sometimes 
vomiting, exist; thirst is troublesome, and mouth clammy ; 
urine scanty, and high colored, and its secretion sometimes 
quite suspended for a day or two ; often some redness in the 
adnata of the eyes, with flushed countenance; oppressed, and 
sometimes laborious respiration; temperature from 100° to 
106° F. 
Pulse at the attack is small, corded and hard ; it soon be- 
comes large, full, and strong, giving a vibratory sensation to 
the finger ; from ninety to one hundred and ten strokes in a 
minute ; sometimes, however, slow and remitting. Often, 
throbbings in some parts, as if the capillaries possessed a vi- 
bratility of action independent of the heart, and this often felt 
in the head ; watchfulness, and liability to delirium. 
The severity of local concentrations and pain, on dense 
tissues, produce intense reflex actions on the general system ; 
the blood soon becomes visibly altered ; at first, when drawn 
from a vein it coagulates without much, if any pellicle ; the OUTLINES OF THERAPEUTICS. 
179 
succeeding venesections show a florid blood, slowly coagulat- 
ing, with a pellicle more or less cupped. 
If the severity of the disease be not early, and sufficiently 
moderated, a train of phenomena ensue in about seven, nine, 
or fourteen days, bearing some resemblance to the severe 
typhoid habit ; as coma, partial coldness, pulse one hundred 
and thirty, small, tremulous, &c., with great liability to a fatal 
termination. Or, it may be so far moderated, by a doubting 
and temporizing treatment, that it may simulate the slew ty- 
phous form, with internal lesions ; continuing several weeks, 
with a doubtful termination, and perhaps change into some 
chronic form of disease. However, the recuperative powers 
are sometimes so efficient, as to produce a salutary crisis 
under very adverse circumstances. 
a. Methodus medendi. 
After having investigated and exposed the conditions of the 
morbid habit in the last division, the intentions to be pursued 
in the removal of the physiological derangements become 
very obvious, and especially in the diseases of this order. It 
has been abundantly shown by the causes, the phenomena, 
and the successful treatment, that there exists an abnormal 
physiological state, and that this is of a morbidly tonic kind. 
This condition has been styled a state of nosodynamia, and 
exists throughout the entire system, and especially affects the 
minutest capillary circulation, perverting or annihilating their 
functions. We consider this alteration to constitute the pri- 
mary cause of the disease, and that it is of the same character 
in the affections of this order, let it be produced by whatever 
cause, if it is not of the same severity. 
We further say, that disease will continue until this abnor- 
mal state is removed, either by the natural efforts, or as 
assisted by art. We may not be able to mention all the re- 
medies that might be used in ulterior resources, but the 180 
SYNOCHA. 
leading ones ; and these are of a simple character, when 
applied to a sufficient extent, and before secondary lesions 
take place ; when the morbid action subsides into the quiet 
physiological state again, if not interrupted by too much im- 
proper interference. 
b. If a patient is early visited, and before the repelling 
force has established vascular action on the surface, then this 
ought to be encouraged by caloric applied in some agreeable 
form- No method can be more useful than the warm bath at 
a temperature of about 98° or 100° of Fah., but this should 
be accommodated to the patient's feelings. This is often 
inconvenient and of slow preparation. Then let the patient's 
legs and arms be bathed in warm water ; and if not suffi- 
ciently warmed, as he lies in bbd apply mild steam of water, 
more or less, over the body by processes well known. This 
is a preparatory process ; but care should be taken not to 
carry it to a great extent, especially if sweat does not flow. 
If the heat should be urged hard, and continued, there will 
be danger of the capillary arteries forcing the blood into the 
interstitial spaces, and producing lesions of circulation, occa- 
sioning petechiae, or at any rate sudamina, and attended with 
worse effects in the nervous tissues. 
c. If the patient should be already hot, and skin dry before 
visited, then merely bathing the legs and arms in warm water 
will be sufficient. In either event, the first internal medicine, 
except some mild aromatic infusions, will need to be for an 
adult, about a grain and a half or two grains of tartarized anti- 
mony ; or about ten of the antimonial powder, or phosphate 
of antimony. 
The patient will be prepared for the next remedy in about 
one hour, after taking the antimony; and then, unless, perad- 
venture, there should be a free sweat, and mitigation of pain, 
venesection should be practised. If this should be the case, 
the sweat should be continued, and observation made how far 
it may be relied on in affording relief. It is but seldom the OUTLINES OF THERAPEUTICS. 
181 
sweats can be relied on, even in a mild state of disease with- 
out blood-letting, and this we will next consider. 
d. The previous measures have been directed, in order to 
produce as equal circulation as may be obtained at this pe- 
riod ; but still there may be much inequality until venesection 
is resorted to. We now take blood with the intention of re- 
ducing, and even removing the nosodynamic state. We 
therefore say, this remedy is debilitating under all circum- 
stances ; and if it is sometimes followed by an increase of 
energy, it is because it relieves the organic impediments, and 
emancipates their inability of function. 
But, how much blood shall be taken in a severe case of 
synochal fever ? Shall we measure it ? If we intend to arrest 
the chief force of the disease, render it safe and manageable, 
or even palliate it at an after period, when it has not pro- 
gressed beyond the bleeding point, the only measure we want, 
is an equivalent to the cardiac and vascular force. The rule 
must be to bleed to the point of relief; and this implies a 
prostration of the nosodynamic force; and in order to effect 
this, it is necessary, oftentimes, to prostrate for a moment 
the physiological energies. The more early and effectual 
the bleedings are practised, the sooner the patient escapes 
the danger of the disease, and with the loss of the least blood 
in the aggregate. 
In order for this remedy to be the most effectual, let the 
patient remain in his warm bed, in a recumbent position ; 
take from a vein in the arm, in a full stream, until the pulse 
falters, and the patient faints so far as to be unconscious of 
anything, or to deliquium animi. He will no doubt revive, 
for we never knew it otherwise. As the circulations resume 
their courses, by a convulsive effort of the recuperative pow- 
ers, the nosodynamia is annihilated for the present, at least, 
and the exhalations, absorptions, and secretions assume their 
natural courses. Sweat flows, and now is the favorable time 
to continue it by mild and easy measures; that is, continuing 182 
SYNOCHA. 
moderate external warmth, and aromatic infusions, &c. Also, 
camphorated powders, or emulsion. 
This change is more certainly produced, if the patient 
should vomit at the moment of resuscitation, and the small 
dose of antimony was given about an hour previous with a 
view, in part, to this result. 
The tokens of the primary cause having been removed, are, 
an immediate flow of sweat from a previous dry surface ; per- 
haps a change of countenance, and cessation of distress and 
pain, with a milder pulse. The intention now is, to prevent a 
return of the severity of the morbid condition ; and for this 
purpose mild sweating should be continued for twentyfour 
hours, unless pain, heat, &c., should return. In this case 
sweating ceases. The morbid force has again accumulated. 
It now becomes necessary to repeat the bleeding, but without 
intending to produce extreme faintness ; but yet to the point 
of relief from pain, &c. 
The disease is liable to accumulate again and again, if it 
has obtained too much fixity at the beginning, and must be as 
early met by efficient remedies. The bleedings should be 
repeated to the amount of relieving the urgency of the symp- 
toms and rendering the case safe, but not now of suddenly 
arresting the disease. When bleedings are early practised, 
they are well borne afterwards to a great extent, if the neces- 
sity of the case should require them, and the bleeding point 
is not soon passed by. 
A case that has proceeded several days without bleeding, 
opght to be treated very much in the same manner in order 
to render it more safe ; for no further time should be lost; 
provided however, it has not proceeded beyond the bleeding 
point. This is often one of the most difficult questions to 
decide. When the question is rather doubtful in relation to 
copious bleeding, it should still be practised, but in a reserv- 
ed manner. Tt is often so, that the case cannot do well 
without it, there being heat, pain, hard pulse, &c. still pres- OUTLINES OF THERAPEUTICS. 
183 
ent. It may be proper to take some blood from the arm, 
and some by leeches, and observe whether it is well borne, 
and if so it may be repeated, and probably to the point of 
relief and safety. 
After fever has continued without bleeding, until there is 
evidently a failure of vital energy, as manifested by many 
phenomena, bleedings are liable to diminish the recuperative 
powers, so that the patient loses the chances of a favorable 
crisis ; or the chances may be diminished by it. Yet, we 
have often known decided benefits resulting from late bleed- 
ings, and in cases supposed to be very doubtful. 
If the case should be attended with a determination to 
some of the organic viscera, with local inflammation, bleed- 
ings should early be extended, in quick succession, to the 
entire relief of pain. The repetitions should be practised 
as soon as pain returns after being mitigated, and without de- 
lay. Organic changes may take place within twenty four 
hours after a re-accession of pain and inflammation, when it 
had appeared to be removed by previous means. So pa- 
tients at a distance should be provided with accommodations 
of relief, during the absence of the medical adviser. 
Considerable observation is necessary to enable the physi- 
cian to use bleeding to the greatest advantage. The patient 
should always be in a warm state when it is practised. In 
any disease whatever, either acute or chronic, the case will 
do better in the end as well as the time present, to take as 
much blood as is necessary, along with the other aids of rem- 
edies, to remove effectually the morbid habit, and without 
resorting to early tonics or stimulants. When this is accom- 
plished, the healthy actions never fail to replenish the sys- 
tem with sound blood. It is the imperfect cures, or state of 
cachexy following disease imperfectly cured, that has given 
origin to the great complaints of Dr Copland, and others, as 
arising from the loss of blood. Neither are subjects, that 
lose much biood when necessary in disease, liable to suffer 184 
SYNOCHA. 
from plethora afterwards, if the previous disease be fully 
eradicated. The salutary actions soon establish their own 
healthy adjustments, when not interrupted. 
e. As soon as the patient has an opportunity after the first 
process of treatment, he should take a cathartic. According 
to circumstances, the first should be more or less drastic. 
If the principal location of pain should be in the head, it 
should be more drastic. Eight grains of calomel and rhu- 
barb each may be sufficient. If the bowels are in a state of 
paresis, the case may require more, and the intestines need 
to be the more acted on. But this is not commonly the fact 
in the affections under consideration. In ordinary cases the 
neutral salts will be the best; and cathartics ought not to be 
so freely employed as to vellicate, or produce excitation in 
the intestinal mucous tissue. In synochal fever they require 
to be repeated, usually, about every other day. 
f. If the head remains affected with pain and heat after 
the bleedings, whilst the lower extremities incline to be 
ansemic and cold, then the semicupium will become useful. 
Instead of this, blankets may be wrung out of warm water, 
and applied several thicknesses over the feet, and up to the 
hips, and continued until the parts become well warmed. 
This diverts the blood from the plus distended parts to the 
exsanguious. 
If there remains some pain of a part, as the epigastrium, 
or abdomen, apply an emollient epithem. A handful of hop 
flowers infused in water, or spirit and water, thickened with 
wheat bran makes a convenient application for this purpose; 
it should be large and thick, as well as of an agreeable con- 
sistence. If much coldness exists in a part, sprinkle it well 
with black pepper ; this is better than mustard, as it readily 
excites without blistering. If there is much heat of a part 
that is pained, the epithem should be of an emollient kind. 
g. After sufficient rounds of the above applications, if 
there should be found tokens of some topical affection in a OUTLINES OF THERAPEUTICS 
185 
considerable degree internally, leeches, or cups should be 
applied. Leeches to the hard and sensible parts, and cups 
to the soft parts. It appears to be a fact, that after there has 
been a local affection sometime established, the capillaries 
keep up for a time an independent action ; or it may be slow 
of removal, and is greatly expedited by local bleeding. 
These applications should be made early, or as soon as gen- 
eral bleedings have been carried to a considerable extent. 
h. Nothing hitherto has been suggested in relation to the 
fashionable practice of blistering with cantharides ; a prac- 
tice we formerly went deep into, but now think it not often 
necessary in fevers of high action. If the suggested reme- 
dies have been assiduously employed, the disease will prob- 
ably be removed in due time. However, this cannot always 
be expected under the adverse circumstances in which cases 
have to be met, and accommodated. Previous time may 
have been lost, or the patient subjected to some unfortunate 
treatment. 
Epispastics add severe, and oftentimes unprofitable stimu- 
lations to the general system, as well as to the part. They 
ought to be avoided in every pyrectic state attended with 
much heat. Nevertheless, there are circumstances in which 
they may be useful, especially in protracted fevers. They 
should always be of ulterior application. If after the general 
and local remedies already suggested, have been well em- 
ployed, there should still be a local pain internally, of some 
considerable importance, an epispastic may be effectual for 
its removal. 
Nothing can be more out of time than an epispastic to the 
head at an early period, whilst it may be hot, and before the 
general remedies may have been fully employed, and perhaps 
whilst the feet incline to be cold. In such cases, if blisters 
are applied, they should be put on the ancles, after bathing 
the feet and legs in warm water ; at the same time, cloths wet 
in warm water and laid round the head and neck, for a little 186 
SYNOCHA. 
time, will probably be far more useful than epispastics, or ice 
at an early period of the disease. 
Epispastics are sometimes useful in transferring local affec- 
tions from the interior organs to the surface ; and when this is 
their effect, they answer a valuable purpose. But, if they 
fail in it, they only add stimulations to a system already suf- 
fering the severest excitations. In order to insure their good 
effects, they should be delayed until the other remedies have 
been assiduously employed, and in as quick succession as may 
be prudent; then, if there should still be tokens of remaining 
local affection, as for example in pleurisy, a large and effi- 
cient epispastic over the part will very certainly remove the 
local affection, by transferring it to the surface ; whereas, if it 
does not, and at an early period of a bad case, it could not, 
the case will then be the worse for it. However, if the oth- 
er remedies with the epithem, should be sufficient for the re- 
moval of the local affection, epispastics may be wholly dis- 
pensed with, greatly to the comfort of the patient. 
i. General remedies should be most relied upon in every 
case of fever, and even in those local inflammations, which 
seem to demand the whole attention from their severity of 
pain, and injury of organic function- But little lasting bene- 
fit can be gained by topical applications, if the general habit 
is neglected. Our attention^ therefore, should be chiefly di- 
rected to this, even if the pain should be intense; for this 
will be the surest method for its radical removal. 
By practising free and repeated bleedings, the general mass 
of blood is deprived of its excess of coagulable lymph, and 
saline substances, which are proved to exist in the synochoid 
diathesis at least; it circulates more freely, and gives less 
stimulations, aside from the force of distention. The absorb- 
ent veins more greedily take up serous fluids, and the matter 
of effusions, to replenish the vessels, and this they accomplish 
very rapidly, in order to produce an equilibrity in the circu- 
lating masses; provided the absorbents are sufficiently set at OUTLINES OF THERAPEUTICS. 
187 
liberty from their embarrassments, and not enthralled by ton- 
ics and stimulants. 
j. The practice of using opiate anodynes to mitigate pains 
in any form of fever, and local inflammations, is greatly to be 
deprecated; it is not only unjustifiable, but should be es- 
teemed unpardonable ; at least, after having heard a warning 
voice. Whilst these are used no benefits can be obtained by 
the radical treatment. In fevers of the synochoid character, 
the state of the diathesis may be such, that a single ordinary 
dose may put the case out of the reach of all remedies ; and 
the greatest proportion by far of fevers of this climate, are of 
this diathesis ; neither are they scarcely more justifiable in the 
reputed typhoid habits. Opium in all its modifications aggra- 
vates the morbid habit more than alcohol, or any other of the 
higher stimulants. 4 . 
The popular composition vulgarly called Dover's powder, 
is used extensively on the supposition, or pretence, of the 
hurtful effects of the opium being altered, or neutralized by 
its other ingredients. There is no modification of opium that 
alters its effects when given in a competent dose to affect the 
system. The black drop, and morphia have very nearly, if 
not entirely the same effects in stimulating the general system, 
in an adequate dose to ease pain, that the extract of opium 
has. These pretences are erroneous and delusive ; for we 
have seen the latter as certainly fatal as the tieute upas, if not 
quite so speedily. 
These articles may occasionally be used in some conditions 
of distress, of the more strictly neuralgic kind, to much tem- 
porary benefit; also, a single dose at the onset of severe dys- 
entery, cholera, and ataxic fever; but after even these disea- 
ses have passed the stage of extreme irregularity, they add 
greatly to the danger j indeed, every condition of the estab- 
lished pyrectic habit is made worse by them, if not irreme- 
diable. It is probable, that for forty years past, opium, and its 
preparations have done seven times the injury they have ren- 188 
SYNOCHA. 
dered benefit, on the great scale of the civilized world. The 
proper discriminations have not been attended to. 
It should be kept in mind, that these strictures in relation 
to the use of opium, are intended for that state of disease 
more Strictly called fever, in which there is more or less of 
internal visceral inflammation, involving the nutritive organs, 
and of course directly affecting the ganglial system of nerves. 
We contend, that in all such instances opium is more or less 
injurious. Still there are instances of fever in which the local 
affection concentrates on the external tissues, in which the 
nerves of external relation are especially distributed ; such, 
for instance, as gout, rheumatism, neuralgia, tetanus, &c. 
Opium often appears to have different effects in the local af- 
fections of these tissues, and it may be used to relieve pain 
with great advantage ; and also, as an excitant of the capil- 
lary tissues, it may be so managed as to promote a restoration 
of healthy action sometimes. The disease is here located in 
other tissues and under the dominion of another order of 
nerves. Still, as the state of febrile excitation is essentially 
supported by the nutritive tissues, the use of opiates should 
still be much restricted in ordinary cases. 
The immediate soothing effects of narcotics are readily ap- 
preciated, whilst their deleterious influences are concealed, 
and only to be discerned in their results as combined with 
the phenomena of visceral disease ; they are not, therefore, 
duly appreciated by every observer. If the patient with 
moderate fever, should have delirium, subsultus, and a fear- 
ful increase of pulsatory action a day* or two after their use, 
it is easy for the friends, and natural to the adviser, to con- 
ceive their effects to be the unavoidable consequences of a 
bad case. Their use in slow fevers is about alike pernicious. 
Even Sydenham might not have had so many unfortunate ca- 
ses to mourn over, had he as well observed the ulterior re- 
sults of his soothing draughts, as he did the temporary tran- 
quillity his treacherous medicine produced in his patients. We OUTLINES OF THERAPEUTICS. 
189 
will leave negative practice after remarking, that in the affec- 
tion we are treating of, all medicine and regimen, in medical 
language styled stimulating, should be avoided. 
k. During the progress of synochal fever, considerable ad- 
vantage is gained by small doses of some antimonial prepara- 
tion, one given in the morning about 8 o'clock, and at about 
the same hour of the evening. The quantities ought to be 
just sufficient to excite a slight nausea, and if there should be 
any thing in the stomach that ought to be dislodged, it may 
excite emesis once or twice. If, however, the dose should 
not be so great as to excite even nausea, it will have a bene- 
ficial effect in promoting the secretions, and inducing compo- 
sure. If we are not greatly deceived, this article has many 
times produced a tranquillizing effect in fever, so that the pa- 
tient obtains more rest at night. It also favors an easy and 
salutary crisis, by directing the efforts of the system to some 
of the emunctories, as the skin, kidneys, or intestines. It 
opposes the morbidly rigid state of the tissues, and relaxes 
them, as it enervates the whole system ; that a state of inner- 
vation exists in synochal fever, is manifested by every phe- 
nomenon. 
Whilst we favor the temperate and easy use of tartarized 
antimony, its very liberal use ought to be deprecated. By 
giving it every few hours for much length of time, the subject 
becomes irritated and exhausted ; it spoils the appetite for 
every thing in a short time, and leaves an increase of sensibili- 
ty and tenderness in the mucous tissue of the primse vise. It, 
finally, adds irritation to the whole system. From half a 
grain to one and a half, twice or thrice in twentyfour hours, 
will be sufficient to answer the intention. It is better to be 
given in the form of a pill, so that it may have a slower effect. 
I. It is a too common fault to oppress the stomach with 
many things at once, called alterative medicines, which can- 
not have any good effect. They commonly consist of con- 
traries, one for this symptom, and another for that; and aside 190 
SYNOCHA. 
from being irksome and oppressive, they render it impossible 
to distinguish, or ascertain whether any particular medicine 
has a beneficial, or injurious effect. Perhaps nitre, camphor, 
senega, rhubarb, capsicum, elixir paregoric, magnesia, 
cream of tartar, castor oil, valerian, snake root, Fowler's so- 
lution, calomel, opium, wine, with many et ceteras,. nearly all 
at once, being ten times more than the gizzard of a cormorant 
could endure, or digest in good health. 
m. The drinks may be of a mild, diluent, and acidulous 
kind. Diluted lemonade, or vinegar and water; barley, or 
crust water ; plain water with a small teaspoon-full of nitrous 
ether ; supertartrate of potash dissolved in water with white 
sugar, or not. The best in synocha, may be bi-carbonate of 
potash and vinegar, in adequate proportions of neutralization, 
well diluted; it may be used as a laxative. We may allow 
at all times, when the stomach will kindly receive them, rice 
water, gum water, arrow root, gruel, panada, sweetened or 
not; weak broths, and other mild nutritious drinks. . Some of 
these in succession, as the case may seem to require. 
Notwithstanding patients often call for cold drinks, they 
had better take them moderately warm, unless in very small 
quantities. There are some conditions in which a free use 
of cold water may be beneficial, after some days. (Sec. xlix. 
2, f.) After the evacuations have been pretty thoroughly 
made, if there should be intense thirst, with external equal 
heat of about 104° or 106° F. cold water drank freely may 
be salutary, by absorbing caloric and lowering the tempera- 
ture to the sweating point. The surest way is, to keep it 
from the patient until he has desired it for some time, and 
then admit it pretty freely; it dilutes, relieves the erethism, 
and if it induces sweat it will be useful, but if chills, hurtful. 
If there are tokens of internal inflammation, it ought not to 
be given, for the cold may add much to its tonic nature and 
increase distress, with pain. As it is often a doubtful reme- 
dy, it should rather be avoided, and only allowed in small OUTLINES OF THERAPEUTICS. 
191 
quantities, often repeated, unless there are sure tokens of an 
ascendancy of action in the centripetal circulations. (Sect, 
xlix. 1, f.) 
n. Cold applications externally, by water, vinegar, ice, &c., 
should be avoided in the early stages of every kind of fever, 
even if there should be partial heats of considerable intensity. 
Whilst there are permanent engorgements, or active inflam- 
mation in the visceral membranes of the head, thorax, or ab- 
domen, or of their organs, the tonic effects of cold applica- 
tions by air, water, or any other medium, will prove injuri- 
ous ; even if they should not produce chills, and seem sooth- 
ing to the patient. They will more certainly be injurious, if 
there exists any partial coldness on the surface or extremi- 
ties. The internal tissues should first be relieved, by the 
proper curative treatment, of their turgidity, and phlogosed 
condition, or they will become more fixed by the constrin- 
ging influence of cold. 
Notwithstanding, after these objects are obtained, and an 
universal high heat prevails on the surface, indicating rather 
a simple state of orgasm than inflammation, then cold appli- 
cations may assuage the erethism of the tissues externally and 
internally, and by diminishing heat, relieve the system of 
considerable irritation. The light delirium unattended with 
coma, is sometimes suddenly dissipated by them, yet, they 
ought not to be so freely used as to produce coldness. How- 
ever, their use may commonly be dispensed with, if the pa- 
tient has had the privilege of judicious treatment ; it is only 
occasionally, in general practice in this climate, that they be- 
come necessary. 
o. We have alluded to the principal of the remedial agents, 
that are commonly required for the treatment of synochal fe- 
ver. We allow it is a mere sketch, and will be made more 
complete in our expositions on other habits of fever. As the 
elements of the morbid habit are few, the treatment for its 
removal is simple and plain. Much discernment, however, 192 
SYNOCHA. 
is necessary in applying enough, and not too much. The 
remedies require to be repeated, in proportion to the urgency 
indicated by the phenomena, and as early as the circumstan- 
ces of the case may require ; always having it in view, that 
if the case is not getting better, it is getting worse, on ac- 
count of the liability of organic changes, and alterations of the 
circulating fluids. The case cannot be rendered safe, until 
the centripetal circulations overbalance in activity the centri- 
fugal ; for, until then, effusions and alterations of the tissues 
are liable to take place, and the absorptions cannot effect res- 
olution of the congestions, and inflammation. (Sect. xlix. 2, f.) 
p. Antiphlogistic Regimen. 
Certain extraneous management becomes necessary in the 
treatment of all diseases of excitation, but especially in fe- 
vers of exalted action, and therefore may be noticed here. 
It consists in avoiding casual stimulations, and is therefore 
called theantiphlogistic regimen. 
1st. It consists in avoiding all unpleasant external impres- 
sions on the senses ; as light; the sight of unpleasant ob- 
jects, whether they be persons or things ; thought and calcu- 
lation ; especially all resentments, and disagreeable associa- 
tions. 
2d. The avoiding all offensive smells, so that all substan- 
ces producing them be removed ; as well as excess of am- 
monia and aromatics, not in themselves offensive. 
3d. All loud and disagreeable sounds, as those of fire- 
arms, tumults, creaking of shoes, conversation, and whisper- 
ings, are injurious. Let there be no arguments or contradic- 
tions, either with the patient or between others, but courte- 
ousness, and affectionate behavior. No conversations should 
be had with the sick, except necessary. 
4th. Avoid unnecessary motion of the sick ; let there be 
but little sitting up, perhaps none, but an easy posture in OUTLINES OF THERAPEUTICS. 
193 
bed ; all pressure on the body, except as some movement in 
bed is necessary, should be done in the easiest manner. 
5th. Thirst should be appeased by pleasant acidulous, and 
mucilaginous drinks, first cleansing the mouth. 
6th. Avoid all stimulating food ; if there exist any offen- 
sive substances in the first passages, their removal becomes 
necessary by light emetics, or eccoprotics. 
7th. The temperature of the room should rather be agree- 
able to the feelings of the patient, having no excess of heat, 
nor exposures to cold; yet, having sufficient ventilation, or 
change of air. The circulation of air produced by a fire in 
a room, is commonly sufficient, unless too much heat is in- 
duced. 
2. Meningitis. 
a. See synopsis of particular character in nosography. It 
is also styled cephalitis, phrenitis, &c. We consider menin- 
gitis most expressive .of its seat, which is in the membranes 
of the brain ; and infer from the phenomena, and post mor- 
tem appearances, the dura mater to be essentially affected, 
and associating the arachnoides and pia mater. The pyrectic 
habit is synochoid. 
The constitutional state of the system is the same as in 
synocha. It may have a primary location in the head, nr be 
transferred there after some continuance of fever, with a loca- 
tion in some other part, as in the instance of parotitis, and 
gout. In this event it has been called symptomatic ; yet, it 
is of the same character, and requires similar treatment. 
The local affection is only changed. 
It is one of the most formidable affections incident to the 
human system ; passing its stages with great rapidity, and 
when attended with wild looks, deep breathing, catching at 
supposed objects, wishing to be gone, exposing private parts, 
almost uniformly proves fatal, and often on the third, or filth 
day from the attack. 194 
MENINGITIS. 
The pulse is constantly contracted, and hard, but does not 
always intrude on a careless observer the amount of danger 
existing at the attack. A few hours delay of the most effi- 
cient treatment, may render the case irremediable. Inflam- 
mation in the meninges of the brain, is more liable to be at- 
tended with pain and delirium ; but when in the pia mater and 
substance of the brain, less pain, and more coma attend it. 
However, they are often so complicated, the diagnosis be- 
comes difficult. The treatment may be the same, only mod- 
ified to suit the urgency of the state of the disease. 
b. Methodus medendi. 
The most efficient1' remedies for the removal of synochal 
fever should be directly employed. Some irregularity of 
heat, pains in the limbs and head at the onset, are liable to 
occur, before delirium seizes the subject. In such cases a 
pediluvium, or even semicupium may be very proper, to 
equalize action, and prepare for subsequent measures. 
Bleed freely to faintness, or to the point of relief. Re- 
peat as the pulse' and other phenomena indicate. The first 
twentyfour hours will decide the case; as whether the mor- 
bid impulses will produce organic changes, or whether the 
absorptions will sufficiently be brought into action and pre- 
vent them. The surface will sometimes incline to be cold, 
whilst the most destructive changes are taking place internal- 
ly. By keeping up external action, a part of the morbid 
force may be diverted from the internal tissues. In this case 
epispastics may be applied to the ancles. 
Repeat the bleedings when the patient can tell of a return 
of pain ; but if delirium be present, as soon as the pulse has 
recovered sufficient energy. When it becomes imprudent 
to take any more blood from the arm, apply leeches to the 
temples, and behind the ears, and cups to the sides of the 
neck. OUTLINES OF THERAPEUTICS. 
195 
Cathartics should be diligently employed, and they will be 
made more effectual, and more useful, by mingling with them, 
occassionally, a grain or two of tartarized antimony. 
After the bleedings have been rather freely practised, if 
the head should be hot, apply cold lotions of water and vine- 
gar, by means of linen cloths, and often renewed, as in syn- 
ocha. If these do not give relief, and if the surface remains 
warm, with pain in the head, or delirium, then have recourse 
to the cold dash. Some extreme cases of synochal fever 
may require this remedy, but it was purposely omitted for 
this place. But, even in meningitis this is hardly admissible, 
if the surface is cold and the countenance pallid. The man- 
ner of using it is as follows : 
Place the patient in a convenient condition, with the head 
upright. A large tub may be necessary, in which the patient 
may sit on a folded blanket, or stool. Let cold water be 
poured from a coffee or watering pot, in a steady manner, on 
the crown-of the head, in a stream of one third, or half an 
inch in diameter; at first about two feet above the head, and 
soon raised to six or eight feet. This may be continued 
from five to fifteen minutes, or until the pain ceases, or until 
some circumstances may forbid its use. If the pulse should 
become very small, and pain removed, it should be discon- 
tinued. 
The patient should then be wiped with warm cloths, and 
laid in a moderately warm bed. If no important organic 
changes have taken place,the pain may be entirely removed; 
but may again return, when the dash should be repeated, and 
probably leeches also. This process will now have the ef- 
fect of exciting internal absorptions, whilst it could not until 
the vessels had been freely emptied. In other respects, the 
patient should be treated in the mildest manner, with strict 
regard to the antiphlogistic regimen, which has already been 
mentioned. 196 
SCLEROTITIS. 
3. Sclerotitis. 
It will not be compatible with our design to detail all the 
minutiae of treatment of individual affections, nor is it neces- 
sary. For, the principles of the order have already been 
explained, and will further be illustrated ; we shall be oblig- 
ed to abbreviate some, and omit others of less magnitude. 
Many valuable treatises on diseases of the eyes are now 
extant. All that wi'l here be necessary to be remarked, is, 
that acute inflammations of the fibrous tissues proceed with 
great rapidity, and with intensity of pain. They are prone 
to be as persistive in the sclerotis and cornea, as in any other 
of the same order of tissues in the system. A delay in the 
removal of the affections endangers the integrity of the or- 
gan, and produces a liability of spoiling vision. 
There ought to be no delay in the treatment ; and as soon 
as manifest inflammation exists, which will be known by the 
continued severity of pain for a few hours, it will be the 
greatest saving of blood, of time, and of pain, to arrest it at 
once. This may be done by closely pursuing the antiphlo- 
gistic treatment to the point of relief. 
Bleed from the arm until pain ceases. Previously, how- 
ever, use a pediluvium. After bleeding, a slight emetic, fol- 
lowed by sweating. If pain returns, again bleed ; or apply 
leeches on the temples, and behind the ears; cups on the 
sides of the neck may be tried. Cathartics. Darkness. See 
antiphlogistic regimen. Avoid cold. 
Flowers of poppy well beat, and moistened with milk and 
water, should be applied largely over the eye, about of the 
temperature of the blood ; or, 15 grains of opium dissolved 
in an ounce of water, and biscuit enough to make a soft poul- 
tice. After two or three days, use a weak solution of acetate 
of lead in water, of such a temperature as is most agreeable, 
by soft rags. Warm applications are usually better than cold. 
The wounds produced by couching, and extracting the OUTLINES OF THERAPEUTICS. 
197 
cataract, are often associated with general disease before 
inflammation begins. (Sect. xx. 12.) So they must be treated 
chiefly by general remedies, when inflammation supervenes. 
4. Tonsillitis. 
Styled amygdalitis, angina tonsiljaris. Proceed in the 
treatment on the same principles. Semicupium ; venesec- 
tion ; an emollient poultice extending from ear to ear ; inhal- 
ation of the steam of vinegar and water; sweating ; an 
emetic. 
The treatment of the three following affections in the noso- 
graphy, may proceed on the same principles, with necessary 
modifications. , 
5. Linguitis. 
In addition to the treatment in the last article, cut the 
fanular veins ; if this is'not attended with free discharge of 
blood, scarify each side of the tongue sufficiently deep for 
this object. Apply an epispastic-to the throat. Same con- 
stitutional treatment as before mentioned. If suffocation 
becomes threatening, then resort to tracheotomy. 
6. Pharyngitis, Laryngitis, and Tracheitis. 
These being of a similar character may be treated together, 
arid indeed they are often combined. The two former are 
most incidental to adult persons, chiefly males, and such as 
have passed the acme of life ; whilst tracheitis most commonly 
appears in children. No diseases are more evidently excited 
by cold than all of these. Notwithstanding, tracheitis some- 
times arises from an extension of faucial inflammation in scar- 
latina, &c. 
The discriminating phenomena are named in the nosogra- 
phy, and may be found more particularly in many books ; 198 
PHARYNGITIS, LARYNGITIS, AND TRACHEITIS. 
yet some will be mentioned in the following pathological dis- 
criminations. 
It was found necessary to make two varieties of tracheitis ; 
and in Order II. Genus 4th, mild tracheitis is placed, as be- 
ing more particularly confined to the mucous tissue, and of 
less severity. ' 
Tracheitis, or croup in its severest form, as in the present 
instance, always involves the subjacent fibrous tissue ; and this 
has been amply demonstrated as being the supporting and 
connecting tissue attached to the tracheal cartilaginous rings 
and muscles, and extending into the bronchia. 
These three affections have much identity of character, 
yet the local determinations produce gome modifications in 
the phenomena. In laryngitis and tracheitis the same tissues 
are affected, but in different degrees. In pharyngitis the 
same kind of tissues are affected, but the difference of func- 
tion to be performed by the tissues, displays a very modified 
train of phenomena. In the one case respiration is affected, 
and in the other deglutition ; whilst the character of the dia- 
thesis is the same. , 5 < 
In severe tracheitis occurring in children, there is com- 
monly but little tissual tumefaction, but a fibrino-albuminous 
exudation escapes into the trachea, and receives some con- 
densation, forming a coagulum of some density. It commences 
at the rima glottidis, extending downwards, but of less dimen- 
sions, and often reaching the bifurcation of the trachea. At 
first it adheres to the mucous membrane with considerable 
force ; but in a few days becomes, loosened, and then de- 
tached. The excitation of the mucous membrane often 
extends into the bronchial ramifications. 
This exudation is very similar to that which appears in 
severe pleuritis, from a serous tissue, whilst the polypus of 
tracheitis comes from a mucous tissue. It is not peculiar to 
either of these tissues to yield lymph when excited, unless 
when their subjacent fibrous tissues are affected. The one OUTLINES OP THERAPEUTICS. 
199 
yields serum as in hydrothorax, the other mucus as in ca- 
tarrh, and also mild tracheitis. In the instances of the dis- 
eases under consideration, we infer, that the subjacent fibrous 
tissue is also affected ; and so examinations show. 
In the instance of laryngitis and pharyngitis, the local 
concentration is severe, and effusions take place into the cel- 
lular tissue more or less, on both sides of the fibrous tissue of 
Reisseissen. Tumefactions suddenly appear, which by com- 
pressing the larynx and pharynx, impede respiration and 
deglutition, and are very liable to produce suffocation, if not 
arrested. No doubt the tumefaction impairs the function of 
the pneumogastric nerve, and hastens the fatal event. 
Examinations have shown these tumefactions of sero- 
fibrinous matter to be extensive, and in some cases more 
fortunate, -to have ended in the formation of abscesses ; the 
tissues being thickened. Some cases of tracheitis in chil- 
dren have been attended with effusions around the outside of 
the fascia of Reisseissen, as well as the formation of polypus 
in the trachea. In some instances the polypus has been 
thrown out quite entire, after becoming loosened from its 
attachments, which are the strongest at the posterior part of 
the trachea. It is liable to produce sudden suffocation, either 
by filling the trachea, or being partially detached. 
All three of these affections, then, consist in a local con- 
centration of the constitutional affection upon the fibrous and 
mucous tissues of the pharynx, larynx, and trachea ; some- 
times most in one spot, and again most in the other, consti- 
tuting the different appellations in medical nomenclatures. 
They are mere modifications of the same disease, acknow- 
ledge the same causes, and are cured by very similar reme- 
dies. They are often complicated in the same subject. 
a. Alethodus medendi. 
The most fatal error that ever crept into pathology, is that 200 
PHARYNGITIS, LARYNGITIS, AND TRACHEITIS. 
which teaches these affections, and many others of similar 
character, to be of primary local origin. We have labored 
this thesis in our pathological investigations, and hope, for the 
cause of humanity, the arguments will be convincing ; if not, 
then the same misplaced and inert treatment will be contin- 
ued, to the loss of life, and prejudipe of the profession. 
Even Dr Good must have had very imperfect views of the 
character of laryngitis, in advising " epithems of pounded ice, 
applied internally also, "gargles of ice-water acidulated." 
b. The medical reputation of the United States suffered 
not a little obscuration, and the nation an irreparable privation, 
in the death of General Washington at the very clbse of the 
last century, by an imbecile, doubting management. It is 
not pretended but that he was himself in fault ; so like many 
others in high stations, skilled in everything, except what re- 
lates to the character of disease. After an exposure in 
December, on horse-back, he had hoarseness and sore throat, 
but called it a cold, and said in the evening, " Let it go as it 
came," as stated in Paulding's Life. So nothing was done. 
He read newspapers on the evening of Friday, and " had 
been remarkably cheerful all the evening." Went to bed as 
usual. Between two and three o'clock had a rigor ; but 
made no alarm, and still had nothing done. Early in the 
morning of Saturday was found, " breathing with difficulty, 
and hardly able to utter a word." Whenever he attempted 
to swallow, he became " convulsed and almost suffocated;" 
at the same time "some phlegm followed" the return of 
vinegar, molasses, &c. attempted to be swallowed. This 
was, no doubt, a complicated case of laryngitis, associating 
other contiguous tissues, and producing pharyngitis, with 
some appearance of tracheitis. 
An overseer attempted to bleed, without any previous pre- 
paration by external warmth ; he obtained half a pint, when 
Mrs Washington interfered, arid had it stopped. Dr Craig 
arrived next day, at nine o'clock, A. M. tie put an epis- OUTLINES OF THERAPEUTICS. 
201 
pastic on the. throat; took more blood ; again bled ; and 
repeated at three o'clock, P. M. No account is given how 
much, but it " ran very slowly, appeared very thick," and 
no doubt it might have been added, was very dark. Bleeding 
without other adjuvants is commonly useless. However, 
" calomel and tartar emetic were administered, without ef- 
fect." At five o'clock, P. M., he said, " I find I am going, 
my breath cannot continue long." He languished until about 
ten o'clock, P. M., and expired, December 14, 1799. 
From the time of the rigor about twenty hours. ' 
No doubt this case demanded the most efficient constitu- 
tional as well as local treatment, and at an early period. At 
a later period, there might have been some chance of suc- 
cess. It might be inquired, at what later period of the dis- 
ease there existed a fair chance of relief. JHis case required 
diligent attention at the time he went to bed ; then it is pro- 
bable a pediluvium, and an emetic followed by sweating, 
would have been sufficient ; especially with venesection after 
the surface became warmed. 
At the time of the rigor, the morbid changes had proceeded 
so far as to require very vigorous measures. He then ought 
to have taken the universal warm bath for twenty minutes ; 
or mild steam well applied might have been a substitute, but 
never an equivalent. Then copious bleeding, even to faint- 
ness, closely followed by an emetic of tartarized antimony. 
Warmth continued, with diluent aromatic drinks, as hyssop, 
pennyroyal, &c., followed by copious and continued sweats. 
Instead of an epispastic to the throat, as was done in this 
case, an extensive emollient cataplasm of linseed meal and 
wheat bran ; first anointing the throat with the anodyne sapo- 
naceous balsam, or some camphorated oil. Also, cataplasms 
with mustard seed flour, to the whole of the f^et. All should 
have been done and repeated in the most perfect manner, 
under the immediate inspection of the physician. 
But, no physician saw him, to prescribe, until Dr Craig 202 
PHARYNGITIS, LARYNGITIS, AND TRACHEITIS. 
arrived at 9 o'clock, A. M. Important time had been lost ; 
the appearances were inauspicious. Still, however, the pa- 
tient ought even at this late hour, and in a disease making 
awful strides, to have had the chances of relief, and this was 
the last hour that presented much prospect. As nothing can 
be gained in these cases if caloric, in a humid form to the 
surface is neglected, he ought to have had all the measures 
diligently applied, as mentioned before, at 3 o'clock, the 
time of the rigor. 
An emetic was indispensible at either of the periods. Al- 
though the difficulty of swallowing was great, yet at either 
period it is probable a little of a concentrated solution of tar- 
tarized antimony might have been got down, or at any rate 
by frequent trials, some might have been absorbed in the 
faucqs. At the same time the epigastrium might have been 
bathed every ten minutes with a warm and strong solution of 
the same. Furthermore, a scruple of the same article in so- 
lution, might have been injected as an enema. By persever- 
ing, there is but little doubt, emesis might have been effect- 
ed. The influence of this process on the general capillary 
systems was as much needed, as its utility in dislodging 
phlegm from the trachea. 
c. In all these cases, the centrifugal circulations greatly 
overbalance the activity of the absorbent processes, and no 
effectual benefit is obtained, until the centripetal processes 
obtain an ascendancy. When this is accomplished, it con- 
stitutes a crisis, or at least a partial one. Then only perse- 
vere, and the case will be safe. If, however, it should have 
proceeded so far, that very extensive accumulations have al- 
ready formed in the tissues, and the recuperative powers are 
greatly exhausted, and embarrassed, this fortunate termination 
cannot be calculated on with much certainty. Yet, a proper 
arrangement, and operations in quick succession, often make 
astonishing changes in the morbid economy. OUTLINES OF THERAPEUTICS. 
203 
The treament in all respects, may be continued, as more 
particularly specified in synochal fever. 
d. Children affected with tracheitis require delicate treat- 
ment, but it must be efficient in proportion to the severity of 
the case. The bronchial and tracheal effusions more easily 
and more readily take place than in adults ; and also, the ca- 
pacity of the trachea being relatively small, it is liable to be 
soon obstructed. Besides this, perhaps in seven eighths of 
the cases, the affection extends into the lungs, rendering it 
complicated with pneumonitis. But, the stridulous cough is 
an early monitor to sound the alarm, and it is well if this 
warning voice is heeded ; for, when early and efficient rem- 
edies are employed, the disease may quite certainly be arrest- 
ed. But, in a single hour, or a few hours, it may put every 
remedy at defiance. 
It must, however, be distinctly understood, that the effu- 
sion constituting the polypus is not always, present in a very 
considerable degree ; for, the local affection in children may 
partake much of the character of laryngitis in adults. The 
mucous membrane lining the margin of the glottis, epiglottis, 
cord® vocales, and even lower down, from a sudden turges- 
cence, soon thickens by inflammation; the passage becomes 
narrowed, and finally obliterated, if the disease is not arrest- 
ed. When this state occurs the stridulous sound of the voice 
cohtinues ; but when the effusiop furnishes the polypus, the 
croupy sound becomes more indistinct, or lost. In this 
case demulcents are of more use than detergents, whilst the 
constitutional treatment should be the same. 
The pathological state of the system has already been 
shown, if not satisfactorily demonstrated. Notwithstanding 
the doubts of some, who may still linger on the false thesis 
of this being a " primary local " affection, we must insist, 
that the warm bath acts as a primary auxiliary in restoring 
the normal actions, and better preparing the way for other 
remedies. It is of easy, and perfectly safe management in 204 
PHARYNGITIS, LARYNGITIS, AND TRACHEITIS. 
children, attended with no more risk than the pediluvium, 
with a little care. A temperature of 98° or 100° F. by the 
thermometer ; or without it, a trial on the part of the nurse 
may be sufficient. Let the child remain in it ten or fifteen 
minutes ; then be folded in a warm blanket. Dress at leis- 
ure in a warm place of 80° F. Repeat it, if sudoresis does 
not well succeed, in co-operation with the other remedies. 
The cataplasm just mentioned, or some other of similar 
character should be applied extensively to the throat, instead 
of a tormenting epispastic ; it should extend on to the ster- 
num, taking care that it keeps its place, and does not grow 
cold, by frequent renewal. When discontinued, apply large 
bats of cotton wool in its place. The part should be embro- 
cated as above, with the saponaceous, anodyne linament, or 
anodyne balsam ; or camphorated oil of almonds. Also, 
take a heated brick, and wrap it around with a clean napkin 
wrung out in hot water, and lay it a few inches from the 
throat, as the child lies in bed, so that a mild steam will mix 
with the common air of respiration. Cold air ought not to 
be breathed. 
Soon after coming from the bath, bleeding should be prac- 
tised, and it will be best to take freely at first, for thi^ may 
save after bleedings; if syncope should be induced, it will 
become more useful. This ought to be done in a recumbent 
position, or faintness may be produced, before a sufficiency 
is taken to make a lasting impression. In yOung children the 
back of the hand is the most convenient place to get the 
blood. A vein can commonly be felt if not seen. We have 
often reached a vein, without seeing or feeling it,' by passing 
a lancet under the skin. 
Without delay, an emetic should be given ; the compound 
syrup of squills, or hive syrup will be the best, and most 
convenient. After it has proved emetic, it should be con- 
tinued in very small doses every hour or two, and in a man- 
ner to occasion a slight emesis occasionally, but without fa- OUTLINES OF THERAPEUTICS. 
205 
tiguing the child too much. The prime object, after dimin- 
ishing the force of the disease, is, to soften and expel the 
dense effusion in the trachea, and in a gradual manner. 
Whatever promotes a secretion of. mucus in the trachea, has 
the effect of loosening the concretion from its attachments. 
AU the means hitherto suggested tend to this, and especially 
the syrup. In addition, as soon as opportunity presents, af- 
ter the first round of remedies, one grain of calomel may be 
given every hour, or until it moves the bowels ; yet much 
purging should be avoided. If it should operate ever so 
much, avoid every kind of opiate; for nothing in all the mate- 
ria medica will so soon dry the fauces, and suspend the se- 
cretion of mucus, as well as aggravate the fever. 
Further, for the purpose of increasing the secretion of mu- 
cus, and detaching the dense effusion, take half a drachm of 
the powdered root of the polygala senega, one drachm of 
powdered liquorice root, and one scruple of nitrate of potash ; 
digest half an hour in half a pint of hot wrater. Give half a 
table spoonful often, according to circumstances. Much 
judgment is necessary in adapting the particular management 
to suit the circumstances of the case ; therefore experience 
and common sense are necessary auxiliaries. Armed with 
these, all overdoings and quack nostrums will be-shunned. 
7. Pleuritis, and Pneumonitis. 
a. By turning to the Nosography, (page 94, note,) it will 
be seen, we have attempted to follow out the tissual seats of 
the different affections of the lungs, although it is acknowl- 
edged to be difficult in some respects. The tissues are in- 
timately blended ; when one is affected, others are liable to 
be associated in the morbid state. For the most part, sepa- 
rate tissues are first affected, and a knowledge of these is of- 
ten of use in the treatment. ■ ' 
Dr Cullen blended all the acute affections of the lungs in 206 
PLEURITIS, AND PNEUMONITIS. 
the article pneumonia; and it is true the 'treatment on gener- 
al principles, must be guided by the intensity of the phenom- 
ena in a given case. Yet, early discriminations have their 
use, and may in some measure obviate the necessity of per- 
cussion and the stethoscope ; for these are chiefly of use to 
detect the lesions, or sequences, when perhaps but little ben- 
efit can be rendered, after these have occurred. Yet often 
both these methods aid the diagnosis. 
b. Our divisions will place some of the varieties in other 
orders. All we can with propriety consider here, are those 
at the head of this'article ; and it will be seen, that variety 
4th, the cellulosa, is merged in variety 1st, fibrosa ; for the 
effusion is supposed to be lodged in the cellular tissue, as in 
other instances where the fibrous tissue is the essential seat 
of the fdfeclion. 
) 
In pleuritis the effusion is thrown into the sacs, of the pleu- 
ra, and in pneumonitis, strictly so called, into the connecting 
cellular tissue of the parenchyma of the lungs. These two 
varieties are therefore identical in character, and require very 
similar treatment at the onset ; notwithstanding the results 
may be very different. 
c. A very violent local concentration may seem to in- 
volvp all the tissues as an organ ; as may be seen in complex 
inflammation, in Order 4th. The effusions in epidemic pneu- 
monia do not form phlegmonoid tumors, but universal' tissual 
exhalations. 
The treatment in pneumonitis and pleuritis requires to be 
quite similar ; but the phenomena are very dissimilar in point 
of obtrusiveness. The former is seated in the bronchial fas- 
cia, distributed through the parenchyma of the lungs, of yield- 
ing texture ; it gives little pain, and excites not great pulsa- 
tory action, but oppresses respiration. 
Pleuritis, seated on the investing fascia of the lungs and 
serous sacs, produces severe pain, intense reflex action, writh 
vascular excitation. Respiration would be quite free, were OUTLINES OF THERAPEUTICS. 
207 
it not that the intercostal muscles do not admit of their usual 
extension and contraction ; they cannot move without intense 
pain ; respiration is mostly performed by the movement of 
the diaphragm. The pain, by a series of harmonies, con- 
centrates at a point, whilst the local affection is quite exten- 
sive in the sac. 
In pneumonitis the phenomena are masked, and liable to 
deceive, whilst in pleuritis they are obtrusive, and tell all 
that transpires. Pneumonitis is liable to terminate in circum- 
scribed tumefaction, followed by imposthumation ; whilst 
pleuritis affords effusions of false membranes, and serosity, 
into the thoracic sacs of the pleurae, constituting empyema. 
These effusions in severe cases take place in a few hours 
from the attack. 
As the sero-fibrinous effusions take place very.quickly af- 
ter the attack of pleuritis, and as recoveries are frequent from 
even severe attacks, the effusions often remain in considera- 
ble quantity for several months, before they are absorbed, 
without very material injury to the patient. And even then, 
the more dense fibrinous parts remain in the form of false 
membranes, yet occasioning but little inconvenience. 
There is but little cough, or expectoration in simple pleu- 
ritis ; and indeed, pneumonitis may proceed to suppuration 
with almost an entire absence of cough. It will be seen that 
tl|e discriminations we have made are essential in relation to 
the diagnosis. 
d. Nosologists have taken but little notice of pneumonitis ; 
its existence, however, cannot be doubted. We have seen 
v^ry dense, circumscribed tumors, occupying about one third 
of one lung, having the appearances of phlegmonous tumors 
in other parts. When these have time to soften, then vomi- 
cae, or abscesses form, as in other parts. 
We have witnessed several cases in which pneumonitis 
and pleuritis were combined, the lesions in their united re- 
sults constituting pneumo-thorax. Some of these have re- 208 
PLEURITIS, And pneumonitis 
covered after long continued discharges, both by the trachea, 
and by paracentesis between the ribs. The lung on one side 
perhaps entirely dissipated on recovery, and the ribs falling 
down, as delineated in Laennec's sixth plate. 
Methodus medendi. 
e. The treatment in pleuritis is very well agreed on ; yet 
the patient is liable to have so many contraries in the man- 
agement, that the case is often unnecessarily prolonged ; and 
more especially if the adviser should think best to manifest 
his skill, in giving sudden ease by some opiate preparation, 
instead of eradicating the affection. 
Apply a pediluvium ; use external warmth unless the skin 
is already hot; bleed from a free orifice at the arm to the 
point of relief, and repeat as the pain, and the pulse may in- 
dicate. 
A solution of tartarized antimony, is to be exhibited in such 
manner as to nauseate, and promote diaphoresis ; perhaps 
about every three hours for the first twentyfour hours ; or 
according to- circumstances of relief. Mild diaphoretic drinks, 
warm. 
Apply a large emollient cataplasm to the pained side, be- 
sprinkled, with powder of black pepper. Or a large piece of 
thick cotton batting ; first sprinkled with tincture of camphor, 
and dusted over with black pepper. If the case should prove 
obstinate after taking what blood might seem prudent, apply a 
large and effectual epispastic to the side ; still keeping up a 
diaphoresis. 
Although pleuritis is not necessarily accompanied with an 
affection of the mucous tissue of the lungs, yet it is often so 
complicated ; in this event the inhalation of mild steam of 
some emollient infusion, as flaxseed, mallows, &c., by 
Mudge's inhaler ; or a heated brick as proposed in tracheitis, 
may be advantageously employed. OUTLINES OF THERAPEUTICS. 
209 
It is expected the general treatment of synochal fever will 
apply in all these cases. 
d. On account of the phenomena of pneumonitis being ob- 
scure, the affection is liable to progress until suppuration be- 
comes inevitable. The treatment, however, ought to proceed, 
on the same principles. The intention should be, to excite 
and assist the absorptions in obtaining an ascendancy over the 
centrifugal circulations, and the method of accomplishing this 
has been already specified. In addition to what has been sug- 
gested, we remark, that in the fore part of the treatment the 
antimony should be used freely ; and after bleeding, it may 
be so managed as to produce emesis every day, yet not given 
but twice in twentyfour hours, as the affection is liable to 
continue some time ; when so protracted, the tincture of dig- 
italis combined with wine of antimony, may be very useful; 
but should rarely be given sufficient to produce emesis. These 
measures should be stopped, if the case must proceed to sup- 
puration. 
8. Brief Reviews. 
The particular consideration of the remaining affections in 
this series must be omitted. After making the necessary dis- 
criminations, the treatment ought to proceed on the principles 
already advanced. Some, and indeed all of them, require 
early and efficient remedies. 
a. Carditis requires venesection to the full extent the sys- 
tem can bear. Then proceed on general principles. 
b. Gastritis is an affection very different from Erythema of 
the stomach. In the former, the pain at the epigastrium is 
often very severe and incessant, with synochal fever ; vomit- 
ing will occur on assuming almost any thing ; perhaps gum 
water, and chicken water may be taken in very small quanti- 
ties ; but sometimes total abstinence must be enjoined for sev- 
eral days. The pulse may be small, and only moderately 210 
BRIEF REVIEWS. 
hard, even when repeated bleedings are required. Anodyne 
lotions to the epigastrium, with warm epithems ; an epispas- 
tic over the pain, if not relieved. Treatment of synocha. 
c. Enteritis is very similar ; no cathartics except castor 
oil, or some of the mildest kind ; the bowels commonly move 
easy ; mild enemata and fomentations are beneficial. A case 
doing well in a young man, proved fatal on the mother ob- 
truding a dose of calomel and rhubarb, contrary to express 
orders.' 
Enteritis, in many of the divisions of the intestines, is a 
disease of frequent appearance, and liable to become suddenly 
fatal. It will be observed in Order 4th, Genus 10th, that en- 
teritis maligna is put down. All the difference we'can dis- 
cover between them, is, that one is attended with the pheno- 
mena of the dynamic, or phlogistic diathesis, and the other of 
the typhoid. It appears to be a fact, that in this affection 
particularly, as in many others, the phlogistic diathesis is con- 
vertible, and very quickly, into the typhoid. It is often, if 
efficient remedies are not early and assiduously employed, 
that a great prostration of vital force occurs within 24 or 48 
hours after the attack. The aspect is fallen, attended with a 
very frequent small pulse; perhaps pain has ceased, and ef- 
fusions already taken place. The case may now be irre- 
mediable. ' ' 
A knowledge of these results ought to excite to the most 
vigilant attention. At the onset, and before the state of ex- 
haustion occurs, such cases bear free abstractions of blood, 
and far more than seems indicated by the pulse, in compari- 
son with affections of the chest. If these are withheld in time 
and in quantity, the case is liable to collapse into a fearful 
adynamic stage. 
However, the first remedy to be used is the universal te- 
pid bath for some length of time ; then immediately followed 
by emollient cataplasms over the abdomen. If the pain should 
not be thoroughly removed, leeches should be used on the OUTLINES OF THERAPEUTICS. 
211 
epigastrium. All the remedies should be repeated in quick 
succession, until the case is rendered safe, without waiting for 
any uncertain events of tomorrow. 
We have often known one and a half grains of opium, with 
eight drops of cajeput oil, or as much camphor, given at the 
onset, to relieve vomiting and pain, and afford better oppor- 
tunity for the use of the other remedies. But not to be re- 
peated. 
d. Hepatitis requires the use of the same remedies to pre- 
vent effusion and suppuration. This variety does not require 
mercury in this climate ; but no doubt hepatitis with the fever 
of hot climates does. However, calomel may be used as a 
purgative, but not freely. Same general treatment. 
e. In Orchitis, besides the ordinary remedies, often re- 
peated emesis has a beneficial effect. At first an emollient 
cataplasm to the part. When heat prevails, a solution of 
acetate of lead. ' 1 •• 
f. Periostitis, (vulgarly called fever-sore) requires as much 
to be done, and as speedily, as in pleuritis, with more early 
epispastics of the most active kind. The most threatening 
cases have been arrested, with all their odious consequences. 
g. In suppression of urine from affections of the trigone 
plane of the bladder, prostrate, and urethra; after the warm 
bath, bleeding, and an emollient enema, apply an extensive 
epithem of the leaves of stramonium and hop flowers, to the 
perineum and pubis. Then take one drachm of extract of 
belladonna, dissolve in half an ounce of warm water. Intro- 
duce a silver catheter as far as the prostrate only, and with a 
penis syringe placed into the outer end, inject the solution 
every twenty minutes; or, repeat at discretion. Afterwards 
introduce the catheter if necessary. Semicupium. 212 
RHEUMATISM AND GOUT. 
SECOND SERIES. 
9. Rheumatism and Gout. Or the two common varieties of 
external fibrous inflammation; or Arthritis. 
a. Preliminaries. 
We now pass from the affections of the internal fibrous tis- 
sues, to those of the external. Although these may have a 
common anatomical name from their structure, and general 
use, they possess different degrees of vital susceptibility. 
This is again modified by the economy of the organs invested 
in these dense membranous expansions. In a more especial man- 
ner, we discover a difference of susceptibility between these 
tunics externally, from what they possess internally. They are 
thicker, they are subject to greater mobility, and more plenti- 
fully supplied with nerves of the sense of feeling. They are 
more easily excited by the causes of disease, and as they are 
numerous, connecting all the locomotive apparatus in a contin- 
ued series of envelopes, it is no matter of surprise, that their 
morbid harmonies should be extended over the entire system, 
as in tetanus, chorea, &c., affecting the muscles as their in- 
closed organs. 
When in a state of excitation, their sensibility of external 
relation becomes exquisite, in connection with the nervous 
tissues; and they possess a consensus, which constitutes a 
unity of feeling, and of action. Motions excited in one part are 
instantly felt over all. Disease with pain, for the moment 
located in a part, may be transferred to some remote part, as 
silently and easily as thought passes from one object to anoth- 
er. The concentrations of morbid impressibility may pass 
from one section to another, with the same facility as elec- 
tricity suffers a maximum and minimum. 
b. The concentrations of local affections in disease often 
pass from one part to another with equal facility, before the 
part has suffered essential lesions by their ravages ; and in- OUTLINES OF THERAPEUTICS. 
213 
deed, in some instances, when this is the fact, without car- 
rying with them the alterations they have already made. 
The localists, and humoralists have always been confounded 
with their own theses, because they never could apprehend 
how their materia excitans should so easily migrate the capil- 
laries, as to get so far without their being able to ken its 
march. 
The local affections in disease, at their onset, are mere 
concentrations of the morbid force, or nosodynamia, which 
always alters the part more or less, even if the knife of the 
anatomist cannot reveal it in the lifeless subject. But, it 
may suddenly leave a part, and migrate to another ; leaving 
the task of reparation to the recuperative powers of the econ- 
omy, to be effected as circumstances permit ; whilst it com- 
mits other ravages in its new habitation. 
The morbid economy is far more capricious under som^ 
circumstances than others. The phenomena sometimes in- 
dicate an infuriate state of versatility, as discovered in ataxia. 
(Sect, xxii.) The local affection, as if impelled by a tornado, 
passing from tissue to tissue, and whatever the function of 
such tissue may be, it becomes accelerated, distorted, or even 
annihilated. In applying these remarks to the affections be- 
fore us, we may be led into some investigations of their in- 
trinsic character. 
c. In the 4th Vol. of Dr Good's Study of Med. p. 251, 
there is a curious case borrowed from the Philosophical 
Transactions. We abbreviate it a little, and insert it for the 
purpose of offering a physiological explanation quite different 
from what he has done. The patient was "a female, about 
forty years of age, and had labored under the disease, 
(ascites) for twenty years. The abdomen was extremely 
hard as well as enlarged." " She was extremely emaciated ; 
had a quick, small pulse, and insatiable thirst ; voided little 
urine ; breathed with difficulty, and could not lie down in her 
bed for fear of suffocation. For an accidental rheumatism in 214 
RHEUMATISM AND GOUT. 
her limbs, she had four doses of Dover's powder prescribed 
for her, 6f two scruples each ; one dose of which she was to 
take every night- The first dose relieved the pain in her 
limbs, but did nothing more. An hour or two after taking 
the second dose on the ensuing night, she began to void 
urine in large quantities, which she continued to do through 
the whole night ; and as fast as she discharged the water, her 
belly softened and sunk. The third dose completed the 
evacuation. The cure too was radical, and the patient re- 
stored to permanent health." 
In this case the powder relieved the pains in the limbs, 
but did "nothing more," did not sweat. We have no rea- 
son to suppose the powder in this instance proved directly 
diuretic ; but relieved the local affection, or rheumatism, and 
by some peculiar associated harmony of action, idiosyncrasy, 
it migrated to the kidneys, and by accelerating their functions 
severely, proved a diuretic, instead of being so intense as to 
excite inflammation. So one affection may cure another, 
thence showing the harmonies in the system, and affinities in 
disease. 
d. The aspects of gout and rheumatism have always be- 
trayed their affinity, and many have attempted the parallels of 
their family likeness ; whilst others have placed them at an 
alienated remove. By inspecting their intrinsic characters, 
we may peradventure, discover them to be not indeed gemi- 
ni, neither Castor and Pollux, but cousins-german, at least. 
These affections have their natural seats in the articular fi- 
brous membranes, but have been considerably noted for their 
migration from one joint to another, and sometimes from the 
external to the internal tissues. But gout has been noticed 
to possess this fugitive propensity far more than rheumatism. 
Let us inquire how it obtains this license, and in doing this 
we may expose both their characters. 
A synopsis of two modified states of the morbid economy 
has been attempted in the synochoid and typhoid diatheses, OUTLINES OF THERAPEUTICS. 
215 
(Sect, xlv.) The phenomena of rheumatism entitle it to a 
place in the synochoid diathesis, whilst those of gout appear 
sufficient to admit it into the typhoid, yet variable. 
e. With respect to rheumatism, the strong, hard pulse, in- 
tense pain, and cupped blood, have been passports with all 
pathologists for its admission to this state. If it shows a pro- 
pensity to migrate more than some other affections, it claims 
this right by keeping within the range of its kindred tissues. 
It goes to the tissue of a neighboring joint, of the same fami- 
ly, and its way is prepared by an altered, and excited state 
of all these tissues, when the morbid habit has been establish- 
ed. If it steals its way to the heart, it there occupies its 
family seat in the fibrous tissues. But, it is not very com- 
mon that it makes this stride ; when it does, it is liable to be 
a fatal one ; it commonly abides there to spend its rage, and 
subdue its victim. It acknowledges the same predisposing 
causes with other acute diseases, which are aided by an idio- 
syncrasy,, and is almost uniformly excited by cold. It is a dis- 
ease chiefly of cold seasons,-but does .appear in the predis- 
posed, from the influence of relative cold, from suddemchan- 
ges in warm seasons. - 
When the fibrous tissues have become exalted in sensibili- 
ty, they retain it with much persistency. The disease is 
prone to linger, and although it relents about the fourteenth 
day of the attack, it is easily recalled by slight exciting cau- 
ses, especially cold. It is liable to become chronic and in- 
jure many organs. Soreness, stiffness, and contractions of 
muscles, thickening of the fibrous tissues, hydropic effusions, 
&c. succeed. One inveterate case of acute rheumatism fell 
under our notice, in a boy ten years old, which was followed 
by repeated attacks, occasionally, until it proved fatal in 
about eight years. Instead of mitigating, it increased in in- 
tensity, so that some of the last attacks were of the highest 
grade of severity of vascular action. There was such an ex- 216 
RHEUMATISM AND GOUT. 
alted state of susceptibility universally, that the attacks seem- 
ed to take place without any evident exciting cause. 
The swellings about the joints in rheumatism, are from the 
sero-fibrous membranes of the larger joints, which yield a 
sero-fibrinous fluid ; the thinner parts are absorbed, whilst 
the thicker condense, leaving a thickening of the parts. 
Gout attacks the smaller joints ; the effusions are similar, 
with the addition of lithic deposites, or chalk-stones. 
f. Gout, in its regular form, occupies for its location the 
same kind of tissues ; and were it not for a different state of 
predisposition, or rather we might say preparation, it would 
be identical with rheumatism. These modifying circumstan- 
ces have their origin in excess of regimen, habits of inactivi- 
ty, and cold, damp, variable climates. A lithic diathesis ac- 
cumulates upon a rheumatic propensity, the tissues assume an 
abnormal susceptibility, or idiosyncrasy, rendering the sub- 
ject liable to disease, and when excited, to partake of the 
character of ataxia. Gout may then be considered a state of 
modified rheumatism. .This physiological state becomes so 
coalescent in the tissues, by long usage, as to be transmitted 
to offspring; and if the children's teeth are not set on edge, it 
is because the great toe wards off the vibratility from them. 
Gout and gravel vegetate in cold, damp, or foggy climates, 
in subjects who assume more nutritious ingesta than the econ- 
omy requires ; also more acid wine than can ordinarily be 
eliminated, in a temperature that throws this process chiefly 
on the lungs and kidneys, whilst that of the skin is nearly in- 
active. Muscular inactivity, also, allows of vascular turgidity 
and cellular accumulations of adipose matter. Plethora with 
irritation constantly excite the organs to abnormal actions, and 
an habitual state of excitation prevails. < 
Uric acid exists in excess, and the vinous acid also, is 
ready to unite with the lime so abundantly taken in with the 
farinacea, etc. as well as the ossific detritus. Chemical com- 
binations follow, manifesting the lithic diathesis. These may OUTLINES OF THERAPEUTICS. 
217 
tardily pass the emunctories, or their slow expulsions give 
origin to concretions in the kidneys, or urinary bladder ; or 
commingling in the fibrous tissues produce ossifications of 
arteries, &c.; or, again, when effusions take place in the local 
concentrations of gout, they become effused with fibrin, and 
form the chalk-stones of gout, as the more fluid matter is 
absorbed. These substances now become local irritants, ex- 
cite inflammation with softening, and are expelled ; the mem- 
branes remaining thickened. The 11th class of calculous 
concretions of Dr Marcet, is called the fibrinous calculus. 
Europe, and especially England, are said to be the regions 
of gout and calculi. Such of the community as may be called 
idle-full-feeders, and excessive drinkers of wine and ale, 
either assume, or aggravate, both the arthritic and lithic dia- 
theses, as the results of climate and indulgencies. Although 
the people of North America feed well, yet they work well, 
and are but little tempted by wine and ale : so they mostly 
escape the twinges of the gout. Nevertheless, they have 
scarcely escaped less calamity in the use of alcohol; which 
if it has not so much contributed to these calamities, has be- 
seiged the nervous system, the citadel of intellect, enervat- 
ed the bacchanal devotee, and made an assault on the tem- 
ple of the moral graces. Still there is a saving spirit in the 
community, that will guide the destinies of the moral com- 
pact, under the direction of Him, who ruleth on earth as 
well as in heaven. 
Reverting, then, to the condition of the arthritic subject, 
we discover him to possess an increase of mobility of tem- 
perament ; slight causes in connection with those of periodici- 
ty, excite disturbance, and produce gout. The steady ac- 
tions of the synochoid diathesis are wanting, and in their stead 
the irregular, and convulsive movements of the typhoid state 
are present. Congestions form, and increase the embarrass- 
ment, whilst there is not a sufficiency of energy to fix the lo- 
cations in their natural places. 218 
RHEUMATISM AND GOUT. 
In this state of things tumults arise in some or in many of 
the internal organs, called misplaced or atonic gout. The 
stomach, head, lungs, or bowels, suffer great oppression. The 
locations may abruptly migrate to different tissues, simulating 
the diseases peculiar to them. A more accumulated energy 
may direct it to its lawful abode in the feet or great toe; it is 
now called regular gout. Perhaps, however, there is not 
constitutional force enough to fix it there in a regular fit; so 
it may collapse, and revisit some of the internal viscera, un- 
der the appellation of retrocedent gout. It now riots in some 
organ with almost uncontrolled confusion. 
g. In this conflict the physiological actions manifest irreg- 
ularity, and often inability of functions. The pulse becomes 
oppressed and irregular ; distress, sighing, faltering, cold 
sweats, &c. succeed. The child of science may wish for in- 
tuitive knowledge, or some directions from JEsculapius to 
direct the course to be pursued; as whether to take blood, or 
use stimulants. If the oracle should answer, he might say, 
bleed with one hand, and give cordials with the other ; that 
is, opiate tinctures, with spiced spirits and warm water, for 
the moment, and consider it not a contradiction. Contraries 
must be opposed, and the nervous commotions quieted. 
Cordials and opiates are required for the time present, to 
sustain an equilibrity of function, and render more stable the 
wavering actions, until the force of the paroxysm has passed 
by, when the latent energies of the system may appear, and 
approximate the more steady synochoid diathesis ; then will 
be afforded an opportunity for a more radical treatment. 
During the period of severe distress and commotion, no more 
opium should be exhibited than to produce some tranquillity. 
A teaspoon-full of vitriolic ether may be given at such times, 
diluted in water; also, ten grains of camphor well ground with 
gum arabic and loaf sugar. Tincture of peppermint; or 
capsium, piperine, &c. may be tried if the affection seizes 
the stomach, or bowels. A blister should immediately be put OUTLINES OF THERAPEUTICS. 
219 
on the top of the feet in retrocedent gout. Opiate tinctures 
may be rubbed on the surface contiguous to the seat of the 
distress. These applications are suggested only for the first 
period of commotion ; the general treatment will presently 
be considered. 
We discover very striking analogies existing between these 
affections, except the modifications of the diatheses ; and 
gout oftentimes possesses a far more stable state of action, 
and admits of the full treatment of the synochoid diathesis. 
The greatest difference consists in the lithic habit of gout 
being commingled with the other common predisposing circum- 
stances. It is no more a subject of surprise that gout should 
oftener prove fatal than rheumatism, than that severe typhus 
should be more dangerous than inflammatory fever. The erad- 
ication of the lithic diathesis constitutes an important part of 
the treatment, during the intervals of the arthritic paroxysms. 
h. Methodus medendi of Rheumatism. 
Acute rheumatism affords as many of the distinct phenom- 
ena of the synochoid diathesis, as any other habit of disease. 
The rigidity of the tissues, and density of the blood do not 
admit of a free circulation in the minute white tissues, until 
much has been done to eradicate the diathesis, and time given 
for the necessary changes in fluids to take place. Neither 
are these changes apt to take place so effectually as in ordi- 
nary synochal fever. The disease is, therefore, liable to re- 
lapse, and even continue in a chronic form. The locations 
being exterior, and more directly associating the nervous sys- 
tem of external relation, they afford reflex actions. The 
treatment needs to be continued until these circumstances are 
obviated. Although the sweats may be free, they do not 
afford full relief; they are often not warm but viscid, and 
manifestly containing an acid. 
Veneseclion is very necessary in acute rheumatism, and 220 
RHEUMATISM AND GOUT. 
sometimes in the chronic; but the disease is rarely so sud- 
denly relieved by it as in common fever. It must, however, 
be persisted in, but not carried to a full extent as in pleurisy, 
with a view of arresting it suddenly. In ordinary cases, 
three or four bleedings during the first two weeks, of 
about sixteen ounces each, may be sufficient for an adult. 
Yet, according to the phenomena. 
Sweating is very useful, but a severe diathesis cannot be 
subdued by it at once ; it needs to be repeated. If often 
urged it dissipates too much fluid matter. If excited by 
severe stimulants, they aggravate the fever. The celebrated 
Dover's powder, in a prudent manner, is well adapted to ex- 
cite sweatingin a mild case, but not in the severest kind. In this 
instance two drachms of the polygala senega root may be infused 
in a quart of water, to which add half a drachm of vinum anti- 
moniale. It may be so far diluted as to be drank plentifully, 
being sweetened, or not. It should not be taken so freely as 
to excite the stomach much, but be changed for some of the 
more agreeable aromatic infusions, as pennyroyal, sage, &c. 
The object of sweating has never been reached, until the cold 
surface and viscid sour sweats, become changed for warm 
fluid sweats. An infusion of the asclepias tuberosa may also 
be used as a sudorific. The reputed sudorifics are nu- 
merous. 
There is much in the manner of conducting sweats. The 
patient cannot bear heated substances in bed, after the joints 
are much inflamed. The covering ought not to be heavy, 
but the air of the room may be at a considerable high tem- 
perature. 
If the patient should incline to sleep, he should be often 
awakened. The face and much of the surface should often 
be wiped with a warm soft cloth. The bed should be fur- 
nished with soft flannel, unless the patient makes strong 
objections, and dry flannels should occasionally be drawn 
over, and often changed. OUTLINES OF THERAPEUTICS. 
221 
If sweat but slowly appears, steam may be conducted on to 
the body of the patient by means of a roll of paste-board, or 
some other apparatus, from heated water. If the heat of the 
patient is not great, Jennings' vapor bath, of burning alcohol, 
may be used. 
Quietness should be observed, and the patient supplied 
with mild, and agreeable nutritious drinks. When he appears 
fatigued, the sweats should be moderated slowly ; but to make 
much impression, they often require to be continued ten or 
twelve hours, but not urged vehemently. 
Purging between the sweatings will be useful, if the patient 
can be moved ; yet not very severe. Calomel may be com- 
bined in the common icteric pill. Sulphate of soda, sulphur, 
&c. 
We have to obtain access to the remote tissues with their 
capillaries, through the general circulation, when it is 
expected to affect such tissues particularly. It has been 
found that certain acrid agents, such as guru guaiacum, col- 
chicum, mezereon, capsicum, phytolacca decandra, mustard 
seed, oil of savin, lobelia, terebinthina, &c., which may pass 
the general circulation without much disturbance, do excite 
action in these remote circulations, different from the morbid 
action ; and they oftentimes assist in removing the affection. 
But, these cannot.be used in the most acute state of the dis- 
ease ; yet when the severity of the diathesis becomes mode- 
rated, they may be used to advantage. Their manner of be- 
ing used may be found in many treatises. 
The pained joints, before swelling takes place, may be 
mitigated by tincture of opium,* and covered with soft hat 
* This may be made extemporaneously as follows : 
Extract of opium, 1 § . 
White soap, . . . . . . . 4 J. 
Proof spirit, 1 ft- 
Digest two hours, then add, 
Gum camphor, 2 J. 
Apply freely whilst warm, and with the naked hand, every 4 hours. 222 
RHEUMATISM AND GOUT. 
case silk, with a cotton bat over it. The same applications 
may be as good as anything else afterwards, if heat is not 
great. If there is not high inflammation, the volatile liniment 
may be used. 
i. Chronic Rheumatism. 
Rheumatism half cured, by continuance is called chronic. 
It often requires twice as much time and labor to eradicate it, 
as might be necessary in the acute stage. During all the 
time of its continuance, there is a masked chronic fever. It 
has been mentioned, that it is liable to be followed with hy- 
dropic swellingsand contractions ; yet sometimes with atrophy, 
or shrinking. One case of an inveterate kind may be insert- 
ed, for the purpose of showing its progress, and the method 
of treatment. 
About twentyfive years past, as by notes, Capt. Clapp, 
of Royalton, made application. He was aged about fifty- 
eight ; perfectly clear in intellect, and stated, that he had 
been attacked with acute rheumatism about one year previous ; 
had endured much distress, &c. His pulse was hard, con- 
tracted, and moderately frequent. He was universally 
affected with hydropic swellings, so much so that the skin 
along the fore part of his legs had burst, and the serous fluid 
continually dribbling down. Abdomen greatly swollen, with 
satisfactory tokens of water in the chest. He could not lie 
in bed, for a sense of suffocation ; and had not attempted it 
for two or three yveeks. Sat in his great arm chair, to the 
form of which he had become perfectly accommodated, as 
neither his hips nor knees could be straightened, nor bent 
any farther backwards indeed, all his joints were fixed, and 
his head bent forwards and downwards, and could not be 
raised to a horizontal line. 
He said he had employed nine doctors more or less within 
the year ; had fully made up his mind to die, but concluded OUTLINES OF THERAPEUTICS. 
223 
finally to know if we had anything to say about his case. As 
he seemed to have some staminal energy left, with an evident 
synochoid diathesis, he was told we would make an attempt, 
the best we could, if he saw fit to risk it. He appeared de- 
sirous to undertake. 
The first process was a full bleeding from the arm, fol- 
lowed by a cathartic of calomel and jalap. Took several 
very large doses in quick succession, all of which had only a 
moderate effect. He then took a solution of tartarized anti- 
mony with a view to excite emesis. The article was not 
weighed. It was astonishing at the time, and might appear 
incredible to others, in offering an opinion how much he took, 
before it excited emesis. He took the medicine in increas- 
ing quantities for about three days, and then vomited but 
moderately. 
After another bleeding, and the impression of the first 
round of medicine, it required less to take effect; in about 
two weeks he could be moved with about a common dose of 
the emetic and cathartic ; one or the other of which he took 
about every day, or every second day. 
In about ten days after commencing treatment, he used 
the universal warm bath every evening, and it was steadily 
used for six weeks. Every other night it was prepared by 
adding about two quarts of flaxseed, as the water was heating ; 
and the intermediate night a quart of common salt. Free 
rubbings were used whilst in the bath, remaining half an hour 
in it. 
At about the end of the first week he could lie in bed with 
some ease, and at the end of two weeks from beginning treat- 
ment, could lie perfectly easy in his contracted condition. 
During the first four weeks he was bled six full bleedings 
from the arm, and required no further bleedings. At length 
he would sweat some after the bath, but took no Dover's 
powder, nor opiates in any other form, during the whole treat- 
ment. 224 
RHEUMATISM AND GOUT. 
Some small articles were used a little, as the essential oils ; 
and for the limbs, some liniments, as the volatile, prepared of 
olive oil, with an eighth part of aqua ammonia. In about two 
months he appeared to be quite well, altogether relieved of 
the dropsy, yet with some stiffness of joints. Attendance 
discontinued, with directions to repeat the bath occasionally, 
and some of the medicines as circumstances might require. 
In one year he had gained good use of his limbs, and labored 
ten years steadily on his farm, to our knowledge, and without 
having an attack of rheumatism, or any other disease. 
Every disease will continue until the primary cause, deep 
seated in the tissues, is removed either by nature or art. 
The recuperative powers unaided, oftentimes cannot effect 
it; and it often requires great force, and repetition of thera- 
peutic agents to accomplish it. 
Chronic rheumatism, with pain and without swelling, is mate- 
rially benefited by the steam bath in heated rooms ; frictions 
long continued ; rubefacients ; thick flannel, and bodily ex- 
ercise. 
j. Use of Thermal Springs. 
These have often been found useful in continued rheuma- 
tism ; they are a natural warm bath, of easy and extensive 
application, and their use is connected with many agreeable 
circumstances. The hot springs of Virginia, in this country, 
have been proved as very useful, with a temperature of from 
100° to 108° Fah. High degrees of caloric combined with 
humidity, either in the form of water or steam, excite the ac- 
tion of capillary vessels, relieve rigid tonicity, and enable the 
tissues to evolve animal caloric, and cdnsequently remove the 
primary morbid changes constituting disease. OUTLINES OF THERAPEUTICS. 
225 
We cannot speak from our own experience concerning this 
method of treating acute rheumatism. This practice pro- 
posed by Cazenave, had not arrested our attention until of 
late. The prize dissertation of Dr Webb, of Rhode Island, 
presents some very favorable reports of the free use of opium, 
as being capable in his hands, and also Dr Maurin's, of ar- 
resting the progress of either acute or chronic rheumatism in 
a few days.* 
The method of using opium as proposed by Dr Cazenave, 
p. 137, is as follows : " To an adult he orders a pill contain- 
ing one grain, and an hour afterwards he gives another grain, 
if the pains continue. At the expiration of the second hour 
he gives a third grain, and after a little time he examines his 
patient. If there be a tendency to hilarity, he administers a 
fourth grain, and so on ; a grain every hour until a complete 
calm is established, or an abundant perspiration is induced. 
This being the case, he orders a grain to be given every two, 
three, or four hours, according to circumstances, solely with 
the view of keeping up the perspiration. 
"Its failure is owing to the timidity with which it is ad- 
ministered. Lt acts in three ways according to the dose 
employed. Given in small doses it obtunds the sensibility, 
and brings on temporary relief; but the cure is not thereby ac- 
celerated. Administered in a somewhat larger dose, it some- 
times occasions nausea, palpitations, giddiness, headache, &c. 
These effects are, of course, but momentary, and should 
form no solid objection to the remedy, if it is found beneficial 
in other respects, besides relieving pain. To the above 
effects of opium, if it be continued, succeed others ; the pa- 
tient does not sleep ; but he experiences a kind of delightful 
ecstasy, forgets his sufferings, &c. The action is then ex- 
k. The use of Narcotism by Opium. 
* See Boston Medical and Surgical Journal for April, 1837. 226 
RHEUMATISM AND GOUT. 
cited like that of wine. In some cases an abundant perspira- 
tion is excited,-but in both events, the radical cure of the 
rheumatism is effected,-that is, with or without the sweating 
process. 
" In respect to regimen during this mode of treatment, it is 
indispensable to keep the patient in an even and mild tem- 
perature, with flannel next the skin, and on the simplest 
liquid food ; use laxatives. Perfect quietude." Many other 
particulars require attention for effecting a speedy and easy 
cure ; perhaps venesection. 
We are aware that the effects of medicines are modified by 
at least three cardinal circumstances ; 1st, the relative quan- 
tity used ; 2d, the particular state of susceptibility of the sub- 
ject at the time of exhibition ; and 3d, the physiological charac- 
ter of the tissu6s most essentially involved in the local affection, 
modifying the diathesis. Many others might be mentioned, as 
age, habit, idiosyncrasy, &c. But, in the present case in 
relation to the free use of opium, perhaps we have much yet 
to learn of its therapeutic properties. Our animadversions 
on this article hitherto, have principally been confined to its 
use in what may be said to be the general pyre'ctic habit ; 
meaning those affections connected with concentrations in the 
internal viscera, and materially affecting the nutritive system 
of nerves. We attempted some discriminations in its use, in 
diseases affecting the two great nervous systems, in a former 
article. (Sect. xlvi. 1, j.) 
We are well assured, that large and repeated doses of opi- 
um in pyrectic affections of the internal viscera have been 
most unfortunate. We consider it a powerful stimulus in 
small doses, and cannot conceive how it loses its stimulating 
influences in large doses, otherwise than in changing the state 
of the vital force, it may show sedative effects in some tis- 
sues, whilst others manifestly show an increase of excitation. 
So it appears in the instance of rheumatism, a disease locating 
essentially on the tissues chiefly under the domininion of the OUTLINES OF THERAPEUTICS. 
227 
nerves of external relation ; the organs of nutrition appear to 
be in a state of sedation by excessive doses, whilst the sys- 
tem of external relation is highly excited, and along with this, 
the exhaling systems. 
Dr J. K. Mitchell, of Philadelphia, appears to have been 
considerably successful in curing rheumatism by excitations, 
as cuppings, blisters, &c. at the spinal origin of these nerves.* 
The use of opium as specified, is commonly attended with 
an increase of exhalations, or sweats ; and of course at the 
same time the capillary absorbents must be excite^. These 
excitations may probably remove the primary causes of the 
disease, and afford opportunity for healthy action to succeed. 
We have already shown that rheumatism, and many other 
diseases both acute and chronic, have been removed by v^ry 
different remedies, which excite the exhaling and absorbing 
processes, increasing the vascular pyrectic state. 
If opium can be so managed in large doses, as to pro- 
duce these desired effects with safety, it will prove to be an 
attainment of a desideratum long wished for. The subject 
merits further investigation by experience and observation.! 
In the mean time we, may be allowed to remark, that an 
attempt to cure the severest cases of acute rheumatism by 
narcotism, would very surely be a dangerous practice ; at 
least, until the diathesis shall have been essentially mitigated by 
time and suitable treatment. Whilst the case remains linger- 
ing, with even strong symptoms of irritative perturbations, 
Cazenave's method may be successful. It surely must be 
the most useful in rheumatalgia, as well as the safest. Yet, 
we are in no degree persuaded, that such a case of chronic 
rheumatism as the one above stated, could be benefited by it. 
* American Journal of the Medical Sciences, Vol. VIII. p. 55. 
t We have seen a very considerable number of cases of " opium-eaters," who 
had contracted this habit by using opium to mitigate the pain of rheumatism; a 
state scarcely less tolerable than the tortures it relieves. 228 
RHEUMATISM AND GOUT 
j. Treatment of Gout. 
Some suggestions have already been made, in relation to 
the manner of guiding a paroxysm of irregular gout, in order 
to render it as safe as possible. Sound discretion should be 
used as to the amount, and timing the remedies. 
The treatment of gout must be conducted on general prin- 
ciples, and modified as may be indicated in any individual 
case. Sometimes the treatment may be very similar to rheu- 
matism, but without urging sweat. Most commonly it does 
not require so extensive bleeding ; but requires more cor- 
dials, and opiates ; yet they should be cautiously used. The 
safest treatment of the swelling in the feet is, to cover them 
lightly with flannel, and not disturb the local concentrations. 
During the intervals of the paroxysm, the only sure and 
safe method to remove the litho-arthritic diathesis is, by taking 
the opposite course from those circumstances which had pro- 
duced it. This will go far, also, in avoiding the evils of an 
hereditary liability. 
The instances reported by writers are numerous", of gouty 
subjects being driven by poverty to hard labor and privations, 
who have thereby wholly escaped the attacks of the disease. 
Yet, few have moral courage and perseverance sufficient, to 
practice voluntarily, what necessity compels to. 
10. Phlegmatia Dolens, or Rheumatismus cruralis. 
It has been our lot to witness a considerable number of in- 
stances of this affection. For many years past it has been a 
topic of much speculation, and too much time has been wast- 
ed in propagating visionary hypotheses, in relation to its pa- 
thological character. 
a. The intumescence possesses much sameness of external 
aspect; whoever has been but little conversant with its ap- 
pearances, will not be very liable to mistake it for any thing OUTLINES OF THERAPEUTICS. 
229 
else. That we have not been mistaken in this affection, we 
have carefully noted the phenomena mentioned by Dr De- 
wees, in paragraph 2147, in his Practice of Physic. They 
are specified in fourteen articles, and accord very exactly with 
our observations. Or, we might except to article 10th ; the 
cases we have seen have been mostly confined to one leg ; 
and it has been rather rare that the opposite leg went through 
a similar course, and if it did, it was of less severity. 
Except, again, article 13th ; although the severity of the 
intumescence abates in a few weeks, yet the remaining swel- 
ling does not assume the full character of the tc common 
cedema," but retains much of its own peculiar appearance. 
It will receive the print of the finger, but feels doughy, and 
does not go off fully in the night, like cedema. The parts have 
obtained some thickening. Some limbs have never obtained 
their former dimensions, but remained thickened, weak, and 
clumsy. 
The affection of the leg is always subsequent to a pre- 
vious pyrectic habit; it seems not to be a necessary, but 
rather accidental sequence, arising from cold, or other cir- 
cumstances, which excite a state of exacerbation at the time. 
It is not confined to any period of the co-existing disease, 
sometimes occurring within the first fortyeight hours ; at other 
times, not until fever may have existed two or three weeks. 
It is not exclusively confined to the puerperal state, neither 
to the sex. We have known two instances in males above 
adult years ; one had been exercised with pneumonic inflam- 
mation for two, and one for three' weeks, when the thoracic 
affection suddenly collapsed to the leg, and we could not dis- 
cover any difference from the puerperal swelled leg. The 
thoracic affection become essentially relieved. We have 
seen several instances of married and unmarried females, nei- 
ther pregnant nor puerperal, who having been confined with 
what we call typhus fever of this climate, some two or three 
weeks, suddenly become affected in like manner with swelled 230 
PHLEGMATIA DOLENS. 
leg, which we could not distinguish from the phlegmatia do- 
lens of puerperal females. One of the unmarried had not yet 
got rid of all the intumescence, at the end of ten years. We 
have known one instance in the arm of a male; and several 
on either side of the body very similar. 
b. Our attention having been early directed to this affec- 
tion, it became a subject of not a little solicitude, to ascertain 
its pathological character ; always having satisfactory reasons 
in conclusion, for rejecting all the suggestions hitherto ad- 
vanced ; some more congenial with the history of the affection 
were sought after. 
There is something plausible, in the view of the circum- 
stances of gestation, and parturition, creating a local predis- 
position in the lower limbs, as well as the uterus ; so that this 
affection may be excited when commotions arise in the gen- 
eral system. This may be, and probably is the fact. 
Again, as the affection seems demonstrated, by many re- 
ports, to arise, aside from the puerperal state, we are com- 
pelled to assign it a more general and constant origin, than 
the gestative predisposition. 
Our limits prevent the following out this subject in the de- 
tail it merits ; we shall, therefore, have abruptly to intrude 
the results of our own observations into a narrow compass. 
Whether it may be considered on the same principles as the 
transfer of other local affections, as eruptions, hemorrhages, 
&c., we will not fully decide. But, whatever may have been 
the predisposing causes of the local affection, or of the pre- 
vious disease, it seems to have its origin from a sort of metas- 
tasis, and a kind of imperfect crisis. 
We are in the habit of considering the puerperal, or any 
other fever, quite safe, under discreet management, after the 
local intumescence appears in the leg. We cannot specify 
the number of cases we have been concerned in, on account 
of having kept notes only in part ; if they have not been 
many, they have not been very few ; but we have had but OUTLINES OF THERAPEUTICS. 
231 
one unfortunate case of the affection, and that under very ad- 
verse circumstances. The local affection manifests no lia- 
bility to suppuration, neither to degenerate into gangrene, 
when not much disturbed ; neither to any destructive state. 
The limb certainly detains much of the Isedentia, which sus- 
tain general disease ; and we have often been persuaded that 
the general habit has been rather relieved, than aggravated by 
the metastasis ; and this now has become the principal local 
affection. But the limb should not be over disturbed by too 
great service done it. 
c. With respect to the pathological character of this affec- 
tion, we long since came to the conclusion, that the effused 
substance was of a sero-albuminous kind, and probably 
containing some fibrin ; and that some other tissue than 
the sero-cellular must be concerned in it. The fibrous 
fascia of the groin, inguinal glands, and of all the muscles of 
the limbs, declare an immediate participation by their extreme 
tenderness, immobility, and pain at the very onset, and before 
any intumescence appears. These tissues of the thuscles, ten- 
dons, and the capsules of joints, are very extensive in the solid 
limbs. And, again, the middle coats of arteries and veins 
claim an affinity. The muscular tissues seem, also, to par- 
take of the affection. 
In acute rheumatism, when the kindred tissues are affected, 
the effusion is of a similar viscid character, and extends 
throughout, to the cutis vera at the joints, and sometimes 
quite over a limb. Distracting pain and soreness, are alike 
mitigated in both cases, as the swelling appears ; unless the 
fever should be urged by stimulants, instead of being assuaged 
by proper treatment. And still, in neither case does the 
fever wholly subside at once, but may continue indefinitely. 
Any objection that might be raised from the circumstance 
of the puerperal fever, seated in the uterus, metastatising, or 
extending to the leg, may be answered by the fact, of a very 
similar condition existing in the peritoneal inflammation, so 232 
PHLEGMATIA DOLENS. 
liable to be associated with hysteritis, and producing similar 
results. The effusions, in this instance, would be identical 
in appearance and in kind, were they thrown into a loose 
cellular texture, instead of a large serous sac, as in the abdo- 
men, where the matter suffers some changes. A fibrous sub- 
jacent fascia is here, also, connected immediately behind the 
serous lining. And farther, the uterus and its envelopes are 
of the fibro-muscular character, and usually associated with 
synochal fever. 
d. If there is any justness in these suggestions, we may 
hail this intruder to the leg rather as a friendly visitor, whose 
formal transit to the peritoneum and abdominal viscera, might 
have been attended with fatal consequences, without more 
energetic repulses than it commonly meets with. 
We have often traced the phenomena of acute rheumatism, 
with phlegmatia dolens, or sparganosis, or tumid leg, and 
found a very constant similarity ; especially, marking the ana- 
tomical .difference between the thick capsules of joints, and 
the thin accommodating structure of the muscular fascia of 
the leg. Therefore, in our nosographic arrangement, we feel 
justified in removing the escutcheon of phlegmatia dolens to 
the family of rheumatism, with its proper cognomen, rheuma- 
tismus cruralis. 
e. Methodus medendi. 
The pyrectic habit in connection, is of the synochoid cha- 
racter, and very similar to rheumatism. It requires similar 
constitutional treatment, which must always be accommodated 
to the severity of the individual case. Some may not require 
bleeding, whilst others may need it two or three times. 
The diathesis, in hysteritis, is of the synochoid character, 
in its natural state; although, frequently assuming the ty- 
phoid, in a state of aggravation. When phlegmatia dolens 
occurs in this condition, there need be no further apprehen- OUTLINES OF THERAPEUTICS. 
233 
sion of danger from a typhoid state, for the susceptibility of 
the tissues in its new location, does not admit of it; not, 
indeed, any more than in rheumatism. The hysteritis is 
always relieved by it; and farther, the local affection never 
retrogrades to the uterus. 
Sweating is well adapted to relieve the irregular and defi- 
cient circulations in the capillary systems, in phlegmatia 
dolens, but the diathesis may be so strong, and the fluids so 
viscid, that sweats flow with great difficulty. As soon as the 
system is reduced to the sweating point, it ought to be em- 
ployed in a prudent manner. 
Moderate cathartics are commonly useful, and occasionally 
a few grains of calomel. We have long been in the habit of 
employing a combination of the root of the American helle- 
bore, or poke root, which is an important constituent in the 
Coit pills.* It may be used as a full cathartic, or laxative, 
in many acute or chronic diseases ; it acts as an easy hy- 
dragogue. 
f. The tumid leg does not require very active treatment; 
it being a sequence, and greatly dependent on the general 
diathesis for its severity. Although its approach may be 
rapid, its removal must be slow. In our early practice we 
were induced to do much for the leg, but found our mistake 
in this. Severe, active treatment, is worse than useless. 
Although we never met with the misfortune mentioned by Dr 
* R. Gum Gambogiae 
Gum Aloes socot. - a. a. - - ss. 
Rad. Veratri viridis - 
Saponis Castil. - a. a. - - § iv. 
Hydrarg. sub-mur. .... 
Antimonii sulph. rub. a. a. - - § ss. 
Gum Guaiaci •••••§ j» 
Gum Ammoniaci - - - - § ss. 
Tinct. Camphorae g. s. Fiat massa. 
The mass should immediately be made into pills, of four grains each, and 
dried on a sieve, and kept free of dampness. One, two, or three for an 
adult. 234 
lumbago and rheumatalgia. 
Dewees, we discovered that epispastics were useless, and 
not only so, but very troublesome. Neither rubefacients, 
unless in the latter stages. Tight bandages are of no use 
until the subject gets so as to walk about ; they then afford 
some support, and preserve warmth. 
In the early stage, embrocate gently with the anodyne 
tincture mentioned in the last article. Cover the limb some- 
times with fresh cabbage leaves, or soft oiled silk, and gently 
support with the twelve tailed bandage. 
Apply twice a day, a mild steam of hot vinegar and water, 
sometimes by means of cloths wrapped around heated bricks ; 
or in the manner advised by Dr Dewees, in a vessel, and 
the bed clothes raised by a hoop placed crucially. 
In the latter stage, bathe the limb in camphorated spirit, 
with the addition of oil of rosemary. Bandages ; frictions. 
11. Lumbago and Rheumatalgia. 
Lumbago is rather of the family of the rheumatalgia, and 
might have been placed in the order of the tetanic affections, 
along with Gephaloxia ; but the removal might seem too far 
distant. 
a. It affects the psoas muscles principally, with their fas- 
cia ; also, other muscles -in the neighborhood, more or less. 
Attended with rigidity, soreness and inability of muscular 
motion. Severe pain at every attempt to move ; but with- 
out effusion, and of course without swelling. The attacks 
are sometimes so sudden that the subject falls down, or re- 
mains liveted in one position. The body cannot bend for- 
ward, and this distinguishes it from nephritis, which allows 
of bending of the vertebrae, and motion of the muscles. 
This affection does not metastatise like rheumatism, and this 
circumstance, with the absence of effusions, are sufficient to 
remove it from the family of rheumatism. 
b. Rheumatalgia fascialis, or when in the lower limbs, OUTLINES OF THERAPEUTICS. 
235 
rheumatalgia cruralis, is of a similar character with what is cal- 
led lumbago. Perhaps some have called it nervous rheuma- 
tism ; but this is inappropriate, and so is neuralgia, although it 
has a strong affinity to it. It is often confined to one limb, and 
occupies the same fascia and muscles as phlegmatia dolens ; 
sometimes both limbs at once, and even extending consider- 
ably over the body. Pyrectic phenomena attend both rheu- 
matalgia, and lumbalgia as it might be called, but of not so 
severe a grade as in acute rheumatism. 
c. In these affections, also, no effusions follow ; and in 
this they resemble the tissual condition, which exists in the 
spastic state of tetanus. These tissual changes disturb the 
sensitive nerves, and render their perceptibility more acute. 
The capillary exhalants appear to be differently affected ; 
in the one case free, and in the other confined, or suffering a 
state of adstriction. The same takes place in excitations, 
and inflammations of the secreting organs in their different 
degrees of morbid impression. We do observe something 
similar in both the serous and mucous tissues. They are 
sometimes dry, and again yield much fluid when excited. 
The urinary mucous tissues yield fluids very differently, and 
so the serous when apparently excited in a similar degree. 
(See Order VII. and VIII. of Nosography.) 
d. .Methodus medendi. 
As these affections are of similar character, they require 
like treatment, making some difference to accommodate par- 
ticular locations. Sweating should be procured in both, al- 
though sometimes difficult. Begin with the warm bath, if 
practicable. Steam bath moderately, but universally applied, 
either in a room, or the portable box. Take blood according 
as the state of the vascular system may require. Cathartics. 
Antiphlogistic regimen. 
In lumbalgia, apply mustard seed poultices to the loins ; 236 
LUMBAGO AND RHEUMATALGIA. 
or, cotton batting, besprinkled with tincture of camphor, 
and dusted with black pepper ; acupuncturation. As the 
affection becomes relieved, a plaster of burgundy pitch, 
dusted with opium and camphor. Thick bandage over the 
loins. 
In rheumatalgia of the limbs, use tight flannel bandages over 
the whole extent of the limb, and passing several times 
around the hip. Remove twice a day, and apply a stimulat- 
ing liniment as below.* As soon as the case admits, thick 
clothing along with the bandages, and walking until sweat is 
excited, taking suitable care to avoid cold. 
The same liniment may be used in lumbalgia. In both 
cases in the state of convalescence, tincture of gum guaiacum 
and aloes. 
Both of these states of disease require narcotics to relieve 
pain, and the compound powder of opium and ipecacuanha 
may be as good as any other. If narcotism is justifiable in 
any case, it may be in these. Still our experience does not 
justify it to any extent. 
* Olive oil, 4 parts. 
Aqua Ammonia;, 1 do. 
Laudanum, 1 do. 
Oil of Origanum, do. 
Shake well in a bottle, and anoint in the iatraleiptic method, with a 
heavy hand, and long continued, in a warm room. OUTLINES OF THERAPEUTICS. 
237 
ORDER II, 
THE MUCOUS TISSUES. 
SECTION X L VII. 
1. Synochus. 
By this we understand a continued state of fever, with 
slight remissions, less severe in intensity than synocha. It is 
more fully defined in the nosography. It is of frequent oc- 
currence ; attended with the common phenomena of the sy- 
nochoid diathesis, as slight depression, chills, heat, pain, 
internal membranous inflammation, &c. with only slight con- 
gestions internally, and morbid action early appearing on the 
surface, as compared with typhus mitior. So far as we know, 
it is excited by the same causes as synocha. 
The notion of its having a bydrid, contagious origin and 
character, partly "synocha and typhus blended together in a 
slight degree," is altogether hypothetical. The supposition 
that synochus at its commencement only, inclines to the sy- 
nochoid diathesis, and soon changes to the typhoid, is a most 
unfortunate circumstance in a practical point of view, and has 
led to very disastrous consequences. 
The diathetical character of synochus is synochoid through- 
out, and as manifestly so by the phenomena, as in synocha, if 
not so severe. The phenomena exhibited towards the close 
of disease of a typhoid appearance, in fatal cases, are facti- 
tious, and the result of a stimulating, or " incendiary treat- 
ment or, the neglect of proper treatment. This we are 
well assured of by long observation, and we do insist, that 
when such treatment is withheld, and the obvious anti-pyrec- 
tic is used, no such typhoid appearances occur. Indeed, a 238 
SYNOCHUS. 
similar improper treatment will clothe the real synocha in 
somewhat like habiliments. When synochus is misappre- 
hended for typhus, and by those who have much dread of 
debility, and more so of sedative measures, the results of 
improper treatment, will be a state of the system simulating 
real typhus, and even partaking much of the typhoid diathe- 
sis, and its accompanying phenomena. The remedies which 
insure a fatal event, are then urged the more thoroughly. 
We have met many cases of this description, some of 
which have been saved, and others lost. Whilst we do in- 
sist, that typhoid fever has often prevailed extensively in the 
New England States, we as strenuously insist, that synochus 
has often been mistaken for it, and attempted to be treated as 
real typhus is said to be in Great Britain. The consequence 
has been as above, a factitious typhoid state. 
It is with peculiar satisfaction we hail our veteran coadju- 
tor in the cause of reform, Dr Dewees. On the subject of 
the typhus form of continued fever, Prac. Phys. p. 152 and 
seq. he says, "For if the pulse be tense and active; pain 
acute ; especially, if in the head, chest, or region of the 
stomach ; the skin hot, and dry ; the tongue dry ; the teeth 
encrusted, and the mouth black ; the fingers employed in 
picking the bed clothes, or the arms twitching with subsultus 
tendinum, we would not hesitate to abstract blood in one 
way or other, be the period of the disease what it may. 
" Nor would this be all; we would purge as just directed, 
and observe a rigid antiphlogistic regimen throughout. We 
would do this, because we could appeal to our experience for 
the comparative success of the two methods ; for the time 
was, when we went with the current ; stimulated as fearlessly 
as any one ; and lost patients as certainly as any other prac- 
titioner. But for the last ten years we have abandoned this 
mode of treatment ; and by doing so, if we do not deceive 
ourselves, we have carried patients through, that would, we 
sincerely believe, have succumbed under the other plan." OUTLINES OF THERAPEUTICS. 
239 
These are the general sentiments he expresses in relation 
to what he calls this artificial disease ; and they are in strict 
harmony with our own observations. We have the satisfac- 
tion of early suspecting the correctness of the then new Bru- 
nonian treatment; had seen others try it, and fully proved it 
erroneous to our satisfaction, within two years practice ; so 
that in 1795 we became as well satisfied of its pernicious re- 
sults, as our author was in 1818. The immense weight of 
opposition was resisted single handed for a long time, whilst 
every returning season has confirmed the correctness of the 
opinion then formed. We had constantly been extending the 
principle and practice to other diseases, commonly reputed 
adynamic, and in a restricted manner to typhus ; and even 
several years, before we had read Dr Rush's Med. Inquiries, 
it being the 2d Phil. Ed. in 1805. •, 
However, there seems to be no necessity of pursuing the 
treatment of simple synochus any further at present. It re- 
quires mild antiphlogistic treatment. This state of disease 
most commonly requires some blood to be taken at an early 
stage ; and if so, large bleedings will not be required. But, if 
neglected, and especially if much stimulation shall have been 
practised, large bleedings will be required, if practised before 
the bleeding point has passed by. Yet, it should be remarked, 
that this point is not so soon passed as in rhany other habits of 
fever ; so that late, and extensive bleedings are sometimes re- 
quired, and even whilst some typhoid phenomena are pres- 
ent. Then continue a mild antiphlogistic treatment. 
It may now be remarked, that most of the diseases of the 
mucous tissues are accompanied with a general state of the 
system approximating to, or resembling the diathesis com- 
monly attending synochus. We, therefore, make use of this 
term as the most proper, or appropriate, we think of, to give 
some idea of the diathesis of the affections of this order.* 
* See definition and reference, in Nosography, p. 100. 240 
CATARRH AND INFLUENZA. 
2. Catarrh, and Influenza. 
a. The phenomena presented by these affections are very 
similar ; as may be seen in the nosographic definition, and 
more particularly, in all the books. The constitutional symp- 
toms indicate a pyrectic grade of the mild synochoid charac- 
ter. The local affection is a concentration upon the mucous 
tissues of the respiratory apparatus ; that is, the frontal sinu- 
ses, Eustachian tube, antrum Highmorianum, fauces, and 
pulmonary tissue ; also including the eyes, and nasal ducts. 
The first discharges are acrid, of a serous character, then 
mucous, or muco-purulent. 
Catarrh is almost always excited by cold, and sometimes 
more readily than at other times. Influenza appears in an 
epidemic manner, affecting almost a whole community in the 
course of a few days, or at most a few weeks. It seems al- 
so, to be excited by slight cold, but is often ushered in with- 
out any evident exposure. There is satisfactory evidence of 
the existence of a wide spreading atmospheric afflatus, 
when it prevails. (Sect. xxv. 2.) It proceeds in a rap- 
id, progressive manner, sparing neither age, sex, nor scarce- 
ly such as are already afflicted with other diseases. 
It is a fortunate circumstance, that it is not a very severe 
affection ; yet it sometimes proves such, whep neglected, or 
badly treated. The primary affection may suddenly destroy, 
by a more than ordinary concentration in the head ; or more 
commonly in the lungs, producing that form of pulmonic in- 
flammation long denominated peripneumonia notha ; or pneu- 
monitis mucosa. Notwithstanding, the sequelae of catarrh 
and influenza, are the most to be dreaded, in their liability, 
when neglected or palliated by narcotics, of establishing a 
predisposition to phthisis pulmonalis. Again, any person al- 
ready predisposed to phthisis, with an incipient tubercular 
state, is liable to severe pulmonic inflammation. OUTLINES OF THERAPEUTICS. 
241 
b. Methodus medendi. 
Most attacks of these affections pass off in three or five 
days, by observing a warm temperature ; keeping in bed ; 
using aromatic, diaphoretic infusions, demulcents, and the 
antiphlogistic regimen generally. Yet, on some occasions 
more active medical treatment becomes necessary. Warm 
ablutions ; mild steam admitted by respiration ; mild sweat- 
ing, and at the very onset a single dose of pulvis ipecacu- 
anhse comp., is useful to allay the thin saline discharges from 
the mucous membranes, to remove the chills, and promote 
warm sweats. If repeated it is liable to increase pain, sus- 
pend the mucous discharges, and aggravate the case. More 
reliance should be placed on mild diaphoretics, mucilaginous 
drinks, and agreeable warmth constantly sustained. Finally, 
pursue the treatment of mild synochoid fever. 
If the pyrectic phenomena become urgent, then venesec- 
tion, followed by an emetic of the compound syrup of squills. 
Neutral salts as laxatives. The disease is liable to be re- 
newed with greater severity, by exposure to cold, in the 
state of convalescence. The phthisical and infirm ought to 
be very circumspect. 
3. Peripneumonia notha ; Pneumonitis mucosa; or Bron- 
chitis. 
a. A synopsis of its character has been given in the nosog- 
raphy, and various allusions made to it already in several pla- 
ces, as well as the last article. It consists in an inflamma- 
tion of the mucous tissue of the lungs, or of the bronchia and 
trachea, very similar to the last affection treated of, but of 
more severity. Dr Eberle styles it acute bronchitis, but in 
its ordinary state the inflammation does not extend beyond 
the mucous tissue. 
The severity of its pyrectic character, and of course the 242 
PERIPNEUMONIA. 
importance of each individual case, will be estimated by the 
attending phenomena. However, it must be especially in- 
culcated, that the severity and danger of the disease, are oft- 
en masked. It frequently occurs in elderly people and de- 
preciated habits, which are not so capable of eliciting an ob- 
trusive suit of phenomena. And, again, as occurring in the 
aerial tissue of the lungs, pain is often absent. 
The tissual excitation at first may not admit of much, if 
any discharge of mucous secretion, for two or three days ; 
and then a sudden, and copious secretion may take place into 
the bronchia, and inundate the aerial cells, producing labori- 
ous respiration, carbonized blood, sublivid countenance, tra- 
cheal rale, and quickly, suffocation. Such a probable event 
should always be kept in view, and we do say it may be ob- 
viated with much certainty, by a previous treatment. 
b. Methodus medendi. 
Let the patient be kept in bed and constantly in a mild di- 
aphoresis, so that there shall be an equal warmth. Use in- 
halations of mild steam of vinegar and hot water. Take 
blood from the arm even if the pulse should be intermittent, 
and without great force or frequency. A second bleeding in 
six hours will be more strongly indicated by prominency of 
symptoms than the first, and the blood may even be cupped. 
Repeat according to circumstances. 
The compound syrup of squills, or antimonial wine, may 
be exhibited every four hours, for the first twentyfour hours, 
so as to excite nausea, and slight emesis once or twice dur- 
ing that time. Infusion of hyssop and flax seed for drink, 
sweetened with honey, or as the patient may choose. After 
emesis, onion syrup, or a clove of garlic once in six hours. 
As a cordial, give half a drachm of oil of rosemary incor- 
porated with two ounces of treacle or honey, in small doses 
as most agreeable. Chicken water, broth, and gruel as nu- 
triment. OUTLINES OF THERAPEUTICS. 
243 
Purging should be avoided ; but a laxative of calomel and 
castor oil may be employed according to circumstances. 
Follow up the treatment, until respiration becomes easy 
and deep ; especially keep up a steady external warmth. If, 
however, the case remains obstinate, and the skin either dry 
and rigid, or cold and damp, the universal warm bath should 
be resorted to, with much confidence of immediate relief. 
Epispastics on the spine between the shoulder blades. 
Leeches. 
The duration of the disease depends chiefly on the man- 
agement, having regard whether it was seasonably employed. 
The severity of the disease ought to be speedily arrested, 
and if the absorptions are well sustained, it may require one 
or two weeks for the natural adjustments to take place in the 
system. 
In Tracheitis mitis, or mucosa, a very similar state of the 
mucous tissue of the trachea is present. It affords, often- 
times, large quantities of a sero-mucous matter, but no dense 
adhesive membrane ; often occurring in children. Emesis ; 
mild and continued diaphoresis ; mild detergent gargles ; as 
infusion of senega, with honey ; onion syrup, &c., are all 
that is required. 
4. Phthisis Pulmonalis. 
"How dost thou rend in sunder 
Whom love has knit, and sympathy made one ? 
A tie more stubborn far than nature's band." 
a. Explanation. 
Having attempted an arrangement of diseases according to 
their tissual seats, it now becomes necessary to notice phthi- 
sis pulmonalis, along with the affections of the mucous tis- 
sues, in Order Second. Yet, as other tissues are implicated, 
we cannot avoid associating them in a consideration of its 
entire character. Reference will therefore be made to Or- 244 
PHTHISIS. 
der Sixth, genera 5th, 6th, 7th, 8th, 9th and 10th, for the 
purpose of bringing together the different diseased states of 
the tissues of the lungs, and reviewing their connections and 
dependencies. 
The adventitious tubercle requires some notice, and is 
placed in the order of the glandular tissues, because we 
could find no more suitable place ; and especially as some 
connoisseurs declare it to have its seat in the lymphatic gan- 
glia. In many cases no lesions are found beyond the mu- 
cous tissue, when the disease terminates fatally, attended 
with the common phenomena of phthisis. 
b. Preliminary notices. 
Of all the maladies, which have visited and afflicted the 
human family, this has constantly borne the supreme sway in 
the middle latitudes ; so that the pestilence in every form of 
plague, cholera, fever, fluxes, &c. dwindles into little com- 
parative importance. It pursues the even tenor of its course, 
whilst those have long respites between their visitations. 
Notwithstanding so many have been engaged,with the best 
motives, and most tender solicitude, to discover some reme- 
dial agents ; yet, according to some of the most recent re- 
ports, the whole world still remaineth in ignorance in a ther- 
apeutic view, as profound as before the flood ; and all the la- 
bor is lost for the want of a right application of the knowl- 
edge obtained ; or, from the want of a generalization of facts, 
or correct theory.. Even the veteran Dewees, who seems 
to have soared above many of his fellows in his intrepid 
practice, prostrates the standard his arm has sustained through 
many conflicts, and says, whilst devoting fiftytwo pages to 
the subject, " we fear we declare too solemn a truism, when 
we say we do not believe that phthisis, properly so called, 
has ever been cured by art."* 
•Prac. Phys. p. 512. OUTLINES OF THERAPEUTICS. 
245 
Perhaps it may be said, that no disease was ever cured by 
art. We say a disease is cured, when the physiological ac- 
tions are so modified by art, that the recuperative powers of 
the system can produce salutary changes, without which they 
could not be effected. 
We have again to deprecate the present ill directed course 
of pathological investigation. Although the anatomical re- 
searches are laudable and useful, still little advantage will be 
gained by a knowledge of all the pathological minutiaa in this 
department, whilst the morbid economy of the system is 
neglected, or erroneously interpreted. 
We are fully aware of the labor, and difficulty of modify- 
ing the abnormal state existing in phthisis pulmonalis, in such 
a manner that the salutary processes shall be restored, and 
the lesions removed. Yet, notwithstanding all that has been 
said to the contrary, we are as well assured that this has been 
done on many occasions, as we are that pleurisy has been 
cured. We do not say that every case can be as certainly 
cured; for, its slow, insidious approach often allows of for- 
midable lesions taking place, before the patient becomes 
alarmed and calls for advice. And again, the adviser is too 
often inattentive ; and if he entertains some serious views of 
the case, his decisions and exertions may be hesitating. Un- 
less he has gone through a long train of experience, the wri- 
ters he consults are useless to him ; as they give contradic- 
tory advice, so that his decisions and exertions are finally 
paralyzed, from not having confidence in any treatment. 
In this dilemma some palliatives are given, and these of 
course consist of opiates in some form, to soothe the cough. 
Even a doubting veteran will escape from the case after pro- 
posing morphia, and fully justifies his conscience on the au- 
thority of multiplied precedents, and the present Lethean 
comfort he affords his deluded patient. Doubt crowding on 
all sides, he wants to look on awhile, to see more of the 
ravages of the disease, before he attempts any radical meas- 246 
PHTHISIS. 
ures. Perhaps the stethoscope is used, more to explore the 
ravages of the disease than the primary changes. If any rad- 
ical treatment is used, it is of a superficial kind, conceived 
in obscurity, and practised in doubt. The giant debility 
staring him in the face, causes him to be abashed ; he again 
calls in the aid of the stethoscope, and finally determines it a 
hopeless case. The patient is still cheated by palliatives, 
and of the chance of a radical cure. The disease progresses 
with all its direful train of phenomena; and that necessity 
which consigns the victim to the tomb, alike satisfies the 
mind of the adviser. 
If this picture appears of too brilliant a tint to some, we 
can say our travels have often brought us in contact with ma- 
ny of even a deeper stain. Whilst we mean not to cast re- 
flections, nor speak lightly of the formidable character of the 
disease we are treating of; we feel deeply, and deplore the 
hypothetical dogmas so industriously circulated and imposed 
by high professional authority, in too many instances. 
Our circumstances at present preclude entering into a con- 
sideration of much, if any, of the false inductions, which 
serve as a basis of the practical errors in phthisis. Every- 
thing must be abbreviated, so that a volume must be con- 
densed into a few pages. Merely a bird's eye view can be 
exhibited in relation to the disease, and yet enough we hope, 
to excite new inquiry, and a review of the subject. Without 
intending to enter the domain of egotism, we may be permit- 
ted to remark, that the principles and treatment of phthisis we 
made public twentytwo years ago, have been well sustained in 
the results, and that our inquiry has been constantly awake in 
relation to the subject. 
c. Causes. 
The causes of phthisis, like those of other diseases, may 
be esteemed to be, 1st, remote; 2d, exciting ; 3d, primary. 
The remote causes so far as they can be recognized, are, OUTLINES OF THERAPEUTICS. 
247 
in many respects, very similar to those which often lay the 
basis of the acute morbid habit, and which have been, in part 
at least, briefly treated of in the preceding etiology, and need 
not to be repeated here. Dr Clark has given a very good 
summary of those which may have a particular reference 
to phthisis, but still they are all such as lay the basis of 
the common chronic morbid habit. 
The hereditary predisposition, or idiosyncrasy, is difficult 
to be defined, as the very term implies. That such a state 
exists in families and individuals cannot be doubted. It im- 
plies a state of more ready susceptibility to extraneous cir- 
cumstances acting on the general system. It may in some 
measure be recognized by the general aspect, and contour of 
the body. A comparative state of tenuity of texture, slender- 
ness, and mobility ; not capable of fatigue ; easily hurt by 
cold, severe mental impressions, and internal stimulations 
above mediocrity. The character of the lymphatic tempera- 
ment does not strictly apply to it, for the subjects are very 
often of a dark complexion and coarse texture. Scrofula is 
a rare disease in North America, whilst phthisis is the most 
frequent. From all the facts, we can only infer, that there is 
some similarity in the common state of increased susceptibil- 
ity, rendering the system more assailable to the ordinary 
causes of disease. Scrofula is a disease of southern latitudes, 
affecting subjects in their nonage with laxity of tissues ; whilst 
phthisis is a disease of cold and variable latitudes, and affect- 
ing adults in their acme of plethora, with much activity of 
tissues, and vascular impulse. 
A state of predisposition is often obtained in those free 
from the congenital, by numerous causes leaving a sort of in- 
creased tissual susceptibility, above the ordinary grade ; and 
now subjecting the individual to injuries, which others pass 
with impunity. Pyrectic diseases of every grade are liable 
to leave a state of more than ordinary tissual susceptibility, 
and especially if often repeated; and more particularly if 248 
PHTHISIS. 
badly treated. This is a fruitful source of phthisical predis 
position. 
This subject needs some closer examination, and by it we 
shall find, that antecedent pyrectic diseases often not only 
leave a state of predisposition, but an actual state of disease of 
an obscure kind, which goes to form the chronic morbid ha- 
bit, presently to be noticed. All the chronic eruptive affec- 
tions ; the exanthemata, as measles, small pox, scarlatina ; as 
well as all fevers of northern latitudes, are liable to leave a 
state of predisposition to be lighted up by slight exciting 
causes, or they dwindle into chronic disease by being only 
half cured. (Sect, xxviii. 3.) 
We might notice here, improper diet, too much exercise or 
great inactivity, alcohol, impure and damp air, exposures to 
evening air, debauchery, venereal excess, and sudden changes 
of temperature, which by frequent repetition create a state of 
predisposition, without exciting actual disease. Oppressions 
of mind, sorrow, disappointment, nostalgia, &c. All the 
passions create a morbid susceptibility of the internal tissues, 
when of any considerable duration. 
d. Exciting Causes. 
These may be all those which usher in the acute morbid 
habit, but of a less severe kind. They often act in a silent or 
masked manner, producing but little present disturbance, but 
act an important part in establishing a permanent chronic 
morbid habit. The causes are slowly and slightly applied. 
If they were severely applied, they would excite acute dis- 
ease. So, in disease being excited soon after measles ; if 
the exciting causes are severe, pneumonia would be the re- 
sult ; if slow and mild, the chronic state of disease called 
phthisis will probably succeed. In like manner all the ex- 
citing causes of phthisis may be slight, and their effects by 
repetition become permanent. Cold, and its alternations with OUTLINES OF THERAPEUTICS. 
249 
heat, is the most prolific of any other. Hence 'the reason 
why phthisis is an endemic of latitudes liable to frequent and 
considerable vicissitudes of temperature. (Sect, xxxvi. 5 
and 8.) 
This scourge of human life is but rarely met with in south- 
ern latitudes, where the temperature is steadily elevated, 
sustaining action on the surface. And again, in northern 
latitudes, it is not very common, where the temperature 
is more permanent, although cold. Sudden changes acting 
on predisposed subjects, especially when in a sweating state, 
destroy the balance of the minute circulations internally, as 
well as externally, and induce a morbidly tissual susceptibil- 
ity, rendering them liable to conflicting actions. 
e. Proximate cause. 
A knowledge of this is the most important desideratum, 
that ever exercised the ingenuity of pathologists. It has giv- 
en occasion to the most vague speculations, apd it is not a 
little surprising, that so many should have mistaken the real 
and simple thesis, which develops its true character. In 
Section xviii. we have attempted to reveal its intrinsic charac- 
ter, on principles that cannot easily be undermined by sophis- 
tical argument. The same facts and arguments, may be ap- 
plied to the chronic as to the acute morbid habit. 
There are certain determinate laws which regulate and 
control the diseased actions, as well as the healthy move- 
ments in the human economy. As one normal law consists 
in this, that health continues until some vital change is made 
in the inmost tissues ; so, disease continues until the abnor- 
mal state of nosodynamia (Sect, xviii. 7) is removed, either 
by the efforts of the economy, or as assisted by art. A rigid 
contracted state of the involuntary tissues remains, on some 
occasions, a long time, as shown in cephaloxia, intestinal con- 
tractions, tetanus, cuticular eruptions, pleurodynia, &c. So 250 
PHTHISIS. 
a fixed nosodynamic state persists in the minutest capillary 
circulations of the exhaling, secreting, and absorbing tissues, 
for an indefinite length of time, supporting the chronic morbid 
habit. 
There exists a great difference of constitutional ability in 
restoring morbid derangements in the tissues. We discover 
in some subjects, when laboring under rather a severe state 
of disease, that the recuperative powers gain an ascendancy 
spontaneously, whilst others may require a thorough round 
of treatment, which may be unsuccessful in the end. The 
former appear to possess a more intense tissual sensibility, 
by which the restorative powers are more readily excited ; 
whilst the latter, remain inactive. So we see many morbid 
habits restored by the physiological repulses, without the aid 
of remedies. If these very circumstances expose a subject 
easily to contract disease, he also possesses an ability where- 
by he becomes freed from it, at least in many instances. 
If these changes, exciting disease, are sudden and exten- 
sive, the economy cannot long endure them ; in this case a 
state of acute disease is excited ; if they are slow and affect 
the economy in a partial manner, then a comparatively mild 
state of disease will be the result. Perhaps there is nothing 
incompatible in all this ; for exhalation, secretion, and ab- 
sorption are only partially interrupted in their regular courses ; 
so, these functions are partially performed ; and as they are 
more or less free, nutrition continues imperfectly, and a se- 
quential diseased state will be more or less dilatory and pro- 
tracted. One case of the chronic morbid habit may be more 
rapid than another, or by a new morbid impulse, may easily 
be converted into an acute state of disease. 
As soon as these morbid changes are made, the fluids be- 
gin to suffer more or less deterioration, and in proportion 
to the tissual changes. Indeed the fluids themselves may 
have suffered some previous degeneration, and add inordinate 
stimulations to the tissues, perverting their functions in an in- OUTLINES OF THERAPEUTICS. 
251 
sensible, or inappreciable manner. Both these circumstances 
may originate and progress together, or one may have antece- 
dence of the other. 
f. Chronic morbid habit. 
The foregoing circumstances may establish a diseased state, 
which is common to many other affections besides phthisis, 
according as the local emanations from it may concentrate on 
different tissues and organs, either by the influence of remote 
causes, or by idiosyncracy. If by any peculiar state of irri- 
tative predisposition, it happens to concentrate on the serous 
tissues, dropsy will be the result; if on the glandular tissues, 
scrofula or cancer may appear ; if on the mucous tissues, 
phthisis may be the result, with all its hydra train. All these 
determinations are liable to be transferred to other tissues and 
organs.* 
We do not discover a very essential difference between 
the acute and chronic morbid habit, in their intrinsic charac- 
ters, except in what relates to severity, or the slow or hasty 
changes of the different tissues. They are both induced by 
quite similar causes, remote and exciting ; they both consist 
of abnormal changes in the minutest tissues ; the chronic is 
often a mere continued sequence of the acute ; they are both 
attended with similar trains of pyrectic phenomena, differing 
in degree ; and as we may show in the sequel, should be 
treated by very similar remedies ; admitting, however, of many 
modifications. 
The word cachexia, as employed by Dr Clark, is too 
vague ; it is saying a bad habit exists ; this is as much as to 
say, something like disease exists. We think some further 
"The esteemed Dr Norton of Middlebury, Vermont, was wholly relieved 
from all the usual phenomena of phthisis, of several months standing, in 
1831, on the attack of a severe chronic inflammation in his knee, which 
continued with all its sequences until his death. 252 
PHTHISIS. 
approximation to facts is made out, in showing that a pyrec- 
tic state exists, with a local affection ; and this is manifested 
by every phenomena in the morbid habit, as relates to phthi- 
sis. The phenomena are sometimes obscure, but a nice 
practical tact will discover an alteration in the pulse, even if 
it is not much accelerated ; if small, it will be more hard 
and pungent than is natural to the subject. The phenomena 
are numerous to show the existence of a febrile state, even if 
we have not the admoftition of a cough. There is an altered 
aspect ; paleness, and occasional flushes in the countenance ; 
cold feet and hands, followed by slight burnings ; dry surface ; 
often slight fur on the tongue, or it shows too much redness ; 
increased susceptibility to cold commonly exists. 
Although the subject may be very sensitive to cold, yet 
any degree of heat oppresses him, and he finds it difficult to 
sustain himself in an agreeable medium. He is liable to have 
shortness of breath on ordinary exercise, especially in as- 
cending even moderate heights. The lips, and roots of the 
finger nails show a sublivid appearance, and the tip of the 
nose and ears will be cold even on exercise, or when op- 
pressed with heat: so of many other parts of the surface. 
Myscular inability is not remarkable, neither does pain but 
rarely attend, and the digestive functions are but little affect- 
ed, whilst a/.close observation discovers a beginning of slow 
emaciation. There is often observed a cautiousness in the 
gait, and an inclination to bend forward in walking. The 
catamenia of the sex commonly close early ; the pulse may 
be a hundred or more a minute for a long time, before the 
stethoscope discovers any thoracic lesions. As these slight 
appearances proceed, and the determinations to the lungs, in 
phthisis, are becoming more important, slight thoracic pains, 
and a short cough are rarely absent. On the first notice of 
these two last symptoms, in connection with other circum- 
stances, no time should be lost in the use of efficient rem- 
edies. OUTLINES OF THERAPEUTICS. 
253 
The affection ought to be recognised at an early period, 
before any essential adventitious changes occur in the tissues 
of the lungs. Dr Rush seemed to have a confirmed opinion, 
that phthisis was a disease of the whole system, but could 
discover nothing in its character but an inappreciable debility 
in its forming state, and vaguely supposed it must be cured 
sometime or another by tonics.* Yet, it seems he never 
made a salutary impression on recent phthisis, otherwise than 
by an efficient antipyrectic treatment. The same vein of 
perverted logic seems to have meandered through the minds 
of empirics, and even of those who have climbed the rugged 
heights of science. True to theory, they commonly treat 
the disease altogether by excitants; or tonics. 
The suggestions of dyspeptic phthisis, hepatic phthisis, 
&c. only serve to mislead from the just mode of investiga- 
tion. The subject may suffer more or less in these organs, 
from infarctions and tubercles, urged on by the constitutional 
impetus, whilst phthisis is being seated in the lungs ; and 
this is nothing more than what may happen to other organs. 
All the attempts for removing these phenomena by local rem- 
edies merely, are useless. 
We have often had occasion to deprecate the falsity of the 
thesis so industriously propagated by some, of diseases orig- 
inating at a tissual point, and from thence radiating, and pro- 
ducing what is styled sympathetic fever. Were the subject 
of less importance, it would not require so much attention. 
There is no instance in the whole catalogue of maladies, in 
which it has a more baneful effect, than in phthisis. 
We are not pleased with controversy, but we will contend 
for truth, and for principles in medicine, when so closely as- 
sociated with the happiness of fellow beings ; and our duty 
to society, as well as to these pages, never will be performed, 
* Med. Inq. Vol. I. p. 213 and II. p. 89, after repeating the essential phe- 
nomena of the morbid habit. "The early inability of function resembles 
other fevers in miniature; afebricula." 254 
PHTHISIS. 
until we have fearlessly done all we can do, to correct the 
evil, and prevent the consequences resulting from it. So 
long as this false thesis prevails, the treatment of phthisis 
will be inert, doubting, and misplaced. Finally, it will be 
worse than useless to the community, as a dispassionate re- 
view of the present methods have fully proved to the under- 
standing of many experienced advisers of the afflicted. 
It is manifest that a general pyrectic habit exists in phthisis, 
from the beginning to the termination of the disease, whether 
in health or in death; and it is marked by the same stages as 
other pyrectic diseases. But, when the ulcerative processes 
have taken place in the lungs, with exposure to the air, and 
when they do not take on the incarning process, the pyrectic 
habit suffers some peculiar modifications, and is then called 
hectic fever. It suffers two paroxysms every twentyfour 
hours ; one at about noon, the other about six o'clock in the 
evening. It partakes of the remittent character. If the 
constitutional affection can be removed before too great de- 
vastations are made in the tissues, then a restoration may 
take place, otherwise not. As soon as the ulcerations, 
whether apostematous or membranous, assutpe the incarning 
process, the peculiarities of the hectic phenomena vanish, 
and soon the whole of the pyrectic also ; provided, there is 
no new crop of tubercles to excite another process. 
Tubercle? once deposited in the tissues act as foreign bo- 
dies, or local irritants, although originating from constitutional 
circumstances. They cease forming when the common mor- 
bid habit is removed. 
g. History. 
• We have not attempted a regular history of the phenom- 
ena of phthisis, because this is sufficiently made out in al ] 
the treatises on the subject; it would be a mere repetition of 
what is familiar to e\ ery one. The phenomena vary in some OUTLINES OF THERAPEUTICS. 
255 
particulars in almost every case, on account of many personal 
circumstances ; also, by the treatment ; and also, by the se- 
verity and peculiarities of location. The common phenom- 
ena of mild febricula are always present; or rather synochula, 
as the diathesis is commonly of the synochoid character. 
We shall have occasion to notice many of the phenomena in 
an incidental manner as we proceed. 
h. Mucous tissues affected. 
In phthisis the primary concentrations are to the mucous 
tissues ; principally to the respiratory, secondarily in impor- 
tance, to the digestive, and occasionally associating the ute- 
rine in females, and the urinary in males. In females there 
is often, first leucorrhoea, afterwards amenorrhoea., Often dys- 
ury in males. See case of Girard, No. 41, by Broussais in 
his work on phlegmasiae. 
These tissues become turgid, and suffer severe hyperemia, 
whilst the surface of the body is dry, shrivelled, and pallid, 
with deficiency of function. The reactive impulses occa- 
sionally produce a transient glow on the surface, on exercise ; 
especially after some continuance of the disease, it is seen in 
a flush on the cheeks. The chief force of circulation, how- 
ever, concentrates in the mucous tissue of the lungs, from 
the many circumstances of predisposition, together with its 
constant exposure to the atmosphere. The aerial cells be- 
come narrowed by a turgescence of their own tissue ; the air 
is not so freely admitted, and very commonly some dyspnoea 
is perceived on every hurry of circulation. 
In a certain time, sooner or later according to the severity 
of the morbid habit, these tissues assume a state of excita- 
tion bordering on inflammation ; at length real tissual inflam- 
mation follows. M. Andral says, "we know that the mu- 
cous membrane of the bronchia, in a state of chronic irrita- 
tion, may furnish all the varieties of secretion which are 256 
PHTHISIS. 
formed in a pulmonary excavation."* The influence of this 
irritation is often extended to the other pulmonary tissues. 
During this progress haemoptysis may appear, and even at 
an early period, if the mucous capillaries take on the hem- 
morrhagic effort, instead of the phlogotic. It may be a favora- 
ble circumstance when early occurring, if opium, acetate of 
lead, &c. are withheld from the patient. He now becomes 
alarmed and will follow advice. This may be a time to re- 
move the disease radically in some instances. The more he 
bleeds at the lungs the better, for there is but little danger of 
a fatal haemoptysis^ when it issues from the mucous tissue. 
Yet it ought to be superceded by venesection, perspiration, 
epispastics, &c. We have seen many such cases restored. 
The haemoptysis connected with tubercles in later cases, can- 
not be so managed ; although severe, it cannot save the case. 
Again, in pulmonary apoplexy, the blood sometimes accumu- 
lates in large clots, whilst much is diffused in the tissues. 
Such cases are not easily restrained, and large quantities may 
be spit up, in this variety. So large portions of blood some- 
times pour forth, from ruptures of blood vessels in ulcers, 
and tubercular excavations. Such cases of haemoptysis are 
liable to prove fatal; at any rate they afford no relief. 
The student is now refered to Section xxi. on the subject 
of the lost balance between the centrifugal and centripetal 
circulations. On the surface there is an almost permanent 
state of anaemia, and in the internal tissues, hyperaemia. It 
has been often called engorgenient ; it is a condition long 
since discovered, and promulgated by the German physicians, 
particularly by the Kempfs, who styled it infarction. The 
capillary veins are distended, whilst the capillary arteries ex- 
tend their impetus into the white tissues oftentimes, produc- 
ing more or less redness, being tokens of excitations. 
This state of things is common to the chronic morbid hab- 
*Vol. I. page 297. OUTLINES OF THERAPEUTICS. 
257 
it, and pervades all the internal tissues, in different degrees, 
and always attends phthisis. In this affection, the mucous 
tissue of the superior part of the lungs is most affected. 
There is a constant conflict exerted ; the absorbents cannot 
take up the fluid animal matter fast enough, being constrained 
by the nosodynamic force ; (Sec^ xxi. 4.) whilst the same 
force increases the arterial impetus. The cough and pyrec- 
tic phenomena gradually, and almost imperceptibly increase. 
We speak in the familiar way, of the circulation being con- 
fined to minute vessels ; yet, we will not contend about the 
thesis of interstitial infiltration and imbibition ; the results may 
be the same, let the communications between the arteries and 
veins be conducted either way., 
i. Tubercles. 
We will now make a digression in order to review some 
of the early results of the state of turgescence, and excita- 
tion of the pulmonary mucous tissue, and particularly in /rela- 
tion to tubercles. Whenever this tissue has been kept in a 
st^te of even moderate excitation for some time, effusions of 
a particular.kind are liable to take place, and especially as 
soon as the contiguous, tissues receive some impression of the 
morbid impetus. For their formation they require a certain, 
but slight degree of excitation, in subjects of a peculiar tis- 
sual susceptibility. They arise from a particular state of ex- 
citation, let the cause of the morbid habit be what it may, 
whether rubeola, scarlatina, catarrh, syphilis, slow fever, 
eruptions, or hereditary predisposition excited into action by 
any cause. They are almost constantly found in the superior 
portion of the lungs. The most frequent exciting cause is 
cold, from atmospheric vicissitudes. If the nocent impres- 
sion is severe, pneumonia may be excited, followed by effu- 
sions of a very different kind from tubercles. Sometimes 
the pulmonary tissues do not possess so ready a susceptibility 258 
PHTHISIS. 
to produce tubercles, and they may be excited for a consid- 
erable time, producing only a very few, or none. 
We will not contend whether tubercles are seated in the 
lymphatic tissue, or in the minutest aeriel cells, or in the con- 
necting cellular tissue. Each has its advocates, and each 
may be correct in their turns. As they appear of some dif- 
ference in kind, they may occupy different locations ; but, 
we have the most convincihg evidence, that they are the ef- 
fect of the morbid excitation of the pulmonary tissues, and 
not the cause of it.' On a former occasion we have argued 
this subject in Remarks on Phthisis, in Sketches of Epidemic 
Diseases, &c., and cannot go into it here. It is more fully 
demonstrated by M. Broussais, in his Phlegmasise, and also 
by many others.* 
One of the most paralyzing and fatal errors that ever crept 
into supposed phthisical etiology, is that of Leannec, in his 
insisting that tubercles are antecedent, accidental bodies, and 
that by their mechanical irritation they , excite the entire dis- 
ease. Also, by restricting phthisis solely to this cause, and 
denying that colds and catarrhs excite the disease, or that 
they are the precursors of it. Yet, he acknowledges he is 
not always able to distinguish catarrh from phthisis.f The 
cases that recover are said to be 'catarrh, and hot phthisis. 
So the argument is ended. This thesis is so absurd, it would 
not require much notice, had it not obtained such an incredi- 
ble ascendancy in the domain of medicine. We almost ev- 
ery day meet with cases, in which the subject can describe 
the time, and circumstances, of obtaining an impression of 
cold, attended with cough, and ending in a fatal train of phe- 
nomena, which no one can distinguish from tubercular phthi- 
sis ; for it is phthisis with tubercles as a sequence, but not 
as a primary cause.' It is again phthisis without tubercles. 
* A case is published in Amer. Jour. Med. Sciences, No. xxxiii. p. 214, 
by R. Christison, M. D , which demonstrates this thesis. 
t Treatise on Diseases of the Chest, p. 77. OUTLINES OF THERAPEUTICS. 
259 
Those who accord with M. Laennec in sentiment, consid- 
er they have not much else to do than to look on, and note 
the desolation of the disease ; they say it is incurable in its 
character, but nature sometimes accomplishes what they do 
not expect. Instead of bestowing strict attention to the nat- 
ural signs, and the early modifications of the vital move- 
ments, the stethoscope is often resorted to and relied upon ; 
and, at a period when it cannot expose the incipient changes 
taking place, or about to take place ; this being the most fa- 
vorable time for the assistance of art. It lends its aid too 
late ; not until after structural changes hav0 taken place ; it 
then discloses a diagnosis of little comparative use. Percus- 
sion affords full as early monitions as the stethoscope, which 
becomes aboqt as convenient to discover the ravages of the 
disease, as a telescope is to view the carnage of a battle- 
field.* 
We wish not to depreciate the merit due to this instru- 
ment. Yet we insist that the student has been wrongly di- 
rected, in that the belief is inculcated, of tubercles being the 
primary cause to be sought for, -whilst they are so manifestly 
the results of a primary state of disease of the whole system, 
and of the lungs in particular, which is capable of being dis- 
covered, and often removed before the stethoscope can elicit 
any signs of internal changes. It invites apathy, and derelic- 
tion of duty, in waiting for the manifest results ; leads to su- 
pineness, and the loss of lives, intrusted to the. charge of pre- 
tended science. A physician that cannot detect the early 
progress of phthisis, in its incipient state by the physiological 
tokens, is not deserving the charge of his patient. 
* On examining the writings of M. Laennec, we find he placed but little 
utility himself on auscultation or percussion, in that stage of phthisis, in 
which remedies are the most available. In p. 220 of his Treatise on Dis- 
eases of the Chest, he says; " In the early stages of Phthisis, neither percus- 
sion of the chest, nor auscultation in any of its forms, affords any means of 
detecting the disease in ordinary circumstances." 260 
PHTHISIS. 
We are informed by Andral, Cruveilhier, Bouillaud, Hope, 
and others, that tubercles bdgin by a small point of liquid 
matter ; no doubt chiefly albumen according to Thenard. 
They harden, and then remain until a slow softening process 
succeeds, and are expectorated along with other purulency, 
and shreds of the lungs. Tuberculated granulations are often 
discovered ; also, hypertrophy of the tissues of the lungs, of 
a semi-cartilaginoiis kind. All these and other lesions are 
the bffects of the disease; and if the primary morbid habit 
had been seasonably removed, these resulting lesions nevei? 
would have appeared. Dr'Hope says, (Morbid Anatomy, 
p. 28,) "Every tubercle is infiltrated into the tissues where 
it exists." 
Indeed, tubercles may remain inactive in some degree, for 
a time after having been formed, on a subsidence of, or^ re- 
moval of the primary diseased state which produced them. 
We have a clear recollection of the case of an amiable young 
woman, who applied rather late for help. By a very diligent 
course of treatment, the morbid habit, and the apparent 
phthisical phenomena seemed to be very much removed. 
We began to entertain an expectation of a successful result. 
However, in a short time we were convinced of the existence 
of permanent lesions too formidable to admit of a free exer- 
cise of the functions of the lungs, in consequence of consoli- 
dated masses of tubercular matter. Yet scarcely any cough, 
no expectoration, and but little dyspnoea existed. She ema- 
ciated more like atrophy than phthisis, and sunk in about twelve 
months after this change. 
Most anatomical pathologists speak of successive crops 
of tubercles. So long as the chronic morbid habit remains, 
there will be new depositions, as well as the softening of for- 
mer ones. If the present crops should not be too extensive, 
they may be cast off by expectoration ; and if the morbid 
habit should be removed, there may be an opportunity of 
saving the case, with some excavations in the lungs, which OUTLINES OF THERAPEUTICS. 
261 
may give but little trouble during a lengthened existence. 
Critics may decide whether the case was cured or not ; but 
we have the comfortable assurance of many similar cases, the 
subjects of which do consider themselves well, and attend 
assiduously to all the ordinary avocations of life. Even if a 
ew tubercles remain, there is some reason to expect that an 
active absorption disposes of them in lime. M. Andral favors 
this sentiment.* 
j. Pulmonary vomica. 
In certain temperaments, not possessing so great an apti- 
tude to the formation of tubercular effusions, whilst the mu- 
cous tissue of the lungs remains in a state of excitation, there 
may be vomicae form, with only a few tubercles. M. Andral 
saw cases where they were so few, he thought they could not 
be esteemed the cause of the abscesses. Such cases cannot 
be satisfactorily distinguished during life, and indeed it would 
be of no practical utility if they could ; for the treatment 
should always be in accordance with the pathological phe- 
nomena, so as to afford every case the best opportunity it 
can have of a restoration. Some have recovered after very 
copious expectoration, and long continued. 
It is a fortunate circumstance for the subject to be, relieved 
of the necessity of vomicae, either with or without tubercles, 
by an early and efficient treatment. It appears that in either 
event the case may prove fatal, and with phenomena very 
similar ; and one condition may as well be styled phthisis as 
the other. 
Phthisis may proceed to a fatal termination without vomi- 
cae, and without tubercles. The mucous surface and folli- 
cles, after being inflamed a certain length of time, become 
abraded and afford a muco-purulent discharge, more or less 
copious, from its extensive aerial surface. There are no aerial 
* Path. Anat. Vol. II. p. 343 262 
PHTHISIS. 
adhesions, nor interstitial effusions in such cases, so that im- 
posthumations do not occur. And again the case may termi- 
nate fatally without muco-purulent discharges, or before they 
occur. > Still the disease is as strictly phthisis as if it were 
attended with tubercles, or a tubercular abscess. It has sim- 
ilar hectical phenomena. 
k. Tracheal phthisis. 
The upper part of the trachea, sometimes, unfortunately 
experiences the greatest concentration of the mucous tissual 
excitation, and consequently of tubercular deposites, consti- 
tuting tracheal phthisis. The voice is changed, and the af- 
fection progresses very certainly to a fatal termination, after 
tubercles have formed ; and probably,.from the circumstance, 
that the character and functions of the tissues are such as not 
to admit of cicatrization. The cartilages are liable to be dis- 
eased. Notwithstanding the lungs are of peculiar complica- 
ted textures, yet recent wounds readily heal; and indeed 
they admit of surprising restoration in phthisis, as soon as the 
general diseased habit is removed ; and before extensive de- 
generations occur in the tissues, and in the general habit. 
I. Intestinal mucous tissue. 
This is often extensively affected with tubercular depos- 
its, either simultaneously, or soon after the pulmonary tis- 
sue. Indeed the intestines are quite uniformly affected, and 
essential lesions occur frequently, attended with pain, diar- 
rhoea, hemorrhage, perforations preceded by ulcerations in 
the mucous tissue, and extending into the other tunics ; par- 
ticularly in the coecum, and its vicinity. Sometimes in the 
latter stage of phthisis, the chief force of the diseased habit 
may seem to concentrate in these organs, producing a con- 
cealed and deceptive state of the pulmonary lesions. 
Whilst writing this, (January, 1837,) was inducted to the OUTLINES OF THERAPEUTICS. 
263 
case of L. Mack, aged 35, dark complexion. Was inform- 
ed he had fever nearly three years previous, followed by 
phthisical symptoms. He got better, and labored some, un- 
til a little time since. About a month before death, respira- 
tion was free, although percussion gave a very dull sound ; 
could talk freely, lie on either side, or back; no thoracic 
pain ; but seldom coughed ; spat a mere fraction of mucous- 
like matter, a few times slightly tinged with blood. Said 
that during a year past he had much pain in abdomen, and 
quite constant diarrhoea, which he habitually restrained by in- 
jections of starch and laudanum. For three weeks before 
death he purged blood, sometimes about a pint, at other 
times less, but lost much blood with gripiugs. 
Autoptic examination revealed important thoracic lesions ; 
lungs adherent firmly at every point of contact with costal and 
diaphragmatic pleura ; they did not collapse in any point ; 
filled every where with tubercles, and tuberculous granula- 
tions ; cartilaginous hardenings in some places, and three ab- 
scesses in others, about the size of pullet's eggs. In abdo- 
men, numerous tubercles, ulcerations in mucous tissue of in- 
testines, in coecum, colon, and ileum ; one perforation ; 
slight adhesions by serous tissue ; a space of contraction in 
colon ; patch of recent inflammation in stomach about the 
size of the palm of the hand. Universal emaciation, with 
internal vascular infarctions. 
This was 3 concealed case of phthisis at the time exam- 
ined, and a superficial observer might have concluded there 
was but little disease in the lungs. It seemed incredible he 
should manifest so few thoracic phenomena, breathe and talk 
so freely, with such essential derangements in the lungs; but 
the morbid impetus had been chiefly transferred to the intes- 
tines, after committing great pulmonic ravages. 264 
PHTHISIS. 
m. Ulterior haemoptysis. 
Through the negligence of patients, and sometimes the in- 
attention of advisers, tuberculated deposits become quite ex- 
tensive before discovered, and without manifesting any urgent 
phenomena, and the first shrious admonition may be an alarm- 
ing haemoptysis. The tissues are now engorged, and the tu- 
bercular deposits act as restraints to a free circulation, and 
a hemorrhagic effort now throws out large quantities of blood. 
The discharge may retard the progress of the disease, but 
the lesions are so extensive the case becomes hopeless. A 
palliative treatment by bleedings and demulcent diet is advisa- 
ble ; but if much amount of 'astringents and opiates are used, 
the fatal termination will be expedited. 
n. On avoiding phthisis. 
It would require a volume to specify all the hygeienic rules 
to be observed, in avoiding the accidental causes which may 
excite phthisis.' A knowledge of the hurtful agents, which 
induce a chronic morbid habit, may be sufficient to incite the 
considerate part of the community to shun many of them. It 
is, however, a sad reflection, that oftentimes those who are 
very circumspect in other matters, are often neglectful of ev- 
ery circumstance relating to their health. It would seem 
that the extensive prevalence of consumption, might admon- 
ish all to be circumspect in the preservation of their health, 
afnd especially to pursue means of restoration, when they find 
the first monitions of the disease upon them. 
We have heard many express a reluctance to call for ad- 
vice, because, they say, all die on taking medicine, no one 
was ever benefited by it. Perhaps there is too much just 
cause for this professional rebuke ; but, it might be expiated 
in time/, if advisers would attempt the removal of the consti- OUTLINES OF THERAPEUTICS. 
265 
tutional derangements, instead of palliating the more obtrusive 
local phenomena. 
Those who possess a liability to phthisis, and others of 
acute sensibility to cold, ought to be very circumspect in 
avoiding atmospheric changes, and especially exposures to 
evening, or morning cool and damp air, westerly winds, &c. 
As the body may be heated by exercise, so these circum- 
stances may make a greater impression. Strict regard should 
be had to clothing, and in a manner to ward off any impres- 
sion of cold by day and by night ; and yet it should not be 
very burthensome. Steady exercise in the open air for those 
who are able, gives stability to the tissues, assists in support- 
ing an equal circulation, and renders the economy Jess dis- 
turbed by vicissitudes of weather.' 
An essential part of the prophylactic treatment for a 
voiding the formation of a morbid habit, in the movable 
temperaments, consists in washing the body with cold water, 
on rising from bed in the morning. This practice should al- 
ways be adopted during die premonitory stage, and before 
the establishment of a morbid habit} or permanent local affec- 
tions. Those suffering coldness of hands and feet, also sen- 
sibility to cold, will commonly be benefited by this practice, 
if it is rightly conducted. A part of the body may first be 
made accustomed to it; such as washing freely the neck and 
breast, and at the same time the feet and legs in cold water, 
with a napkin. Foliowit immediately by dry rubbings with 
flannel, until warmth or some redness arises on the surface. 
Then dress, and exercise by walking until general warmth is 
produced. It may soon be extended to the whole body, if 
the first attempts are successful. Feeble persons, inclining 
to febrile irritations are sometimes liable to suffer injury by 
this practice. Such should adopt it more cautiously, and be 
careful to obtain warmth soon. It is sometimes prudent to 
temper cold water a little, with warm water added, on begin- 266 
PHTHISIS. 
ning the practice. If found beneficial, the practice should be 
continued for months, and years. 
The diet should be mild and moderately nutritious, with- 
out rendering too high stimulations ; milk, and vegetables, 
and avoiding much meat and condiments. Hot drinks 
should be avoided by those who can dispense with them, 
except when necessity requires. Avoid all exciting, or 
depressing emotions beyond mediocrity. In middle aged 
people, much may be done to inure the system to bear the 
vicissitudes of changes without injury. 
On the access of every impression of cold, however, in 
the form of catarrhal fever or otherwise, be careful to re- 
move it in a short time by the ordinary means. Reference 
may be had to all that has been said on the subject of etiolo- 
gy. In the event of any attack of exanthematous, or other 
fever, be careful to have it entirely eliminated, before expo- 
sure to cold air, or indulgence in ordinary regimen. Finally, 
observe temperance in every thing, with uniform exercise, 
avoiding all circumstances of agitation of body or mind, and 
keep the system as nigh the standard of equilibrity as possi- 
ble. ' . 
In the instances mentioned by writers, of great exposures 
and fatigue curing phthisis, the subjects are in very different 
conditions from what they are at the attack of the disease, 
when a recent morbid habit exists. Steady, and even labo- 
rious exercise goes far to sustain uniform circulation, to ob- 
viate a predisposition, and give stability to the system in such 
a manner that the subject may'not be so likely to contract the 
disease. And again, after the morbid habit has existed for 
some time, and has been essentially removed by remedies, 
or the natural efforts of the system, and without very exten- 
sive lesions in the lungs, then exercise is often very useful to 
sustain an equilibrity of circulation, to keep up secretion, and 
give stability to the tissues. However, if practised with ex- 
posures to cold, at the onset of the morbid habit, such exci-> OUTLINES OF THERAPEUTICS 
267 
tations would inevitably aggravate the disease, and render it 
more certainly fatal. 
o. Methodus medendi. 
Let not the visibles of the long foiled satiric&l critic be 
moved, on seeing the inscription of this paragraph. Even if 
the finger of scorn should be pointed at us, we will still talk 
about curing phthisis, or assisting nature to do it. By this 
we only mean, that a part of the cases may be conducted to 
a favorable termination, under the adverse circumstances that 
are commonly met with, in private, or in hospital practice. 
The case may have been greatly neglected; it may have been 
treated by charlatanic palliatives, and made worse ; or the 
patient may not be willing to submit to rigid discipline ; and 
if he should, he may after a while fly to those who promise 
soothing treatment, and a speedy cure. Or,-his circum- 
stances may be such, that he cannot be supplied with the 
necessary conveniences, or suffer the loss of his time. 
It is often a long and laborious task to alter the progress of 
so unrelenting a disease, which has already made considerable 
advance. The sooner it is undertaken, and the more effi- 
cient the treatment, the greater will be the chance of a 
successful issue. 
We have endeavored in the briefest manner to expose the 
character of phthisis. From the existing abnormal condi- 
tions of the system, the indications of treatment are naturally 
inducted. We have endeavored to show, that the general 
constitutional derangements are the basis of the local affec- 
tion. Remove this, by directing the axe to the root of the 
tree, and the foliage will commonly wither. The local treat- 
ment is of but little use. 
In reviewing the primary changes in the morbid habit, we 
find them to be few, and simple in their character in the be- 
ginning. They remain so, until the sequences of the repul- 268 
PHTHISIS. 
sive powers of the system, produce lesions of textures, more 
difficult to be removed, than even the primary changes. The 
remedies to alter the primary state of the tissues, are also of 
a simple character, and only a few are required, when sea- 
sonably and properly applied. 
The means which bring about this change may be various, 
and sometimes apparently quite opposite in their nature ; but 
all unite in one single circumstance, viz : such agencies as 
overcome the state of nosodynamia, and excite absorption 
and secretion in the minutest tissues of the body. A severe 
state of agitation of the minute capillary system, by emotions 
of the mind, has sometimes effected this change. (Sect, 
xviii. 7 and 8.) 
Jt has been brought about by severe exercise of the body, 
exciting extreme agitations in the minutest tissues, when 
under favorable circumstances. Numerous cases are re- 
corded of such sudden changes in the economy of the system 
produced accidentally. Several cases are related in Dr S. 
G. Morton's Illustrations, of casual cures by protracted exer- 
cise ; there are many such by other writers, who consider it 
a mere tonic. Dr Salvador! practised it more systematically, 
but with what intentions is not stated by Dr Young.* " He 
directs his patient in the morning to climb, as quickly as he 
can, up some eminence, till he is out of breath, and bathed 
in sweat ; and then to place himself near a large fire to 
increase the perspiration. He is afterwards to change his 
linen, and gradually withdrawing from the fire, to partake 
freely1 of salted meat and wine." 
These severe agitations have a far more certain beneficial 
effect, when the mind is ardently excited. Yet the case of 
the captive sergeant, mentioned by Dr Chisholm, was under 
very adverse circumstances. " The merciless enemy, re- 
gardless of his wretched condition, forced him at the point of 
the bayonet to keep up in the.hurried march," although he 
*Dr S. G. Morton's Illustrations, note, p. 144. OUTLINES OF THERAPEUTICS. 
269 
labored under the worst symptoms of phthisis, colliquative 
diarrhoea, &c. In a few days all the symptoms of -the dis- 
ease vanished, and with a scanty allowance of rice for diet. - 
, Phthisis has sometimes been cured by an intense exacer- 
bation of the fever, somehow excited. An instance of this 
is shown in Dr Holmes' Dissertation, in the abbreviated 
case of Bayle, the pathologist, p. 234. "It began in 1802, 
and presented the symptoms of phthisis to such a degree that 
he himself, and the physicians around him, looked forward to 
its speedy and fatal termination. About twTo months from its 
commencement, there took place a violent chill, followed by 
the most profuse sweating. A few days after, he was convales- 
cent, and in a month from the apparent crisis, his health was en- 
tirely re-established. From this time until 1810, when the 
work which contains this observation was published, he had no 
symptom which resembled phthisis, and was then enjoying 
good health. The observation is entitled, ' Chronic pulmo- 
nary catarrh, having all the appearances of pulmonary phthisis, 
cured spontaneously.' He died soon after of pulmonary 
phthisis." - . 
This case shows emphatically the impropriety of confining 
phthisis to supposed primary tubercles. As it did not prove 
fatal in the first attack, of course, the case must be called 
chronic pulmonary catarrh, yet having all the appearances of 
pulmonary phthisis. In the last attack, because it proved 
fatal, it most certainly must be styled pulmonary phthisis. 
Without any further commentary, this case shows the absur-, 
dity of confining phthisis to originateTrom primary tubercles, 
whilst catarrh may be attended with all the appearances of 
pulmonary phthisis. We must discriminate things by their 
similarity and dissimilarity. This case also shows, that the 
agitation of a severe paroxysm of fever, attended with free 
evacuations, may excite the inmost tissues, and remove .the 
primary cause of the morbid habit; and on similar principles 
to the cases cured by terror, and other agitations. 270 
PHTHISIS. 
Many cases similar to the above might be mentioned ; and 
what instruction do we obtain from them ? Certainly much. 
These severe exertions and agitations, excite absorption and 
secretion, when the nosodynamic state has been diminished. 
When the enthralments of tissues are in part removed, the 
capillary circulations are more readily excited, and capable of 
being sustained in their actions under favorable circumstances. 
In Salvadori's cases, they were excited by exercise, and 
sustained by continued caloric, and by meat and wine. In 
Bayle's case, by long continued sweating during the parox- 
ysm ; and in Henderson's, by continued exercise of body. 
Perhaps the case of the sergeant might have been sustained 
by extreme resentment, whilst the excitations were produced 
by severe exercise. 
In all these cases it appears, that the abnormal changes 
sustaining the morbid condition are removed, and the normal 
circulations take their courses ; and as a sequence of this, the 
pulmonary turgescence, and even inflammation subside very 
soon, unless too great ravages have been committed in the 
tissues. And even in this event, the case stands on the foot- 
ing of other lesions happening to the lungs, unsupported by a 
morbid habit. These fortunate cases usually occur after con- 
siderable subduction of the phlogistic state of the system by 
treatment, or otherwise, and before extensive lesions arise in 
the lungs. A severe agitation in a case with much inflamma- 
tion, might very certainly have done injury, provided the 
primary cause should not have be^n removed by it. 
Can these favorable results be obtained by art ? or, can 
we gain instruction from the casual operations of the restora- 
tiv*e processes of the human economy ? Indeed we must be 
very drowsy pupils if we do not. These cases can more 
surely be conducted in safety by the aids of science, than left 
entirely to fortuitous circumstances, and the capriciousness of 
the undirected vital .movements. Whilst these casually favor- 
able cases are carefully recorded, how numerous are those OUTLINES OF THERAPEUTICS. 
271 
which have been hurried to a fatal termination, by some ad- 
venturous exposures ? 
PARTICULAR REMEDIES. 
p. Caloric. 
Having the previous expositions in view, the rational treat- 
ment immediately intrudes itself to the apprehension. On 
the surface paleness, dryness, anaemia with chilliness ; the 
centripetal circulations deficient, with internal engorgements. 
This condition cannot be, safely altered by mere internal sti- 
mulants ; and every attempt in a severe case, increases the 
perturbation of the centrifugal series of vascular action. In 
nine times out of ten, the disease is excited by cold, and the 
first treatment requires the use of caloric in some form to the 
surface. A warm temperature is indispensable in the first 
stage of treatment. 
In cold seasons the patient should be defended by a warm 
room of about 75° Fah. A steady temperature should be 
observed by day and by night ; or, so as to be agreeable to 
his sensation. Capillary action should be excited on the sur- 
face by caloric, by frictions,, and by such exercise as the 
patient can take without exposure to cold. Both exhalation 
and absorption should be excited. 
It was not until about eighteen years past, that we became 
fully convinced of the utility of the universal warm bath in 
phthisis. We now think it indispensable in recent cases, and 
enjoin it every, or every other evening, before retiring to bed. 
It may be continued a month or two, and occasionally for a 
much longer time, if there should be chilliness, or dryness of 
the skin. It even moderates the hectical paroxysms, and 
converts the colliquative sweats into a state of warm perspi- 
ration. A temperature of about 100° Fah. may be employed, 
but always such as to be agreeable, and easily borne by the 
patient. 272 
PHTHISIS. 
A tub of sufficient size for some motion should be employed. 
A flannel blanket should be wrapped about, and kept loosely 
around the body in the bath. As the patient comes out, he 
should be covered up with a dry blanket over the whole body, 
and laid in a warm bed. Whilst in the bath use severe rub- 
bing, and on rising up, continue it with a dry cloth. A mild 
warm sweat should now be promoted by aromatic infusions, 
as hyssop, &c., sweetened, or not. The patient will then 
be prepared for other measures. 
Sometimes the bath may be impregnated tvith common 
muriate of soda ; at other times with a few quarts of wheaten 
bran, or even common soap. The warmth on the surface 
should be sustained by occasional rubbings with warm flannel, 
by a sufficiency of clothing, with flannel next the skin, and 
some agreeable nutriment mostly in a fluid form. 
q. Venesection. 
Although the antemic aspect of the patient might seem to 
forbid taking of blood, yet the internal infarctions and inflam- 
mations imperiously demand it. The pulse is usually small, 
hard, and frequent at the commencement, from 90 to 120 
pulsations in the minute. Even late cases require it ; but 
subjects bear more bleeding, and with greater benefit, when 
it has been practised at the beginning. This is the surest of 
all remedies, after due preparation, to moderate the progress 
of the disease, whether we have regard to the constitutional 
diathesis, or the local inflammation. 
After one full bleeding in recent'cases, if the subject is 
kept warm, the pulse becomes more expanded, and the blood 
shows an inflammatory buff, more or less cupped, like as in 
many other states of disease. This is a sure token that the 
disease is of the synochoid character, and that it will be well 
borne. This is generally the result in the first stage of the 
disease, and much so in protracted cases. But, our treat- OUTLINES OF THERAPEUTICS. 
273 
ment must be chiefly confined to the first stage of the dis- 
ease. <• . - 
We discover the same diathetical difference in phthisical 
habits, as in other conditions of pyrectie diseases. Whilst 
many exhibit more free and expanded vascular action at the 
commencement, others of the temperament called lymphatic, 
or scrofulous, show but feeble vascular action. The feet and 
hands are constantly cold, except sometimes a burning sen- 
sation, with a flush in one or both cheeks. The veins are 
small and blue, the surface anaemic, with a small thready 
pulse, 120 or 130 in a minute. Slight pain in the thoracic 
region, and often in the forehead ; small and dry cough in the 
beginning. We call this the typhoid state of phthisis. 
We formerly had much hesitation about taking blood in 
such cases. Believing, however, that no favorable impres- 
sion could be effected without it, full trials have been made, 
and the results have sustained its utility, when employed 
under the circumstances just mentioned. About half an hour 
after coming from the bath, in the fore part of the evening, 
will be the most suitable time, and whilst the .patient is in a 
recumbent position. If there should be faintness this will be 
no objection, as it insures a very general impression on the 
system, and a return of more natural circulation, and warmth. 
Within a short time after the first bleeding, the pulse/will 
commonly be fuller and stronger than before, if external 
warmth is continued ; perhaps there may be more pain. 
This will be a sure token that the circulations and nervous 
sensibility are becoming more free, and that more bleeding is 
necessary ; and that the diathesis is approximating to the sy- 
nochoid character. If these phenomena appear, blood should 
be taken to the point of freedom from all pain ; and even 
further at proper intervals, until the pulse diminishes in fre- 
quency, in the course of a few weeks. 
In order to subdue the morbid habit in any diathetical con- 
dition, the bleedings should be full instead of small, and 274 
PHTHISIS. 
repeated at as short intervals as the case will admit of. This 
is as necessary, according to the urgency of the symptoms, 
as in pleurisy. When the economy ' is once disturbed by 
bleeding, it ought to be quickly pursued as far as is necessary, 
or as far as the circumstances of the case admit, whilst bleed- 
ings with long intervals may be altogether useless. 
One of the most distinctly marked cases we ever met with 
of the typhoid character, was in a young lady of about twen- 
tytwo years, who had several previous attacks of haemoptysis, 
and the case had been of slow access and of considerable 
standing. We made full bleedings three times during the 
first week of treatment, and two of them to syncope. The 
greatest severity of the case was soon overcome ; no more 
haemoptysis; and with a few after bleedings, with other 
anti-pyrectic measures, she recovered in about four months. 
We saw her well, at the head of a family of children, fifteen 
years after. 
No practice is more reprehensible than that of making 
small bleedings, and repeating it at long intervals. All the 
good is lost and the disease has been gaining the victory. If 
certain changes in the system are to be effected by bleeding, 
it should be quickly followed up until the object is effected. 
This can be done in an efficient manner, oftentimes, and with 
the loss of less amount of blood in the whole, than by small 
and protracted bleedings to a greater amount, which often do 
no benefit to the case. 
The chronic morbid habit is of more difficult removal, and 
requires a greater amount of remedies than the acute. Suc- 
cess depends on perseverance to the point of relief, if the 
powers of the system have not become previously too great- 
ly exhausted; and on improving the earliest opportunities to 
save the integrity of the internal tissues. 
The balance of fluids is quickly restored to the blood ves- 
sels, after bleeding, and the dynamic actions are soon renewed 
after it, and sometimes with greater force. The intention OUTLINES OF THERAPEUTICS. 
275 
should now be to proceed on, until the object is obtained. 
Prudence must be used to proceed no faster, and no farther, 
than the phenomena indicate the patient can bear with safety. 
And, again, not so dilatorily, as that the disease will gain 
strength by delay, and render useless all that has been done. 
Here is a specious opportunity for doctors to disagree, 
and we can give no further opinion without examining the 
particular case. We can only observe, that the aspect of 
the patient, and the false notions of the theory of debility, 
are liable to intimidate both the veteran, and the noviciate. 
However, it should constantly be borne in mind, that 
nothing efficient has been gained, until the centripetal circu- 
lations have obtained an ascendancy over the centrifugal; or, 
until the absorptions become more active than the depositions. 
As soon as this is attained, there is but little more to do than 
to observe carefully, that nothing be done to interrupt the res- 
torative processes going forward. But few and light medi- 
cines are necessary; perhaps none for a time. There should 
be strict observance that the patient is supplied with mild, 
fluid, albuminous diet, but not in excess, yet sufficiently sup- 
porting. 
Taking blood from a vein in the arm is preferable to any 
other mode, as its sudden influence is more effectual in over- 
coming the morbid tonicity. If this is accomplished, the 
turgid sanguineous capillaries will yield up their contents to 
the now active venous absorbents. However, cups and 
leeches may sometimes be used as palliatives, in cases of 
much lowness, where further general bleeding may be es- 
teemed not advisable, and where there are large pulmonary 
deposits. When the general affection is removed, there 
will be no more successive crops of tubercles ; and if a first 
crop is already formed, yet not too extensive, they may be 
eliminated with the sputa, and the case saved. 
Cases of long standing with considerable tissual lesions, 
attended with much exhaustion, where bleeding has been 276 
PHTHISIS. 
omitted at the onset, do not require bleeding, or only spa- 
ringly as a palliative. Notwithstanding, there may be some 
protracted cases which require it, when they become aggra- 
vated. A young woman, aged thirteen years, had suffered im- 
mensely by pneumo-thorax ; had large discharges by paracen- 
tesis, as well as by expectoration, for twelve months. She 
became affected with a re-accession of severe pyrectic phe- 
nomena ; a peripneumomary with pains, &c. Took from 
her two bleedings in one week, of twelve ounces each ; and 
but for this, the case would have been fatal in our opinion. 
She recovered in about six months from this, and has so re- 
mained for eleven years and more, with en-bon-point and 
strength. ' ... 
In cases where bleedings have been practised from an early 
period, by which vascular action has become free, the blood 
may show a dense pellicle to the last. We do not bleed to 
get rid of all this, for it might require the last ounce that 
would flow ; but, to alter the physiological actions which pro- 
duce it. Much circumspection and discrimination are re- 
quired, to conduct bleedings in phthisis to the best advantage. 
It is for the want of just discrimination, and energetic- proce- 
dure, that this remedy has not gained reputation in the honest 
opinions of many practitioners. 
r. Emetics. 
We have aimed to simplify the character of disease, to 
dissolve it of mystery, and to'resort to the most uncompli- 
cated means to change the primary derangements to their 
normal condition. This may be an easy task in some condi- 
tions, yet in phthisis it is laborious, and not always attainable. 
We need to call in various resources to suit contingencies, 
and are liable to use too many internal, as well as inefficient 
remedies, or slow alteratives. 
The character of the chronic morbid habit leads us to in- OUTLINES OF THERAPEUTICS. 
277 
fer, that certain operations which may bring into exercise the 
minute circulations, may be useful to restore their integrity 
of function. One adjuvant has been found in the exercise of 
vomiting ; and we make it a substitute for corporeal exercise 
for those not in a condition for this. Not only so, but it ex- 
ercises every minute tissue more effectually than any mere 
muscular exercise. It is necessary that this, with other pro- 
cesses, should precede, and prepare the system to endure 
muscular motion with benefit, by removing the morbid de- 
rangements. 
The lungs, as well as all the internal organs, are exercised 
by emesis, and their functions promoted by it. The exha- 
lants and mucous follicles discharge more freely, and the in- 
ternal infarctions of the, blood vessels are agitated, and ab- 
sorptions promoted by it. The centrifugal and exhaling sur- 
faces are excited, not by direct stimulants, which would add 
to the diseased state, but by a train of associate motions res- 
toring or exciting their lost functions; Even the exercise of 
nausea is extended very considerably to all the tissues, and in 
many conditions may, where there is much lowness, be used 
as an occasional substitute for emesis. These processes may 
be so conducted as not to exhaust overmuch. Like corpo- 
real exercise, they may be extended to the point of fatigue, 
but not of exhaustion. „ < 
It is not a single emesis that will be of much use, to re- 
move a fixed state of disease of slow access ; but it must be 
reiterated, and in connection with other auxiliaries. The patient 
should always be in £ warm condition during the process, 
so as to promote dermoid ,action, and sometimes moderate 
sweats. Emetics may be used once a day, yet sometimes 
every second day, and in the intermediate day a nauseating 
dose. Oftener than this, they become very disgusting, and 
spoil the appetite for everything. The patient needs time for 
rest and refreshment, and should not be teased with other 
medicines that are of doubtful, or no use ; perhaps injurious. 278 
PHTHISIS. 
As soon as the patient has rested, and manifests some de- 
sire, agreeable nutriment in a liquid form should be presented 
him. Sometimes the broth of the flesh and bones of pork, 
as practised by Dr Sentor ; -or indeed of other flesh, as beef 
tea, or chicken broth, when tired of the farinaceous and mu- 
cilaginous mixtures. 
The evening, in an hour after coming from the bath, offers 
the most advantages in many respects for the use of the 
emetic, especially at the commencement of treatment. If 
the subject is not reduced, it may be used even after bleed- 
ing. Some who suffer much in the morning front collections 
of muco-purulent matter, receive the most benefit by using it 
at this time. 
We have had cases in which the patient desired an emetic 
every morning, for several weeks in succession, because 
it afforded so much immediate relief. In cases of a dry 
cough, without expectoration, both emetics and nauseates 
promote secretion, and relieve the excitation of the pulmo- 
nary mucous tissue. 
Various are the means of exciting emesis. .We have long 
been in the habit of using the pill below, on account of its 
efficient, yet mild operations.* In common treatment it pos- 
sesses advantages over any other, in our opinion, especially 
in the first stage of this disease ; or in any other when 
*Red Antimonial Pill. . , 
R. Antimonii Tart. 5 
Antimonii snip, rub 5 jss- 
Gum Ammoniaci 
Gurp Guaiaci . ,a a 5 "j- 
Sapo. Cast. . . . . . . . 3 ij. 
Pulverize and levigate separately, and make into a mass of pills well 
beaten, with Ol. Olivae. The mass does not soon grow hard, and pills of a 
size required may be made when wanted. About two or three grains will 
excite emesis in an hour and an half, or two hours, in an easy manner. It 
may be so managed as to nauseate more or less. By a slow solution it pro- 
motes diaphoresis, and may prove laxative. OUTLINES OF THERAPEUTICS. 
279 
emetics or antimonial alteratives are required ; we have 
proved it for a long time. 
The simple ipecacuanha may be used, especially if a dis- 
position to diarrhoea should exist. The compound syrup of 
squills, (hive syrup) is a useful medicine. It may be used 
instead of the pills. In protracted cases where there is much 
lowness, with some ulcerations of the lungs, and disposition 
to diarrhoea, the cuprous powder becomes the most useful.* 
If the stomach should become irritated by the use of emetics 
at any time, they should be suspended for awhile, and a 
demulcent diet more strictly pursued. 
s. Cathartics. 
There is bat little use for cathartics in phthisis ; the anti- 
monial pill just mentioned will often move the intestines suf- 
ficiently, and possibly too much sometimes. The mucous 
coat of the intestines being liable to become tuberculated and 
ulcerated, should not be irritated by cathartics, and yet cos- 
tiveness should be obviated. When laxatives are needed, we 
have had a predilection for sulphur, combined as below.f 
* R. Ipecacuanhas . . ... . . 2 parts. 
Sulph. Cupri • . 1 part. 
Two or three grains, given in treacle, will excite emesis in a few minutes, 
and leave an appetite for refreshment. We have known patients use it 
every morning for a month in succession, even when much reduced. It is 
a tonic withal. A cup of broth sits well after it, and digestion is promoted. 
It should be used soon after being compounded, as the copper acts/ on the 
ipecacuanha. 
t R. Sulphur. 2 parts. 
Enulae campanae ... . . 1 part. 
Glycyrrhizae glab. . . . . . . 3. parts. 
The proportions may be varied ; we esteem it the best expectorant the 
patient can have, pulverized and mixed in treacle, or honey. If diarrhoea 
attends, the sulphur may be omitted. The electuary may be taken in the 
quantity of a coffee spoonful, three or four times in twentyfour hours, and 
continued a long time, if no particular objection arises. 280 
PHTHISIS. 
Finally, the laxative pill, (see Index,) .should have prece- 
dence on almost all occasions, when such articles are required. 
t. Demulcents. 
The whole tribe of demulcents may be employed in one 
form or another ; including the class of mucilages. These 
constitute the necessary expectorants instead of the very 
acrid articles of that class ; except on particular occasions of 
much viscid sputa. . The Iceland moss, boiled in milk and 
water : preserve of quinces, &c., may be used to advantage. 
Such articles compose a part of the diet, and when there is 
intense sensibility at the stomach, they should mostly be re- 
lied on for nutriment. 
u. Counter-irritants. 
We cannot take so favorable notice of these at present, as 
formerly. The .external irritations are painful to the patient, 
and the stimulations are reverberated to the affected organs, 
and also to the whole system, occasioning some excitation. 
Their early use ought to be prohibited ; but ulteriorly, in ca- 
ses giving fair prospects of restoration, they are often, of use, 
by diverting the internal local irritations to the surface, by 
which the internal tissues obtain more safety. 
A few epispastics may be applied to the thorax, after the 
principal part of the general treatment has been extended to 
its justifiable, limits. When once drawn, their discharges 
should be continued for a week or ten days. 
The antimonial ointment often gives more irritation than 
relief; yet, in the more torpid cases of arterial action, and in 
instances of the recedence of chronic eruptions operating as 
a cause, it becomes useful when extensively applied. 
Cuppings and leeching are, for the most part, superceded 
by the necessary remedies used to eliminate the constitutional OUTLINES OF THERAPEUTICS. 
281 
affection. Still some cases may be benefited by them, aft^r 
general bleeding has been extended to its justifiable limits. 
Setons are oftentimes useful, in keeping up a steady diver- 
sion of the local affection to the surface, and serving as cen- 
tre points, in the event of any occasional aggravations of the 
disease, after the severity of the general disease has subsided. 
They should be applied late, and long continued ; in such 
cases only, as show signs of restoration. 
Plasters of Burgundy pitch may be ysed with considerable 
advantage, after a few weeks of the treatment; applied be- 
tween the shoulder-blades, and on the sides, Where the 
warm bath is not used, they may be early employed, and if 
they do not excite manifest irritation on the surface, they 
ought to have a small admixture of cantharides; yet not so 
much as to excite vesication. They should be taken off 
when becoming loose, and the part wiped, and gently rubbed. 
Patients confined to their rooms, and especially those con- 
sidered as convalescent, should rub themselves universally, 
as far as they are able, twice every day ; and they should al- 
so require the aid of the nurse. A woollen mitten is con- 
venient, and it may sometimes be moistened with camphora- 
ted spirit. -'it 
v. Tonics. 
No directly tonic, nor high stimulant medicaments, should 
be given during the continuance of much of a pyrectic habit. 
As soon as this has chiefly subsided, some advantage may be 
obtained from them, used in a cautious manner. They are 
more especially useful when excavations exist in the lungs, of 
long standing, attended with large sputa. 
We have often used Griffith's chalybeate, or myrrh mix- 
ture, and with considerable satisfaction. If the pyrectic habit 
should increase, it ought to be suspended. Ulcerations in 
the lungs cicatrize more certainly by the use of tonics. When 282 
PHTHISIS. 
the constitutional disease is essentially removed, quinine may 
sometimes be preferable to chalybeates, when the disease 
shows more distinct paroxysms of exhaustion, and the general 
state of disease is essentially removed. So also, wine with 
exercise. 
Iodine, at present, promises to be the most useful tonic 
in the exhausted stage of phthisis. It possesses other prop- 
erties than tonic. It appears to possess some peculiar prop- 
erties of gently exciting action in the absorbent systems. It 
removes scrofulous swellings, whilst it shows a tonic influence 
generally. If this is its character, it must be well adapted to 
the state of phthisis, when not much remains of a pyrectic hab- 
it. In this manner we have used it considerably, and with 
satisfaction. It is also well approved by many others. Lu- 
gol's preparation is the one we have preferred ; as below.* 
A syrup of the tincture of balsam of tolu is an agreeable 
cordial and restorative, in cases of considerable exhaustion. 
It may be used freely, and it is often rendered more grateful, 
by the addition of a few drops of the tincture of Gaultheria, 
or of peppermint. We have not been able to discover the 
benefits of the balsam of copaiba, as represented by Arm- 
strong. We would not, however, discard it in conditions 
free of much fever. 
We do not wish to stop and dwell on negative treatment ; 
but as these are recommended by even some late writers, and 
.... * . 
w. Narcotics. 
*R. lodini, ........ 9 j. 
Potassec Hydriodat. Q ij. 
Aquae dist. . . . « . . • . § vij. M. 
Begin with six drops twice a day, and increase one drop a day to what 
the patient will bear, without producing uneasiness at the stomach ; perhaps 
to twenty or twentyfive. It should be taken in a large proportion of water, 
or half a pint of some demulcent drink. It should be continued several 
months. Large doses are hurtful. OUTLINES OF THERAPEUTICS. 
283 
so much used, they are introduced for the purpose of disap- 
proval. From much observation of our own, we are assured 
no progress can be made in the removal of the constitutional 
pyrectic affection, whilst opiates, or any other narcotic is 
used. Every case in which they have been used antecedent- 
ly to the treatment, is sure to be rendered more uncertain, 
as respects a favorable result ; unless we may except digita- 
lis in a limited manner. 
The same remarks already made in relation to the use of 
narcotics in the acute morbid habit, (Sec. xlvi. 1, i.) will ap- 
ply in the chronic, and in an especial manner as relates to 
phthisis. We insist that no progress can be made in the re- 
moval of the disease whilst narcotics are used in any form. 
We impute the failures of those who have attempted the treat- 
ment of phthisis on some just principles, in a great measure, 
to the use of these deleterious agents, so freely intermingled 
with almost every other remedy. In part, however, in not 
having just views of the character of the disease. 
We have, on several occasions, shown the illusions which 
have led to their use; and we may now merely notice, that 
they are the highest stimulants ever introduced into the ma- 
teria medica. They retard the exhalations, absorptions and 
secretions ; render the tissues dry ; afford a delusive truce 
to painful sensations, by diminishing the sensibility of exter- 
nal relation, and ultimately aggravate every phenomena. 
They co-operate with the remote and proximate causes of 
phthisis, and serve to fix the primary changes in the inmost 
tissues more permanently, and render them more difficult of 
removal. Internal engorgements, or infarctions, are increased 
by their use, even in small doses; and every post mortem ex- 
amination in subjects destroyed by narcotics, shows a violent 
state of congestion in the internal tissues of the head, thorax, 
and abdomen, similar to those produced ih the internal tis- 
sues in the most malignant fevers. 
It is an unfortunate circumstance, that those who have, ad- 284 
PHTHISIS. 
vised their use in phthisis, have no better understood its pa- 
thological character, than the properties of these deleterious 
agents. There is something more than mere local irritation 
in the former, and the latter are something besides soothing 
sedatives. Many are more mistaken in these respects, than 
the deluded dram-drinker is in conceiving that another alco- 
holic draught will surely do him good. Their soothing in- 
fluences are quite as brief, and their' sequences more certainly 
pernicioiis. 
We freely declare, if compelled to use laudanum, Dover's 
powder, opiate cordials, or cough drops, &c., we would 
never attempt a radical cure of phthisis pulmonalis in any of 
its varieties. In the last stage of a forlorn case, they are 
more justifiable, in small doses ; and yet a previous well con- 
ducted case will hardly need them, as the calm composure of 
the downward way is commonly disturbed by their use? In 
their omission, there is no running the risk of exciting a re- 
pulsive delirium, or a forbidding lethargy. 
The articles placed in the class of narcotics by materia 
medica writers, are not precisely similar in their physiologi- 
cal effects in the system. The article digitalis may be used 
to some advantage in phthisis, after the pyrectic habit is es- 
sentially subdued, but never until then. It is sufficiently nar- 
cotic to mitigate uneasy sensations, and possesses certain pe- 
culiar properties over the nutritive system of nerves. How- 
ever, when too freely given it is liable to excite delirium, and 
a new train of typhoid phenomena. Of the saturated tinc- 
ture, from fifteen to forty drops, two or three times a day, 
has been found useful to allay arterial irritation, diminish the 
frequency of the pulse, and allay the cough and uneasy sen- 
sations. It has a more sure composing effect, when com- 
bined with one fourth, or one half of a grain of tartarized an- 
timony, previously dissolved in water. An emulsion of cam- 
phor, and also an infusion of hops, often produce some com- 
posure. OUTLINES OF THERAPEUTICS. 
285 
x. Regimen. 
Some suggestions in relation to this have already been 
made. It may be observed, that the appetite, and even di- 
gestion of phthisical patients often remains measureably good, 
when n6t disturbed by much treatment; and they should be 
supplied with more mild, demulcent food, than in many other 
conditions of disease. Milk and vegetable food have been 
found by long experience the most proper. In protracted 
cases with exhaustion, broths, animal jellies, oysters, and 
white meats are commonly necessary, and useful; and some- 
times moderate quantities of meat. 
When the primary diseased state is essentially removed, 
and the patient can take exercise in the open air, he ought to 
have more generous and nutritious diet, if he desires it ; for 
it assists, with exercise, to sustain the equilibrity of the minute 
circulations, especially when aided by a Sufficiency of cloth- 
ing. In cases attended with a thin expectoration, a more 
generous diet may be used whilst exercising, with a moderate 
use of port wine and milk, sweetened with, loaf sugar. 
The notions about exercise in phthisis, have been vague 
and undefined. In the early period of the disease, especially 
in cold seasons, exercise and exposures are as injurious as in 
any other pyrectic disease, not excepting even chronic pleu- 
risy. If there is any justness in the assigned causes, the 
morbid habit, and the preceding treatment proposed, it will 
directly appear manifest, how injurious exposures to cold air, 
and the agitations of exercise, must' necessarily be in phthisis. 
This is not the period for obtaining benefit from out-door ex- 
ercise, and we have known many injured by attempting riding 
under these circumstances. 
Notwithstanding, there are other states of the disease in 
y. Exercise. 286 
PHTHISIS. 
which exercise, protracted even to fatigue, becomes benefi- 
cial. After the severity of the disease has passed by, and 
the morbid habit is essentially removed, as, it often may be, 
whether there be ulcerations or not, exercise tends to keep 
up the centrifugal circulations, and promotes the secretions 
and excretions ; finally, it invigorates the whole system far 
better than any medicament ; and this for the obvious rea- 
son, that all tonic medicines are liable to act more on the 
susceptible arterial series, than on the absorbent, or centripe- 
tal series of circulations. This accounts for the increase of 
the pulsatory action on their use, and an aggravation of the 
pyrectic phenomena, whilst muscular energy is diminished. 
Exercise ought to be as steadily persisted in, as the ability 
of the patient may permit, either by sailing, riding, walking, 
or manual labor ; and in such a manner as to support the ab- 
sorbent, or centripetal circulations, with the aid of suitable 
clothing, and well advised nutriment. The mind ought to be 
ardently engaged in some earnest pursuit, instead of going 
over and again the same ground as a task, in search after 
health. 
On first attempting exercise in the open air after confine- 
ment, and the necessary treatment, patients should be very 
circumspect not to pass suddenly to this new state of things ; 
but use moderation,, and take the necessary precaution of suf- 
ficient clothing, so that no chills be contracted, but a con- 
stant warmth on the surface sustained. At first it should be 
1 I 
attempted in mild weather. We have seen many instances 
of injury by imprudence in these respects, so that the patient 
must necessarily take his room again, and endure another 
round of treatment. > 
On a successful adventure, the patient sometimes experi- 
ences so much benefit by exercise in riding, that he inclines 
to think his recovery had depended altogether on it ; where- 
as, without a previous preparation, he would have very surely 
been made worse by it. If it should be a cold, season when OUTLINES OF THERAPEUTICS. 
287 
ready to take exercise in the open air, the patient had better 
wait a jnonth or two for an agreeable mild season, and take 
such exercise as he can in a safe condition in the mean time. 
Walking, or gentle labor of some kind, are substitutes. 
Those who travel into foreign; and milder climates for the 
preservation of their health, should undertake it bdfore they 
contract a morbid habit. Those who have already contract- 
ed such a state, should most assuredly do every thing that 
ean be done to be freed from it, before they set off; and be- 
fore the tubercular deposits take place ; otherwise, their 
pilgrimage will commonly be to find a grave in distant lands, 
away from the social intercourse, and comforting aids of their 
friends, in their last hours. 
We have not exhausted this most difficult of all topics ; 
much remains that might be said, and yet it must be aban- 
doned. In decidedly asserting those principles we esteem 
just, we have had no intention of hurting feelings, or exciting 
sarcastic resentment. The subject is too important to be 
surrendered to the pride of any opinion, be it ever so digni- 
fied. 
Although contrary to our general design, we may be under 
some obligation of inserting a case or two, in order more 
fully to illustrate the treatment of what we call phthisis pul- 
monalis. 
z. Case of W. P. Gibson, M. D., made out by himself, not 
long after his recovery. 
"I was engaged in the study of medicine, in 1818, with 
Dr Gustin of Croyden, N. H. In February of this year, he 
was attacked with the usual phenomena of phthisis. It pro- 
gressed in its usual unrelenting form, until it occasioned his 
death, after about ten months sickness. I was very constant- 
ly about him, especially the last half of his sickness, render- 
ing him many services. 
" His treatment consisted chiefly of blood-root and opium. 288 
PHTHISIS. 
He was once bled to the amount of six ounces. Took va- 
rious of the common expectorant medicines, and of the re- 
storative, or stimulating kinds, balsams, &c.; neglecting alto- 
gether any efficient remedies. 
" It may not be irrelevant to mention here, that in a few 
wepks after Dr Gustin's death, his wife was attacked with 
symptoms very similar to his in the beginning, and through 
the whole course of her sickness, which terminated her ex- 
istence in about the same length of time. 
<c In November 1818, whilst along with Dr Gustin, I had 
some cough, and he told me he was fearful that I should have 
the consumption.* However, I got over the cough at that 
time, took a school in a neighboring town, and scarcely 
coughed any until the middle of February, 1819. But, in 
the mean time did not feel well, had a poor appetite, and lost 
flesh. . , . . 
" At this time walked two miles to meeting ; became fa- 
tigued ; sweat'some ; sat in the house until I became cold. 
Had slight chills before I got to my lodgings ; a coldness, or 
chilly sensation followed me, more or less, through a great 
part of my subsequent sickness, with some modifications, 
until the month of August, and until after using the universal 
warm bath, to be mentioned presently. 
" A distressing dry cough, from this time, very constantly 
harassed me, both by day and by night ; which in all re- 
spects, so far as I could discover, very exactly resembled 
that of Dr Gustin. Burnings in the palms of my hands and 
soles of my feet. Pain in the thorax, especially under the 
sternum and right scapula. The common phenomena of ha- 
bitual fever were constantly upon me, and by the month of 
May had more regular exacerbations at noon,, and in the ev- 
ening. Sweats,'and copious expectoration of rather a dark 
muco-purulent matter, had now become frequent. 
*Dr Gibson is high in stature, thin flesh, rather long neck, dark complex 
ion, and was about twentytwo years of age at the time,; accustomed to ex- 
ercise. Rather of the sanguineo-melancholic temperament. OUTLINES OF THERAPEUTICS. 
289 
" I went to Dr Gallup the middle of April 1819, with a 
hope of pursuing medical studies. Soon found it impossible 
to attend to any thing, except my distressed and forbidding 
state of health. For the first three weeks did not attend to 
much, if any regular treatment. Thinking it might be best 
to do something, had a talk, and concluded to attempt some 
rigid discipline, but with much hesitation. A summary of 
the treatment will be soon mentioned, as the daily record 
might be tedious. j 
" Latter part of June my case was no better ; cough, pain 
about the chest, fever, night sweats all continued, and I now 
had serious doubts about the propriety of the treatment pur- 
sued. As all the other physicians passed sentence of death 
upon me, I concluded it would be as well to die under this 
treatment as any other. 
I was not in a condition, or did neglect to keep myself as 
warm as I now think was necessary ; by which I am fully 
persuaded I lost much of the benefits of the treatment. By 
the last of July I had been bled eight times, pretty full bleed- 
ings ; blood for the most part coated, and cupped. Had 
taken repeatedly an antimonial pill in the morning, which had 
usually vomited two or three times, but sometimes not. 
This course was pursued more than a month, almost every 
day. Took also, tincture of digitalis with a small proportion 
of wine of antimony, as an alterative, for considerable length 
of time. Had epispastics in succession over the thorax. 
Frictions over the surface were used extensively. Occasion- 
ally took a moderate cathartic. Used for some time an elec- 
tuary of sulphur, elecampane, and liquorice ; besides several 
small medicines of but little importance. Diet consisted of 
simple vegetables and milk, variously prepared. 
" Still the disease was severe upon me ; although much 
relieved of pain and excess of fever, yet chills, sweats, hec- 
tic fever, lowness, &c., bore hard upon me. Cough fre- 290 
PHTHISIS. 
quent, and expectoration large ; pulse still rather hard, and 
averaged about 120 in a minute. 
" The very last of July, Dr Gallup suggested using the 
universal warm bath every evening, with friction in the bath, 
and after; and, also, to bleed what might appear necessary 
in future, soon after coming from the bath ; my friends, and 
several physicians had despaired of my recovery, and I began 
to be indifferent to every thing.* 
" However, I immediately set about using the bath, con- 
tinuing the same course of management in other respects. I 
experienced much benefit from it ; my cold chills began to 
abate ; my other remedies seemed to have a better effect, 
and my night sweats were very much relieved. I used it 
nearly every evening for about a month, and occasionally af- 
terwards. 
" Finally, besides the eight former bleedings, I was bled 
five times after beginning to use the bath, and the improve- 
ment in my health greatly exceeded my expectations. My 
cough abated with my chills, heats, and sweats. The fre- 
quency of my pulse soon diminished, and my expectorations 
were less. 
" My appetite and strength improved also, and without 
-using any tonics ; rode a little by the last of August, and in 
the last of September, rode on horseback to Croydon, about 
thirty miles, and saw Mrs Gustin, not long before her death, 
'We improve the opportunity of stating, that at this crisis, the case gave 
us much anxiety. About two days were mostly spent in reflecting on the 
most proper measures next to be taken. In addition to the refractory aspect 
of the case, a neighboring physician, whose opinion was entitled to respect, 
signified to me, that the case must be fatal. In this dilemma, the use of the 
warm bath bccured to my mind, as the most suitable of all auxiliary reme- 
dies in the case. This event was the origin of our partiality for this rem- 
edy, when used in the 'manner already specified. We had previously pre- 
scribed it on accidental occasions, but since then have esteemed it as a car- 
dinal remedy, and seldom Used it without satisfaction, when rightly per- 
formed. It greatly aids in giving an ascendancy of action to the absorbing 
circulations, and removing the nosodynamic state. OUTLINES OF THERAPEUTICS. 
291 
and felt gratitude to the Great Disposer of events, that I had 
apparently escaped the calamity she seemed destined to. I 
have been very well, since I had a little time to recover my 
strength.* 
" W. S. Gibson. 
Woodstock, Vt., October, 1820." 
Case of Mrs. .f 
Became acquainted with this case in February 1820. The 
patient was aged about 38 years, tall and thirl habit, dark 
complexion, dejected in mind ; had a family. Was inform- 
ed that she had lost her husband the year before ; and for 
many years past had been subject to some accidental cough, 
but for the most part free. 
She stated, that she had been unwell for about five months 
past; had a' slight cough with transient pains about the tho-< 
* But few men have been more active, or supcessful in their profession, 
than the author of this case, for twelve years to our certain knowledge ; but 
in a letter from him, Feb. 12, 1837, he states, " sincd- I have been in New- 
port, within two years past, I have had two turns of cough, attended with 
some haemoptysis, which have been suppressed precisely in the way my first 
cough was treated." • • / 
He further mentions in this letter a new fact worthy of notice. " A fe- 
male domestic who was in the family of Dr Gustin at the time of his sick- 
ness, soon showed symptoms of phthisis, lingered a year and a half, and 
died of consumption." 
Nov. 22nd, 1838. We now have to state, that his wife died about a year 
and a half ago, with the usual appearances of phthisis. He had now be- 
come some depreciated in his general health, and in a month or two had a 
new attack of haemoptysis, shortness of breath, ancf the usual phenomena of 
phthisis. We saw him last June. He had become despondent in mind and 
made no hopeful attempts of relief, neither had he reason to expect it. He 
was able to pursue the studies of theology ; attended to some small business, 
and mixed in society. He travelled about a hundred miles to Burlington, in 
Vermont, in the month of September, and died there in October last; hav- 
ing been afflicted with the usual phenomena of phthisis pulmonalis. 
t As this lady resides at a distance, we have not obtained liberty to mention 
her name, but will give it to individuals, who may require it. 292 
PHTHISIS. 
rax ; that of late, her cough had grown worse, and that she 
was disposed to have coldness generally through the system. 
The present appearances were, a general deficiency of func- 
tion of the capillary circulations, settled coldness universally, 
rather than chills ; pale sallow complexion ; shrunken aspect; 
dryness of the surface ; pulse small, 100 in a minute ; stitches 
of pain in various parts of the thorax ; frequent, short cough, 
with little or no sputa ; shortness of breath on exercise ; dis- 
turbed sleep ; absence of catamenia. 
We considered this a slow typhoid state of phthisis ; its as- 
pect was so forbidding we did not immediately enter upon so 
decided a course of treatment as we ought to have done. 
She wag advised to keep a steadily warm condition, use fric- 
tions, and try the warm bath ; but by some accidehts these 
were but partially attended to ; she took an emetic, and a few 
aromatic diaphoretics ; and applied epispastics. 
We Hesitated about taking blood ; therefore bled but once 
for three weeks. Used antimonial wine and tincture of digi- 
talis, with occasional vomits ; squills ; ammonia; infusion of 
senega, &c. Still little or no impression was made upon the 
disease, except a slight increase of vascular action. 
We then decided on more efficient treatment; warmth, 
baths, frictions, emetics, were increased ; more bleedings. In 
the course of two months, that is, to the middle of May, she 
was bled five times ; full bleedings of about twelve ounces, 
from the arm. These were well sustained ; she did not loose 
much, if any strength, although confined to a milk and vege- 
table diet, and without the aid of those articles called in med- 
ical language, tonics and stimulants. 
There had now become a more equal circulation, and 
warmth, with a more free expectoration; absence, of pain, 
with rather an increase of the frequency of the puisne. Con- 
cluded not to take more blood, but continue the other gener- 
al treatment as she might be able to bear it. We do not OUTLINES OF THERAPEUTICS. 
293 
mention various small medicines on which no dependence was 
placed, for radical treatment. 
During the month of June, there was some manifest im- 
provement in her health; a mitigation of all the symptoms. 
She had a desire to ride out the last of June, in which she 
was indulged prematurely. Had a few short rides without 
injury. 
On the 4th of July rode with her daughter in a chaise, four 
miles outward. The weather became overcast ; she was 
suddenly attacked with chills, pain in side, and dyspnoea so 
severe that she got home with much difficulty. Saw her in 
the evening, when she said it was impossible for her to lie 
down on account of the pain. 
She was prevailed on at length to take a warm bed, and 
had steamed oats applied to the thorax. A free circulation 
took place ; and she sweat freely. Took a pint of blood 
from the arm, and according to my minutes, a larger quantity 
next morning. It was a case of pleuritis, and the usual round 
of remedies was pursued. Blood was covered with a dense 
pellicle. 
Bled again on the 9th and on the 12th of July, and still 
the inflammation continued with more or less severity. Yet 
soon after abated, and still she was not free from disease. 
According to my minutes, she was bled five times more, be- 
fore the 24th of September, and every time with some relief. 
By about this time, the immediate danger of the case seemed 
to be overcome. In a short time she was as well as before 
this severe relapse, and continued to improve moderately, 
although expectoration was considerable. 
By the 20th of October she had evidently improved ; ex- 
pectoration less ; had gained some flesh and strength. Con- 
tinued to improve through the winter of 1820-21, within 
doors, so that she required only monthly visits. Still, how- 
ever slight expectoration, with the lighter phenomena of fever. 
Having given many particulars of the first year's sickness, 294 
PHTHISIS. 
we will rehearse the events of the second in a more summary 
manner, in order to shorten the case. 
Although she passed the winter in rather a comfortable 
manner, still she was not considered as free from the disease. 
In the spring of 1821 the case became gradually worse in all 
respects. Although its aspect was very forbidding, she con- 
tinued a very submissive patient, and willing to conform to 
rigid discipline. Pulse usually 150 a minute. 
We now had the trials of patience and perseverance. 
Combated the disease in its various states of aggravation and 
mitigation, until into October, when every thing relating to it 
began to wear a brighter prospect. But, previous to this, 
she was so reduced by expectoration, hectical sweats, diar- 
rhcea, &c. that for some length of time the inquiry amongst 
neighbors from day to day, was, is she alive ? 
During this space of time, there seemed to be a saving 
principle ; the pulsatory and • capillary actions were' in some 
measure better sustained, and the case admitted of several 
bleedings to apparent advantage, and some slight encourage- 
ments were offered her. The whole number of bleedings 
she had during the two years, was twentyeight. No cup- 
pings nor leechings, but many epispastics ; setons much of 
the time, and sometimes two at once. Took no narcotic but 
digitalis in moderate doses. There occurred no haemoptysis ; 
but it was evidently a tubercular case. 
She remained in a measure comfortable through the next 
winter, keeping within doors ; greatly emaciated, but took 
more nutritious diet. In the spring was much better, although 
still emaciated; walked, and rode some. Had no more re- 
turns of aggravations ; expectoration ceased, and by the next 
autumn she had acquired a considerable degree of strength, 
and fulness,,and bestowed ordinary attention to her domestic 
concerns. She still improved ; catamenia returned, and she 
considered herself well for eleven years to our knowledge ; OUTLINES OF THERAPEUTICS. 
295 
but having moved away, we did not hear any thing partic- 
ular for about three years. 
Although she esteems herself perfectly well, there are evi- 
dent tokens of small cavernous spaces in the lungs, which 
however, give her no trouble. Could this case have termi- 
nated favorably, if left to the natural processes undirected ?* 
Saw this patient again in October, 1837. She informed us, 
that for about two years past, she had some slight cough, and 
had expectorated. It would be aggravated on taking cold, but 
she was rarely confined by it for a day ; she mixed in society, 
and bestowed ordinary attention to her concerns. The mat- 
ter expectorated at this time, appeared to be a thin muco- 
purulency. She had used no remedies, and made use of 
common food ; slept well, and passed the time with a good 
share of comfort. Comments are unnecessary. 
5. Pertussis, or Hooping Cough. 
a. Its character. 
This disease sometimes affects districts of people almost 
simultaneously, like epidemic fevers. It, however, more 
frequently appears to be subject to the laws of contagion, and 
is manifestly communicable from one subject to another in 
succession, until it has passed through entire districts.' The 
same subject is but rarely liable to the disease a second time, 
and this fact proves it to belong to the class of contagious dis- 
eases. 
It most commonly spreads by a communicable aura, when 
it appears to resemble epidemics, being at such times, fa- 
vored with an atmospheric afflatus increasing its facility of 
propagation. Its recurrence is so frequent, that its spread is 
chiefly amongst children, although no age is free from its 
primary influence. 
* No opium, or other narcotic, except the small doses of digitalis, was used 
in either of these cases. 296 
PERTUSSIS. 
Being then a contagious disease, (Sect, xl.) it must ne- 
cessarily affect the whole system in a primary manner ; this 
is an universal fact, although so many have been deceived, as 
in other instances, on account of its local irritation in the 
lungs affording the most obtrusive symptoms, and in a 
manner to arrest the entire attention of both the patient and 
adviser. The common phenomena of the morbid habit are 
always present, and easily discoverable, especially in the 
more severe cases ; such as frequency and hardness of pulse, 
furred tongue, slight pain in head or thorax, &c. 
Its specific location is in the mucous tissue of the lungs, 
trachea, and larynx. In severe cases other tissues of the 
lungs become associated in the process of progressive in- 
flammation ; and post mortem examinations have revealed 
effusions, adhesions, &c., as in other cases of pneumonia, of 
the most decided phlogistic character. The affection often 
extends to other of the internal tissues ; and even the sto- 
mach is very commonly associated, and manifests traits of 
inflammation. The same diathesis continues as long as any 
vestige of the disease remains, and is liable to be protracted 
in the form of some chronic disease. 
The peculiarity of this morbid affection of the mucous tis- 
sue is, that it is attended with a state of adstriction of the 
tissues, rather than a profluvium. In consequence of this, 
they secrete from the follicles, and exhale from the capilla- 
ries, but very scantily. Their surface is prone to be dry, 
and the sequence is, an irritation liable to excite sudden and 
severe coughing. 
The paroxysm is sudden ; the involuntary movements pre- 
vail ; the necessity of coughing, like as from dust thrown into 
the trachea, is so great, that the patient immediately expels 
air, without having time or ability to draw in his breath. 
These interrupted expirations continue, until the lungs expel as 
much as possible of the air of reservation, and to the utmost 
degree of contraction the muscles of respiration admit of. OUTLINES OF THERAPEUTICS. 
297 
Still the expiratory effort remains in a state of fixity, when 
no more contractions are practicable, until there is a great re- 
tardation of the circulation through the lungs, and perversion 
of many of the other functions of circulation. Tbp subject 
remains breathless for a short time ; the countenance dark 
and hypersonic ; blood sometimes bursts from the nostrils. 
After very considerable exhaustion, the rigid fixity of the 
tissues relaxes, and inspiration takes place in a slow labored 
manner ; the glottis, still partially contracted, admits a 
straightened current of air, with a peculiar soundr or indrawn 
whoop, which gave origin to whoop, or hooping cough. 
Furthermore, this state of agitation forcibly impels from 
the mucous follicles and exhalants, their soft shielding fluids 
in considerable amount, so that the irritations are sheathed ; 
the subject coughs, as in ordinary conditions, apd spits off a 
viscid albumino-mucous fluid. The stomach also becomes 
oftentimes excited, and much of the increased membranous 
secretion is vomited ; and by this very act, the lungs are 
more effectually disburthened, and the inflammatory state 
relieved. ' ' ' 
The paroxysm now being over, the subject remains quiet 
until the tissues again become dry and irritable, when the 
involuntary conservative energies are again excited, and an- 
other paroxysm ensues. The further history of the disease 
may be learned from many writers. 
Dr Hope remarks, in his Morbid Anatomy, p. IS, " Lo- 
bular and vesicular peripneumony are, according to my 
observation, frequent in pertussis, and are more common in 
children than in adults." He uses the term peripneunomy, 
as synonymous with inflammation of the mucous vesicular, or 
aerial cells of the lungs. In describing the effects of inflam- 
mation in this tissue, he says, "the walls, instead of continu- 
ing to thicken, may either ulcerate, or secrete pus, or 
tubercle/' But we also obtain evidence, that the inflamma- 
tion extends into other tissues. 298 
PERTUSSIS. 
The adstrictive state of the tissues retards the .exhalations, 
and more effectually than in ordinary states of inflammation. 
It is of a persistive character, and remains through the whole 
course of the disease. It is even apparent sometimes after 
the fever has essentially passed by. The same state of dry- 
ness and irritation of the turgid tissues, keeps up the parox- 
ysms of cough, then erroneously called spasmodic. 
The apparent spasm, is a part of the involuntary movements 
of the conservative power of the human economy, exerted to 
relieve the tissues of the intolerable irritation. So a child 
will have a similar exercise of coughing to expel dust, or 
even a few drops of water,'from the trachea. The expulsa- 
tory efforts will be sudden and irresistible, whilst inspiration 
is not admitted, as if by an intuition, that by this act the of- 
fending substances would gain further admittance into the 
lungs. ' r 
The false thesis of spasm, has led to very disastrous results 
in, the treatment of pertussis. It has inducted into.its service 
not only the most stimulating of the anti-spasmodics, but that 
most destructive of all narcotics, opium, in some form. 
Whilst all the phenomena of the general habit and local in- 
flammation, show a fixed and persistive phlogistic state, this 
most incongruous of all stimulants is brought forth to insure 
destruction, and on the pretence of its being anti-spasmodic. 
The pathological error was concieived in darkness, and the 
remedy brought forth in ignorance. 
Were the subject less important, we might be spared the 
pain of the above remarks. But, in consequence of an erro- 
neous principle, the young sufferers in this disease are libe- 
rally fed with Dover's powder, black drop, morphia, pare- 
goric, and the tribes of pedler's cough drops. We are not 
content to speak through pages which may never reach the 
public eye, but wish for a lengthened trumpet, that might 
tingle the ears of empirics and charlatans, in every avenue of 
their retreat. OUTLINES OF THERAPEUTICS. 
299 
b. Methodus medendi. 
There is no necessary fixed period required for this dis- 
ease to abide in the system, otherwise than what arises from 
the severity of the morbid habit, and inflamed tissues. In 
this it hardly accords with the character of the contagious dis- 
eases. After structural changes have taken place, if the sub- 
ject is not destroyed, it may become changed into chronic 
disease. We have known cases commence with considerable 
severity, and every morbid condition pass off in two weeks. 
Neglected cases, and when exposures ane frequent, may 
grow worse for three weeks, continue bad three or-four 
more, and require as many more to pass off. Mild cases, 
without structural changes, very often pass off in two 
weeks. 
Physicians are not commonly called until the disease has 
assumed a severe aspect, and it then has become more or 
less tenacious. In its incipient state it is simple in its diag- 
nosis, and of easy treatment. All agree in the fact, that it is 
milder in warm seasons than in cold. This fact, without the 
aid of medical lore, ought to be sufficient to teach us the 
necessity of securing the tender subjects of its influence from 
cold, and that they' should be effectually protected in cold 
seasons by warm clothing, and warm rooms ; and in temper- 
ate seasons from atmospheric changes ; also, by warm clothing 
for the season. 
If at an early period capillary action is well sustained on 
the surface, internal inflammation moderated, and the exhala- 
tions promoted, the disease will become of easy management, 
and soon pass off. ' 
If it manifests unusual severity, then moderate it at the 
earliest opportunity ; and particularly promote the secretions 
of the pulmonary tissue, instead of .suppressing them by 
stimulants. The means of accomplishing these indications 300 
PERTUSSIS. 
are very similar to those for other states of inflammation, and 
scarcely need to be repeated. 
With regard to venesection in pertussis ; in severe cases 
it is as much required as in pneumonia, whilst the phenomena 
of pain, and fulness of pulse do not indicate its necessity 
half as much ; by which the adviser is liable to be deceived. 
Blood may be taken freely unless too great exhaustion has al- 
ready taken place, when the bleeding point of the disease 
may have passed by. In young subjects when bleeding at 
the ar,m is very difficult, leeches may be applied to the 
thorax. In obstinate, and protracted cases, apply the oint- 
ment of tartarized antimony on the thorax. 
It is a remark in the mouth of every nurse, that when 
children vomit in hooping cough after a paroxysm, they will 
do well. This shows that the tissues secrete, and the 
sooner this takes place the shorter will be the paroxysm of 
coughing. In order to promote this, many contrive to 
give them a domestic medicine of chamber-lye, molasses 
and hog's lard, warmed together. There is not a more 
eligible composition in any pharmacopoeia. If it should 
fail in some c^ses, add a quarter of a grain, or more, of tar- 
tarized antimony, previously dissolved in warm water. Hive 
syrup is useful as an emetic, or as an alterative. 
Occasionally give a cathartic of castor oil and calomel, or 
Rochelle salts dissolved in an infusion of liquorice root. 
The warm bath may be often repeated ; or mild steams to 
the body universally whilst in bed, by any convenient appa- 
ratus ; also, mild inhalations of the steam of warm water, or 
an infusion of flax seed. 
After venesection has been practised, if tjie case remains 
obstinate, it should be soon repeated, with epispastics to the 
thorax. Give mucilages and demulcents of various kinds, in 
the form of drinks, and also lozenges, to be held in the 
mouth. Acids are not so proper as alkalies dissolved in a 
large proportion of water. The preparation below has been OUTLINES OF THERAPEUTICS. 
301 
satisfactorily employed.* Let the patient take freely as much 
as may sit well on the stomach. More water may be taken 
with it, for it is necessary to dilute the fluids of the body, in 
order to supply the exhalations and secretions. 
If anti-spasmodics are required, a watery emulsion of assa- 
foetida may be used. A more agreeable one may be found in 
a small quantity of gum camphor, ground with a large pro- 
portion of gum arabic and loaf sugar, in such a dose as may 
be agreeable to the stomach. Also, chloric ether, from ten 
to fifteen drops to a child five years old, diluted in water. 
Fresh animal oils, as pig's foot oil, neat's foot oil, and that 
of wild animals, mixed with treacle, are often useful; also 
pure olive oil; they may be largely used, and if they should 
provoke emesis they will do more good. 
A quarter of a clove of garlic, in the latter stage of severe 
cases, may be tried three times a day, for a child five years 
old. Also, onion syrup. 
A thin, but wide pad of cotton wool or soft flannel, may 
be constantly worn around the neck. The neck may be 
often moistened with oil of almonds. In bad cases, poultices 
of garlick or onion to the feet. The diet should consist of 
demulcent articles in a fluid form, as oleaginous broths, &c. 
6. Hemorrhage. 
a. General Character. 
with a fulness of blood. The capillaries are well filled, as 
manifested by distention, and floridity of countenance, with 
an equal balance of circulation. The processes of the econ- 
omy maintain a nearly equal balance between the ingesta 
Many subjects possess good health through a long life, 
* K. Carbonate of Potash , . . . « 3 2 
Cochineal, * . . . . . . . . Q 2 
Spring water § 10 
Loaf sugar § 2 
This may be diluted with mucilage of gum arabic. 302 
riEMORRHAGE. 
and the egesta, and health is continued until this balance is 
interrupted. They suffer not so many contraventions of 
health commonly, as those of a less relative proportion of 
blood, because the activity of the capillaries sustains their 
action better, when exposed to the laedentia of disease. 
Hemorrhages oftener occur in apparently less sanguine 
habits, and the same may be said of other diseases also ; yet, 
when they do occur they may be more profuse. In all hemor- 
rhage, aside from lesions done the tissues, there first occurs a 
change in the economy of the system generally, and the circula- 
tory apparatus experiences its part of the injury. The just 
balance of the circulation is interrupted, and so far as we can 
discover, in a very similar manner as in the access of the 
common morbid habit. 
A disparity often obtains between the ingesta and excreta, 
producing plethora. This may be of some continuance, and 
still enhanced by the use of more nutriment than the system 
requires ; it may arise from the suppression of some accus- 
tomary evacuations ; or it may arise suddenly from numer- 
ous external circumstances constringing the capillary system. 
A disproportion between the amount of fluids and capacity 
of the vessels is the result ; this is a plethora or hyperaemia. 
All the causes which co-operate in establishing a morbid 
habit, lay the basis of the hemorrhagic, and there will not 
probably be a hemorrhage without the existence of such an 
abnormal condition. The hemorrhagic habit implies a less 
state of severity than exists in the ordinary pyrectic habit ; 
it still, however, makes near approximations to it. It is 
either in the forming or declining stages of the phlogistic, or 
of the typhoid diatheses, that hemorrhages occur. It is a 
more fortunate circumstance when they do appear early in the 
forming stage of disease, as it becomes mitigated on this ac- 
count, if all other things are equal. 
Yet, again, their appearance towards the close of pyrectic 
disease, when its severity has become mitigated,, is often OUTLINES OF THERAPEUTICS. 
303 
beneficial, and sometimes essential for the saving of the case, 
and ought not to be hastily suppressed.1 
All that has been said in Sect. xx. 5. et seq. in relation 
to the local emanations of the morbid habit, will apply to 
hemorrhages, the same as other local affections. They are 
invited to particular tissues by certain physiological idiosyncra- 
sies, or some particular state of irritation of the parts. 
Their continuance, and amount of loss of blood depend on these 
conditions, and each of them may have an agency in the pro- 
cess. If there should be much hypersemia, and a thin crasis 
of blood, there may be a large flow ; but this will be modi- 
fied by the state of the tissue admitting its egress. If the 
diathesis should approximate the phlogistic state, the flow 
will not be so free. Every process in arresting hemorrhage 
consists in condensing the tissues, and the crasis of the 
blood. ,' ' 
In the first place, there is an impetus of morbid impulse 
directed to the part ; this acts as a stimulus to the tissues and 
the result is an accumulation of fluids in the part ; it directly 
becomes turgid, and makes progress to a state of morbid ex- 
citation. But, before effusions or any important changes 
occur in the tissue, there intervenes what has been called an 
hemorrhagic effort in the capillary blood vessels of the part, 
and the blood is thrown out by the exhaling vessels on to the 
surface of the tissue ; 'yet sometimes the vessels suffer a rup- 
ture. In some organs it has a ready outlet ; in others it ac- 
cumulates in masses. If this morbid concentration had been 
directed to the same tissues, not in a state admitting an 
egress of blood, there would have been effusion, preceded 
by inflammation ; whereas it is now merely a state of excita- 
tion, liable to be transformed into inflammation. 
The concentrations may be directed to other tissues than 
the mucous. In severe malignant diseases the serous have 
been affected, and transmit blood into their cavities. The 
serous membranes of the thorax and abdomen have been 304 
HEMORRHAGE. 
found covered with thick, dense coagula of blood. Mr 
Paisely found a parturient uterus covered with a coagulum a 
foot and three inches long, twelve inches wide, and one 
fourth of an inch thick. When the impetus is directed to 
the brain, the effusions of blood occur by rupture, and are 
diffused in the connecting pia mater. The same may occur 
in the lungs, occasioning pulmonary apoplexy, or clots, with 
ecchymosis of the aerial cells. Or, it may distil from the 
mucous tissue. 
When hemorrhage has continued for some time in the mu- 
cous tissue, the capillaries of the part take on, or assume a 
state of excitation, and act by their susceptibility indepen- 
dent of the heart; and in this event, continue to throw out 
blood, when even an exhaustion has taken place. So he- 
morrhage may continue even in a state of anaemia. It is at 
this period the interposition of art is required to suppress 
the flow of blood, and much discrimination is required to de- 
termine when the interference is necessary. The inter- 
ference by astringents, is liable to be too early ; the bystander 
is liable to be deceived in the quantity lost, as it spreads out 
and makes much show. The pulse best indicates the condition. 
If the hemorrhage should be too early suppressed, the 
organ, or some contiguous one may suffer by inflammation. 
We should be slovy and cautious in suppressing hemorrhage, 
when we consider, that but few cases of the more lingering 
kinds ever go to the excess of causing death. There is more 
danger in a sudden and impetuous flow, but not so much as 
many apprehend. 
There is scarcely such a state as passive hemorrhage, any 
more than sub-inflammation. Although the vessels are more 
patulous, and transmit more readily in , some instances, such 
cases require soonest the interference of art. The general 
habit in hemorrhage may be so modified as to save much of 
the pressure of blood upon the affected tissue. Venesection, 
by a sudden depletion, has a more beneficial effect in remov- OUTLINES OF THERAPEUTICS. 
305 
ing the hemorrhagic diathesis, than the gradual flow of blood 
from the part. Besides it is followed by a more uniform cir- 
culation, an essential circumstance to be regarded in suppress- 
ing hemorrhage. 
Those hemorrhages which occur in a weakened crasis of 
the blood, are the most difficult to be restrained. There is a 
hemorrhagic idiosyncrasy affecting'certain families ; when re- 
ceiving merely a slight wound, they bleed to excess, and 
scarcely any means are adequate to the object of suppressing 
it. There seems to be an extraordinary susceptibility in the 
capillaries, to take on the hemorrhagic effort. 
7. Epistaxis. 
Reference may he had to the nosography for a short defi- 
nition. 
This usually occurs in young persons near puberty ; fre- 
quently at the commencement of fevers ; also, during amen- 
orrhoea. It is often preceded by a sensation of pressure, 
pain, or dizziness of the head. In such an event, no local 
measures should be taken to suppress it, The case should 
be treated by bleeding, saline cathartics, and low regimen. 
In amenorrhoea, by establishing the natural course. 
If at any time it needs to be suppressed, applying cold may 
be sufficient, by wetting linen cloths in cold water, or salt 
and water, and laying them upon -the face, the patient being 
quietly in bed, with the head elevated. If required, they 
may be applied to the back of the head. Sulphuric acid and 
cold water may be taken internally. Bathe the feet in warm 
water. Cathartic of sulphate of soda. 
If the case should go to great excesss, as sometimes occurs 
in a bad crasis of the blood, a plug may be used of linen, 
just so large as to pass into the nostril as far as it will go, 
first being dipped in cold water, and rolled in pulverized 
alum. It may be left in two or three days. Or, if the case 306 
HEMOPTYSIS. 
requires, a dossil of lint may be applied in the fauces to the 
velum palati, by a lobp passed through the nostril, and tied 
over another dossil at the entrance of the nostrils. Quinine, 
in addition to sulphuric acid, may be freely used internally. 
However, if epistaxis should be early suppressed at the 
onset of fever, attended with only slight pain in the head, 
phrenitis will be liable to occur. 
8. Haemoptysis. 
a. Phenomena. Remarks. 
Even when this discharge of blood from the lungs appears 
as vicarious of epistaxis, haemorrhoids, or the sexual catame- 
nia, it is preceded by a state, more or less, of hypersemia, 
which implies an approximation to a morbid habit, although 
not always very intense. It is a morbid plethora. 
In some instances the subject has no previous monition of 
its approach ; but more commonly feels some pressure under 
the sternum, some soreness, and slight pain, or cough. 
There is some change in the taste of the saliva; perhaps 
chilliness and dyspnoea. The quantity spit off may be small, 
yet sometimes very large, and it may flow even so fast as to 
endanger suffocation. The exhalants of the aerial tissue, in 
an active state of excitation, may transmit large quantities of 
blood, without rupture of any blood vessels ; still larger ves- 
sels may sometimes rupture, and discharge freely ; and per- 
haps be attended with ecchymoses also. 
In consequence of the mucous tissue of the lungs and nose 
being unprotected by adjacent organs, hemorrhage occurs 
oftener in them than in any other parts, except the uterus. 
The great exercise of the mucous tissue of the lungs might be 
supposed to occasion it, oftener than it actually does occur. 
A turgid state of this tissue, supported by a mild morbid habit, 
is liable to be attended with haemoptysis, whether there are OUTLINES OF THERAPEUTICS. 
307 
tubercles or not. Perhaps tubercles may not so often occa- 
sion haemoptysis, as that state of the tissues which gives 
origin even to the tubercles ; for many cases of manifest tu- 
bercular phthisis have never been attended with it. 
Again, many cases of haemoptysis recover without phthisis 
following it. Even if phthisis should succeed, and on exa- 
mination tubercles are found, it will be difficult to decide 
whether the tubercular formation had priority of the haemop- 
tysis, or not ; for both the tubercular deposits, and the 
haemoptysis, we allege to be sequences of the general dis- 
eased state. Therefore, as soon as the one appears, the 
other is suspected, and the curative measures should be dili- 
gently employed, as proposed in the article phthisis ; if they 
had been hitherto neglected. Indeed, the early appearance 
of haemoptysis may, perhaps, be considered a kind monitor 
to the negligent, and those of tardy apprehension, of the dan- 
ger connected with every concentration to the lungs. 
b. JUethodus medendi. 
After the remarks already made on phthisis and hemor- 
rhage, there need be but little said on the treatment of hae- 
moptysis. We begin with an earnest request, that opiates, 
narcotics, and astringents be totally withheld^ until a severe 
exhaustion shall demand them; and this will but rarely 
happen. 
Let no time be lost in effectually removing the constitu- 
tional affection, which gave origin to, and supports the hemor- 
rhage. Whether there are tubercles or not, the rule ought 
to be observed. Venesection repeated to the necessary 
extent; saline cathartics ; antiphlogistic regimen (Sect, xlvi, 
4) ; spare vegetable and milk diet ; epispastics to the tho- 
rax ; afterwards a seton in the side as a prophylactic. The 
amount of these must be adapted to circumstances. A slight 
emetic of ipecacuanha, has often relieved the flow of blood, 308 
H^MATEMESIS. 
and been followed by a more equal circulation. If there 
should be a tendency to cough, small doses of digitalis, and 
demulcents. In case of necessity, one grain of opium and 
four of acetate of lead ; or, a table spoonful of salt with cold 
water : alum, and vegetable astringents. 
9. Hazmatemesis, and Hazmorrhagia intestinalis. 
These are very much of a similar character, and in general 
terms, require like treatment. The diet should be very 
mild ; mucilaginous drinks ; wine whey ; arrow root, &c. 
Mild astringents may be employed, such as a decoction of log- 
wood with an infusion of elm bark, sweetened with loaf sugar. 
Or, extract of catechu one drachm, gum Arabic half an ounce, 
in a pint of water. The stomach should not be crowded 
with anything. 
The patient may be supported with panada ; tea; coffee ; 
if great exhaustion should appear, a spoonful of port wine oc- 
casionally. After the bleeding has ceased for thirtysix hours, 
give a laxative infusion of rhubarb and manna. Avoid dras- 
tic and all very active medicines. After cleansing the prima 
via, small doses of quinine and port wine. 
In these cases there is commonly great exhaustion of fluids 
and vital force ; the supporting remedies should be of a mild 
character ; for if high stimulation should be resorted to, as 
some might incline to think necessary, it might soon extin- 
guish the small remains of life, as it does in famished subjects. 
Whenever the blood vessels of the mucous tissue of the 
stomach or intestines take on the hemorrhagic impetus, the 
flow of blood is commonly very large. It is liable to sur- 
prise the attendants, and there is danger of more being 
done, than is actually necessary or safe. It is always neces- 
sary that the flow should continue until the abdominal infarc- 
tions are removed. 
The remaining affections of this order must be omitted. OUTLINES OF THERAPEUTICS. 
309 
ORDER III. 
THE SEROUS TISSUES 
SECTION X L V I I I 
1. Preliminary Notices. 
In attempting an inquiry into the harmonies, and reflex ac- 
tions of the serous tissues, in health and disease, we have to 
explore an almost unbeaten way. Its physiological impor- 
tance has been too much neglected ; and in a pathological 
view, it has not received attention in proportion to the ex- 
tensive influence exercised by it, in the morbid economy. It 
was a remark of Bichat that it was one of the tissues most 
exposed to inflammation ; and whilst the cellular tissue had 
been shown to give a character to the phlegmonous, the der- 
moid to the erysipelatous, and the mucous to the catarrhal, 
we have not a general name to express that of the serous.* 
This tissue is of greater extent than either the dermoid or 
mucous ; it has an intimate connection with all the internal 
organs, closely investing those of the head, thorax and abdo- 
men. By means of the arachnoides and pia mater, it holds 
an intimate association with the minutest divisions of the 
brain, and whole nervous system of external relation. As 
the envelope of the visceral ganglia are of similar structure 
with the serous tissues, may we not infer the existence of an 
unobtrusive harmony existing by its agency, between the in- 
ternal and external nervous systems, especially during the in- 
creased sensibility of disease ? The very circumstances, 
Gen. Anat. Vol. II. p. 31. 310 
SEROUS TISSUES. 
which essentially increase its sensibility, are liable to depress 
its functions. 
In both the thorax and abdomen, we have proof of a ready 
associability of function of this tissue, in discovering so often 
the whole of the investing surface inflamed, even if the prin- 
cipal disease is confined to one organ, or even a single point. 
This is shown in pleuritis ; also, in severe hysteritis, in 
which greater ravages of the disease are seen in the perito- 
neum, than in the uterus itself. Dropsies embrace extensive 
surfaces. 
Bichat also suggests, that the internal motions of the serous 
tissues, "should be regarded as carrying through the whole 
machine a continual excitement, which supports and animates 
the forces of all tjie organs." And, again, "inflammation 
has a peculiar and distinctive character in it, of which all the 
serous membranes partake, with spine modifications."* 
In Sect. vii. 4, we have bestowed some attention to the 
character of this tissue in health and disease. We do not 
expect to say all that might be embodied in relation to it. In 
the physiological state, it posseses the common sensibility of 
the nutrient tissues, yet in a delicate manner; when irritated 
and excited, it receives the sensibility of external relation, by 
which the condition of this tissue, and often of the organs it 
invests, is transmitted to the centre of perception. The 
acuteness of pain on pressure, or motion of the thorax or 
abdomen, transmits the degree of suffering, in a manlier to be 
quite accurately estimated. When, however, this tissue is 
relieved by the effusions so liable to, flow through it, the 
sensibility becomes blunted. It is, therefore, in the more 
early stage of inflammation, that the degree of injury can be 
most accurately estimated by pain and tenderness in this 
tissue. 
The serous tissues have suffered from inflammation oftener 
than is manifested in after examinations. It is a very attenu- 
* Vol. III. pp. 138, and 154. OUTLINES OF THERAPEUTICS. 
311 
ated tissue, not admitting red blood in its physiological 
state, but quickly admits it in a pathological state. It, again, 
very soon gives up its blood to absorption, as soon as general 
life ceases. It may not show very obvious traits of inflam- 
mation in an hour or two after death, whilst the effusions in 
its sacs show it had existed. The experiments of the Vivi*- 
sectors show a turgid, reddened state of it during life, when 
moderately excited. 
When one portion of this tissue receives the burthen of 
disease, the remotest parts are affected by a sudden consen- 
sus. In peritonitis the tissues of the brain partake also, 
sometimes giving pain, commonly slight delirium ; yet on 
an early inspection they show no structural changes, even if 
such had existed. 
We have endeavored to show, that all fevers have internal 
locations ; not excepting the exanthemata, the eruptions being 
merely the translations of the internal, and becoming more 
permanent. These concentrations may affect extensively ei- 
ther the internal fibrous, mucous, or serous tissues of the head, 
thorax and abdomen, more or less, but always some one por- 
tion more than the rest, making the part what is called the 
seat of the disease. The diathetical difference consists in 
the circumstance, of which of the tissues is primarily affec- 
ted. If it be the fibrous, the diathesis will mostly partake of 
the severe synochoid character ; synocha. If it be the mu- 
cous, it inclines to the mild synochoid diathesis ; synochus. 
These have been illustrated. It now remains to be shown, 
if the concentrations should essentially be on the serous tis- 
sues, the diathesis will savor of the mild typhoid kind ; ty- 
phus mitior. And furthermore, when the causes of disease 
are overwhelming, and complex inflammation is induced, 
there appears to be an affection of more than one of these 
tissues, and the severest grade of the typhoid state is induced ; 
typhus gravior ; as in the fourth order. 312 
SEROUS TISSUES. 
The effects of these tissual inflammations prove the reality , 
and the importance of the distinction. The fibrous tissues 
yield the dense fibrinous effusions ; the mucous, a modified 
increase of the fluids of the tissue, or a muco-albuminous dis- 
charge ; the serous tissue yields serum of different grades of 
viscidity; whilst the state of complicated inflammation pre- 
sents mixtures of all these, with the addition of exhaled 
blood sometimes. The complex inflammation of the serous 
tissues sometimes resembles erysipelas of the surface. The 
states of disease are mutable, passing one into the other, and 
affecting different habits modified by many circumstances, so 
that the results are not always precisely as stated, yet they 
maintain their general characters. 
In the instance of a mild access of general disease locating 
essentially in the serous tissues, with venous congestions, the 
phenomena are of a peculiar kind ; there is usually a vacil- 
lating state of all the functions ; an inability of muscular mo- 
tion ; the heart and vascular tissues-are deficient in force, 
but increased in frequency; calorification is deficient; ina- 
bility of intellect, and disposition to sleep; hence the origin 
of the term typhus. 
A congestive state of the capillary veins constantly attends, 
and is discoverable in the tissues of the head, thorax and ab- 
domen. It appears that the nervous systems early suffer. 
We assign that the primary changes in the nutritive system 
early affect the entire capillary circulations and nervous sys- 
tems. When these changes more immediately impress the 
serous tissues, the phenomena of the low typhoid diathesis 
appear. 
The instances of arteritis and phlebitis might be alluded to, 
where there exist extensive excitations of the inner coats of 
the vessels, which are of the serous kind. The affection 
called delirium tremens is attended with a vacillating state of 
the nervous system, with injury done the serous tissues of the 
brain. Limpid serous effusions are very constantly found in OUTLINES OF THERAPEUTICS. 
313 
the arachnoid tissue when excited, in the cerebral ventricles, 
and investments of the spinal cord. In cases of this charac- 
ter, we find the prevailing diathesis considerably different 
from the synochoid ; it constantly partakes of the mild typhoid 
aspect. 
In sudden and fatal cases of the disease called spotted fe- 
ver, the serous tissues of the head and thorax exhibit a con- 
gestive state, and a stellated appearance, with sudden collec- 
tions of serum in the ventricles of the brain, after four hours 
sickness. There are acute and chronic dropsies. Finally, 
there are numerous modifications in the diseased habit having 
similar concentrations in the serous tissues, and attended with 
a feeble, vacillating state of vital movements, whilst there is 
a great weight of general disease accompanying it. 
Besides the state of profluvium of the serous tissues, where- 
by they yield an excess of serosity, there is an adverse state, 
which may be considered as a state of adstriction, attended 
with dryness, and scantiness of exhalation, similar to what oc- 
curs in the skin and mucous surfaces. The parts do not 
move easily on each other, but attended with soreness. 
Chronic irruptions have been discovered in these tissues, and 
the retrocedent exanthemata sometimes fall on this tissue, and 
produce an alarming train of phenomena. When adhesions, 
false membranes, tubercles, &c., arise in the serous tissues, 
the subjacent fascia are implicated in the local determinations. 
The serous tissues, then, being susceptible in their char- 
acter, and extensive in their harmonies with the nervous tis- 
sues, show the necessity of diverting all internal excitations 
as much as possible, to the external, or dermoid tissue. Ex- 
anthematous diseases are often attended with great distress 
previous to appearing on the surface, arising from impressions 
on the visceral serous tissues. 314 
TYPHOID FEVER. 
2. On Typhus mitior, or Typhoid Fever, or Dothinenteritis. 
a. We consider this the disease that has extensively prevailed 
in New England from its first settlement, and the most fre- 
quent form of continued fever that has afflicted both city and 
country. The remittent form is rarely seen here, and yet a 
mild fever often prevails of the character of synochus, of easy 
treatment when rightly directed. Typhoid fever sometimes 
prevails as an epidemic, or an endemic. It may persist only 
a few months in a place ; and yet it commonly does for a 
year or two, with sometimes greater, at other times less se- 
verity. In some sections it has lingered for a greater length 
of time, progressing' slowly from one town to another. It 
often attacks only a few families in a neighborhood, and only 
a part of such inmates may have the disease. At other times 
it affects entire families of ten or twelve in succession, re- 
quiring four or six moths in passsing through. The circum- 
stances which arrest its progress are equally as obscure as 
those which give origin to it. It affects all ages and sexes, 
with the exception of very young children. It has prevailed 
in all seasons of the year, mostly, however, in the latter part 
of summer and beginning of winter ; but seems to give place 
to other morbid influences, sometimes producing dysentery 
in summer, and pneumonia in winter, or some other form of 
disease. 
Its attacks are commonly slow and insidious, and the dis- 
ease is two or four days in becoming developed. It has been 
called slow fever, nervous fever, and for the last thirty or 
forty years, typhus, or typhus mitior. Very recently it has 
obtained the name of dothinenteritis, by the French patholo- 
gists, on account of a pretty constant affection of the inner 
coat of the lower portion of the small intestines, and the up- 
per portion of the large, in the form of a furunculous exul- 
ceration. Unless the severity of the disease is mitigated by OUTLINES OF THERAPEUTICS. 
315 
efficient treatment at an early period, it persists from three to 
six weeks. It is said to be the most common form of con- 
tinued fever at Paris, and even in France, and indeed in many 
northern sections of the world. 
The phenomena of typhoid fever, dothinenteritis, or ty- 
phus mitior, as it has appeared in New England, manifest a 
greater prostration of vital energy than in synochus, as shown 
in the operations of the mind, in the muscular system, and 
the heart and arteries ; the eyes have a dull aspect, the pa- 
tient shuts them, and inclines to sleep. A preternatural sen- 
sibility occurs after many days, with an excitation of func- 
tions bordering on delirium, or alternate excitations and ob- 
scurity of intellect called coma-vigil. At the attack, slight 
chills, and increased sensibility to cold ; dizziness ; slight 
pains in the head, neck, and spine, sometimes in the limbs. 
Some cases incline to be attended with coldness, with slight 
occasional flushings; others with considerable heat, especially 
in the head ; sometimes epistaxis. Surface dry, at the onset 
cold, followed by heat. Pulse commonly small and frequent, 
sometimes more full, from 90 to 120 in a minute ; when 130, 
the event is liable to be unfortunate ; it is often tremulous. 
Subsultus is frequent but not constant. Tongue tremulous, and 
covered with a white fur, which in a few days turns dark and 
rubs off, with sordes from the teeth, and mucous tissue of the 
mouth. Tenderness in the abdomen, occasional diarrhoea, 
tympanitis, and liability to intestinal hemorrhage, after about 
the third week. Some thoracic affection, cough slight, with 
a muchoid expectoration. Urine at the attack often limpid, 
soon becoming scanty and high colored. As the disease pro- 
gresses, many other consequential phenomena may become 
developed. 
To this history of the phenomena may be added, the le- 
sions most commonly found in the mucous glands in the neigh- 
borhood of the ctecum, and which give origin to the term do- 
thinenteritis. In conformity to the most approved writers of 316 
TYPHOID FEVER. 
late, we consider these lesions as of secondary origin. They 
will receive attention as we proceed in the general history of 
the disease. 
b. Much controversy has existed whether this form of dis- 
ease, as it has prevailed in this country, is contagious or not. 
There seems to be nearly as much evidence on one side as 
the other; yet our prevailing opinion has always been in the 
negative, with the persuasion that a high concentration of ef- 
fluvia from the sick, may act as an adjunct exciting cause on 
deeply impressed predispositions. The French pathologists 
are decided in its non-contagiousness ; whilst they contend 
that typhus fever with petechias and absence of intestinal ul- 
cerations is contagious. We shall not pursue this subject at 
present. 
c. The affection under consideration seems not necessarily 
to be attended with an eruption. Sometimes, however, a 
few rose colored pimples appear on the surface, but we think 
oftener there is none, or we have been defective in observing 
them. Still we are certain, in relation to the disease that has 
so extensively prevailed in New England, under the appella- 
tion of typhus, that in some seasons we have seen certain ca- 
ses, according to judgment one in fifteen, attended with a 
dusky skin, and manifest petechise extensively, and thick over 
the body. These cases have been considered as the same 
disease, yet of a more malignant character than the rest. 
From the neglect of autoptic examinations, we are not able 
to say, whether the intestinal lesions have existed in these ca- 
ses or not. The sudamina have often been discovered, and 
they frequently depend on the degree of warmth used on the 
surface. 
d. The intestinal lesions, giving origin to the term dothin- 
enteritis, have been described by many writers. Those 
which are most constant occupy the follicles, and the gan- 
glia of the mesentery. It is the glands of Peyer which ex- 
hibit the greatest changes ; next, those of Brunner are affec- OUTLINES OF THERAPEUTICS. 
317 
ted. A slightly yellowish white substance, one or two lines 
in thickness, forms beneath the mucous coat, which is now 
of a dark red color. In a short time this softens, and the 
follicles become enlarged, the coats of the tissue become 
thickened, and in a few days ulcerated. The edges are har- 
dened, and in the dead subject assume a livid or bluish ap- 
pearance. The mucous membrane becomes rugous, and 
soon shows ulcerations, affording a kind of purulency. The 
coats thicken, whilst the ulcerations extend still deeper, until 
the muscular coat becomes affected, and in lengthened cases 
even the serous. In protracted cases some of the ulcerations 
begin to cicatrize, whilst others are extending. This state 
of cicatrization probably continues in prosperous cases for 
some time after the crisis of the fever, and the injury is grad- 
ually restored. The extent of surface is different; generally 
two and a half feet from the caecum upwards, and about one 
foot downwards into the colon. The caecum suffers severe- 
ly, and is sometimes half an inch in thickness. Sometimes 
the coats present a simple ulcer, and are thinner ; at other 
times the muscular and adipose tissues, as well as the mu- 
cous, are hypertrophied, and almost of schirrhous hardness. 
M. Chomel appears to consider these lesions as not having 
any influence whatever upon the violence or progress of the 
disease, except perhaps causing diarrhoea, and some abdomi- 
nal disturbance. He considers them as effects merely of the 
morbid condition. " The lesions of the intestinal mucous 
follicles, and of the mesenteric glands do not present the same 
degree of development in every case. In some, all the grouped 
and isolated follicles are tumefied or ulcerated, in others 
there are only a certain number which are altered in struc- 
ture ; twenty, for example, in some cases, in others fifteen, 
and in others only five, three, two, or even one, and that too 
only partially. Now if all the symptoms of the disease and 
its severity, depended on the lesions of the follicles, there 
would certainly exist a relation between the phenomena dur- 318 
TYPHOID FEVER. 
ing life, and the extent of the lesions discovered after death ; 
whilst also the violence and danger of the case would be in 
direct proportion with the number of the follicles affected, 
and the extent of the alterations in each." But he remarks, 
this is not the fact. 
e. Perforations sometimes occur in some portion most af- 
fected, and even whilst the patient is convalescent ; and by 
admitting the contents of the intestines into the abdominal 
cavity, prove fatal within a day or two, attended with much 
suffering. Perforations have occurred in the appendicula 
vermiformis. The mesenteric glands also suffer alterations, 
which may presently be noticed. 
f. Do these structural lesions attend the fevers of 
New England, denominated typhus or typhus mitior 2 
There has not been a sufficiency of observations to fully 
determine this question. It is not until lately that the atten- 
tion of physicians has been directed to this object. The dif- 
ficulty of making minute examinations in the country is known 
to every one. Whatever is done must be done hastily ; and 
this portion of the body has seldom been attended to, for the 
abdominal inspections have chiefly been directed to the exte- 
rior of organs ; to inflammations, engorgements of vessels, 
&c. And again, the attention in the few cases of autoptic 
examinations has essentially been directed to the head, and 
not without reason, as the phenomena during life have shown 
a morbid action in this part; and lesions have almost constant- 
ly been found in the membranes of the brain and spinal cord, 
with traits of inflammation, together with venous engorge- 
ments. Besides' these, alterations have occasionally been 
found in the lungs. 
The phenomena of the intestinal affection have rarely been 
very obtrusive as to pain, although diarrhoea and tympanitis 
are common. It may be observed, that the very section of 
the intestines which receives no nerves of external relation, OUTLINES OF THERAPEUTICS. 
319 
is the part essentially affected, and of course few or no res- 
ponses are made to the centre of perception, or at least not 
until the serous tissue becomes also involved. Even pres- 
sure gives scarcely any perception until this takes place in 
some degree. This may be another reason why attention 
was not earlier directed to this circumstance. 
However, the attention of physicians in New England has 
been more directed to these lesions for a few years past, and 
similar ones have been detected, to those delineated by the 
French pathologists. Our intercourse has been too limited 
during this time, to make many references. Notwithstanding, 
we notice in Professor Jackson's memoirs of his son, J. 
Jackson, Jr., fourteen cases at Boston, in 1833, in which the 
autoptic appearances accorded with those of the French pa- 
thologists, in cases assigned to be typhoid fever. His state- 
ment is, " In the course of that season there were fourteen un- 
doubted cases of typhus examined by myself, or my friends, 
and in every one the phenomena accorded with the descrip- 
tions given us by M. Louis." (p. 274.) Two of these ca- 
ses were attended with perforations, and two others the same 
season positively inferred to be so, by unequivocal pheno- 
mena, 
A case occured at Dedham in March, 1835, which was 
inspected by four gentlemen, and published by Professor 
Jackson in the Boston Medical and Surgical Journal, which 
exhibited similar intestinal lesions. The reported phenom- 
ena indicated the same kind of typhoid affection. Eighteen 
inmates of a factory established there, were attacked in about 
two days, with a few other scattering cases before and after 
these, and the disease suddenly subsided without extending 
further. 
A similar occurrence took place at Lowell a month or two 
previous, amongst the inmates of the Hamilton factory, the 
subjects being chiefly if not all young women. The number 320 
TYPHOID FEVER. 
was larger than at Dedham. Several cases proved fatal, and 
autoptic examinations were made by Dr. E. Bartlett, and are 
believed to have been published in the Boston Medical Mag- 
azine, which, however, is not on hand at this time. He 
showed me excellent preserved specimens of the intestines 
with their lesions, which seemed very accurately to accord 
with the descriptions of the French pathologists. 
These specimens accorded with several cases of autoptic 
examinations we afterwards witnessed during one and a half 
years residence there ; and furthermore, during this time we 
had an opportunity of verifying the phenomena and progress 
of the disease in that place, and comparing them with similar 
fevers in other places in New England, of former years. 
The fixed impression is, that the main features of the disease 
were very similar. In the fevers then examined, compared 
with those formerly observed, the same obtrusive cerebral 
symptoms were present, although the intestinal lesions were 
progressing in almost a silent manner. From all the obser- 
vations combined, the conclusion seems to be enforced, that 
we have not found a new disease, but that we have discov- 
ered a new anatomical lesion, or concentration of morbid 
action. We seem to have much yet to be established in re- 
lation to the causes, character, and treatment of this affec- 
tion.* 
g. Jit what period of the disease do the follicles suffer 
* Since writing the above, a Report on the Typhoid Fever in the 
Massachusetts General Hospital, by Professor J. Jackson, has come to our 
knowledge. (Boston, 1838.) He remarksThe work of M. Louis, on 
continued, or typhoid fever, is now, I trust, well known in this country. It 
was not until the year 1833, that it received from me the attention it mer- 
ited. Since it has been known to me, I have found that the continued fe- 
ver, which is so well known to us in this city, at least, was the same as that 
which he has described. The symptoms are essentially the same, and the 
Appearances discovered in the body, after death, are precisely the same. 
From 1833, our fever has been the same it formerly was." OUTLINES OF THERAPEUTICS. 
321 
these morbid changes ? This question cannot be answered 
with precision on account of the want of opportunity of such 
early examinations as might be necessary to establish it. M. 
Chomel states generally, that it is from the eighth day of the 
disease to the twelfth that ulceration takes place. But the 
tissue had suffered alteration previous to this. Some cases 
do not show ulceration until after the twentieth day of the 
attack. 
h. At what period do these ulcerations cicatrize 9 They 
are found in greatest severity in those who die between about 
the twentieth and twentyfifth days of the disease ; when the 
patient sinks at the end of six or eight weeks, the thickening 
of the tissues is absent, and the mucous membrane has be- 
come smooth, except some inequalities where the follicles 
were ulcerated ; indeed the ulcerations may have cicatrized, 
or partially so. Patients who have an early crisis may prob- 
ably still have ulcerations requiring some time for cicatriza- 
tion. 
i. The mesenteric glands present phenomena, also, very 
constant, and different at different periods of their examina- 
tion. They increase in size, become discolored, at length 
soften, but never ulcerate. Those nearest the csecum suffer 
the greatest alteration, and it is here the follicles suffer the 
most. Sometimes the glands are only increased in bulk ; 
sometimes softened, and when cut into, a kind of muco-puru- 
lency may be pressed out. When first enlarged they are red 
or rose colored ; at a later period they exhibit a dark yel- 
lowish or slate color. As the ulcerated follicles change, the 
glands diminish, and as they cicatrize the enlargement dimin- 
ishes, whilst they often assume a dark color, and for some 
time at least, remain hardened. 
j. Are these lesions constant in typhoid fever 9 All the 
observations made in France, England, at the Pennsylvania 
Hospital, and elsewhere, go to establish the fact, that the 
above alterations, in greater or less degree, are always pres- 322 
TYPHOID FEVER. 
ent in the form of fever denominated typhoid, or dothinen- 
teritis. And, also, a third phenomenon is almost always, but 
not constantly, present; which is, that the spleen is, for the 
most part, enlarged and softened. Besides these, lesions are 
almost constantly found in the membranes of the head, espec- 
ially of the serous tissues ; and in protracted cases, lesions 
are frequently discovered in the serous and mucous tissues of 
the lungs ; and redness with softening, in portions, or patches 
of the mucous tissue of the stomach. 
k. Are these lesions peculiar to this form offerer ? They 
are no otherwise peculiar than as being pretty constant; for 
very similar lesions are found in many other affections occa- 
sionally, and in some quite frequently, particularly in phthisis, 
in cholera, and in scarlatina. It may be proper to notice 
these briefly. 
In phthisis, the lesions in the follicles, in the mucous and 
other tissues as well as in the solitary glands, are very fre- 
quent, and show a great resemblance to those in typhoid fe- 
ver, although some nice distinctions are made by some pathol- 
ogists . 
In cholera, there are slight, but manifest traits of inflamma- 
tion of the intestinal follicles, which is sometimes restricted 
to the glands of Brunner. The discoloration is not so great 
as in typhoid fever ; some have a grayish color, others are 
red, some of a deep brown. Although the lesion is suffi- 
ciently plain, it is not so prominent, and does not proceed to 
ulceration, but exhibits about the same appearances at the end 
of four weeks in protracted cases, as it does at the end of 
forty eight hours in those that terminate suddenly. 
In scarlatina, also, the thickening of tissues is slight com- 
pared with that in typhoid fever : the tissues show redness, 
but never progress to ulceration. 
I. What harmonies seem to exist between the phenomena in 
typhoid fever, and the intestinal lesions ? Indeed it is diffi- 
cult to discover much, unless so far as relates to diarrhoea and OUTLINES OF THERAPEUTICS. 
323 
the meteorism, and these are not always constant, although 
very frequent. The ulcerations at any rate do not appear un- 
til many days after stupor and headache have been present. 
Yet there is undoubtedly an affection of the part previously. 
The cerebral phenomena are very constant, and precede 
the ulceration if not the intestinal inflammation ; and although 
the progress of autoptic examinations have revealed important 
lesions in these tissues, yet the most imposing tragedies seem 
to be acting in the cerebral organs, and especially in their serous 
tissues. It is here the concentrations in the disease meet 
with the greatest force ; it is here the most prominent phe- 
nomena are elicited by excitations of the nervous system of 
external relation, and the ravages are sufficiently demonstra- 
ble in the autoptic appearances. Of fortytwo fatal cases sta- 
ted at one time by M. Chomel, fortyone had cephalalgia. 
The same author considers the intestinal alterations as a se- 
quence rather than an antecedent of the disease. 
Notwithstanding, the intestinal lesions cannot be esteemed 
as unimportant; they may have some share of influence in 
the silent harmonies of the nutritive system in disease, and 
by their reflex action modify the condition of the morbid 
habit in some degree. It however, behoves us. to stop short 
at present as respects pathological references, until perhaps, 
other facts in connection become elicited, which may guide 
to some safer inductions. In the mean time we cannot think 
otherwise, than that the cerebral lesions are altogether the 
most important in a practical view ; and that they give origin 
to phenomena which must direct the treatment, and will al- 
ways indicate the severity and danger of the disease. 
m. Treatment of Typhoid Fever. 
Whatever the causes of slow typhus may be, the physio- 
logical actions show a change having been made in the vital 
energies of the system. The whole series of the nutrient 324 
TREATMENT OF TYPHOID FEVER. 
system of blood vessels and nerves are engorged ; the heart 
is enfeebled, and the absorbing systems are in a great meas- 
ure suspended. The blood loiters in the brain, and offers 
considerable impediment, especially to the energies of the 
system of nerves of external relation. 
We find a greater degree of disparity between the centri- 
fugal and centripetal circulations, than in synochus. The 
case seems to demand direct stimulants internally, in propor- 
tion to the degree of inability of functions. But, as has been 
remarked heretofore, these do not afford a remedy suited to 
the physiological condition. They excite unavailing action 
more in the outward, than in the inward series of circulation, 
and for reasons often explained. Of course the case is made 
worse for them. 
If direct stimulations can be applied to the absorbing se- 
ries of circulations, increasing their functions, a way is open- 
ed for the recuperative powers to act, and restore a free cir- 
culation. When this is accomplished the proper curative 
treatment may be used to advantage. 
This is a kind of morbid action that can seldom be so 
changed as to leave the system suddenly. It can be modifie'd 
most commonly, so as to pass off without destroying the or- 
ganization. It seems that some time is necessary for the 
preparation of the depurations, and their passing off by the 
proper outlets. These processes should be allowed to pro- 
ceed without too great interference by medicine. The sys- 
tem needs, also,, to be sustained by mild nutriment during a 
process of some length. (Sect. xliv. 4.) 
However varied the causes of disease may be, and how- 
ever different the degrees of injury done to the tissues, we 
find much similarity in the nature of the primary changes ; 
and the remedies are rather similar in kind, although differing 
in degree, and manner of impressing the system. Hence the 
simplicity of disease at its onset. OUTLINES OF THERAPEUTICS. 
325 
n. Caloric. 
In typhoid fever the first indication is, to excite the mo- 
tions of the absorbent systems in as easy and compatible a 
manner as possible. When this is only in part effected, cal- 
orification takes place, and this serves as a natural excitant to 
continue capillary action. As caloric is so natural a stimulus, 
and now so deficient, it ought to be applied from without, as 
a substitute well suited to light up its internal evolution. If 
at a future period it should be evolved in excess, it ought to 
be diminished. 
Warmth may be applied at the time of the chills, to the 
greatest advantage by the universal bath. Or, bathing the 
extremities, and covering well in bed, with the aid of mild 
and partial steams to the surface. At the same time may be 
used the more diffusible and evanescent stimuli internally. 
Camphorated julep in warm water ; a few drops of diluted 
aqua ammonia; or, 25 drops of chloric, or vitriolic ether ; 
the former is preferred. Also small and repeated doses of 
any of the most agreeable aromatic tinctures in warm water ; 
infusion of saffron and senega root, &c. Some of these may 
be given in a manner most agreeable to the patient, but not 
too freely, nor too long continued, as internal heat and in- 
flammation may be aggravated. 
It is common for typhus (patients to be attacked with uni- 
versal distress, faintness, and sinking at various periods of 
the disease. We have seen nothing so effectual to relieve 
these as warm applications, and additional coverings ; at the 
same time some light cordial, as the tinctures of lavender, or 
camphor, or gaultheria, &c. with nutmeg in hot water ; sweet- 
ened or not. 
The utility of the act of vomiting has been sufficiently ex- 
plained. For the purpose of exciting universal vascular 
* o. Emesis. 326 
TREATMENT OF TYPHOID FEVER. 
action, promoting absorption, perspiration, &c. a mild emetic 
of ipecac should early be employed, and repeated every two 
or three days until the case shows amendment. If there 
should be distress at the epigastrium, the part may be freely 
bathed with the saponaceous tincture with opium. Or, a 
poultice of hop flowers and bran. In its absence a thick bat 
of cotton wool so as to cover the abdomen, unless there 
should be much heat. In moderate cases, when the patient 
is free from epigastric uneasiness, the emetics may be omit- 
tecl. 
p. Cathartics. 
Most commonly a cathartic of three grains of calomel and 
six grains of rhubarb should,be given a convenient time after 
the emetic at the onset of the disease. There are often ac- 
cumulations of dark, viscid sordes in the intestinal canal, 
which ought to be gently moved off during considerable part 
of the time. These add irritation, and no doubt aggravate 
the inflammation in the mucous tissue, and increase the tym- 
pany tic affection. We have had no trouble from the tympany 
when the laxatives have been sufficiently employed, and the 
abdomen kept warm. • ' 
Every other day the calomel and rhubarb may be used, or 
every third day, unless diarrhoea exists. In this case even, 
something laxative may be used. Care should be taken in 
using calomel where salivation has previously been practised 
on the patients, as they are liable soon to be salivated. If 
salivation should arise it will commonly be worse for the pa- 
tient than the disease itself. The laxative pill (see index) 
may be advantageously used. If diarrhoea supervenes, about 
six grains of carbonate of magnesia with three grains of rhu- 
barb may be given.two or three times in twentyfour hours, or 
at discretion. At the same time eight or ten grains of pre- 
pared chalk, in water. Castor oil or manna may sometimes OUTLINES OF THERAPEUTICS. 
327 
be used. We are well assured of the utility of such a course 
in preference to allowing of constipation of the bowels, or of 
viscid accumulations, even if diarrhoea should attend. From 
a series of experiments at Paris, by M. Piedagnel, the re- 
sults were greatly in favor of the purgative treatment, in the 
various degrees of severity of typhoid fever. 
We are well aware of the terror excited in the minds of 
some, on the suggestion of bleeding in any typhoid state of 
disease. But, there is something more than debility to be 
contemplated and opposed. There is inability of functions 
from tissual embarrassments, which must somehow be re- 
moved before the case is rendered safe. Moderate bleedings 
at first are commonly well enough borne, and nothing is so 
effectual in giving opportunity for the exercise of the absorb- 
ent veins to take up the congested blood. 
We do not wait for the pulse to indicate venesection as in 
pleurisy ; even a small pulse shows some hardness oftentimes, 
and without much of this the case may require it. It may 
be necessary to take eight or twelve ounces of blood early in 
the disease. In twentyfour hours, it may be necessary to 
take a larger quantity ; or, omit as the case may be. We 
can give no positive rule how often, or how large the bleed- 
ings should be ; but according to the necessity of the case, 
until headache is removed ; and in other cases until coma is 
moderated ; and until excess of heat should be lessened, if it 
abounds. 
The blood at first may be thin and dark ; when vascular 
action has been more free for a short time, from the previous 
bleeding, it assumes more of a florid color, and more inclines 
to coagulate. Cases which have been bled early, bear after 
bleeding much better, if the phenomena should demand it. 
In many cases of prostration at the onset, we have taken 
q. Venesection. 328 
TREATMENT OF TYPHOID FEVER. 
blood in the third week of the disease, that would show a 
dense pellicle ; whilst taken from one who had not been early 
bled, it would be dark as at the commencement. These 
cases may not be benefited by bleeding, but commonly bet- 
ter trusted to the recuperative powers, with diaphoresis and 
catharsis. However, some cases may occur in which it may 
be tried as a doubtful remedy. Many cases are benefited by 
late bleedings, when the vital force is not too much ex- 
hausted. 
We meet with cases that do not require any bleeding ; 
others that require one, two, or three bleedings before the 
case is got through with. We have the utmost confidence 
of cases being saved by late bleedings in such as had the 
benefit of early bleedings. Cases so treated are not liable to 
be attended with intestinal hemorrhages, nor secondary coma. 
However, cups and leeches may often be substituted for gen- 
eral bleedings. Cups may be -applied on the upper part of 
the spine, and sides of the neck, and leeches to the temples 
and epigastrium. 
The use of blood-letting has been rigorously investigated in 
France of late, in relation to typhoid fever. It appears 
in an analysis of Professor Chomel's lectures, delivered at 
the Hotel-Dieu, of Paris, in 1834, that he approves of it. 
" He appeals to the tables published by M. Louis, in 1829, 
to show that blood-letting, practised at the beginning of the 
disease, exercises a beneficial influence on its duration and 
termination."* 
r. Sedantia. 
But few of the neutral mixtures are required in typhus. 
However, when heat and thirst prevail at the acme of the 
disease, the bicarbonate of soda and tartaric acid, or lemon 
•Edinburgh Med. and Surg. Journal for July, 1838; p. 207. OUTLINES OF THERAPEUTICS. 
329 
juice, in the act of effervescence may be useful, and agreea- 
ble ; it is often better to be sweetened. 
We have found the most satisfaction in low cases, with 
heat and dry skin, in the use of the carbonate of ammonia 
and vinegar, in small doses, and the articles justly propor- 
tioned ; in the act of effervescence. This is particularly 
useful in cases attended with thirst, and a brown tongue, after 
the injudicious use of opium. 
Camphor, prepared with gum arabic and loaf sugar as be- 
fore mentioned, is a grateful cordial and sedative to most 
patients, and may be taken at any stage of the disease at the 
pleasure of the patient, in six or twelve grain doses. It 
often induces sleep. Infusion of hop flowers occasionally. 
With respect to opium, it is scarcely ever necessary, often 
does mischief, and but few cases require it. In a few cases 
where the responding actions are very dilatory, with coldness 
and a thready pulse, the patient may take a grain, or half a 
grain of opium, with four grains of the blue mercurial pill, 
night and morning, for two or three days. They help to ex- 
cite equal action and warmth. If continued longer they 
might excite salivation, which would be a misfortune, as we 
have known perhaps, ten injured by it, where one has been 
benefited. As to to the continuance of opium nothing could 
be more injurious. It should only be used under the above 
circumstances. 
With regard to the use of cold water to the body,, it is 
never required when the general treatment is well conducted. 
There is but one condition in which it ever ought to be ap- 
plied to the head. That is at the latter stage of the disease, 
if there should be a light delirium with universal heat. In 
other cases it confirms tissual inflammation, and aggravates 
coma. This practice of applying cold water to the body, 
and the head in an indiscriminate manner, must have arisen 330 
TREATMENT OF TYPHOID FEVER. 
amongst those, who attend more to palliating troublesome 
symptoms, than radically removing their causes. (Section 
xxxvi. 9.) 
s. Tonics. 
There is not so much use for tonics as the advocates of an 
ever presiding debility insist on. However, a watery infu- 
sion of orange peel and gentian root may be used at any time. 
It is commonly agreeable to the stomach, moderately tonic 
and detergent. If diarrhoea prevails to considerable extent, 
quinia may be used in about two grain doses every four or 
six hours, with prepared chalk. A great variety of tonics 
may be employed ; still but little reliance should be placed 
on them, or on more direct stimulants for the cure of 
typhus. 
The nitras argenti is advised by Dr C. Hooker of New Ha- 
ven in cases of meteorism and hemorrhage of the intestines. 
Although we cannot speak decidedly from our own experi- 
ence, yet we do regard it favorably as a tonic in doses of 
one eighth of a grain in pills, every two or three hours. It 
deserves further trial.* 
Cases of considerable lowness, coldness, and small pulse, 
admit of small quantities of wine, repeated at intervals. 
Port or Lisbon wine may be used in table-spoonful doses, 
but not oftener repeated than is necessary to remove faintness, 
or considerable depression. Some extreme states of de- 
pression may require a larger quantity for a short time. Ex- 
ternal warmth should be used at the same time. 
The intention ought to be, to convert the embarrassed ty- 
phoid state into the mild synochoid ; and then the curative 
processes may commonly be conducted with precision. 
But, as has been often insisted, this must be done by modify- 
*See Boston Med. and Sur. Jour, for April, 1837. OUTLINES OF THERAPEUTICS. 
331 
ing the physiological movements by other means, than direct 
stimulants and tonics. 
A mild nutritious diet in a fluid form commonly is more 
required in this, than in many other forms of fever. 
t. Blisters and Frictions. 
Epispastics are often useful in this habit of fever; but a 
very frequent use is not profitable. They irritate, and give 
too much trouble to a patient that is weak. The patient re- 
quires rest and quietness as much as may be convenient. In 
the case of coma or delirium, applied on the ankles they in- 
vite the circulation from the head. On the occasion of coma, 
they are useful, applied on the spine between the shoulder- 
blades, or back of the ears. In the instance of continued 
distress in the epigastric region, one may be placed there, 
and often affords essential relief. If the blistered surfaces 
look dark colored, it is a token the typhoid diathesis still pre- 
vails, and the case is in danger of going wrong. 
Rubbing the surface of the body with flannel, or a woollen 
mitten, is useful. Also frequent lavings with a flannel wrung 
out of warm soap-suds, with the addition of some spirit. 
This may be often repeated and the process finished by rub- 
bing with warm dry flannel. 
If the patient should do well, he will require careful treat- 
ment during convalescence. Prudence is necessary in regard 
to diet, cold, and other circumstances which might excite a 
relapse.' 
u. We have hitherto neglected to notice an accidental 
occurrence very liable to happen in all cases of protracted 
fever, and which may often be avoided by suitable attention. 
This is, the occurrence of excoriations and sloughing of the 
nates, and parts covering the ossa innominata. They arise 
from the weight of the body where the circulations are feeble, 
and may commonly be avoided by an early attention to turn- 332 
DROPSY. 
ing the patient into different positions, and when he lies on 
his back to placing a pillow under the loins. Also, the parts 
should be kept clean, and bathed night and morning with 
camphorated brandy, with a portion of white shaving soap 
dissolved in it. 
These sores are not only very troublesome to the patient, 
but liable to fatal consequences in the extreme state of ex- 
haustion of protracted fevers. All which may commonly be 
avoided by proper attention. 
The treatment of the remaining diseases of this series 
may be conducted on similar principles to those already spe- 
cified. 
SECOND SERIES, 
4. Serous effusions into cavities not having apertures; or 
Dropsies. 
We can only attend to making some general remarks on 
the pathological character of the hydropic diathesis. 
These collections have been styled dropsies, or serous in- 
tumescences. They may arise in any part of the body where 
serous tissues are found, and these imply sacs without open- 
ings. The great sacs of the thorax and abdomen are isolated ; 
those of the brain communicate ; so, also, the innumerable 
small subcuticular sacs over the entire surface. When effusions 
occur, the upper portions of the fluid gravitate to the depend- 
ing parts, until they are considerably distended ; after being 
filled over the body, the pressure on the inferior parts is 
sometimes so great as even to rupture the skin, gradually 
pouring out the fluids. 
We speak of the hydropic diathesis, because we have no 
better term by which to designate the morbid state ; and from 
the circumstance of the tissues in their excited state yielding 
a serosity, whilst there is evidently a constitutional affection, OUTLINE^ OF THERAPEUTICS. 
333 
which is rather difficult to be designated from the common 
morbid habit. Indeed it is very common for diseases of the 
pyrectic character, when only partially removed, eventually 
to terminate in dropsy. 
It is not a little surprising that the true pathology of hy- 
dropic intumescences should be so long misapprehended ; 
and in our estimation^ it can only be accounted for from a 
fidelity to the false thesis of the local origin of diseases, so 
universally adhered to, and inculcated. Still the constitu- 
tional phenomena are very obtrusive, and described by every 
writer on the subject ; viz. dryness of the skin ; thirst, more 
or less intense; clammy, or viscid secretion in the mouth ; 
dry cough, or sometimes a thickened mucus spit up ; short- 
ness of breath, especially on exercising ; scanty, and high 
colored urine ; costiveness ; in the sanguiferous system, fre- 
quency of pulse, often very considerable, and more or less 
strong or feeble, as the disease may be acute or chronic, and 
modified by temperament; with muscular inability generally. 
Those phenomena commonly exist before accumulations 
take place, and afterwards increase in severity. 
There appears to be no doubt of a pre-existing general 
diseased state, which we call the hydropic diathesis, and 
local concentrations follow in the serdus tissues. If the con- 
centrations should happpen to be on other tissues, then some 
otherform of disease would appear. The result in the hy- 
dropic state will be an excess of a modified exhalation into 
the serous, cavities. It is retained there, whilst a result 
somewhat similar in principle occuring in the mucous tissues, 
the exhaled serosity finds an exit by some of their outlets. 
Instances are reported of diarrhoea treated by astringents and 
opiates, being converted into ascites. 
At the same time we do not doubt, but that there are 
particular local irritations sometimes affecting portions of the 
serous tissues, or extended to them, producing an excess of 
serosity but little altered ; such as hydrothorax from disease 334 
DROPSY. 
of the heart, hydrocele and hydrops ovarii from similar local 
irritations. The part may eventually produce a morbid ex- 
halation. So, also, we find ascites may be complicated with 
a diseased organ. The common morbid diathesis primarily 
concentrates on the organ, and through this the investing se- 
rous membrane receives its excitation, producing the effusions. 
We have before shown the readiness the whole serous tissue 
possesses, of becoming excited when a part is stimulated ; 
the entire tissue acts harmoniously more readily than the mu- 
cous under similar excitations. 
a. Characters of the Hydropic Diathesis. 
The hydropic diathesis, for the most part, partakes very 
much of the synochoid character. The drawn blood, on 
cooling, commonly shows the fibrinous pellicle ; the urine 
has so large a share of sero-fibrinous matter, that it coagulates 
by heat or acids, and becomes more or less dense as the dia- 
thesis is more or less strong. Notwithstanding, in protracted 
and exhausted cases, and especially when an organ has been 
primarily associated and spoiled, the diathesis approximates 
towards the typhoid character; in these cases the fibrinous 
pellicle does not form, nor the urine coagulate. The differ- 
ent diathetical states require a modified treatment, as in other 
diseases. 
b. It may be acute or chronic. 
The hydropic diathesis may be acute or chronic, and both 
incline to be persistive and obstinate of removal. Even if by 
some extreme effort of the salutary processes, excited spon- 
taneously or by medicaments, absorption should take up the 
exhaled fluids, and they become eliminated, they are liable 
soon to accumulate again, so long as the general diseased state 
remains. OUTLINES OF THERAPEUTICS. 
335 
Acute hydrothorax, and acute ascites, are nearly allied to 
what are called chronic pleuritis, and chronic peritonitis. 
The exhalations are a dense serosity very difficult of absorp- 
tion. If paracentesis should be practised, it affords only a 
few days respite from a fatal termination. The case is urged 
on by a strong diathesis, and it is the more incontrollable 
when excited, as it too often is, by alcoholic potations. The 
visceral organs are suffering inflammation. 
On the reverse, chronic ascites, with a mild hydropic dia- 
thesis and tissual excitation, with freedom from organic lesion, 
may continue an indefinite period of time. It may admit of 
paracentesis several dozens of times, with an astonishing 
amount of thin transparent serosity drawn off.* These cases 
sometimes admit of radical cures. When, however, the 
fluid becomes darkened in color, and turbid, it will ere long 
have an unfavorable termination, being connected with some 
spoiled organ. 
The hydropic collections of the great cavities show, in 
magnitude, what the minute tissual depositories are, in min- 
iature, in the case of oedema and anasarca. It is unphiloso- 
phical to say one series alone of the capillary circulations is 
in fault. The exhalants and absorbents are both deranged in 
function, as in most other cases of disease. Besides, the 
more severe the diathesis, the more dense are the fluids ex- 
haled ; and the more dense they are, the more difficult of 
absorption. If the general diseased state can be removed, 
and the absorbents become active, the thinner portions may 
be absorbed, whilst the more dense cannot be. 
* A case is related in the N. Y. Met}- Rep. by Dr Chatard, of a woman tap- 
ped seventynine times in about three years; seventysix of the tappings 
afforded 871 quarts, besides the first three by Dr Mathien. 336 
DROPSY. 
c. Therapeutical remarks. 
The proper treatment consists in removing the general dis- 
eased state, and in restoring the harmony of the capillary 
functions. General anasarca can more certainly be cured 
than hydrocephalus, hydrothorax, or ascites. It is proba- 
bly because they are so often associated with some diseased 
organ. 
Of the acute anasarcas, that which follows scarlatina is the 
most rapid and fatal, unless opposed by a severe round of 
bleedings and purgatives, even whilst the vital actions are 
greatly oppressed and depreciated. There is no time for al- 
teratives to take effect on the kidneys, or any other organ, 
and diuretics are always capricious ; the more stimulating 
diuretics increase the phlogistic habit, and are opposed to 
diuresis ; they should be withheld at least until the constitu- 
tional state is removed by the proper remedies. We have 
often found the drawn blood in hydropic swellings after scar- 
latina, deeply cupped, when the pulse was very small. 
The phenomena just now recited, cannot be doubted as 
pertaining to the united economy throughout the system, and 
prove an universal derangement existing. An adviser, ha- 
ving an opportunity of observing the lingering train of pheno- 
mena, may readily apprehend the liability to hydropic effu- 
sions, and ought early to anticipate the results, without 
looking on and waiting to see the extent of the injury which 
may be done. The fatal bloatings liable to follow scarlatina, 
may easily be anticipated and obviated. He needs to take a 
wider range in view, than those who apprehend nothing be- 
yond mere tissual irritation or debility. 
The morbid habit preceding uncomplicated dropsy, can 
commonly be removed; and when this is done, the precarious 
use of specifics, as the pretended diuretics, &c., is antici- 
pated. Even if effusions have taken place, the affection can 
never be radically removed until the general diseased state is OUTLINES OF THERAPEUTICS. 
337 
altered. Our attention, therefore, ought, chiefly and season- 
ably, to be directed to this object; not only with a view to 
save the serous effusions, but also the resulting injury of the 
visceral organs, which often has so large a share in producing 
the effusion. ' . , 
The phenomena themselves, both singly and collectively, 
indicate the necessary treatment. Take, for example, the 
dry harsh state of the skin. How shall its functions be re- 
stored ? We have often indicated the safe and surejemedies 
to produce cutaneous exhalation ; tepid bath ; an,timonial 
powders, &c. All the phenomena indicate a pyrectic habit, 
and deficiency of secretion, exhalation, and absorption. The 
frequent, hard, though small pulse, tells the obstacles and 
labor in the sanguiferous system, and that venesection is most 
commonly necessary to thin the crasis of the blood, to give it 
a freer circulation by removing the tonicity of,the capillaries, 
and by their depletion to ensure a better absorption also. 
Perspiration cannot soften the epidermis until the rigid con- 
dition of the tissues is removed, notwithstanding the inability 
of functions, and apparent debility. There is no necessity of 
repeating all the remedies adapted to answer the intention ; 
the simplicity of disease is such, that the very means that 
have so often been proposed to remove the common morbid 
habit, are nearly the same to be used in this instance. To 
this, however, may be added, the iatrileptic treatment by 
ointments and frictions. 
But, the ill-educated, and those who never profit by ob- 
servation, will stop short of obtaining, the object; they will 
cease* to proceed when their work is only half done, for many 
erudite ones have said, that debility everywhere prevails in 
such like cases. Notwithstanding, such subjects often obtain 
strength by the use of debilitating remedies judiciously admin- 
istered. As soon as the hydropic diathesis is removed, the 
exhalations and absorptions take their natural courses, and the 
serous tissues are relieved of their unnatural service. 338 
DROPSY. 
Although there is a great difference in the severity of the 
hydropic diathesis of different individuals, still every case of 
the mildest character, consists in a state of morbid excitation. 
Some need but little reduction, but require that absorption be 
excited ; and it is a fortunate circumstance when such articles 
as gum guaiacum, squills, senega, mustard, phytolacca decandra, 
colchicum, cantharides, &c., can be so directed as to excite 
secretion and absorption, aided by frictions and caloric, with- 
out adding hurtful irritations to the centrifugal circulations. 
In the largest proportion of cases, the neutral salts will be 
the safest, and most useful to promote diuresis ; such as the 
acetate and tartrate of potash ; nitrate of potash, &c. The 
supertartrate of potash is useful, and has long kept its place 
as a diuretic in dropsy. 
These saline substances are readily soluble in water, and 
soon taken up by the radicles of the veins, and diffused in 
the mass of circulating fluids, and in an unchanged state. 
They possess the property of exciting action in the elimi- 
nating organs, without greatly disturbing the general circula- 
tory system. They are, therefore, safe excitants ; they may 
b$ used in either the syndchoid or typhoid states of the sys- 
tem. They should be exhibited in large doses, and sus- 
pended in a full proportion of water. The quantity should 
be regulated ' by the ability of the patient. On ordinary 
occasions, an ounce of the acetate of potash should be taken 
every twentyfour hours, in divided doses; and of the 
nitrate of potash, from one to two scruples in the same length 
of time ; yet only one of .these should be used at the same 
time. All these saline substances are taken to the best ad- 
vantage, in some pleasant bitter infusion, as orange peel or 
gentian, and sweetened with refined sugar ; or an infusion of 
some of the reputed diuretics, as juniper berries, senega, or 
even a draught of new ale. Some habits may require larger 
doses than the above mentioned. 
However, neither these nor any other diuretics can take OUTLINES OF THERAPEUTICS. 
339 
effect on the eliminating organs, until the synochoid diathesis 
is principally removed by the proper remedies, viz : blood- 
letting to the necessary point; eme?is ; diaphoretics ; purga- 
tives, and the avoiding stimulating food and drinks; These 
measures should always precede every attempt to excite diu- 
resis, where the phenomena indicate a synochoid diathesis. 
In the reverse state, when the urine does not show a cbagu- 
lum by heat, acid, or alcohol, nor the blood a buff, the 
preparatory treatment will be short; perhaps merely the tepid 
bath and an emetic. It is best to begin the treatment by the 
above method, and if it succeeds in dissipating the accumu- 
lations, there will be but little necessity of resorting to the 
uncertain use .of diuretics. If diuretics should be used after- 
wards, the patient should be exposed to a moderately cool air, 
with exercise, for diaphoresis and diuresis can rarely be ex- 
cited to much advantage at the same time. 
d. On Emesis. 
' ' • ? ♦ ♦ • ; 
Perhaps there is no more effectual method of exciting the 
absorbent processes, than the act of emesis ; whilst it does 
this, it also diminishes the rigid nosodynamic state jexisting 
throughout the entire system, in greater or less degree. It 
seems to affect the remotest tissues, and we verily think we 
have witnessed as much benefit from this as any other means, 
in relieving hydropic collections in any section of the system. 
It is most useful in anasarcous swellings, and directly after 
using the universal bath, and being well covered in bed. 
Emesis excite? the absorbents, to take up the fluids, and 
causes them to be eliminated by the cutaneous emunctories. 
It is often difficult to produce emesis at first, where the ac- 
cumulations are large, (Sect. xlvi. 9, i.) By repetitions it 
may be quite easily effected ; it should be practised every 
other day for a considerable length of time, or according to 
circumstances.. When the patient can bear it, a purgative 340 
DROPSY. 
should be interposed on the intermediate days. Wine of an- 
timony may be used as an emetic ; or tartarized antimony ; 
or the red antimonial pill as in p. 278. Othet emetics may 
be used, and the lobelia inflata would be very eligible, if we 
coulcj be sure of avoiding its deleterious properties. The 
method of preparing and using it, may be found in various 
writings on the materia medica. 
e. On Cathartics. 
Purging has often been successful in removing hydropic 
collections ; yet these are more liable to return than when 
treated by some other methods. In order to be permanently 
useful, cathartics must be repeated, and in many cases the 
patient can hardly endure their frequent repetition. It is 
better to alternate them with emetics, according to the ability 
of the patient to endure them. Where there is evidence of 
disease in any of the visceral organs, the cathartics, and in- 
deed all the other remedies, should be directed for its re- 
moval, rather than for the evacuation of the fluids ; still, 
however, it is. an encouraging circumstance that the same 
treatment may benefit both these, conditions. Anasarca is 
oftener cured than local dropsy, which so often stands related 
to spoiled organs. 
The saline preparations mentioned above often prove ca- 
thartic, and if they occasion the discharge of much liquid mat- 
ter, their use ought not to be interrupted by other'measures, 
and more especially if they promote diuresis. In Cases ad- 
mitting more drastic operations, the composition long used 
by the former physicians is worthy of trial.* This often 
proves hydragogue without producing great exhaustion. 
* Supertartrate of potash, 20 grains ; Jalap, 15 grains. To be used for one 
dose to an adult; or according to circumstance^. Sometimes three or four 
grains of calomel may be added. OUTLINES OF THERAPEUTICS. 
341 
Elatin is too drastic, and liable to be attended by extreme 
exhaustion, and in cases attended with inflamed viscera, adds 
irritation. 
The cathartic pill mentioned p. 233, containing the vera- 
trum viride and gamboge, often proves hydragogue, and is a 
mild and eligible cathartic in dropsy. 
f. Remarks on Hydrocephalus internus. 
Perhaps it may be esteemed difficult to demonstrate the 
existence of this affection ; but so far as the usual series of 
the external phenomena indicate it, and in accordance with 
the opinion of several physicians, we are prepared to state its 
removal in three instances at least, by cathartics. All the 
cases had lingered two or three weeks, whilst the general 
state of disease had seemed very much to have subsided, 
although the subjects had -become greatly reduced. They 
occurred in children from four to ten years of age. Such sub- 
jects cannot bear very drastic purgatives, but they need to be 
repeated, and the morbid energies- sometimes may seem to 
be very much directed to the stomach' and intestines. As 
the serosity'in the ventricles is but slightly albuminous, (not 
coagulating by heat,) it may more easily be absorbed. One 
case, and seemingly a hopeless one, was overcome by the 
use of the Tinctura 'Sennae cotnposita, formerly the Elixir 
Salutis. It took effect from small doses of only a tea-spoon- 
ful once in four hours, and afterwards only once or twice a 
day. The case had been attended with frequent vomitings. 
There were ten or twelve dejections daily, chiefly of fluid 
matter. It was gratifying to discover, that the strength and 
appetite of the little emaciated sufferer daily improved, al- 
though these operations were continued for ten or twelve 
days in succession. The vomiting immediately ceased. No 
other medicine was used, only a mild, and agreeable aliment 342 
DROPSY. 
consisting chiefly of panada, porridge, and broths. This 
subject recovered, however, with the entire loss of hearing. 
The others fully recovered by the use of various cathartics 
according to their ability of enduring them. 
g. Remarks on digitalis in Dropsy. 
This article in various forms, has been used with some 
success in exciting absorption from serous cavities, and pro- 
moting diuresis, and thereby removing hydropic collections. 
For this purpose it is necessary to be given in repeated, yet 
cautious dose^ until something like a state of narcotism is 
induced. It however seems to affect more essentially the 
system of internal susceptibility than the external ; and par- 
ticularly in the first instance, by diminishing the frequency of 
the cardiac actions. 
It is probable, as it belong to the narcotic tribe, that its 
effect on the capillary systems has some affinity to what is 
represented by Cazenave of repeated doses of opium, in 
rheumatism (Sect. xlvi. 9, k.) If the dose should be pushed 
too far, and in cases more strictly synochoid, it is liable to 
unpleasant, apd even fatal consequences, by producing head- 
ache or comatose delirium ; increasing the frequency of the 
pulse after retarding it, and entirely exhausting the vital 
force. We have witnessed such cases in other diseases, 
and have perhaps in consequence been too timid in the use 
of it to insure success- We cannot therefore, say much in 
favor of its use in dropsy, although we have often used it to 
considerable extent. It appears that Dr Withering had very 
considerable success from its use in dropsy. Dr Ferriar 
had less success on thorough trials with it, whilst Dr Lett- 
som in fair trials, had no success at all. On the whole we 
must confess, we have had ill success in the radical treatment 
of any disease, by the extended use of narcotics- OUTLINES OF THERAPEUTICS. 
343 
h. On Anasarca following Scarlatina. 
As this is of very frequent, and fatal occurrence, it seems 
to merit some further passing remarks. It is a very treach- 
erous, as well as formidable state of disease ; often proving 
suddenly fatal without much warning to those not familiar 
with its character. ' 
This kind of anasarcous bloating, occurs in - about three or 
five weeks after the disappearance of the eruption in scarla- 
tina, or scarlatina anginosa ; it is most likely to occur after 
cases so mild, as not to require much treatment, or in those 
previously treated by tonics and stimulants, to the neglect of 
proper evacuating remedies. ' 
The effusion is more viscid than in ordinary anasarca ; it 
is equally diffused, being as much in the face as in the lower 
parts. It extends to the cellular tissue of organs internally. 
It is attended with shortness of breath, and a very frequent, 
small, and oppressed pulse. The patient may often be up 
and about the house for only a few hours before death; yet 
sometimes he is comatose, and complains of distress, and 
perhaps has some pains. The phenomena are not usually 
obtrusive in proportion to the danger of the case. We con- 
sider this state a sequel, or continuance of the*previous dis- 
ease, it not having been radically removed. 
From the smallness of the pulse, though very frequent, 
with the other specious phenomena, the inexperienced advi- 
ser may be much inclined to make use of tonic and exciting 
remedies, to the neglect of free evacuation^. If so, his pa- 
tient will most probably be lost in a short time. " The first 
case I met with was suddenly fatal, in 1795. A boy of 
about six years ; by the account of his parents, had the epi- 
demic three weeks before ; showed but small signs of disease 
afterwards until a short time before I saw him, and then noth- 
ing to greatly alarm the family. The day previous tt> my 
seeing him, which was in the evening, he showed more signs 344 
DROPSY. 
of indisposition ; appeared drowsy, and complained of some 
pain ; there was a fulness over his body, as much in his face 
as in his feet ; shortness of breath, &c. His pulse was most 
astonishingly frequent, small and tremulous, and could scarcely 
be counted. The family were surprised when I told them, 
although the case was new t;o me, that it was my opinion 
he could liot continue but a few hours.. He died that night. 
He took a portion only of common physic !* 
Since then in different epidemics, we have met with many 
cases apparently as formidable as this, which have been re- 
stored by the treatment about to be detailed. 
If the case should be of a milder kind, perhaps free ca- 
thartics may be efficacious in removing the anasarcous effu- 
sions, and relieving the organism of oppression. For this 
purpose efficient doses of calomel and jalap may be em- 
ployed, and repeated until relief is obtained. 
-However, most cases require more efficient remedies. 
Notwithstanding the smallness of the pulse and the apparent 
debility, the taking of blood freely is indispensable. It should 
be taken from the arm, and in sufficiency to relieve the em- 
barrassment of the organs. This should be followed by the 
cathartic just mentioned, or some other equally active, in 
doses sufficient to insure free operations. If it should prove 
emetic^ it will be of more utility*. 
It is gratifying to see how soon the sufferer'will gain ener- 
gy of body and mind, after these operations ; together with 
a, more expanded and less . frequent pulse, whilst the bloat- 
ing is being dissipated. 
The blood uniformly shows signs of a synochoid state, be- 
ing covered with a pellicle and cupped. It is. truly a marked 
state of disease. We have often been obliged to repeat the 
bleedings two or three times, together with the cathartics, 
before the affection might be considered effectually removed, 
and safety insured. Furthermore, in cases that remain more 
* Author's Sketches of Epidemic .Diseases, p. 354. OUTLINES OF THERAPEUTICS. 
345 
obstinate, emetics may be used to much advantage, alter- 
nately with the cathartics. 
Patients in this condition cannot be made to sweat but 
with much difficulty, on account of the dynamic state of the 
system ; it need not be attempted; yet the tepid bath and 
external rubbings are useful. Trust the remaining treatment 
to gentle antiphlogistic measures, together with mild nutri- 
ment. 
Dropsy following measles and rheumatism requires quite 
similar treatment, whether the collections are in the cellular 
tissue, or in some of the internal cavities. • 
ORDER IV. 
HABITUS TYPHOIDES GRAVIOR; USUALLY STYLED 
ATAXIA, OR ADYNAMIA. 
SECTION XLIX. 
L Remarks on the pathological character of severe typhoid 
• fevers. 
a. We now approach the most formidable order of dis- 
eases to which the human family is incident; and which under 
different modifications, with modified trains of phenomena, 
have destroyed vast multitudes at different periods, and in 
various sections of the world. 
Although these severe scourges of mankind may arise from 
different causes, and exhibit some discordant phenomena, yet 
we discover in their intrinsic character many things in com- 346 
TYPHOID DIATHESIS. 
mon, linking them together, and proving them to be nearly 
allied. The close connection that exists between the two 
great nervous centres, often occasions some confusion and a 
preponderance of phenomena, showing a disturbance more 
in the one than in the other, whilst the real seat of the patho- 
logical derangements exists almost exclusively in the primary 
nutritive tissues. . (Sect, xvh 3.) In order to separate these 
phenomena, we need have reference to the distinct physio- 
logical susceptibilities, to the harmonies existing in health, 
and the divergencies occasioned by the perturbed actions of 
the pathological state ; and these should be regarded both in 
organs dependent on the vital force of internal, and of exter- 
nal relation. 
For the purpose of duly appreciating these formidable 
states of disease, it will be necessary to reflect on all that has 
been said on the causes and character of disease in general, 
the manner by which the causes impress the tissues, the 
state of the tissues at the time, and the repulsive efforts there- 
by excited. (Sect, xxiii. 2.) 
b. We contend that the causes are always excitant ; that 
they produce an acceleration of motion in the contractile fi- 
bres. But, the constitution of the nervous tissues is such, 
that an .excess of stimulation suddenly exhausts their suscep- 
tibility, and the organs are left in a state of paresis. When 
such causes are overwhelming, the entire nervous systems 
may become paralyzed, and a fatal quietus must be the result. 
Such instances have sometimes occurred in many of the af- 
fections of this order, as history and observation prove, and 
will be likely to occur again, at such times as a concentration 
of the causes may be combined. (Sect. xxiv. 3.) 
Fortunately, however, such severe impressions in any con- 
siderable degree, are not very frequent. In the range of dis- 
Ataxia. OUTLINES OF THERAPEUTICS. 
347 
eases of an ordinary caste they never occur ; but when the 
impressions are severe, yet not overwhelming, there is liable 
to be a train of sequential phenomena of an alarming kind, and 
following in quick succession, especially in the organs de- 
pending on the nerves of external relation-. And furthermore, 
the sudden and severe impressions produce much irregularity 
in the succeeding phenomena ; the movements are unsteady, 
and consequently the results are unequal ; the disease pre- 
sents many anomalous phenomena, and such states have been 
denominated ataxia. (Sect. xxii. 1.) 
In such conditions of a more severe morbid impression, 
the functional exercise of many organs becomes suspended, 
whilst others may be increased. Some portions of the sys- 
tem may be unable to evolve animal heat, whilst another 
evolves it in excess. Whilst one organ may secrete in ex- 
cess, another may be dormant. Indeed the same organ may 
experience these changes in a very little time. So we see 
the iritellectual organs at one time shrouded in obscurity, and 
in a ■ short time again manifesting perception and increased 
energy. The muscular system most commonly harmonizes 
with the intellect. The secretion of bile may be entirely 
suspended, and in a short time again produced in, excess. 
These discrepancies are most manifest in this order of disea- 
ses at their onset; after a little while, a few days, the local 
concentrations become more fixed, and the disease assumes a 
more steady character. 
c. On account of the manifest deficiency of many func- 
tions at the onset of this order of diseases, the epithet of ady- 
namia has been bestowed upon it. We consider this term 
equivalent to the term debility. We apply it, if in any sense, 
to express the inability of functions, but not to denote the 
pathological state of the tissues in disease. We have en- 
Jldynamia. 348 
TYPHOID DIATHESIS. 
deavored to show in Sect, xviii. that an increased state of 
tonicity exists in the most intimate tissues in disease, and 
have denominated it a state of nosodynamia. This is a state 
directly opposed to debility.. On this thesis we explain most 
of the phenomena, and by induction from facts, the treatment 
also ; all which we have endeavored to establish by direct 
proof, in the above section, and other parts of the pathology, 
and particularly from the most successful treatment. 
The two series of Circulation. • 
d. In all these affections, although not peculiar to them, 
we immediately discover the equable balance severed be- 
tween the converging, and diverging capillary circulations. 
Some of the first manifestations of disease are legible in the 
countenance, and perceived on the dermoid surface by a 
looker on, whilst the suffering subject expresses a corres- 
ponding internal distress. The balance of circulation is in- 
terrupted, as is proved by many phenomena. Absorption is 
at least partially suspended throughout-the system, not totally ; 
for if so, life must soon close, as in the tragical cases ; yet 
sufficiently so as to produce more or less discrepancy of 
function in all the organs. In the secreting organs the same 
changes take place, with the same despoiled functional exer- 
cise ; and each one in a small circle, represents in miniature 
that of the entire system. 1 
Engorgements and maculce. 
e. The causes, if applied externally, suddenly impress the 
entire organization through the agency of the nervous suscep- 
tibilities. The derangements of the internal tissues are near- 
ly synchronous with the exposed surface. The most mani- 
fest pathological changes that are discovered in the cases of 
unfortunate termination at an early period, seem to be the OUTLINES OF THERAPEUTICS. 
349 
distention of capillary veins, called congestions, or engorge- 
ments. They may frequently be discovered in the serous 
tissues of the three cavities. The engorgements of many or- 
gans, as the liver, spleen, and others, seem to be of quite a 
similar character. 
In many of the diseases called malignant, we also discover 
maculae on the dermoid tissue, in the form of petechiae, vibi- 
ces, ecchymoses, &c. with a dusky color of the skin. These 
depend on the same changes as those of the internal tissues, 
only the density of texture alters the appearance. These ex- 
ternal phenomena may be absent, but the internal congestive 
state is never wanting in the diseases pf this order ; they are 
often found in milder states of pyrectic diseases, which shows 
that all diseases of excitation possess some affinity. 
Mstrictive state of Capillaries. 
f. Shall we consider these ostensible phenomena as the 
primary cause of the disease ? Very certainly they are sec- 
ondary, and should be considered as merely one link in the 
catenation of sequences of the morbid changes. It appears 
incumbent on us then to inquire, what the antecedent cause 
may be, in order to induct a rational method of treatment. 
The enquirer after facts and truth is desired to turn back to 
Section xxi. 3, 4, and 5, for some short expositions on this 
subject, which may essentially assist in the present illustra- 
tions. 
We must not lose sight of the fact, that the centrifugal 
circulations possess a nervous susceptibility, whilst the ve- 
nous, converging circulations are destitute, and depend on 
the vegetative force. The arteries soonest feel the impres- 
sion of exciting agents, and hold out their physiological move- 
ments the longest. The veins are more readily distensible 
than arteries. The blood now is forced into the capillaries 
faster than the venous radicles can absorb. And furthermore, 350 
TVfHQID DIATHESIS. 
the nosodynamic adstrictive force has already affected the in- 
ternal capillaries, as well as the external. The free egress of 
the easy circulation of health is retarded, whilst the veins are 
incapable of a quick performance of their function. The re- 
sult is as might have been anticipated from the premises, an 
accumulation of blood distending the origins of veins,, produc- 
ing engorgements, and also a retardation in the capillaries, 
showing a darkened color of the tissues. The blood assumes 
a darkened color partly from the delay, and partly from defi- 
cient pulmonary absorption, and aeration., 
Notwithstanding all these embarrassments, a partial absorp- 
tion takes place in ordinary cases, and the tissues assume an 
increase of sensibility. Directly, if life is prolonged, the ar- 
terial capillaries act with more force, their blood assumes 
more of a florid color, and the process of inflammation com- 
mences. This increased action is partially extended to the 
venous absorbents, and by a forced impetus their congestions 
are partially removed, and the more manifest phenomena of 
excitation appear. A severe tissual conflict arises. This is 
the condition of cases more likely to, be prosperous under 
discreet management; whilst those going on to a fatal termi- 
nation remain as at first, with carbonized blood. The tissues 
now show an injection of red arterial blood, and soon are lia- 
ble to be attended with effusions of various characters accord- 
ing to the diathesis, unless arrested by a mitigation of the 
general diseased habit, either by the efforts of the restorative 
processes, or as assisted by art. If not,, both arteries and 
veins exhibit dark blood. 
The morbid conditions of the capillaries in the tissues of 
the lungs, are very similar to those in other portions of the 
system. The origin of the pneumogastric nerve in the ence- 
phalon suffers, impediments ; and the same circumstances oc- 
cur in its distribution in the tissues of the lungs. In conse- 
quence of this, the blood is not aerated, but remains dark. 
The dark blood serves further to diminish nervous, energy. OUTLINES OF THERAPEUTICS. 
351 
The patient breathes often, both for the purpose of increasing 
the circulation, and also, to promote the absorption of oxy- 
gen. Still he gains but little relief, neither can he so long as 
the primary changes in the tissues remain. The nervous in- 
ability is sometimes so great that the external respiratory 
muscles become weakened, and the respirations are slow. 
That something very similar to the preceding takes place, 
in all the diseases of this order, has been abundantly proved 
by many autoptic examinations. And it pertains also, in all 
the ' anomalous epidemics which casually appear in different 
seasons, and sections of the world, (receiving names after the' 
places they happen to exist in,) and which make severe de- 
vastations of human life. 
Especial local concentrations. 
g. Besides the state of venous engorgements, the general 
diseased impetus is directed to some point, or tissue, or or- 
gan, in every habit of disease, unless the vital force is too 
greatly exhausted. These concentrations become more or 
less severe, according as the degree of general morbid im- 
pression, and as the vital energy may be more or less free. 
In ordinary states of disease the concentrations are directly 
made on some of the simple tissues of the organs. They 
are wont to remain so, but as disease advances, the morbid 
harmonies often associate other adjoining tissues, and the lo- 
cal affection at length becomes of a complicated kind. So 
the effusions on, and between tissues of different organs in 
the course of the alterations they suffer, are liable to associ- 
ate adjoining tissues, producing eventually a complicated state 
of local affection. 
The topical concentrations in the present order of diseases, 
appear to derange the order of our tissual nosography. They 
often impress all the tissues of. organs, by the great weight of 
general disease, and in so effectual a manner as to suspend 352 
TYPHOID DIATHESIS. 
their functions, and even retard the circulations, so that the 
part suddenly dissolves in gangrene. Or, if not quite so 
severely, the part is quickly urged through the stages of effu- 
sion, and wasting suppuration. It is in consequence of this 
circumstance, that the appellation of diathesis fervida complexa 
is bestowed on diseases of this order. If these circumstances 
do not attend all the milder cases, they do often occur. 
We discover in the affection called pneumonia typhoides, 
an indistinguishable impression on all the tissues of the lungs ; 
sortietimes with various effusions from the mucous and serous 
tissues, with infiltrations of the connecting cellular tissue ; or 
we find a large portion of this organ in a state of hepatization 
and disorganization ; all these changes taking place, perhaps, 
in fortyeight hours. So buboes and carbuncles suddenly 
appear in the plague, assurpe hardness in the parts, affecting 
several tissues, and liable to sudden gangrene. We have 
seen the scrotum and the penis suddenly affected, and turning 
black in a few hours, and passing into.gangrene. 
If we should be enquired of, in relation to what pathologi- 
cal circumstances give origin to these severe local affections, 
we must answer, that they receive their chief force from the 
onus of disease pervading the general system ; and that such 
a condition implies a severe nosodynamic state, attended with 
alterations of the fluids, and ataxic phenomena. We have 
repeated, that such a state manifests the severest condition of 
disease ; although, some parts of the system may be nearly in 
a state of quietus, not eliciting strong tokens of disease. We 
have made various allusions to the typhoid state, and reference 
may particularly be made to Sect. xxii. and Sect. xlv. 1, 2. 
This state is manifest at the onset of disease ; there is a 
greater deficiency of circulation on the surface, than in ordi- 
nary diseases. . The centrifugal forces are inadequate to 
overcome the obstacles existing, from the deranged condition 
of the tissues. These impediments exist in many diseases : OUTLINES OF THERAPEUTICS. 
353 
but in the present instance they exist in an eminent degree, 
and in some fatal cases reaction never obtains. 
Deficiency of Caloric. 
h. Not only does coldness exist on the surface, but some- 
times throughout the internal organization. The deficiency of 
animal heat is so great, that patients having an integrity of 
intellect, complain of an internal sensation of coldness, and 
sometimes demand very hot drinks, and in severe intermit- 
tents have eaten the pods of red pepper. In cholera there 
exists a great deficiency of internal heat, in the first and most 
dangerous stage of the disease. It has been demonstrated 
that enemata of heated liquors will soon be returned of a tem- 
perature far below the natural standard of 98°; the breath, 
also, is cold to a person in health. All these circumstances 
prove, that more or less of the same impediments, which de- 
range the external circulation,' exist internally, especially in 
the lungs ; from a deficiency of capillary circulation, there 
must be a deficiency of calorification. The importance of 
using early and efficient means to restore capillary circulation, 
must be apparent to every one. 
When the capillary circulation does obtain, it is partially at 
first; and as the diseased state progresses, is liable to go to 
excess. The tissues acquire a morbid sensibility, and the 
vibratory action is such, that the circulation becomes vehe- 
ment, with an extrication of high heat. There are some 
cases of the typhoid state, in which high heat is present 
without much previous coldness. The severe typhoid fevers 
of hot climates afford the most Examples of this early and 
ardent state of fever. 
Cardiac actions, and ganglia. 
i. As diseases of this order show phenomena of a general 354 
TYPHOID DIATHESIS. 
disordered state externally, so likewise there is proof of a 
general derangement of organs in all the three visceral cavi- 
ties. The impression is always more severe in one cavity 
than in any other, and in one organ more than another. 
Notwithstanding, if today the concentration should be most in 
the thorax, perhaps in the same subject, it may tomorrow ap- 
pear most in the head. 
The heart suffers impediments like other organs. Its pul- 
satory motions may be unperceived, but its prolongations, 
the arteries, bring it close to the touch, and its force may be 
quite satisfactorily estimated. There is a change at the very 
onset of disease, its motions being more or less feeble and 
vacillating. The rythm of the heart is commonly unequal, 
with but little force and small volume of the arterial current. 
It is soon either retiring in fatal cases, with great frequency, 
or rising into considerable force,, with from 100 to 130 pul- 
sations in a minute. The very state of adstriction of con- 
tractile tissues, produced by morbid stimuli, serves to embar- 
rass the functions of the nervous ganglia and plexuses, 
thereby impeding the nervous force due to the heart. Yet 
we know there is a force exciting its movements when sepa- 
rated from all nerves. Its motions, like other organs, will be 
wavering and unstable. The abdominal and thoracic ganglia, 
have been shown to be enveloped in a red vascular tissue in 
health, and the undue concentration of blood paralyzes their 
functions in greater or less degree ; and in proportion to 
these lesions will the functions of organs be, that are depend- 
ent on their vital influence. The same adstrictive stale that 
constitutes nosodynamia, and gives origin to congestions, also 
operates here. 
In this view of the subject, a morbidly exciting force is 
acting, but in a manner to paralyze, instead of affording 
organic energy. When, however, this morbid force becomes 
relaxed, so as to allow of vital energy to organs, these act OUTLINES OF THERAPEUTICS. 
355 
impetuously from the remaining morbid force in the tissues, 
and, in a degree, difficult to be restrained. 
Dr Rushy with all his views of debility, practised rational 
treatment, although inconsistent with his theory. It seems 
that he, as well as Dr Southwood Smith, could discern 
through the dark vista of physiological movements, something 
besides mere debility in the exalted movements of disease. 
The latter is explicit and bold when he says, "''The brain 
(ganglia ?) is overwhelmed by the intensity of its affection ; 
the energy that should, animate the system, and of which it is 
the great source, is withheld ; but that energy is suspended, 
not destroyed ; and the debility which seems to be the result, 
is not real, but apparent, not direct^ but indirect."* His 
very mode of explanation shows the cloud he was enveloped 
in ; although he could cwt the cord that held the " giant" 
bound, he could not untie the knot. However, his work 
does honor to himself, and demands the thanks of the com- 
munity. " . • - 
Cerebral Functions. 
j. With respect to the cerebral organs of external relation, 
the same circumstances exist as in the abdominal ganglia and 
plexuses ; we discover in autoptical examinations, similar con- 
gestions on the surface, and clots internally, or small masses 
of blood dispersed in the substance of the brain. The blood 
does not move naturally through the cortical portions, but 
suffers more or less of a remora. The nervous force suffers 
delay, and the organs a paresis. Intellect is obscured ; 
muscular motion is deficient, and the external sensations 
blunted, from derangements in the sanguineous capillaries. 
Yet, as soon'as the impediments are removed, all these func- 
tions rise in preternatural force ; as displayed in the brilliancy 
of intellect, energy of muscular force, and acutepess of sensi- 
* Treatise on Fever, p. 176. 356 
TYPHOID DIATHESIS. 
bility, constituting the state of delirium. Notwithstanding, 
these phenomena are dependent on the modifications of ca- 
pillary vessels, under the influence of the nutritive system of 
nerves.* (Sect, xvi.) 
Dr. Cartwright of Natchez has made many valuable con- 
tributions to morbid anatomy, in his Essays on Yellow Fever 
of that place, in the Medical Recorder, Vol. IX. They are 
particularly interesting, on account of his having made in- 
spections very early after death, and bestowing particular 
attention to lesions of the abdominal ganglia and plexuses. 
A specimen may be taken from page 256. " The mem- 
branes of the brain, the dura mateR excepted, were very 
highly inflamed. The tissue immediately investing the me- 
dulla spinalis was of a light scarlet color. Membranes about 
the root Of the lungs, and those particularly investing the pos- 
terior pulmonary plOxus, were black with,inflammation. The 
lungs were heavy and abounded with a frothy substance. 
The tissues immediately investing the semilunar ganglion, and 
all the primitive plexuses, together with those near the situa- 
tion of these plexuses, were very highly inflamed." In the 
next>case he says "the tissues investing the ganglions, and 
the nerves of organic life were of a deep scarlet." And the 
same of many other cases. In cases where redness appears, 
they have been of some continuance. 
Therapeutical remarks on the first stage of severe typhoid 
fevers. 
k. As we do not intend to treat extensively on all the dif- 
ferent diseases of this order, we will devote some attention 
* The following is a remark of M. Lobstein, on the sympathetic nerve : " It 
has been long taught, that sudden deaths invade the body in three different 
ways; by the cerebrum, heart, and lungs; and I add a fourth, the solar 
plexus, the source and centre of the abdominal nerves; a plexus which, by 
a sudden commotion, vellication, or any grave derangement whatever, is 
affected with paralysis, followed by sudden death." OUTLINES OF THERAPEUTICS. 
357 
to their general treatment at their onset, as well as to their 
affinity of character. This may be the more convenient, to 
expose the simplicity of treatment, in opposition to the em- 
pirical, and even charlatanical oppression of a vast amount of 
medicaments, which far oftener do mischief, rather than 
good. In all our investigations of the character of disease, 
we are constrained to acknowledge' a great similarity in the 
primary changes, wrought in the minute tissues, as well as the 
phenomena, and even when induced by different causes ; yet 
differing in degree. It seems that noxious agents do not ex- 
cite general disease, until they effect certain changes of a 
similar, and permanent kind. When this is once done, there 
follows a train of sequences constituting diseased action. At 
other times the causes, although in close contact, are not 
succeeded by injurious effects, on account of these morbid 
changes not being induced. 
We have endeavored to investigate these changes, and find 
them to be few and simple, until other destructive alterations 
take place as sequences of diseased organic action. The con- 
dition of disease now becomes complex, the organization be- 
comes more or less marred, and a new series of complicated 
phenomena are presented to view. It now becomes difficult 
to predetermine what the most appropriate treatment should 
be, as it must be predicated on the iexisting state of the 
diathesis as manifested by the phenomena. 
If the foregoing pathological conclusions are correct, the 
indications of treatment of even the prostrate state of disease, 
are apprehended to be few and simple at the onset. They 
will indeed be very similar to those of other states of fever, 
having suitable regard to the. degrees of severity, and liability 
of sudden collapse. They may be reduced to two cardinal 
indications. 
1st. To restore the broken balance of the circulation. 
2d. To remove the impediments, particularly the state of 
nosodynamia. 358 
typhoid Diathesis. 
A strict attention will be required to both of these circum- 
stances at the same time, rather than in succession. 
Having in Section xlii. attempted some illustration of the 
phenomena of disease, we discovered a shrivelled, aspect 
externally, sometimes attended with chills ; at other times a 
settled coldness without chills. This last condition most 
commonly obtains in the malignant states of disease, when the 
recuperative powers of the system are incapable of resisting 
the rigid state of the capillary tissues, and eliciting circula- 
tion and animal heaU All the functions are in danger of be- 
ing suspended, unless capillary circulation, and its result, ab- 
sorption, are restored. The same derangements exist inter- 
nally, that are so plainly manifested externally, in common 
with other states of disease. 
Animal heat is indispensable for the purpose of exerting 
the tissues in the performance of their functions; and.we see 
how liberally it is provided in the natural state, when the cir- 
culations are free and unembarrassed. But as soon as any 
causes intervene interrupting this function, it is deficient, and 
this directly becomes-a cause of other derangements. As a 
substitute, we need to apply caloric externally in one form 
or another, to all the accessible surfaces ; that is, 1st, to the 
dermoid tissue ; 2d, to the mucous tissue of the stomach ; 
3d, sometimes to that of the intestines, by enemata ; and also, 
4th, to the lungs, by means of mild steam. 
The methods of applying caloric, to the surface are nume- 
rous. In the first place it will be necessary for the patient 
to be in a warm apartment, yet not to that degree rendering 
it liable to be oppressive ; nor should the air be too confined, 
so as to deprive the patient of free oxygen. ' / 
The affected should be easily placed in bed, with a suffi- 
ciency of covering. This must always be directed by the 
judgment of the attendant, and in accordance with the sensa- 
tion of the sick, when they possess intelligence. They 
should be induced as far as possible, to keep quiet and still. OUTLINES OF THERAPEUTICS. 
359 
Various warm, substances should be laid around the body, 
not so hot but that they may be placed in pretty close con- 
tact ; such as heated sand in small bags partly filled ; bricks, 
or suitable sized stones wrapped in cloths ; brands of fire 
quenched, after much of the steam has subsided ; billets of 
wood from heated water ; bladders of warm water, &c. 
If the subject should be affected with cold sweatings, dry 
warmth will be preferable ; if the surface should be dry as 
well as cold, mild steams ought to have the preference. 
This may be accomplished by many ingenious methods of 
conveying it through heated lamps, or otherwise. The va- 
por of burning alcohol by Jennings' apparatus is convenient,, 
and in much lowness preferable to the steam of water. It 
may be used whether the patient has sweatings or not, only 
care should be taken that too much heat does not accumulate, 
but that it be applied uniformly over the body by means of a 
light rack. 
After the patient has laid a little while in this condition, 
the surface may be carefully rubbed, by putting the hand un- 
der the bed clothes with a woollen mitten, previously moist- 
ened in a tincture of capsicum and camphor. These rub- 
bings should be continued, in a moderate manner, until 
warmth is restored uniformly over the body, if practicable. 
If circumstances should permit, the universal warm bath 
may be preferable to any other method of applying caloric. 
In all the milder forms of attack it should have the prece- 
dence, but the patient is often too prostrate to admit of it, 
especially in cholera. 
If a freshness should appear in the countenance, a warm 
fluid sweat may arise, and this will be a token of the good 
success of the process. The capillaries now begin to act, 
and the sweating should be continued in a careful manner, 
for some length of time. Still the heat should not be urged 
excessively, whether the patient sweats or not. It should be 
noticed, that much heat ought not to be applied to the surface 360 
TYPHOID DIATHESIS. 
in the eruptive, or exanthematous diseases ; for, as the natu- 
ral tendency of the local affection is to the surface, the erup- 
tion will be liable to become greatly aggravated. It is, how- 
ever, admissible in dark petechial eruptions. 
Removing atmospheric pressure. 
I. One especial benefit of the patient being placed under 
coverings, besides the retention of caloric, is, that- the rarified 
air relieves, in some degree, the atmospheric pressure on the 
surface ; and if this is only of a small amount it becomes 
very important, by inviting the circulation to the surface, and 
thereby relieving the internal congestions. 
Some intimation is made in the Boston Medical and Sur- 
gical Journal, for January, 1838, of an ingenious method pro- 
posed by Sir James Murray, of relieving atmospheric pres- 
sure by a kind of " slipper bath," with a bladder at one 
end of a tube, and tied tight around, say, under the arms, 
with an air pump fixed to it. By taking a pound of atmos- 
phere the surface is relieved of a ton of pressure. The ca- 
pillaries of the surfaqe become turgid ; the circulation being 
invited outwardly, assists in removing visceral congestions. 
It may be used on the extremities very conveniently. Fur- 
ther experience may be necessary to establish its actual util- 
ity, but the contrivance seems to promise several advantages. 
A mild steam might be moderately admitted into the box, as 
the air is pumped out, and if this should be done, the air 
would not require to be so much exhausted. . 
During some of the above processes, a portion of steam 
might commingle with the air the patient breathes, and this 
may easily be increased by many contrivances, diffusing it 
with the air he respires, without its extending throughout the 
apartment. Care should be taken to use no more than is 
altogether agreeable, and easy to the patient. OUTLINES OF THERAPEUTICS. 
361 
Light stimuli. . 
m. The stomach should be supplied with warm aromatic 
infusions, and such as may be most agreeable. The tinc- 
tures of gaultheria, mentha piperita, &c. may . be mixed with 
warm water, as hot as the patient can conveniently use, and 
taken liberally cajeput oil, four or six drops in a tea- 
spoonful or two of alcohol, with a gill of hot water sweet- 
ened, may be taken, and repeated according to circum- 
stances. These articles may be varied, and others of a 
similar character substituted; especially gum camphor in 
doses of four or eight grains, with gum arabic and loaf sugar. 
Also, wine in warm water with nutmeg, sweetened. 
Where there is great nervous commotion, or much vomit- 
ing and purging as in malignant dysentery, cholera, &c. about 
thirty or fifty drops of laudanum may be used at the onset ; 
but it should not be repeated without much caution ; for the 
subsequent reaction, or recuperative force, is liable to be 
greatly aggravated by it. If it, or opium, should be given in 
the quantities advised by some, it would increase the mor- 
bidly tonic state of the tissues, so that the object would be 
totally defeated that we are aiming at; that is, to elicit the 
actions pertaining to the synochoid diathesis. The conges- 
tions become more fixed by it, instead of being resolved, 
with equal diffused action in the system. 
Injections. 
n. Some cases of ataxic diseases not only admit, but re 
quire warm enemata of large bulk, at their commencement. 
Malignant enteritis, attended with vomiting ; some of the 
severest grades of dysentery at the onset, before the rectum 
has acquired so much sensibility as to preclude their use; in 
the first stage of cholera, &c. They should be composed of 
mucilaginous substances in a large proportion of water, with 362 
TYHOID DIATHESIS. 
two or four ounces of brandy, when there is coldness with a 
small, tremulous pulse. They may be repeated every two 
hours for a reasonable time, as they may seem to be useful. 
They act as an internal bath, and by their distention relieve 
the intestines of spasm and the danger of intussusceptions. 
They also do much in exciting equal action. 
Tobacco has a peculiar effect to quiet disturbances in the 
organs supplied by the ganglial nerves. From half a drachm 
to a drachm of solid tobacco infused in a large proportion of 
water may be used as an enema, and in cholera two ounces of 
alcohol may be added. There is much danger in using too 
strong an infusion of tobacco. It always ought to be 
weighed. It should not be repeated oftener than once in 
two, or four hours, nor then if the pulse- shall have become 
smaller, and more tremulous. In large quantities and fre- 
quently repeated, the tobacco injections are liable to extin- 
guish the vital forces in a short time. It should therefore, 
be used cautiously, and if in a judicious manner, it essentially 
relieves the adstrictive state of the tissues, and produces 
quietness. It is not liable to all the objections of opium, un- 
less used too freejy. 
o. Some or all of the above measures should be used as- 
siduously at the onset, and their repetition should be deter- 
mined by the subsequent appearances. There will be injury 
done by extending their use too far. When capillary circu- 
lation is well established on the surface, their use should be 
partially suspended. But still, it should be borne in mind, 
that a steady action should be sustained on the surface, either 
by the stability of the morbid impetus, or a continuance of 
external warmth, with some other of the means suggested. 
If these circumstances are neglected, with exposure to cold, 
the case most certainly will be followed by a retrocession of 
morbid force to the central tissues, attended with faintness, 
sinking, and perhaps death. So liable are the functions to OUTLINES OF THERAPEUTICS. 
363 
suffer collapse, that these circumstances should steadily be 
regarded. 
Through the whole of these processes, the patient may 
use agreeable nutriment in a fluid form, if he desire it. In 
such cases as the recuperative powers act very tardily, a 
little wine may be used, with nutmeg and sugar ; or in water 
alone if most agreeable. Still, diluted alcohol may be equal- 
ly useful, and either of them far preferable to opium in any 
form. Their influence soon passes off. 
Second indication. 
p. The previous remedial course has been chiefly directed 
to the accomplishment of our first indication ; but this can 
rarely be attained without further means, and the fulfilment of 
each of them ought to progress together ; so that, together 
with the preceding operations, other measures should not be 
neglected. We shall confine our remarks chiefly to two 
agencies, emesis and blood-letting, for the accomplishment of 
the second indication^ 
Emesis. 
It may be questioned whether emesis fulfils more directly 
the first, or second indication. We assign it to have an in- 
fluence in both. Nausea and emesis promote the capillary 
circulation, and at the same time alter the condition of noso- 
dynamia. Nausea relaxes tissues in the physiological state, 
and has been used to render luxations more easily reducible, 
and the pangs of parturition less severe. All experience 
proves its utility in reducing the rigid condition of tissues in 
the pathological state. Whilst the state of nausea exists, the 
process of emesis excites reaction, or the recuperative pro- 
cess. The derangement in the circulation is very considera- 
bly removed by it, and exhalation, absorption, and secretion 364 
TYPHOID DIATHESIS. 
promoted. With these results, when moderately and judi- 
ciously used, the processes of nausea and vomiting become 
very useful auxiliaries in the removal of primary derange- 
ments, constituting pathological movements at the onset. 
It might be supposed by some, that if the impression is 
made on the system, it is immaterial what the agents may be 
which are employed. There are many substances liable to pro- 
duce emesis, which would undoubtedly prove injurious in other 
respects. In accordance with the views of a large portion 
of practitioners, we are inclined to give the preference to 
preparations of antimony ; occasionally using ipecacuanha. 
The wine of antimony then may be used ; ordinarily to 
an adult, from ten to twenty drops or more every hour 
from the onset, and whilst the preceding measures are in pro- 
gress. 
This course may be pursued unless emesis take place 
spontaneously, and then it may be suspended for a time. It 
performs useful purposes in promoting the circulations even 
without nausea, or emesis, and it rarely ought to be employed 
in a full dose, with a full determination to excite sudden 
vomiting. In some prostrate states of vital movements, early 
and full vomiting, has been known to be manifestly injurious, 
and even hastening a fatal termination. Still when used in 
the manner proposed, the patient being warm in bed, and the 
medicine making slow as well as favorable alterations in the 
tissues, by removing their rigid adstrictive state, it is very 
constantly attended with useful results. The countenance 
becomes expanded and more florid, and what obtains here, 
takes place universally. 
If the medicine should be attended with universal warm 
sweats, its utility will be more certain, yet it should con- 
stantly be kept in mind, not to extend the heat, nor protract 
the sweats too largely, for fear of dissipating too great a por- 
tion of the fluids, and exhausting the susceptibility of the 
solids. Not only this, but heat protracted beyond the point OUTLINES OF THERAPEUTICS. 
365 
required, aggravates the congestive state, and even the suc- 
ceeding state of tissual inflammation. 
Venesection. 
q. Our attention may now be directed in a more particu- 
lar manner to the accomplishment of the second indication, 
which is, to remove the impediments embarrassing the free 
action of the preservative powers of the system. We dis- 
cover an active and opposing force existing in the inmost tis- 
sues, instead of an inappreciable and indefinable debility. It 
has been repeatedly shown to consist of a morbid tonicity, 
and we need not recapitulate the facts which direct to this 
inference. 
The remedies adapted to the removal of this condition, 
which renders the morbid habit so persistive, are of a relax- 
ing kind, giving freedom to the repulsive and recuperative 
exercise of the tissues. Bearing Constantly in mind, that 
we are investigating the remedial agents of the first stage of 
typhoid diseases of the severest grade, we now examine the 
influence of blood-letting in this exciting state of'disease. 
The attacks are liable to be sudden ; the history of dis- 
ease teaches, that some subjects'fall and suddenly perish. In 
such cases there is no opportunity to interpose remedies ; the 
favorable moment of probable relief has passed by ; there 
exists no more opportunity indeed, than in the most abrupt 
cases of cerebral apoplexy. Such sequences we assign to 
be brought about by a series of events, in the abdominal 
ganglia and plexuses, very similar to cerebral congestive 
apoplexy. Even this is produced by derangements in the 
nutritive tissues. The exciting causes act with great force 
on predisposed habits, and suddenly produce a suffusion on 
the ganglia, plexuses, and entire prolongations of this order 
of nerves, sufficient to paralyze their energies, and in conse- 
quence the functions of all their dependent organism. 366 
TYPHOID DIATHESIS. 
Fortunately, however, these cases are comparatively few ; 
and when a more moderate impression is made, we discover 
the faithful repulsive efforts aroused into action ; and this 
effort is more or less visible, according as tissual ability is 
more or less left at liberty ; or, as it may be enchained by 
the severity of the primary acting cause. In every case in 
which vitality persists from one to six hours, there may be 
perceived an internal conflict between the tissual derange- 
ments, and constrained repulsive forces. It might appear for 
a time that the contest is equal, and indeed very trivial cir- 
cumstances sometimes seem to decide it, and the scale may 
be turned one way or the other. If science interposes to 
aid the recuperative powers, it is supposed to be enlightened 
by a right knowledge of the existing state of things ; or, it 
is otherwise personified by ignorance, and assumes the garb 
of empiricism, drawing conclusions from certain exterior, 
and superficial appearances; the most palpable of all errors 
is, the mistaking of debility for inability. 
Pursuing then the principles already advanced, we assign, 
that reducing the amount of fluids contained in the vascular 
system is always followed by a debilitating effect. If the 
vascular system acts more freely, it is on account of the re- 
duction of morbid constraint. We use blood-letting then for 
the purpose of diminishing the morbidly tonic state of the 
tissues. If the physiological susceptibility suffers a little, 
temporarily, manifested by faintness, this soon passes by, and 
the recuperative movements gain some advantage. The 
nosodynamic force is more weakened than the restorative 
powers, on a revival. The relative plethora, which was sud- 
denly produced by the universal contractility of vessels on 
their fluids, is removed by the abstraction. The general cir- 
culation obtains more freedom of action ; a florid aspect 
takes the place of a pallid, and the internal congestions are 
being removed by the renovated activity of absorbing veins. 
, In the abstraction of blood in such cases, particular re- OUTLINES OF THERAPEUTICS. 
367 
gard should be had as to the time of its employment. If the 
assault of the disease should be sudden, it is common for 
some faintness to supervene ; this it not the time. Let the 
patient have rest, and also the use of external warmth, as has 
been proposed ; it may soon be perceived that the pulsatory 
actions will be making some impetus, although feeble and 
faltering. The time should not long be delayed, for the 
oppressing influences may, by and by, gain an ascendancy, 
when it may be too late to abstract blood. There is then a 
bleeding point; and this is, as soon as the first shock of the 
impression is passed by, and the time when the restorative 
energies are becoming overpowered by the morbid force. If 
the collateral aids are diligently regarded, the abstraction of 
appropriate quantities of blood is quite certain to afford more 
or less freedom of vascular action, and eventually to make an 
approximation towards the expanded action of the synochoid 
diathesis. 
If venesection should have been delayed beyond the bleed- 
ing point, its utility will be more doubtful, and in proportion 
as internal changes may have occurred ; the tissues are suffering 
changes, and becoming more incapable of a restoration. The 
medical adviser is often placed in a very unenviable and as 
responsible a predicament as is possible. The alternatives 
are, to abandon the case as hopeless, or trust it to doubtful 
expedients. The former must not be done. If the case 
shall have passed to a great degree of oppression, it may be 
most proper to trust to the preservative powers, with such 
aids as may be indicated, especially warmth and evanescent 
stimuli. 
It is often a critical question for an occasional visitor to 
determine, whether the most favorable bleeding point be 
passed or not. This period is very indefinite, depending on 
the severity of the attack, the attending phenomena, and many 
personal circumstances. In some sudden attacks it may have 
gone by in two, four, or twelve hours. Ordinarily not until 368 
TYPHOID DIATHESIS. 
twentyfour hours. In some less severe cases, it may not 
have passed by for two, five, or even more days. If there 
should be some force in the pulsatory action at the wrist, and 
the beats do not exceed about one hundred and twenty in a 
minute, it may not have passed by. Some evidence may be 
obtained by examining the chest, and discovering whether 
the heart possesses some considerable force. If so, bleed- 
ing will be justifiable, even if the arterial action should have 
failed considerably, or even ceased. But, if the heart itself 
should act very feebly, we should be more cautious. 
The bleedings always ought to be practised before the tis- 
sues give out their effusions. The earlier they are employed 
after the first responding actions, the greater the chances of 
utility will be, and the probability of bearing subsequent 
bleedings to advantage. 
In the incipient stage of the prostrate state of the severe 
typhoid diathesis, the bleedings ought invariably to be taken 
whilst the patient is warm in bed, and' in a recumbent posi- 
tion. If he is in a cool condition, we lose the chief of the 
advantages of the restorative powers re-establishing the circu- 
lation, for cold always increases the morbid derangements of 
capillaries ; and as the surface is affected, so are the internal 
tissues simultaneously. 
It is an injudicious practice to bleed in an erect position in 
any condition of disease. Faintness is liable to supervene 
before a sufficiency of blood is taken to ensure much benefit. 
In the present condition of disease, we never ought to bleed 
at first with a view to produce, syncope, yet it is liable to oc- 
cur, and if it does may probably be of greater utility. Still 
we do not advise it in these wavering cases. We never, 
however, knew an instance but that resuscitation followed syn- 
cope from bleeding. One case of spotted fever gave serious 
alarm ; an abstract of which we will make from Sketches of 
Epidemics. A girl about nine years old, was visited on the 
third day of sickness. It appeared to be a hopeless case. OUTLINES OF THERAPEUTICS. 
369 
and the parents desired any rational expedients to be tried. 
About ten ounces of blood were taken from the arm, when 
syncope suddenly took place. Having staid two hours, and 
used all the ordinary means of resuscitation, we were obliged 
to leave her, and with the impression she could not survive, 
being then cold, insensible, and pulseless. Saw her in two 
days after, and was told, that soon after leaving her, she re- 
vived, and directly appeared to be almost well. She then 
needed no further treatment ; appeared cheerful, and in a 
few days her health was perfectly established. It would have 
been more safe to have taken less blood at first, and repeated 
according to circumstances ; which probably might not be 
long. 
When bleeding is practised in the erect position, either 
standing or sitting, the patient is liable to faint before the ne- 
cessary quantity is taken, and a repetition will soon be re- 
quired. In the act of syncope, the nosodynamic state of the 
tissues appears to be prostrated, and the returning energies 
of the restorative powers seem to gain the ascendancy ; and 
with a little attention to warmth, and small evanescent stimuli, 
they may commonly be enabled to retain it. 
In many cases of children, and enervated subjects, a suffi- 
cient depletion and revulsion may oftentimes be made from 
the internal tissues by leechings, and emollient poultices to 
the extremities, abdomen, and spine. Still, the diseases of 
children are rapid, and require early and efficient remedies. 
Leechings have a favorable impression on the general system, 
as well as locally ; although the more sudden abstraction has 
still greater. Yet, in cases of much prostration, and where 
doubts may exist in relation to venesection at the arm, leech- 
ings and cuppings may be employed to great advantage. 
These ought to be applied as near to the known concentra- 
tions internally as may be convenient. 
After taking some blood in this manner, dry cuppings may 
be extensively used on different parts of the body. They 370 
TYPHOID DIATHESIS. 
answer some temporary useful purposes, by inviting the cir- 
culation exteriorly, and prepare the system for future general 
abstractions of blood. 
We have undoubted evidence, that there is a great burden 
of disease in the prostrate state of malignant fevers. The 
constrained, embarrassed condition of the tissues acts as an 
obstacle to its development, into the ordinary character of 
affections of the synochoid diathesis. It is fortunate, when 
these deceptive states can be converted into the open, free, 
and tangible condition of this diathesis. The treatment then 
becomes plain, and only requires to be seasonably applied to 
the point of safety. In either condition, stimulants should be 
but sparingly employed. In a case where there was a state 
of ticrotismus for more than two hours, with only the slight- 
est degree of vitality remaining, the pulse returned, and the 
case progressed in about three days into the most unequivo- 
cal state of sthenic fever we ever witnessed, and four full 
bleedings were practised in the course of about as many days, 
before it took on even a safe range ; yet the case was fortu- 
nate in the end. 
All stimuli of any considerable importance were withheld 
in this case during the absence of pulse, and extreme ex- 
haustion ; and on the persuasion, that much excitants at such 
a time, would be liable to overact, and extinguish the flicker- 
ing flame of life. We have the most solemn conviction, that 
multitudes of cases of vital depression have proved unfortu- 
nate, on account of too much stimuli having been used for 
their restoration. 
r. We are well aware of the fastidiousness which some in- 
dulge in their raillery against the practice of bleeding, unless 
the most obtrusive phenomena demand it. Theorems are 
fabricated, and published under the patronage of much spe- 
cious pretence. So, again, some servile imitators of the 
incendiary treatment have been very vociferous in vindication OUTLINES OF THERAPEUTICS. 
371 
of principles, which are capable of destroying more than the 
pestilence itself. 
Let us turn from such unpleasant topics, and listen to men 
who have bared their drms to the contest, and opposed the 
destroyer in the midst of hecatombs of victims.» We might 
fdl our pages with authorities of the first rank, in favor of the 
utility of early bleeding in fevers, and even in very malignant 
states. Many advocate this treatment, also, who have adopt- 
ed, apparently, sincere views of an existing state of debility 
throughout the entire system. If such men advocate bleed- 
ing, it must be, that their experience warrants it in opposition 
to their theory. 
It might seem invidious in us to select only a few of the 
many authorities that might be brought, only from the modern 
time of Huxham to the present. As specimens we will make 
only a few short references. Dr Jameson in a report of the 
Medical Board of Bengal, not long after the rise of the late 
epidemic cholera in India, on the subject of bleeding, states 
in general the common practice to be, .to tie up the arm, and 
bleed, if the blood could be made to flow. And in cases 
where the pulse was already small, and rapidly sinking. 
Thereby " cutting short the disease, resolving spasm, allay- 
ing gastric and intestinal irritability, and removing the de- 
pression of the system." 
In the yellow fever at Philadelphia in 1793, Dr Rush 
states, " The effects of bleeding on the system were as fol- 
lows ; it raised the pulse when depressed, and equalized it 
when it was preternaturally slow, or subject to intermissions. 
Blood-letting when used early on the first day, frequently 
strangled the disease in its birth."* 
In the N. E. Journal (1820) a writer remarks ; " The ac- 
tive practice of the East and West India physicians is mak- 
ing great progress in England ; the use especially of blood- 
* Inquiry, Vol. III. pp. 257 and 261. 372 
TYPHUS GRAVIOR. 
letting is supported by a host of writers, some of them of 
great talents and experience. This treatment is adopted even 
in fevers of the typhoid character in their early stage, and ap- 
parently with much success. In a late English journal, there 
is a case of debility cured by blood-letting" 1 
We now* turn from making any further reflections on the 
first stage of the severe typhoid diathesis, to some considera- 
tions on the particular diseases, which have from their sever- 
ity, been placed in this order. As we proceed there will be 
opportunities of further developing the treatment. 
2. Typhus Gravior ;. Severe Typhus ; or Jail, Camp, Hos- 
pital, or Putrid Fever. 
Phenomena. 
a. In relation to the causes of these fevers, we can make 
no further references than those contained in our animadver- 
sions in etiology. The nosographic definition of typhus gra- 
vior was taken from Dr Good ; it requires a more extended 
history. At the commencement some cases are attended 
with much embarrassment in the functions, and require cer- 
tain of the measures recommended in the preceding article, 
to aid their inability, and produce a freedom of vascular ac- 
tion. Yet this is not so often needed as in some other affec- 
tions, as in cholera, the plague, and spotted fever. There is 
frequently from the onset, an elevated state of action, and the 
phenomena proceed on a high grade of action. The repul- 
sive movements are heightened by an exquisite state of sensi- 
bility throughout the tissues. 
The rigors are considerable, alternating with heats, and 
often continuing more or less, for about the first twentyfour 
hours, and yet without sweats. The disease thence contin- 
ues with high heat, although sometimes with sudden lowness 
and chills. Severe vomitings often attend at the commence- OUTLINES OF THERAPEUTICS. 
373 
ment; intense pain in the frontal region, extending back- 
wards and along, the spine ; eyes often injected, and face 
bloated. Pulsatory action in the head extreme, with heat ; 
whilst the pulse at the wrist may be small, and extremities 
cold. Soon again the pulse becomes full and throbbing ; it 
is full and frequent in many cases,, yet destitute of the firm 
impress on the finger as in synocha. In other cases not so 
frequent, the pulse is embarrassed, small and scarcely to be 
perceived, yet often with great frequency, or else intermittent 
and slow. 
There is liable to be extreme faintness, and soon again an 
appearance of unusual strength for a while. There has been 
noticed to exist an extreme disproportion in the phenomena 
compared with other fevers. Whilst some of the ordinary 
phenomena of fevers may be absent, others are present in 
excess, and often changing in such a manner as to present 
great irregularity, frdm which circumstance fevers of this 
character have been called ataxic; and the severity of the 
disease being liable to a sudden state of prostration of vital 
force, they have been styled malignant. And furthermore, 
as the vital action of the vascular system is perverted, and 
disenabled to impress the blood,, in a manner to sustain the 
integrity of its crasis, it suffers changes, which have been de- 
nominated putrid, typhoid, or adynamic. 
Local inflammations of a severe kind are liable to occur in 
some parts, and prone to become gangrenous. They some- 
times assume the erysipelatous character. The heat is often 
very considerable, amounting to what has been called calor 
mordicans, giving a pungent sensation to the touch. The 
tongue is covered at the onset with a whitish fur, but soon 
grows dark colored, and even black. Respiration is fre- 
quent, oppressed, and laborious ; the breath hot, with offen- 
sive effluvia ; the urine high colored, often scalding, and as- 
suming a dark color. Emesis is liable to attend, with ejec- 
tions of dark bilious matter. The skin is liable to a dingy 374 
TYPHUS GRATIOR. 
color, and often beset with petechiae, and purple spots of dif- 
ferent sizes, or vibices. 
In this grade of disease, the pain and other phenomena are 
intense from the beginning ; there is, therefore, less liability 
to deep coma, but a disturbed state of insensibility, attended 
with jactitation and meanings. Delirium commonly succeeds 
after a few days, and this is liable to be followed by seconda- 
ry coma, a presage of an unfortunate termination. If the dis- 
ease does not take on a favorable course, the stools become 
blackish and fetid; clammy colliquitive sweats supervene ; 
often convulsions ; hemorrhages occur from different organs, 
with the train of fatal phenomena described in Sect. xliv. 
4. b. 
The duration of fevers of this character is various, from 
the third to the fourteenth day ; depending on numerous cir- 
cumstances in relation to the severity of the causes, and idi- 
osyncrasies of the sick. They have been called jail, hos- 
pital fevers, &c. front often arising in such situations. Fevers 
of similar character, with some slight modifications of phe- 
nomena, sometimes appear endemically, and are called after 
the places they may happen to visit. All being of one family, 
depending on similar causes, and requiring one general meth- 
od of treatment, only to be varied by the intensity of the 
phenomena. 
Pathological remarks. 
b. The remote causes whatever they may be, producing 
the state of predisposition, appear to have excited a high de- 
gree of tissual susceptibility ; when, therefore, disease is 
excited, the responding movements are on an elevated grade, 
they exhibit much intensity of action, unless enchained by 
the causes producing a severe congestive inundation on the 
nutritive nerves. We discover very similar conditions as in 
low typhus, except as relates to severity, or the • general OUTLINES OF THERAPEUTICS. 
375 
amount of morbid derangements. The internal organs are 
all affected more or less ; they receive a severe shock, and 
their increased sensibility renders them impatient to act with 
strong repulsive movements. In every case of this descrip- 
tion, where organic force is free, we find expanded action in 
all the organs, and disease fully developed ; for there is a pre- 
ternatural morbid strength existing throughout the entire 
system. 
When, on the reverse, we meet a case which has been 
exposed to similar causes, the phenomena may be liable to 
induce some to suppose, there is existing a real state of 
debility ; when in reality there is more strength and a greater 
burden of disease than in the other ; yet it resembles a smo- 
thered coal-pit struggling for vent. The distress is great, 
but the patient is mainly insensible of it; he writhes about, 
utters moans, and is chiefly unconscious of his malady ; he 
may soon expire if no friendly hand administers relief. Such 
cases may often be relieved if time should be improved, and 
by the most simple means. 
Methodus medendi. 
c. When the character of a disease is well understood, the 
treatment becomes familiar ; provided the favorable period for 
the use of remedies shall not have passed by. The burden 
of disease is sufficient to be borne, without an intolerable far- 
rago of internal medicaments. The superficial appearances 
of debility may induce some to load the irritable stomach in 
such cases, with wine, opium, and quinia, together with a 
crowd of alterants, as calomel, capsicum, &c. Such a course 
will insure a speedy and unfortunate termination of the cash. 
We only name these for the purpose of expunging them from 
the table of the sick room. The stomach cannot endure 
much in such cases of increased sensibility, and if we were 
not possessed of other means of altering the condition than 376 
TYPHUS GRAVIOR. 
through the agency of this organ, we might well despair of 
affording relief to suffering mortals. 
The pride of medical science is liable to extend its re- 
searches into the circle of mysterious agencies, and invite to 
its aid a host of auxiliaries more burdensome than the super- 
numeraries of Xerxes' army. Yet we find the further 
the primary morbid changes in disease are pursued to their 
origin, the more simple and plain they appear ; and they 
require equally as few and simple means, well directed, for 
their removal. If it should be suggested, that the remedies 
we propose are very similar, even too much alike, it need 
only to be answered, that the primary derangements consti- 
tuting disease with all its sequences, are found to be equally 
simple and very similar, but not in degree. The great dis- 
parity in their severity, in the different organs affected, and 
personal idiosyncrasies, are subjects meriting severe scrutiny, 
and the exercise of deliberate judgment. 
d. In the instance just mentioned, of an embarrassed con- 
dition of the functions of organs, we need to put in operation 
some of the means proposed in the last article ; keeping in 
mind not to apply external heat too far ; not so far as in low 
typhus. For, the responding movements sooner make their 
appearance, when heat is liable to become excessive. Per- 
haps bathing the hands and feet in warm water, with slight 
external warmth may be sufficient. For it should be kept in 
mind, that the burden of adstrictive force is so great, that the 
Subject cannot be made to sweat, and in this instance heat is 
liable to become intolerable and injurious. 
Other means may be necessary to be employed, before the 
vital actions can emerge from their embarrassments, and elicit 
internal heat. Here, again, the benefits of taking a little 
blood, are as conspicuous as in any condition whatever. It 
is sometimes truly surprising, to observe how soon the load 
of embarrassments may be removed, when it is timely em- 
ployed, and before the organism suffers essential lesions. In- OUTLINES OF THERAPEUTICS. 
377 
ternal distress is mitigated, although the pains may ere long 
become more severe. The intellect begins to be disburthened ; 
the circulations become more equal, distributing a uniformity 
of heat ; and finally, an approximation is made to a more 
free and expanded circulation universally. 
Still the disease is not removed, it has only assumed a 
more tangible condition, and if left to its own energies will 
very certainly overact, and produce more certain and irreme- 
diable lesions of organs, or exhaust the vital susceptibility 
totally. The disease now manifests its giant strength, and 
must be met by efficient means. Shall we rely on1 the aids 
of feeble alterants ? As well may we spend our breath 
against the northen blasts of winter. The same means that 
have relieved the tonic state of the tissues admitting the cir- 
culations to obtain freedom, if pursued, will remove the 
excess of morbid impetus, which is now liable to make irre- 
parable lesions in the organs. Although the recuperative 
powers are essential to the restoration of health, yet the 
increased sensibility of the vascular tissues urges all the move- 
ments to a destructive excess ; they are novV to be restrained 
and guided to safe results. It becomes necessary, then, to 
repeat the bleedings'until the morbidly tonic state,is reduced 
to the point of safety. 
But how shall we know when we have attained this point ? 
It is never attained until there appears a relaxation of the ad- 
strictive state of the external exhalants ; nor until the 
centripetal circulations shall have obtained an ascendancy 
over the centrifugal. As soon as this is effected, the recu- 
perative forces become enabled to restore ordinary lesions, 
and re-establish healthy action. If there should have been 
morbid changes in the blood, the depurations will take place 
by the relaxed emunctories, or even the same of any peccant 
humofs. Bleedings ought to be practised freely, and to the 
extent of accomplishing the objects in an essential degree, 
although other means may be used as adjuvants. After lever 378 
TYPHUS GRAVIOR 
is established, some time will be required for the depurations 
to take place. . * . , 
If syncope should be induced, it inay save the loss of much 
blood ; for it shows the object has been considerably ob- 
tained, as has been already illustrated on other occasions. 
It manifests a subduction of the relative plethora of vessels, 
and relaxation of the nosodynamic force. Still the remains 
of a severe morbid habit may again rally, and require further 
subduction.. It is the morbid tonicity that causes a contrac- 
tion of vessels on their contents, otherwise the loss of so 
much blood could not be endured ; most certainly it could 
not in ordinary health. If the bleedings have been early 
practised, they may safely be extended to the full extent re- 
quired. If they are employed rather late, it will not be ne- 
cessary to practise them to so great an extent, but leave 
something to be done by the slower operations of the resto- 
rative processes. 
No rule Can be proposed as to the amount of blood neces- 
sary to be taken ; this must be determined by the demand 
indicated by the phenomena of the case. It is common, 
however, to take two or four bleedings, each one of a suffi- 
cient quantity to make some impression on the pulse. They 
should be followed in as quick succession as the pulse indi- 
cates the repetition. Experience and observation are neces- 
sary to enable the medical adviser to decide on the extent of 
this remedy, as well as others. Every remedy carried to 
excess, becomes injurious ; but to stop short of the object 
aimed at, is equally hurtful. The object is to remove the 
rigid state of nosodynamia, so as to ensure capillary absorp- 
tion. 
Those who practise bleeding with doubt and timidity, are 
liable to stop short of obtaining the object. The disease 
still progresses with sufficient force to destroy the organism ; 
and they then conclude the bleeding was injurious, whilst the 
injury results from too little having been taken. Such medi- OUTLINES OF THERAPEUTICS. 
379 
cal attendants are greatly -prone to be rather liberal in the use 
of cordials $nd tonics, and thereby lose all the benefits of the 
bleedings, by the use of such opposing remedies. The pa- 
tient might have done as well, or even better, to have been 
let alone, trusting to nature entirely. If they do not employ 
these counteracting means exactly at the same time, they 
commonly use them as soon as they have bled as far as they 
dare to, for fear of debility ; and by this neutral practice the 
disease may suffer a fearful renewal, or a lengthy protraction. 
e. Emetics should be cautiously used on account of the 
morbid sensibility of the stomach, and its liability to inflam- 
mation in its mucous coat ; yet where spontaneous emesis 
has not occurred, if there should be some epigastric distress, 
it will be proper to exhibit a slow emetic. The phosphate 
of antimony, called James's powders, may be given in small 
doses to excite general secretion in an insensible manner. 
As long as there may be a disposition to coldness, the sudo- 
rific aromatics may be used as adjuvants. The use of these 
means should follow venesection. Full emesis, however, is 
often indicated. 
As soon as the patient has had some respite, a cathartic 
will become necessary. During the protraction of the fever, 
and after as much blood has been taken as may be necessary, 
they should be repeated rather often, or as the patient may 
seem to bear them. The first dose may be calomel, perhaps 
ten grains.. If it should not be sufficiently operative, it may 
be assisted by a solution of acetate of potash, or phosphate of 
soda, or Rochelle salts. These inay be taken in solution, 
along with bicarbonate of soda and tartaric acid in a state of 
effervescence, and sweetened, if desired by the patient. 
The sick have commonly a desire for acids,.and they may 
be freely used, both mineral and vegetable. They should be 
so diluted as tozbe pleasant to the taste, and this is a conve- 
nient method of replenishing the system with fluids. Tama- 
rinds, vinegar, bicarbonate of soda, lemon juice, &c. 380 
TYPHUS GRAVIOR. 
Cold water internally and externally. 
f. When thirst is great, with high internal heat, the patient 
desires cold drinks, and he may commonly be indulged. 
When the heat exceeds 100° of Fah., they may induce 
sweatings of a salutary tendency. If there should, however, 
at any time be chills, and pain follow their use, they ought to 
be withheld.- The thirst will not be great until vascular ac- 
tion has become quite free, and the absorbing processes have 
obtained some degree of inactivity : and these phenomena 
indicate an approximation to the synochoid diathesis, although 
it possesses,much severity as yet. Still they indicate an as- 
cendancy of the preservative force. 
After the subductive treatment has been carried to a Consi- 
derable extent, if there should be an equal action established 
universally in the system, not' attended with internal pain, 
and at the same time a heat of about 101° or 102° of Fah., 
then cold sponging of the surface may be employed, and pro- 
bably to advantage, especially in hot seasons. Cloths wet in 
cold water may be applied to the head, and indeed conside- 
rably over the surface. Its effects Should be watched, and 
if the system is not prepared for its use, it will be liable to 
induce chills and increase pain ; if so, it will be an indication 
that the state of nosodynamia predominates, and certainly re- 
quires further subduction. (Sect', xxxvi. 9.) The same cir- 
cumstances which render hrge' quantities of cold drink 
admissible, will justify the use of external cold applications. 
When .not used at the proper time, or in an unsuitable manner, 
they both may prove injurious. An exposure to cool air will 
often be preferable. 
Neither of these remedies can ever be justified at the on- 
set of the disease, nor until internal inflammation is greatly 
resolved by the antecedent treatment; nor until the heat is 
intense, and the phenomena indicate a free and expanded 
state of circulation. All this implies a continuance of dis- OUTLINES OF THERAPEUTICS. 
381 
ease for some length of time, and the phenomena now indi- 
catev that absorption, or the centripetal circulations, have 
obtained a considerable advantage. If this were not the case, 
the fluids taken in would not be so soon absorbed. (Sect, 
xlvi. 1, b.) 
We have many instances of patients, urged by the extremity 
of thirst, taking largely of cold water of their own accord, in 
fever, and being cured by it; and, also, of their even running 
away when delirious, and being exposefl to cold and snow, 
and greatly benefited.* We may enquire whether all these 
cases were not such as have passed the stage of depression 
long since, and when the nosodynamic state is greatly reduced, 
and the recuperative powers have obtained an ascendancy ? 
Such cases have had considerable continuance, and are 
already approximating to a favorable issue. The tonic force 
of cold may now give energy to the restorative powers, and 
the cure is rapidly expedited. Still we have experienced ir- 
remediable injury to patients suffering by one night's expo- 
sure to cold, near the onset, by neglect of watchers. 
So, also, in the instance of sudden cures of fevers and 
other diseases, by the stimulus of surprize, as that of the 
house being on fire. Do not the absorbing, powers receive a 
severe stimulation, and having already some advantage over 
the state of morbid tonicity already weakened, they are ex- 
cited to salutary purposes, and the natural processes become 
established. Under certain ^adverse circumstances, terror has 
been known to destroy life suddenly ; and we see how much 
patients are made worse on some occasions by surprise. 
Although this may be a powerful agent in the treatment of 
disease, yet the laws by which it acts,,and the circumstances 
under which it may be admissible, ought to be better 
studied. (Sect, xviii. 8 and 9.) 
g. If towards the close of severe typhoid affections, there 
should be much exhaustion, with a slow and feeble pulse, 
* Good's Study, Vol. II. p. 140. 382 
PLAGUE AND YELLOW FEVER. 
some tonic medicine may be required. An infusion of gen- 
tian and orange peel, with the addition of two or four grains 
of sulphate of quinia may be used, once in three or four 
hours. Wine must be used with much caution. Animal 
broths and jellies afford suitable nutriment, with the necessa- 
ry caution. 
When diseases of this grade prevail in districts subject to 
intermittents, they are liable to take on an intermittent char- 
acter. Ip such cases, after using the necessary preparative 
measures to an extent sufficient to arrest the severity of their 
march, quinia may be given in large doses, say ten or twelve 
grains about an hour before the expected,paroxysm. It will 
not be safe nor proper to continue this very long, whilst great 
caution will be necessary to obviate the injurious tendency to 
hypertrophy, and other lesions of the internal organs. 
When the proper treatment has been early applied, and to 
a sufficient extent, the physiological actions approximate so 
fully towards the synochoid diathesis, that the tendency of 
the fluids to putridity is obviated, and the oppressive state of 
adynamia does not very manifestly appear. Such cases 
should be treated like synocha. 
When fevers even of the present grade have been treated 
in a judicious manner, they pass off without, any very alarm- 
ing crisis. Yet they are liable to exhibit some critical evac- 
uations by a mild crisis. But, Mien left very much to their 
natural progress, or under r mere expectant treatment, they 
often terminate by very abrupt crises. For an account of 
such terminations, reference may be bad to Section xliii. 4. 
3. Plague and Yelloio Fever. 
a. These subjects, the 2d and 3d Genera, in the Noso- 
graphy, will be passed with a few cursory remarks. Their 
severity, and fatal tendency will be discovered in every his- 
tory of them, which' has been published. A compendium 
may be found in Tytler's Treatise. OUTLINES OF THERAPEUTICS. 
383 
The phenomena are well portrayed by numerous writers. 
With respect to their origin, and whether communicable 
from one subject to another, is still not fully agreed on. 
However, from their histories, the balance of proof is in fa- 
vor of their observing the laws of other epidemics. The 
plague has its rise, progress, and decline like them, in par- 
ticular seasons, and becoming milder in its decline. They 
depend on similar meteorological circumstances for their ori- 
gin, under certain modifications, and are no more communi- 
cable than epidemic lung fever or cholera. This is the opin- 
ion of some medical men who have been familiar with the 
plague, notwithstanding so much has been said in relation to 
its contagiousness. It is now the general opinion that yellow 
fever is not communicable. * '• 
No doubt the plague has destroyed more of human life 
than any other malady. Even the cholera is not so destruc- 
tive, nor has it been so frequent. The plague has been 
known in ancient and modern history to be on many occa- 
sions far more destructive, sparing in some instances only 
half, or one third of the inhabitants in the places of its visita- 
tions. Its attacks are very sudden, some even dropping 
down dead, and on ordinary occasions the scale is soon 
turned on the side of life or death. 
The rapidity of its course is so great, that but little oppor- 
tunity is given for the interposition of remedies, when the 
means are at hand ; much less in the consternation of such 
periods ; the disease occurring in armies, and thick settled 
places, there cannot be much systematic treatment employed, 
even if the methods of treatment were agreed on. The des- 
titute are the most exposed to have the disease excited in 
them, and at the same time possess the least means of avert- 
ing its rage. The Journalist says of the plague of London in 
1665, " The misery of that time lay chiefly upon the poor, 
who being infected, had neither food nor physic ; neither 
physician nor apothecary to assist them, nor nurse to attend 384 
PLAGUE AND YELLOW FEVER. 
them." Of the physicians, Dr Hodges says, " that many 
died whilst prescribing for others."* 
Pathological remarks: 
b. An intense state of predisposition is readily affected by 
exciting causes, producing severe and perturbed action, very 
quickly interrupting the free play of the vital forces ; and 
sometimes so great as to destroy life immediately. Com- 
monly, however, the repulsive forces act, or strive to make 
an effort; and they commonly so far obtain an ascendancy 
as to develop the characteristic phenomena of the disease. 
Yet again, they may only partially be developed, on account 
of embarrassments, which have been already explained. 
< The entire histories of the phenomena of the plague and 
yellow fever go to prove a,similar state of pathological char- 
acter as exists in typhus gravior. The local concentrations 
are on different tissues, and organs, which give origin to some 
change of the phenomena, and occasion some inappreciable 
modifications of diathesis. Still we find the most successful 
methods of treatment to be predicated on similar principles. 
If these principles are correct, they go far to demonstrate 
the general affinity existing in disease., The yellow fever 
has been treated with much success by many efficient practi- 
tioners in the United States, and in the West Indies, and we 
have no doubt the plague might be so likewise, wherever 
circumstances might permit; especially by those who would 
approach(the sick free from prophylactics in their noses, and 
without 'a tobacco leaf interposed between the finger and the 
pulse. It will not be expedient for us to ^proceed any further 
than general views, in relation to these,diseases. 
* Tytler, p. 552. OUTLINES OF THERAPEUTICS. 
385 
4. Cynanche maligna, Malignant Sore-throat; Scarlatina 
anginosa, Canker rash. 
Preliminaries. 
a. This might have been placed in the order of eruptive 
diseases; but as it sometimes appears clothed in the garb of 
the severe typhoid character it has a place assigned it here, 
for the purpose of grouping the most important diseases of 
this kind together in one order. Although the term malig- 
nant is applied to it, yet the greatest proportion by far of the 
cases, as they have appeared in different epidemic seasons 
since the year 1793, have been of the synochoid character. 
It is believed the term malignant, or putrid sore-throat, has 
too much biased the treatment towards the tonic, or antisep- 
tic method. 
When it prevailed extensively from 1793 to 1796 in New 
England, there were a larger number of cases of the typhoid 
character than in the later epidemics. From the previous 
history of the disease, we might be inclined to believe, that 
the former epidemics were still more inclined to the typhoid 
character, or that they were made to be such by the almost 
invariable practice of treating the disease by high stimulation. 
Taking the whole time together since 1793, we might esti- 
mate, that not more than one in twenty had a primary, typhoid 
diathesis. Still physicians might not judge alike respecting 
the diathesis of particular cases. 
In consequence of some of the epidemics in Scotland 
manifesting a typhoid diathesis, and at other times mostly the 
synochoid, Dr Cullen was led to the erroneous conclusion 
that they were two distinct diseases, depending on different 
specific contagions. Nothing is more obvious than that the 
same disease, whether from contagion or otherwise, appears 
sometimes in the synochoid, and other times in the typhoid 
livery, in the same season ; and indeed in members of the 386 
CYNANCHE MALIGNA. 
same family. We therefore consider there is but one dis- 
ease, subject to the same laws as other epidemics, yet like 
most of these, even the small pox, liable to exhibit different 
aspects, the typhoid and synochoid ; and this is only saying, 
that some cases are more severe than others. 
Phenomena. 
b. A breviary of the phenomena of this disease will show, 
that the affection is ushered in with the common symptoms 
of the pyrectic habit, together with a local concentration in 
the fauces and larynx ; attended with stiffness in the neck, a 
red^and thickened state of mucous tissue of the throat, ton- 
sils, &c. There is some subjacent tumefaction, often extend- 
ing to the parotid glands, which frequently become tumefied 
and tender. The affection of the mucous tissue extends to 
the nares, and along the Eustachian tube ; at the same time 
the trachea is affected, extending more or less into the mucous 
tissue of the lungs. 
The fauces become covered with a thin exudation, show- 
ing ash-colored spots ; at the same time there is some spitting ; 
and in the typhoid variety, the exudation assumes a dark, or 
black color, with an ichorous coryza. Some cases are at- 
tended with the effusion of croup, and the false membrane 
has occasionally been thrown up almost entire, towards the 
termination of the disease. Deglutition and respiration are 
sometimes very difficult to be performed. In the progress, 
especially in protracted cases, the affection spreads through 
the alimentary canal, attended with epigastric tenderness, pro- 
ducing diarrhoea, with excoriations at the anus. 
It is common, but not constant, for a bright efflorescence, 
or rash to appear on the surface, between the first and 
third day, spreading from above downwards over the whole 
body. The heat is very intense, amounting to 106° or 108° 
Fah., and some have thought it more. In consequence of OUTLINES OF THERAPEUTICS. 
387 
the intense determination to the dermoid and mucous tissues, 
the internal serous membranes and nervous tissues are not so 
severely affected as in ordinary fevers, so there is more mus- 
cular energy, and freedom of intellect. 
In the typhoid variety, the eruption is often quite imper- 
fect, rather dark, and sometime^ wanting. Sloughing ulcera- 
tions of the fauces and larynx are liable to follow, injuring 
the cartilages, in protracted cases. These are rare cases ; 
the disease commonly terminating in about seven or eleven 
days, under proper treatment, and the epidermis is cast off in 
branny scales. 
There is an universal increased susceptibility in the organ- 
ism, and this is shown by a more frequent pulse than attends 
ordinary fevers ; it often being from one hundred and fifteen 
to one hundred and thirtyfive or even more, in a minute ; 
sometimes very small, but often full and hard. The disease 
is most frequent amongst children, probably on account of 
those more advanced, having previously had the dis- 
ease. Those who have once been affected, are not very 
liable to a second attack, yet there are exceptions. In two 
or three weeks after the disappearance of the eruption, these 
are liable to anasarcous swellings universally, which have 
been already noticed under the article dropsy. 
Methodus medendi. 
Typhoid variety. 
c. For the treatment of the variety scarlatina typhoides, or 
maligna, we make reference to article first of this section, 
the principles are there explained ; they are further illustrated 
in the author's Sketches of Epidemic Diseases, with specifi- 
cations. Primary cases of the typhoid character rather sel- 
dom appear in ordinary seasons of its prevalence ; but many 
are converted into it by neglect of proper treatment, or 388 
CYNANCHE MALIGNA. 
the employment of incendiary measures, the principal of 
which is some preparation of opium, under the pretence of 
calming irritation. 
These cases have a scanty efflorescence, a dingy complex- 
ion, dark crimsoned cheeks, whilst the chief force of the 
disease is thrown upon the internal tissues, and the nervous 
force is impaired. The pulse is very frequent ; one hundred 
and thirty or one hundred and forty in a minute, small and 
oppressed. Notwithstanding these untoward appearances, 
many cases have been conducted to a favorable termination 
by taking four, six, or eight ounces of blood from the arm ; 
and also, by a repeated use of the warm bath, with continued 
but moderate frictions. Moderate emesis is very useful, by 
promoting cutaneous circulation, and cleansing the throat of 
viscid sordes, which is often so abundant as to render deglu- 
tition difficult, and respiration laborious. 
We have used the bath three times in the course of twenty- 
four hours, for fifteen of twenty minutes each time, with fric- 
tions over the surface whilst in it, merely by the naked hand. 
As the pulse and other phenomena indicate, so the bleedings 
may be repeated. 
Steam of warm water and vinegar may be moderately in- 
haled, and detergent gargles often used. Amongst others, a 
decoction of marsh rosemary, or senega root, and honey. 
When the fauces are much excoriated, a solution of nitrate of 
silver, ten grains to the ounce of water, may be freely applied 
with a small swab, or camel's-hair brush. The throat exter- 
nally may be bathed in camphorated liniment, but no epispas- 
tic should be applied to it, or to any other part. As deglutition 
is difficult, we can but rarely make use of alterative medicines. 
If the camphorated emulsion can be swallowed, it has a cor- 
dial and calming effect. Some cases of this character, with a 
pulse of one hundred and forty in a minute, have been soon 
arrested, and attended with a speedy and favorable termina- 
tion. OUTLINES OF THERAPEUTICS. 
389 
In other respects the general treatment for this order of dis- 
eases may be pursued. 
Synochoid variety. 
d. The treatment of scarlatina synochoides ought to be 
conducted on the general principles of treating fevers of this 
diathesis. The increased sensibility of the tissues is so in- 
:ense, that the phenomena proceed on an elevated grade, and 
he contest will soon be decided. Asit is a fact, that small 
neans improperly employed, aggravate the affection very sen- 
sibly ; so, inconsiderable, but right treatment, never fails, if in 
season, to moderate its severity, and in a manner that it soon 
passes off without any disaster. Every case manifesting any 
considerable severity, should be treated by bleeding at the 
irm. It should be repeated as the phenomena may indicate, 
being guided by the same rules as in other pyrectic habits, of 
a synochoid character. We have sometimes bled even three 
er four times, when the disease is more protracted, and with 
the most happy effects ; the blood exhibiting the phlogistic 
pellicle, and cupped. When there is much pain and swel- 
ling in the throat, the ranular veins may be cut, and even 
scarifications into the sides of the tongue. If blood issues 
but scantily, apply leeches externally. 
It is sometimes proper, in warm seasons especially, and 
when there is a vivid eruption with intense heat, to use cold 
water externally. This affords a striking instance of the di- 
versity of treatment in the same disease, under different cir- 
cumstances. Still, if the bleedings are practised, it will but 
seldom be necessary. . 
As the patient lies on a mattress, or even straw bed, with 
a sheet over him, the water may leisurely be applied to the 
superior parts, and gradually sprinkled, or dashed over the 
body. But it is not necessary to drench him very severely. 
The evaporation gives a soothing sensation, and it may be 390 
PNEUMONIA TYPHOIDES. 
repeated as the clothes grow dry, until the excess of heat is 
abated, and the eruption begins to fade away. This will 
commonly be effected in six or eight hours, if the bleedings 
have been previously practised. As all the internal mucous 
tissues are very turgid with blood, especially the lungs, the 
cold applications ought not to be urged too far. The use of 
cold water as above, should only be practised in urgent cases, 
with a vivid eruption. 
Avoid all internal stimulants, as opium, wine, calomel, and 
a host of others. Use occasionally mild, saline cathartics. 
Notwithstanding the results of this affection, throughout the 
country, are commonly very disastrous, we have a sincere 
belief, that when the proper treatment is reasonably and judi- 
ciously employed, there would not be more, perhaps, than 
one case in fifty prove fatal; perhaps not so many. 
5. Pneumonitis complexa; Pneumonia typhoides, or Epi- 
demic Lung Fever. 
a. Although this disease might occupy much space, our 
remarks will be few, considering the general principles have 
already been illustrated. It is a frequent epidemy in north- 
ern latitudes, occurring in cold seasons. It has often pre- 
vailed in Europe ; and it seems as though other preceding, 
or accompanying diseases were converted into it, by a change 
of season, or certain extraneous circumstances. In the win- 
ter of 1795-6 it was in close connection with scarlatina, and 
in 1812-13 with the spotted fever. It affects the most ro- 
bust at the middle periods of life, and males oftener than the 
other sex. Many heads of families have been' destroyed by 
it. (See Author's Sketches of Epidemic Diseases.) OUTLINES OF THERAPEUTICS. 
391 
Phenomena. 
b. The general diathesis is of the severe typhoid aspect, 
with a concentration to the thorax, the principal seat being 
the lungs. There are chills and rigors, but often not severe ; 
paleness, or a sublivid color of the face ; but as responding 
action begins, the cheeks look of a crimson color. Distress 
internally, with pain in one, or both sides ; oppression of 
respiration; cough, for the most part attended with sero-mu- 
cous discharges, colored with blood. 
There is a prostration of vital force at the commence- 
ment ; pulse is small, irregular, and oppressed ; but, if the 
disease becomes developed, it is full, strong, and hard. 
Muscular motion is impaired, and the patient would be dis- 
posed to sleep, if distress did not prevent. As the disease 
progresses the common phenomena of fever appear, or oth- 
erwise they are strangled, and the blood retains a dark color. 
This disease has had a fatal termination oftentimes on the 
third day, in some at a later period. Even the earliest 
deaths show extensive lesions in the organs of the chest ; the 
pleura, mediastinum, diaphragm, pericardium, heart, and 
lungs manifest the usual appearances of inflammation, with 
adhesions, and effusions; the effusions often sanguineous. 
The lungs are engorged with dark blood, which is often 
effused in their cellular tissue, but more commonly into the 
aerial cells. The bronchial vessels are filled with a sangui- 
neous sero-mucous fluid. The affection sometimes extends to 
the larynx, producing croup-like effusions. There is neither 
opportunity, nor necessity for the use of the stethoscope in 
this affection, for the disastrous events must be anticipated, 
and obviated, by a discernment of the prominent physiologi- 
cal derangement of the functions, if opportunity presents. 
Both the effusions externally on the lungs, and the great in- 
crease in the sputa, demonstrate a morbidly tonic force 
existing universally. 392 
PNEUMONIA TYPHOIDES 
.Metho dus medendi. 
c. The prostration of vital force constantly presents to the 
superficial observer, the existence of debility ; and there- 
fore, the treatment is liable to be pursued with stimulants, to 
the neglect of the remedial course that will insure safety. 
Although this disease is of a formidable character, it can most 
commonly be disarmed of its violence, if treated early, and 
in an efficient manner ; and this assertion is made from no 
inconsiderable observation. 
As the principles of the diseases of this character have 
now been largely explained, and the treatment illustrated suf- 
ficiently, we need not dwell upon it very long. There is 
much inability of function existing, with a strong state of 
morbid tonicity, embarrassing more or less the physiological 
movements. 
External warmth is indispensable, and attempts should be 
made to promote a diaphoresis. The universal warm bath 
possesses high claims to preference, but as it is so often in- 
convenient, or impracticable, it must commonly be dispensed 
with. A warm apartment, warm bed, and external warm ap- 
plications may be sufficient. 
As soon as the patient begins to grow warm, blood should 
be taken freely from the arm, even if the patient should suffer 
syncope. The bleedings should be repeated in as quick suc- 
cession as the pain and the pulse indicate, and until pain is 
removed. Still the diaphoresis should be encouraged. 
Early and free bleedings save thp loss of larger amounts, 
when longer delayed, and which then have less utility. 
The cardiac action should be examined, and if it should be 
found more feeble than the arterial, the external warmth will 
do much in promoting an even balance. In such cases the 
first bleedings should be small, and time given for the recu- 
perative movements ; for they cannot be dispensed with. 
We have taken blood' from persons more than eighty years 
of age, and with happy effect, and on some occasions re- OUTLINES OF THERAPEUTICS. 
393 
peated it several times, when the disease had made consider- 
able progress before its employment. It is always desirable 
to arrest the disease, before it has made any permanent 
organic changes. 
Emesis may follow bleeding to great advantage. A solu- 
tion of antimony may occasionally be used as an alterative, 
but not too frequently in the early treatment ; or, the com- 
pound syrup of squills. 
Aromatic infusions may be used to promote diaphoresis, 
and sustain action on the surface, but no Dovers' powder, 
nor any medicine that contains any narcotic principle. 
Mild steams of mucilaginous substances in water, may be 
inhaled into the lungs, by any convenient apparatus, yet in a 
manner not to give any fatigue to the patient, nor impede 
respiration. 
The following epithem should be extensively applied to tZie 
thorax, and something' similar to the feet. Hop flowers, four 
ounces, digested in three quarts of water; thickened to stiffness 
with wheaten bran, and moderately dusted over with flour of 
mustard seed. Let it be extensively applied over the thorax 
and spine, and renewed about every four, or six hours, and 
repeated longer than any pain remains. When disccntinued, 
cover the thorax with cotton batting, after bathing in campho- 
rated liniment. These measures will commonly supersede 
the necessity of epispastics ; they are more comfortable, and 
are commonly efficacious ; if not epispastics ma; be used. 
External heat to a certain amount, is indispensable at the 
commencement of the disease ; but after the circulations 
have become established, it should not be urged too far. 
Still it will be dangerous to expose to cool air, or cold drinks. 
As this affection occurs in cold seasons, we have constantly 
observed, that a mild perspiration kept up, obviates the ex- 
cess of heat. It is therefore safest, and conduces to the more 
speedy removal of the disease, tp remain in a warm bed, and 
promote mild diaphoresis quite steadily, with pleasant diluent 394 
TYPHUS PETECHIALIS. 
drinks, for about the first week at least; during this time the 
disease may commonly be rendered safe; and soon pass 
away. 
On the second or third day, if the previous medicines have 
not been sufficiently laxative, some use may be made of calo- 
mel, castor oil, or neutral salts; but much purging should 
not be employed. If a strict regard be had to the measures 
proposed, the expectoration, which is liable to follow for 
some time, will commonly remain free and easy. Some- 
times an electuary of sulphur and liquorice root, each three 
parts, and senega root one part, made up with treacle, will 
be useful to be taken leisurely. If there should be much 
restlessness with heat, take of gum camphor and nitrate of 
potash, each eight grains, ground with gum arabic twenty 
grains, for one dose for an adult ; repeat according to cir- 
cumstances. 
The remedial measures may be varied to the particular 
condition of the case ; yet strict regard should be had to ex- 
tend them to the point of removal of the nosodynamic force, 
and establishing the ascendancy of the centripetal circulations 
over the centrifugal; when the rest of the cure will be expe- 
ditious aid safe. By a strict adherence to the above simple 
treatment, the disease can most commonly, in otherwise 
sound habits, be conducted to a favorable termination, if 
seasonably used. If organic changes should have superven- 
ed, before tie use of proper remedies, still very similar treat- 
ment should ie pursued, but without expecting certain and 
speedy relief. 
6. Typhus petechialis ; Spotted Fever. 
a. See definition in the nosography. For a more extend- 
ed history of its phenomena and character, than can be here 
made, reference may be had to the Author's Sketches on 
Epidemic Diseases, p. 223. OUTLINES OF THERAPEUTICS. 
395 
It is a disease of cold seasons ; and seems to have an ori- 
gin, in connection with an atmospheric afflatus and cold. It 
has the peculiar trait of affecting children, and young persons 
most commonly ; and in this it is different from the disease 
of the last article, pneumonia, which sometimes immediately 
follows it, affecting the most robust males. The severe epi- 
demic, or spotted fever of 1811, and 1812, appeared to be 
converted into pneumonia, as has been intimated. The spot- 
ted fever first appeared, and the next year pneumonia, and 
also spotted fever. 
Perhaps there is no disease of the pyrectic character, more 
irregular iq its external phenomena than this ; being accom- 
panied with what some have denominated nervous, or pro- 
tean symptoms. It presents a good specimen of ataxic fe- 
ver ; many of the ordinary phenomena of fever being absent 
at the attack. Its most prominent feature appears to be an 
impression on the abdominal ganglia generally, or the system 
of nutritive nerves, producing a paresis of organs, especially 
of the heart. Still, an impression is soon transmitted to the 
encephalon, exciting many anomalous phenomena. The 
eruption which has given origin to its name, is often absent. 
The most constant phenomenon is the frontal pain ; but still 
the chief seat of pain is often in some of the extremities, and 
sometimes in the head or abdomen. 
When the disease becomes developed, it is almost always 
concentrated in the serous membranes of the head and spine. 
At its onset it affects the system of the abdominal nutritive 
nerves, as is demonstrated by the phenomena in the circula- 
tions depending on this system ; by the numerous congestions 
there, and by the internal petechias, or stellated appearance 
of the serous tissues, and their sublivid appearance likewise. 
It sometimes proved fatal in two, or four hours; often in 
less than twentyfour hours, or sometimes not until after the 
first week, when the phenomena of- the pyrectic habit had 
been developed. Sometimes the patient would expire before 396 
TYPHUS PETECHIALIS. 
the arrival of the physician, and perhaps another in the family 
be taken sick. Cases that extended beyond about the third 
day, were liable to assume the progressive grade of slow ty- 
phoid fevers. Its first attack had some resemblance to an 
anomalous, ephemeral remittent. There would sometimes be 
an irregular remission ; and the disease be again renewed, by 
a more severe and fatal paroxysm, but without rigors. 
The heart very early suffers more or less of a paresis J the 
systolic contractions become feeble and retiring. Soon it 
increases in frequency, whilst the arterial action is small, and 
the pulse thready. There is a salutary cardiac effort, but 
the resisting forces may have gained strength, and there is 
danger of their obtaining an ascendancy. 'As the physiologi- 
cal movements preponderate, so the case must terminate. In 
these early efforts of severe cases, the pulsatory actions 
amount to 140, 160, or 180 in a minute, being small and 
tremulous in proportion to their increasing frequency. In 
unfortunate cases, an acrotismus or cessation of pulse com- 
monly takes place an hour or two before death. We have 
known the pulse return after an hour or two, and the patient 
recover, but never when the acrotismus succeeds to such 
great frequency of cardiac action. 
In the case of a strong athletic man, on the contrary, who 
had taken large quantities of opium, alcohol, and other stimu- 
lants, by the advice of his physician, with a view to sustain 
the vital energies, the pulse continued to beat distinctly at 
the wrist for about a minute or more, after respiration ceased, 
and every appearance of death was present in the functions 
of external relation. We saw him only a few minutes before 
this event. In this instance, the greatest state of apoplectic 
oppression seemed to be in the head, attended with coma, 
and a florid countenance ; whilst in ordinary cases it is in the 
abdomen, with a pallid appearance. OUTLINES OF THERAPEUTICS. 
397 
Methodus medendi. 
b. In relation to the treatment in this affection, it may be 
remarked, that when it has assumed the type of slow typhoid 
fever, it requires very similar management. The difficulty 
and danger consist in guiding the pathological movements at 
the onset, in a manner to relieve visceral engorgements, and 
that they assume a more stable course. The time is usually 
short, and like as in cholera, but little opportunity is some- 
times afforded, to do as much as might be done, under more 
favorable circumstances. This is especially the case in coun- 
try practice, where a single hour may be of vast importance. 
For an essential part of the treatment in the ataxic stage of 
this affection, we 'must make reference to the first article in 
this section, which is unnecessary to be repeated here. The 
juvantia should be adjusted, as far as possible, to oppose the 
impediments in any particular case. There is need of much 
discernment and discrimination ; an opinion must be formed 
directly, amidst hurry, and often confusion. The most diffi- 
cult cases occur in children, who are then, at least, incapable 
of giving any account of their sensations. The disease may 
have so far progressed, that the recuperative powers are about 
succumbing before the severity of the morbid derangements, 
which are similar to those which have often been shown 
to exist in the severe typhoid state. 
The restorative force requires aid ; but, how can this be 
effected without aiding the rigid nosodynamic state ? Unless 
remedies can be found to answer this intention, many cases 
will be subject to an unpropitious termination. We have 
given the best advice we are capable of in this particular, in 
our expositions on the severe typhoid diathesis. It should 
be noticed, that the vital susceptibility of children is very 
exquisite ; and as the morbid changes in disease are liable 
to be impressive ; so also, medicinal excitants are liable to 
provoke ready and severe movements. A remedial agent 398 
TYPHUS PETECHIALIS. 
out of time, and of disproportioned amount, may assist the 
disease instead of suppressing it. 
External warmth should be used according to the specified 
directions already advanced. That certain excitants by the 
stomach are indicated sometimes by the external phenomena, 
we do not doubt, and, we conceive, under particular restric- 
tions, are admissible,. But, we must attempt to discern and 
look at the internal changes also, and well regard the patho- 
logical derangements existing there. If we can select exci- 
tants that will more surely aid the recuperative powers than 
the opposing morbid tonicity, they may find a ready place in 
the therapeutical catalogue. We will venture to propose 
some ; such as the chloric, and vitriolic ethers ; carbonate of 
ammonia ; the various more agreeable essentials oils, diffused 
in alcohol, such as peppermint, horsemint, pennyroyal, caje- 
put, juniper, annis, without reference to their technical names. 
These, or some of them, may be diluted in Warm water, and 
made agreeable. Also, gum camphor suitably prepared and 
given in substance. So again, aqueous infusions of sage, saf- 
fron, lavender, valerian and senega root, perhaps capsicum. 
These should be attended with warmth and frictions, as for- 
merly suggested. 
All these may be styled evanescent excitants, in moderate 
quantities. They pervade the system very quickly, and 
excite cutaneous action. It is impossible to specify the 
amount that may be proper to use. We can only say they 
may be rather freely used, until it may be ascertained that 
some favorable change in the circulation becomes' manifest. 
Yet, they ought not to be so freely used as to.overact, and 
by this means depress the vital actions ; always having in 
view, that high stimulations are liable to end in exhaustion. 
Where reaction is slow in appearing, and danger of a sudden 
and severe paroxysm is apprehended, about two grains of 
sulphate of quinine may be employed for a child two years 
old, about once in four hours, for a short time. OUTLINES OF THERAPEUTICS. 
399 
If more powerful stimuli should be deemed necessary for 
those of adult age, alcohol in moderate quantities will be pref- 
ferable to opium or any other narcotic. It should be well di- 
luted with warm water, to which may be added allspice and 
loaf sugar. Or, an infusion of camomile flowers, to which 
add spirit, lemon juice, and loaf sugar. All articles of this 
character should be withheld as soon as the pulse shows any 
considerable force, and especially if heat should appear on 
the surface. Still nothing can be gained by high stimulation. 
Having made some suggestions in relation to excitations of 
the restorative processes, we may now enquire, whether we 
possess any means of diminishing the relative plethora of the 
vascular tissues, and also weakening the abnormal, more than 
the normal state of the tissues ? We assign that such a re- 
medy may be found in blood-letting, as experience testifies, 
and sound physiological inductions warrant, when conducted 
in a suitable manner. As this subject has been detailed in 
various places, especially in the first article of this section, 
we may pass it without further illustration. We will only 
say further, if the system should be emancipated from its 
state of embarrassment, and the recuperative powers in their 
turn become triumphant, and, in connexion with the morbid 
condition, threaten to excessive action, the same remedy 
may now be used to suppress it, until safety is insured to the 
organism. 
There is scarcely room for the employment of emetics in 
these cases ; and we have known several instances, in which 
their use in children appeared to hasten the fatal event. 
7. Cholera. 
a. This affection frequently appears sporadically in New 
England, mostly at the close of the hot season of the year, when 
Preliminaries. 400 
CHOLERA. 
warm days are succeeded by cold nights ; but was never seen 
as a wide spreading epidemic until 1832 ; and then it was not 
so severe here as in many other places. The spasmodic 
epidemic cholera is evidently an aggravated state of disease, 
as compared with the casual sporadic kind. It may merely 
be remarked, that the late cholera asphyxia, or spasmodica, 
is the only instance on record of a wide spread epidemic of 
this affection ; or rather it may be called pandemic ; although 
it has from time immemorial prevailed as an endemic in many 
sections of the eastern continent, and occasionally in Europe. 
It appears to show the versatility of disease, and the ready 
conversion of its causes in a manner to excite new modifica- 
tions. We consider the common cholera morbus, and the 
late epidemic in America, as nearly allied in their intrinsic 
characters, and bearing the same affinity to each other as or- 
dinary remittent fevers do to yellow fever ; yet with a differ- 
ence in the intensity of predisposing causes, The cholera 
asphyxia being attended with a more severe typhoid diathesis ; 
yet spasms attend both of them. 
The phenomena are so much the subjects of history, that 
they do not require to be repeated. See nosographic defini- 
tion. Our expositions on cholera will be restricted very 
exclusively to its pathology. 
b. We consider that this peculiar habit of disease, ought 
to have a place at the head of the climax of malignant dis- 
eases, or beside the oriental plague. The circumstance, of 
having destroyed between sixty or seventy millions of human 
beings, in its late peregrinations is sufficient to confer on it 
this distinction. 
We will say no more in relation to its causes than has been 
expressed in the preceding etiology. It appears that cer- 
tain extraneous causes have produced changes in the econo- 
Pathological remarks. OUTLINES OF THERAPEUTICS. 
401 
my of the system ; and we infer that these changes consist in 
an altered state of the tissues. Whatever changes may arise 
in the circulating fluids, either the blood or the secretions, 
ought rather to be considered as secondary. As these sub- 
jects haye already been sufficiently discussed, no further ob- 
servations will be made on them. 
Notwithstanding this affection appears clothed with many 
anomalous phenomena at its access, yet it must be contem- 
plated as belonging to the family of the severe pyrectic dis- 
eases. The circumstance of its development always mani- 
festing many of the phenomena of the general morbid habit, 
although ataxic, is sufficient to establish this fact. The phe- 
nomena (at the onset are but little more eccentric than those 
of the disease last treated of, although considerably different; 
and this may be explained by the circumstance of its local 
determination being directed, by the peculiarity of the pre- 
disposing causes, to a different order of tissues. 
c. Our attention then may be directed, for an investigation 
of its intrinsic character, to the general state of the vital sol- 
ids, and the condition of the tissues most emphatically im- 
pressed. 
Fearless of contradiction, and any opposing facts, we as- 
sert there is no debility in the vital solids, but they show 
every where an elevated tonicity; a state of ataxia also pre- 
vails ; for whilst some organs are elevated, others are de- 
pressed in function. The facts and illustrations have already 
been adduced in the preceding pathological investigations, 
and reference here may only be made to the shrivelled and 
contracted state of the body, as proof. There is a manifest 
condensation of all the vascular tissues. The vessels strongly 
compress the fluids, a relative plethora is suddenly induced, 
and it is agreeable to true physiological inductions, that such 
a state impedes secretion and absorption. 
Furthermore, the nosodynamic force of the tissues is ade- 
quate to the impeding of glandular secretion, and all the absorb- 402 
CHOLERA. 
ing processes. Even the centrifugal circulations 'are per- 
formed with difficulty, except those tissues most emphatically 
affected by a concentration of local irritation, such as the 
intestinal exhalants. Every morbid process is conducted 
impetuously where the tissues are left free to act, which im- 
plies energy, instead of weakness. And, again, those cases 
which surmount the ataxic stage, and when the morbid habit 
becomes developed, constantly manifest more or less of the 
synochoid diathesis : and besides, all the phenomena in the 
moving powers of the tissues prove such a state ; the blood 
declares the diathesis by a buffy and cupped appearance, as 
soon as v&scular impulse takes place. 
If any further proofs are needed of the existence cf a mor- 
bid tonicity, we might allude as collateral evidence, to the 
opinion of many practitioners, who have attempted to treat 
the disease by tonics and stimulants. We will only make 
reference to a few instances. M. M. Gerardin and Gaimard 
were sent as an embassy from the Royal Academy of Medi- 
cine of France to Russia, Prussia, and Austria, to study the 
cholera then raging. In reference to the treatment,'they 
make this remark in relation to stimulants ; " all practitioners 
agreed in regarding them as often inefficacious, and still more 
frequently as aggravating the symptoms they were given to re- 
lieve." Again, " Bark and its preparations administered 
with the view of treating algid cholera as a malignant inter- 
mittent, have not produced the beneficial effects which were 
expected." So indeed will be the result of every remedy 
predicated on the asthenic hypothesis. 
The most prevailing opinions of physicians in America, 
who have had extensive experience in cholera, appear to be, 
that high excitants are injurious ; many might be quoted. 
We will merely mention the views of Prof. J. W. Francis 
of New York, in his lucid letter to Dr. Read. " Need I say 
any thing to you on the preposterous practice of large doses 
of opium or laudanum in any of the stages of this com- 
plaint ?" p. 19. OUTLINES OF THERAPEUTICS. 
403 
More recently in an excellent treatise " On the Relation be- 
tween the Respiratory and Circulating Functions," by Dr C. 
Hooper of New Haven, Conn, in the Boston Medical and 
Surgical Journal, Vol. XVIII. p. 279, we find the following 
remark ; " Most physicians, like myself, from mistaken 
views of the pathology of this disease, (cholera) treated their 
first cases by attempting to arouse the action of the heart by 
opium, alcohol and other stimulants." Although he pursues 
the adynamic hypothesis in explaining the relations of the 
phenomena of disease, yet he seems forced to the conclusion, 
that stimulants are injurious. 
Coldness is so prominent a feature, that it has been called 
algid cholera. The adstrictive state of the capillary tissues 
prevents that free vital circulation, which is necessary for the 
extrication of animal heat. The same circumstances existing 
in the tissues of the lungs, embarrass the calorific processes 
there. And, furthermore, the delay of venous absorption of 
the skin and internal tissues, gives occasion to the dark or blue 
color, externally, and congestive state internally, as has al- 
ready been amply illustrated in other malignant states. A 
great force of nosodynamia exists ; the fever is of the ataxic, 
malignant character. 
Particular tissues affected. 
d. Having made allusions to the morbidly tonic state of 
the general system, we may turn our attention to the state of 
tissues most emphatically impressed. 
It is characteristic of all epidemic diseases, that the remote 
causes, whatever they may be, possess a certain specific 
property of affecting or increasing the susceptibility of par- 
ticular tissues ; so that, when disease is excited, the local 
concentrations are made on such tissues. We assert this as 
a law made plain to our understandings, without attempting 
to specify the modus operandi. We can only suggest, that 404 
CHOLERA. 
it consists of a series of excitations on these tissues, and that 
their susceptibility becomes increased when so affected. 
Influenza and epidemic pneumonia may be cited as examples ; 
and if more should be required, we might suggest dysentery 
as an instance in point. In this affection the mucous coat of 
the rectum and colon are the points of local concentration. 
Now it cannot do much violence to correct logical induc- 
tions, to extend the analogy in cholera to the mucous tissues 
of the ileum, jejunum, and duodenum, with all their follicles 
and exhalants ; neither, indeed, if it were to embrace those 
of the stomach also. The extent of surface then might not 
be greater than that of the inner surface of the lungs, and but 
a little more than that of the colon and rectum in dysentery. 
The concentrations sometimes embrace large surfaces, as the 
membranes of the head and abdomen in typhoid fevers, and 
the entire surface in simple scarlatina. 
We have good evidence of the whole of the mucous tissue 
of the alimentary canal being involved in this disease ; per- 
haps the three upper divisions the most. Lesions of this tis- 
sue have been noticed by many investigators, but the most 
positive proof seems to be shown by Professor Horner, in 
his detecting at the Philadelphia almshouse, in a cholera 
subject, a pseudo-membrane on the mucous tissue of the 
small intestines. This membrane, in all essential respects, is 
represented as resembling the membrane often lining the 
trachea in croup, but much thinner. This is sufficient to de- 
monstrate the local affection being in this tissue, and in ac- 
cordance with other phenomena proves its synochoid charac- 
ter. Still, tissues may suffer by local concentration without 
leaving any traits of injury. 
We are aware that tissues in a state of excitation some- 
times possess an adstrictive condition, and remain dry ; but 
we are as well assured they are as often subject to a state of 
profluvium, by the agency of which they pour out large quan- 
tities of fluids, either in a normal or abnormal state. Dysen- OUTLINES OF THERAPEUTICS. 
405 
tery, diabetes, and diarrhoea serosa may be cited, as in- 
stances. There is then nothing exciting surprise in cholera, 
except the great amount of serous discharge^ in proportion to 
the surface affected, and the extreme pressure of the disease. 
Cholera discharges. 
e. We are, moreover, assured, that the cholera discharges 
are sometimes tinged with blood ; in this we trace an analogy 
in the raucous membrane of the lungs in pneumonia ty- 
phoides ; in the intestines in dysentery; in the sudor anglicus or 
bloody sweats on the skin ; in the mouth of thpse salivated 
by mercury ; in hsematemesis, and many other affections. 
The exhalant openings transmit particles of the cruor, urged 
on by the great force of vascular impulsion, and not by 
debility. 
The loss of the serosity, along with some albumen and sa- 
line substances is very great, and effected in a short space of 
time. It has been computed to be from twenty to forty 
pounds in two days. The remaining portions of the blood 
become more dense, and less fit to perform healthy pur- 
poses. M. Whittstock, of Berlin, found the blood taken 
from the right ventricle, of persons who had died of cholera, 
to contain thirty per cent, of solid matter on drying, whilst in 
health, blood only yields twentyone per cent. The albumen 
was also increased, as it is in other cases of sthenic disease. 
Along with the serum discharged, pass also the saline sub- 
stances of the blood, which are always suspended in it. The 
loss of these and other alterations occasion essential changes 
in the integrity of the blood, which no doubt contributes to 
the fatal termination. 
We fully assign these immense intestinal serous discharges 
to come from the exhalants of the mucous tissue, directly 
through the arterial capillaries, increased in some measure by 
the secretions of the mucous follicles. At the same lime 406 
CHOLERA. 
they are not wholly excited by the irritations in this tissue. 
The severe state of morbid tonicity, pervading the whole of 
the vascular tissues, propels forward the circulations in their 
vessels, and with an increased velocity greatly above the nor- 
mal state. The diathesis always modifies and even controls 
the local concentrations, whether in the form of inflamma- 
tions, profluvia, or muscular contractions. 
The exhalants act inordinately in a comparative view, from 
the circumstance of the centrifugal circulations possessing an 
ascendancy of nervous force, as has been heretofore illustra- 
ted. In consequence, the exhalants of the dermoid tissue, 
also pour out the serosity very freely in cholera, which con- 
denses on the cold surface, in the form of sweat. In the 
sudor anglicus this tissue was the seat of concentration of the 
morbid force, and so intense was this state, that blood was 
exhaled along with the serosity. In this instance, had the 
concentration been on the mucous tissue of the small intes- 
tines instead of the skin, there is but little doubt the disease 
would have mimicked the unrelenting cholera, and the historic 
poet would have had' no occasion to sing of 
The sweats o'erflowing; but in a clammy tide; 
Of tinctures various, as the temperature 
Had mix'd with blood; and rank with fetid steams. 
Although the cholera discharges in some particulars resem- 
ble those in diarrhoea serosa, the latter disease depends on 
other remote causes, and is not founded on the severe malig- 
nant state of the cholera diathesis ; and is therefore in all its 
stages a comparatively mild disease. 
Organic secretion. 
f. The secretory organs maintain circles of vascular circu- 
lation, similar to the entire aortal circulation, extending to the 
periphery. As impediments are offered in this, so the same 
takes place in the visceral organs ; so they also assume an OUTLINES OF THERAPEUTICS. 
407 
adstrictive state. The . blood circulates through with great 
difficulty, and an inability of secretion is the consequence. 
In cholera this is shown most clearly in the liver and kidneys. 
Secretion is suspended ; and a relaxation of this rigid state, 
attended with secretion, is a sure pledge of a favorable crisis. 
The diathesis in the common sporadic cholera, is not ordina- 
rily so intense as to interrupt the secretion of bile, but the 
mere increased irritation promotes it, as it does in epidemic 
cholera as soon as secretion is permitted to take effect ; the 
bile then appears. 
Deficient absorption. 
g. We have no evidence of much of the continuance of 
absorption in cholera, only just enough to sustain the circula- 
tions for a little time. The blood in the skin is not absorb- 
ed, but continues to give it a peculiar darkened complexion 
to the last. So, likewise, the internal congestive state re- 
mains long after death. 
We have no evidence of any absorption by the alimentary 
mucous tissue, in the severest state of the disease. It is 
true that thirst is intense, from the want experienced in the 
circulatory vessels. But fluids are not taken with great avid- 
ity unless cold. Cold drinks are sought for to soothe the ere- 
thism of the mucous tissues, and they afford some momentary 
relief; the fluids are either vomited, or discharged with the 
abundant exhalations, but they are not absorbed to supply the 
waste of fluids, and the whole body suffers a rapid marasmus ; 
even so much so that the skin becomes wrinkled. Still it 
should be understood that the shrivelled state of the skin is 
occasioned by the adstrictive, or tonic state of this tissue. 
Spasms. 
h. It is nothing extraordinary, and indeed very much in 
accordance with other severe affections, that spasm should 408 
CHOLERA. 
compose a part of the group of symptoms of the first stage of 
cholera, like most other malignant diseases. The abdominal 
nutritive nerves experience much of the primary assault of 
disease. These spasms arise from irritations on the extrem- 
ities of these nerves distributed to the muscles, along the 
coats of arteries. The great derangements of the circulation 
throughout the muscular tissues, and want of warm oxygena- 
ted blood, will be liable to excite involuntary movements in 
the muscular tissues. Their contractions may be severe and 
painful. No exercise of the muscles can have much effect 
in moving onward the blood, so long as the capillaries are 
held bound by the rigid nosodynamic force ; still we may even 
regard these muscular movements, as a part of the recupera- 
tive force, attempting to overcome the impediments. Tonic 
spasm is also present in the internal canals ; many instances 
are recorded of the common biliary duct being found con- 
tracted in autoptic examinations, in a manner to interrupt the 
passage of the bile ; the same is often found in the intestines. 
Vomiting in cholera is of the spasmodic kind ; and spasms 
constantly attend the alvine dejections. 
Resuscitation. 
i. Spasms and jerkings of muscles, so as to move the 
limbs, commonly occur several hours after apparent death ; 
and they show an attempt in the vegetative susceptibility to- 
wards resuscitation. In cholera, different from what occurs 
in apoplexy, the organs of external relation are the last to die. 
Intellect and sensibility often remain to the last. The fatal 
impression is on the system of the nutritive nerves, and these 
first cease in their functions, even, whilst there may be some 
gleams of intellect for a short time. Still both these systems 
of nerves may be in a state of paresis, and all their functions 
have ceased, whilst there is yet a redeeming trace of anima- 
tion left in the primitive susceptibility. (Sect. v. 3 and 7.) OUTLINES OF THERAPEUTICS. 
409 
There may yet be hope of resuscitation, when under all 
these adverse circumstances, the death of the nervous sys- 
tems should give opportunity for the relaxation of the noso- 
dynamic force, and afford opportunity for the absorbing pro- 
cesses to take some effect, by an effort of the vegetative sus- 
ceptibility. We esteem these briefly expressed yiews as 
something more than mere chimeras. Surely there have 
been many instances of reanimation, even after some length 
of time, in various affections not complicated with irredeema- 
ble lesions of the organs. 
There are some facts recorded of resuscitation having actu- 
ally taken place in cholera; and others manifesting signs of 
such an event, which, if suitably aided at the proper time, 
might perhaps have been successful. It has often been 
remarked, that several hours after apparent death, the body 
grows warm, that had been as cold as marble ; and the coun- 
tenance assumes some degree of freshness, which before death 
resembled the cadaver. Yet in most of these instances there 
was not enough of returning vital energy to effect resuscita- 
tion. 
There is quite satisfactory evidence of resuscitation having 
taken place in cholera sometimes, and without going abroad. 
A sufficient amount for our present purpose may be found 
near home, in an excellent essay on cholera, by Dr Thomas 
Spencer, of New York ; even enough to astound the scep- 
tical incredulity of any consistent mind. The liberty will be 
taken of making some transcripts. 
Speaking of resuscitation from apparent death following a 
state of collapse, he says, u Facts sustain this conclusion. In 
answer to a circular, inviting information on this subject, 
Professor Potter, of Baltimore, says : ' I saw no case of ap- 
parent death from collapse, followed by convalescence, 
though I have learned from high medical authority, that two 
cases, apparently dead from collapse, were resuscitated. 
They are now in good health. I have seen them both within 410 
CHOLERA. 
the last week.' Dr Noyes Palmer, of Cayuga, remarks : 
' that two had recovered from apparent death, one of whom 
was actually laid out upon the board, and the coffin prepar- 
ing.' Dr Lyman Celary, of Salina, remarks : I saw a child, 
three years old, in which, at two hours from the attack, respi- 
ration and pulsation ceased ; the child was laid by, and a 
shroud prepared. Some hours after, the child was perceived 
to move, and recovered so as to call its mother by name. It 
died, however, about fourteen hours from the attack.' Aider- 
man Barnes, and Mr Gore, of New York, mentioned two 
cases of the kind within their knowledge, one of whom, a wo- 
man, was apparently dead from an hour to an hour and a 
half, and subsequently recovered. The other case was a 
man, who was apparently dead for a longer time, afterwards 
revived, but subsequently died of consecutive fever. Ai- 
derman Coxe, of the same place, mentioned to me that there 
were some cases in the Bellevue almshouse, that were appa- 
rently dead for several hours, and afterwards recovered." 
We might remark that the evidence is of too loose a nature 
to be received in a court of judicature, and yet we may give 
it fidl credence. So, also, we might add, that we were cre- 
dibly informed of two cases at Montreal, in 1832, of resusci- 
tation after apparent death by cholera, but we are unable to 
say more. 
Indication of Treatment. 
j. After having stated in the most concise manner what we 
conceive to be the fundamental principles of the pathology of 
cholera, we shall decline any attempt to suggest a remedy. 
Still we are free to suggest, that if ever a successful method 
of treatment should be found, it will consist in means directed 
to the removal of the strong nosodynamic state of the tissues ; 
(Sect, xviii. 4, 10,) thereby affording opportunity for other 
adjuvants to establish all the physiological movements in 
their proper courses. OUTLINES OF THERAPEUTICS. 
411 
8. Dysenteria maligna. 
Preliminaries. 
a. The history of the phenomena of this disease is so well 
described by many writers, and so well known, that we do 
not need to say more than is mentioned in the nosography. 
It most commonly prevails in hot seasons, particularly July, 
August, and September, and sometimes later. We once 
knew it as an endemic in the month of March, when the wea- 
ther was cold, and the ground covered with snow, but the 
disease was not of the malignant kind. It is not contagious, 
but great numbers may be affected at the same time, and es- 
pecially on a change of weather from hot to cold. Slight 
causes excite it, when the system is prepared for it by the 
remote causes. It finally obeys the laws of other epidemics, 
but the local conpentrations of irritation and inflammation are 
in the rectum and colon, and give occasion to a modified 
train of local phenomena; whilst the diathesis is subject to 
the same modifications as other pyrectic diseases. 
It has often proved very fatal in New England, and maybe 
esteemed as one of the great scourges of mankind, in different 
regions, destroying armies and collections of people nearly 
equal to the plague, and has been denominated the plague in 
the bowels, camp disease, bloody flux. Dr Mosely ob- 
serves, " The page of military history weeps less for the 
slain in battle, than for those fallen victims to this calamity." 
Pathological Character. 
h. Like all other epidemics, this disease appears some- 
times in the- synochoid, and at other times in the severe 
typhoid character. It is the latter state we are more re- 
stricted to treat of in this place, but our expositions may 
easily embrace both conditions, by making reference to the 
previous illustrations on these different states. 412 
DYSENTERIA MALIGNA. 
Perhaps the character of this disease was never so well 
portrayed as in the laconic definition of Sydenham, when he 
said, it was a fever turned inwards upon the intestines. It 
truly consists of a fever ; but the intensity of visceral erethism 
is so great, that the surface is anaemic and cold, so that a su- 
perficial observer might conclude there was an absence of 
fever. The same venous congestions are found on autoptic 
examinations, as in typhoid fever, with a membranous inflam- 
mation in the mucous coat of the rectum, and extending 
along the colon, often its whole length, and in solitary patches 
some further. Sometimes the muscular and serous coats are 
slightly affected, and liable to become gangrenous. 
The mucous surface of the intestine is covered with a vis- 
did sanies, which being scraped off, show red inflamed points 
from which blood is exhaled along with serum, and uniting 
with the secreted mucus in gome abundance. It consists of 
an extended membranous inflammation, which is most intense 
at the sphincter ani, exciting severe tenesmus. In the syno- 
choid state, the excited mucous surface presents an extended 
red appearance, whilst in the typhoid it is dark, and some- 
times nearly black. The whole of the intestinal canal is mo- 
derately distdnded with gas, and rarely contains much besides 
some mucous sanies. When in severe cases the disease 
mitigates, the mucous surface of the rectum is liable to be 
cast off, and discharged in shreds, followed by a muco-puru- 
lent discharge, constituting chronic dysentery, with an ex- 
citation extending to the other intestines. 
JWethodus medendi. 
c. The severity of typhoid dysentery is often so intense., 
as to destroy life in a few hours ; it therefore requires to be 
met with decision in the treatment. When it prevails in epi- 
demic seasons, no time should be lost at the onset, of em- 
ploying the most efficient means to arrest the severity of its OUTLINES OF THERAPEUTICS. 
413 
progress, and these same measures often greatly cut short the 
disease. If other typhoid states of disease require a diver- 
sion to be made to the external surface, then surely this dis- 
ease most imperiously demands it. We discover in every 
habit of disease at the onset, a retrocession of vital action 
from the surface to the internal tissues, unless the exanthems 
may be considered exceptions ; and even these do not show 
their eruptions sometimes, without difficulty. As dysentery 
has a fixed point of concentration internally, attended with 
much distress, this requires to be diverted from the part, and 
action more equally' eliminated to other organs, and to the 
surface in particular. The intention then will be, to divert 
the circulation from the centre to the circumference, and 
guard on the one hand against a fatal collapse, and on the other, 
in due time, against excess of responding action. 
External warmth is always required at the access of this 
disease ; and not only warmth but sweating is necessary. 
The capillary vessels of the skin should be made turgid with 
blood, in order to save the internal pressure and injury of the 
tissues. This action requires to be sustained for a consi- 
derable length of time, until the force of the disease may be 
subdued. Having been particular in describing the treatment 
of the typhoid diathesis, we need not spend much time on 
this habit of disease, for it requires very similar management ; 
it is only another modification of severe typhoid disease, or 
fever. 
Emesis has a very favorable effect in this disease ; it pro- 
pels circulation to the surface, and promotes sweats. A full 
and free vomiting, together with sweating, we have often 
known to arrest the disease in a short time ; but it is not sure 
to be so prosperous, without the aid of blood-letting ; even 
these are not always sure to arrest it suddenly. Cerated 
glass of antimony, ipecacuanha, or tartarized antimony may be 
used. Vomiting may be practised nearly every day until the 
disease becomes mild. 414 
DYSENTERIA MALIGNA. 
Bleedings should be extended to the point of relief in chil- 
dren, as well as adults, and taken from the arm. The first 
shows a carbonized blood, but if repeated, the after bleedings 
show a more florid blood, and probably the synochoid diathe- 
sis may be developed, when the case may be easily managed. 
The warm bath is very useful, and when convenient may 
be frequently repeated, until there is a mitigation of the dis- 
ease. By this, capillary action is more steadily sustained on 
the surface ; besides its softening and cleansing the skin. 
The false notion of exposing the body to cool air, in order to 
obviate gangrene, is most absurd, and has caused the death of 
thousands. 
The abdomen and perineum should be frequently bathed 
with a tincture of opium and camphor ; then well covered, 
unless heat prevails, with cotton batting, made tight by a 
bandage. Sometimes cloths dipped in a warm decoction of 
aromatic herbs, or in warm milk, may be applied, after being 
well wrung out. These applications should be used with 
discretion ; sometimes omitted, and dry substances applied. 
No opium should be--given internally, unless a single dose at 
the beginning, when the disease is attended with great tor- 
mina, and perhaps much vomiting. It is better to aim at a 
radical cure, than to smother the disease, for it will show 
itself with more violence, after the use of this article. Still, 
nature will triumph sometimes, over very improper treatment. 
The same as in other pyrectic cases, opium only gives a de- 
ceptive respite, and the disease will be more prolonged, and 
made more dangerous by its use. It often occasions a sup- 
pression of urine. This symptom never has occurred in our 
observation where opium has been withheld. This accords 
with the experience of Dr W. Philip. "Many writers 
mention suppression of urine among the symptoms of this 
disease (dysentery), but as I have never seen anything like it 
occur, where opiates or astringents had not been improperly 
used, I consider it rather as a symptom of mismanagement OUTLINES of therapeutics. 
415 
than of the disease. From opium I have often observed this 
effect ; and I have speedily removed it by increasing perspi- 
ration, and giving a cup of strong, clear, good coffee, every 
few hours."* 
No purgatives should be given until the third or fourth 
day; and we may wait still longer, unless pain at the umbil- 
ical region exists. They are sometimes necessary to dis- 
lodge the contents of the colon and csecum ; but not other- 
wise, for they are liable to give unnecessary irritation to the 
lower intestines. A solution of tartarized antimony in small 
doses, and repeated once in four hours, will often operate as 
a laxative ; or it may be assisted by castor oil, or an infusion 
of senna and. rhubarb, with tartrate of potash. Dislodging 
the hardened collections in the colon, often relieves spasmod- 
ic pains and tenesmus. 
Mucilaginous and demulcent drinks may be used as the pa- 
tient may incline to take them, being made as pleasant as pos- 
sible. Also, crust coffee, chocolate, beef tea, and chicken 
broth; but in the early stage of the disease no cold drinks. 
If the cure proceeds successfully, there may be a time, 
after several days, commonly a week, when vascular action 
has become permanent, with heat, and a florid countenance ; 
at which time thirst may be great, and the absorbing process- 
es are established. The patient may now desire cold water, 
and it may be allowed him by spoonfuls at first. If it is 
found not to produce pain in the abdomen, it may be given 
more freely. We have known some patients indulge largely 
in cold water for several days, and with very beneficial ef- 
fects. Absorption having taken its course, and the warmth 
become permanent, the system receives no injury, but the 
blood vessels become filled with the simplest and most agree- 
able of all diluents. In some cases attended with vomiting, 
this has ceased on the use of cdld water, and the patients 
soon restored without other remedies. 
* Treatise on Febrile Diseases, p. 405 416 
ENTERITIS MALIGNA, AND ILEUS. 
The chronic state of dysentery requires a strict regard to 
diet, and avoiding of cold. Farinaceous, and demulcent food 
mostly in a liquid form, animal jellies, and broths, are the 
most proper. Some astringents may be used, as a decoction 
of logwood, with gum arabic and allspice, sweetened with 
loaf-sugar; also, souchong tea, two ounces, boiled in milk 
and water, a pint each, and sweetened with loaf sugar, may be 
freely taken. According to circumstances it may be changed 
for prepared chalk, four parts, with carbonate of iron one 
part. Bayberry tallow and loaf sugar may be freely given. 
Also the nitrate of silver in pills containing one sixteenth of a 
grain each, three times in twentyfour hours. 
9. Enteritis maligna, and Ileus. 
a. There seems to be some ambiguity, and not a little con- 
fusion amongst nosologists, in their classifications and defini- 
tions of acute diseases of the intestines. The great extent 
of these organs, and being folded on themselves, their arbi- 
trary divisions, their being composed of different tissues, and 
performing functions in many respects considerably different, 
all serve to make discriminations of their particular diseased 
state rather difficult. The embarrassment is increased by the 
change of one apparent slate of disease into another, and of- 
ten the want of discriminating phenomena, to identify the ex- 
isting state. Thus, a mere distension of an intestine by air 
may suddenly be attended with intolerance of pressure, with- 
out any traits of inflammation discoverable on dissection. 
The first stage of inflammation may be more sensible to pres- 
sure ; but after effusion haj> taken place, pressure can some- 
times be borne without much increase of pain, even whilst 
the greatest destruction of organization is taking place. Other 
cases apparently similar have more sensibility. 
The natural signs are 'deceptive sometimes, not only on ac- 
count of the chief force of disease being thrown on tissues of OUTLINES OF THERAPEUTICS. 
417 
different sensibility, but on account of the different degrees of 
susceptibility for the time being bestowed on these tissues, by 
the abdominal nerves. The phenomena in the incipient stage 
of acute diseases of these organs manifest a state of ataxia, 
especially previous to their development. Some portions 
suffer a paresis, whilst others, as the stomach, may possess an 
increase of sensibility, and spasmodic action, with vomiting. 
We need to have in view certain cardinal principles ,in con- 
nection with general phenomena, which will indicate the state 
of the organs and the safest course to be pursued. Thus sud- 
den and extreme pain and distention of the abdomen, with a 
frequent hard .pulse, is certain to be succeeded by destruc- 
tion, not only of the functions of the organs, but of their or- 
ganization, unless seasonably obviated. It is proper to seek 
for every phenomenon that will indicate the particular state 
of the organs. 
Phenomena. 
b. The patient is suddenly seized with severe pain insome 
part of the abdomen, most commonly at the umbilical region. 
It is so intense in ileus, that he soon may be compelled to 
scream aloud, and toss about. The recti muscles are con- 
tracted in ridges, and become tense. There is soon a reflex 
action directed upwards to the stomach, which excites a dis- 
tressing spasmodic vomiting. This has the effect of a natu- 
ral effort to relieve the morbid derangements, and the pain 
suffers some mitigation. It soon, however, returns, and the 
same process is repeated in quick succession. This course 
is followed in enteritis, and also in ileus. 
The pain is more constant in enteritis and ileus, after the 
inflammation has become established. Still it is more severe 
at some times than at others, and the abdominal muscles are 
not drawn into ridges. The pulse is more full and hard. 
In this state there may be no constipation, and cathartics may 418 
ENTERITIS MALIGNA, AND ILEUS. 
operate freely in enteritis, but still give no relief, further than 
the mere expulsion of fecal matter, and if repeated they are 
liable to produde aggravation. The patient becomes thirsty, 
and if he takes drinks in either case, they are soon expelled 
by vomiting; in ileus there is liable to be thrown up, by an 
inverted action of the intestines, not only the contents of the 
duodenum, but also of the jejunum, ileum, colon and rec- 
tum, unless there exist some obstacles as constipation or in- 
tussusception, to interrupt the perverted movements. The 
vomitings in these cases are repeated to the last, and are ulti- 
mately effected by a convulsive effort of the stomach alone, 
mere belchings, without the aid of the abdominal muscles. 
Tympanitic swelling of the abdomen is liable to occur 
early, both in ileus and enteritis, most often in the former. 
As the disease advances the abdomen may be largely distend- 
ed. Pain becomes moderated at last, as sensibility diminish- 
es on the approach of a fatal termination. This is the com- 
mon event, unless the disease should be early removed. 
From the commencement, and in every variety of the in- 
ternal affections, whether from inflammation, obstruction, in- 
tussusception, or hernia, the surface is pale and ansemic, the 
countenance fallen, and expressive of anguish, whilst the in- 
ternal tissues are loaded with blood as in typhoid fever. Cold 
sweats also are very common. 
The pulse sometimes in ileus, is not accelerated until sev- 
eral hours, and even several days after the attack, or until in- 
flammation supervenes. It then increases in frequency to 
100 or 140 in a minute, whilst it is very small and feeble. 
The more strictly marked cases of enteritis, are commonly 
attended with a full and hard pulse for a time; but if unfortu- 
nate, the same kind of thready pulse soon supervenes. The 
morbid force now gains an ascendancy over the recuperative. 
The duration of these affections when not removed, are as 
various as their pathological conditions. Severe enteritis 
usually terminates about the third or fourth day ; yet some OUTLINES OF THERAPEUTICS. 
419 
have been destroyed within fortyeight, or even twentyfour 
hours. All the other affections may have nearly as speedy 
terminations, but are liable to be more protracted ; as the fe- 
ver and inflammation less early are manifested. There are 
cases of obstruction, of ileus, and hernia that have been pro- 
tracted for a fortnight, and then have had a favorable termi- 
nation. In these cases inflammation has not been so severe 
as to end in disorganization. Sometimes the subject becomes 
exhausted by fever and pain, whilst the organization remains 
entire. 
A case occurred within our knowledge, of intussusception 
of a fortnight duration, in a girl twelve years of age, in which 
no very judicious treatment was adopted. On dissection an 
intussusception of the ileum was found from above downwards 
of five inches, and doubled on itself in folds making three 
times this length. JVo inflammation proper was found, and 
the part was easily drawn out, and without adhesion. There 
were only rather slight vascular injections ; no distention nor 
accumulation. It was attended with tormenting pains, return- 
ing at short intervals. 
Pathological Character and Lesions. 
c. Much has already been advanced in relation to impres- 
sions made on the nutritive ganglia and their plexuses, in va- 
rious habits of disease. The organs now under review are 
in the neighborhood of these nervous tissues. Besides the 
circumstances of a primary general impression, they suffer 
more or less excitation from their contiguity to the seats of 
local concentration. Every excessive impression on these 
tissues has the effect of diminishing their nervous force, and 
the organs under their charge suffer in consequence, more or 
less of a paresis. This is so much the case, that all inflam- 
mations of the abdominal organs, even on the muscular and 
serous tissues, are never attended with the strong and full 420 
ENTERITIS MALIGNA, AND ILEUS. 
pulse of similar inflammations in the head or thorax, or even 
the external dense tissues. They are liable to show an early 
appearance of what is styled the typhoid state of disease. 
The weight of disease is concealed and liable to deceive. So 
in all the inflammations liable to supervene in the instances 
under consideration, their course is short, with a few excep- 
tions, and all the phenomena partake more or less of this dia- 
thesis. Even the most distinct cases of enteritis, where all 
the tissues of the intestine are involved, are attended with ra- 
ther a small typhoid pulse, liable to become tremulous and 
soon cease. 
In cases of ileus, the numerous autoptic examinations of 
different authors show, that gangrene may take place without 
the strong phenomena of inflammation,-and rather suddenly ; 
this shows an embarrassed state of the vital force of the 
organs. And again, Dr Abercrombie in his Researches on 
Diseases of the Abdomen, has shown, that in ileus, some por- 
tions of the intestine, for twelve or eighteen inches, are 
greatly distended with gas and some fluid matter, whilst other 
portions are empty and contracted, as in health. Thus alter- 
nately, contraction and distention. Substances are propelled 
along the calibers of the apparently contracted, or healthy 
parts, whilst the other parts have lost their contractility, and 
suffer great distention ; even so much as sometimes to rup- 
ture. These distensible portions, also, admit the contracted 
portions into their calibers, forming invaginations. Still this 
often takes place when no distention exists. 
May we not safely infer, that this inability of portions of 
the muscular coat to contract, arises from a deficiency in cer- 
tain ganglia to transmit nervous force to these particular 
tissues, whereby they suffer a paresis ? It is a common 
opinion that the contracted parts are held by a rigid spasm ; 
but we fully agree with Dr Abercrombie in his suggestions, 
that these parts have retained nearly their former contractility, 
being easily dilatable and looking healthy, whilst the distended OUTLINES OF THERAPEUTICS. 
421 
parts are those suffering inability, and affected with inflamma- 
tion and gangrene. Parts confined in hernia are deprived of 
their nervous force and circulation, so they quickly terminate 
in gangrene. 
There are instances of fecal collections attending ileus, 
which afford relief when they can be dislodged ; but the dis- 
ease runs through its fatal course the same when there are no 
collections, as when they exist. Cathartics are often ineffi- 
cient in ileus ; they cannot excite movements in the distended 
parts, and often increase distress and vomiting when used, 
until the nervous force is restored to the tissues. 
The quantity of fluid matter thrown up in ileus, by vomit- 
ing, shows that exhalations are made into the stomach and 
intestines, which have free communications with the stomach. 
The dilated portions of intestine contain some fluids, but the 
chief agent of distention is the air, or gas exhaled frOm the 
circulation. 
As stated in the preceding case, we have seen ileus with- 
out distention of gas, or any other collections. Such cases 
are liable to occur in various malignant fevers, but they have 
of late been particularly noticed in subjects who have died of 
yellow fever. Many lucid specimens may be found in Dr 
Cartwright's Essays on Yellow Fevqr at Natches, in 1825. 
From a very interesting case in the ninth volume of the Me- 
dical Recorder, page 254, we extract the following as 
appertaining to ileus. The case was a protracted one of 
fourteen days, in a robust man of twentyfive years of age. 
The dissection began jive minutes after death. " The sto- 
mach and duodenum contained a quantity of matter termed 
black vomit. Introsusception had taken place in two or more 
places in the small intestines. These intestines were very 
much contracted in several places, and on moving the bowels, 
which were yet warm, I found that introsusception would 
readily take place." "The membranes about the root of 
the coeliac artery were inflamed, but not so much so as in less 422 
ENTERITIS MALIGNA, AND ILEUS. 
protracted cases. The semilunar ganglion, and the plexuses 
of nerves proceeding from them, were evidently diseased 
the fine tissues enveloping them being of a scarlet redness." 
The next case was that of a man thirtyfive years of age, 
who died at the end of the first twentyfour hours ; took no 
medicine. 11 Dissection immediately after death." " The 
membranes immediately investing the hepatic plexus of nerves, 
the semilunar ganglion,'and all the primitive plexuses pro- 
ceeding from it, were very much inflamed ; so were those 
about the root of the lungs." Intussusceptions were found in 
this^ and in many other cases. 
These cases, along with many others, show the state of em- 
barrassment that the abdominal ganglia and plexuses must labor 
under in diseases of the typhoid character. Most certainly 
their nerves distributed to organs, must suffer various inabil- 
ities, and alter the organic movements, if not destroy them. 
The extraordinary circumstance, that invagination followed on 
moving the bowels in a case examined five minutes after death, 
whilst the tissues were yet warm and excitable, seems to de- 
monstrate, that it takes place in consequence of the complex 
actions of the circular and longitudinal fibres of the muscular 
coat of the intestines. These invaginations are commonly 
from below upwards. Are they sometimes excited by vo- 
miting ? We have no doubt that these displacements are 
oftentimes restored, when the constitutional disease is removed 
in due season, and healthy action otherwise established. 
It appears as a fair conclusion from the existing phenomena 
in ileus, also in enteritis in all its forms, and in adstrictive 
hernia, that there exists a primary change in the , tissues uni- 
versally, of a rigid adstrictive kind, as in other diseases of 
excitation, which may be denominated nosodynamia, with 
concentrations essentially in the region of the ganglia. This 
state first occurs^ although the patient may not be sensible of 
it, nor be able to trace the causes. It is the primary cause 
in the morbid state. (Sect, xviii. 4, 7.) OUTLINES OF THERAPEUTICS. 
423 
Soon after the above changes, spasmodic contractions of 
muscular tissues are liable to follow, and these are always at- 
tended with pain, and prone to be extended to other organs. 
Even tetanus is a secondary state, and may change into fever, 
and fever into that. 
Herniae of all kinds are liable to be attended with very si- 
milar constitutional phenomena, to those which occur in ileus ; 
and there are various instances of the intestines being bound 
down by a kind of ligamentary portion of old adhesions pass- 
ing over, or entwining them, in some of their convolutions, so 
as to intercept their functions. In every case of supposed 
intussusception, there ought to be a careful enquiry, whether 
an obvious or concealed hernia exists. A partial hernia may 
exist at the abdominal rings, which cannot be detected, unless 
some slight pain at this point might render it probable. 
Methodus medendi. 
d. Notwithstanding the complexity of phenomena attend- 
ing the affections under consideration, the chief attention 
requires to be bestowed on the general state of the system, 
having a special regard to the various existing modifications, 
and to the safety of the internal organs affected. The same 
intentions should be had in view, as heretofore suggested in 
malignant fever. We will first bestow some attention on 
[ Enteritis. 
e. This has been styled malignant on account of its seve- 
rity, sometimes destroying life in one day, and before the 
disease becomes fully developed. The patient is afflicted 
with extreme pain in the abdomen, and prostration of strength. 
The location is in all the tissues of the intestine, sometimes 
limited, but on account of the associability of the peritoneum, 
it often occupies almost the whole extent of the intestines, 424 
ENTERITIS MALIGNA, AND ILEUS. 
attended with effusions of various kinds, and sometimes gan- 
grene. Vomiting often attends, and many ataxic phenomena. 
When this is the case, it may be proper at the onset to 
give a single 'dose of opium of two grains, with ten grains of 
gum camphor ; or eight drops of cajeput oil may be used in- 
stead of the camphor. Heat should immediately be applied 
to the surface, as it is always cold and anaemic ; it should be 
continued until warmth is established on the surface, and the 
mesenteric engorgements are relieved. The warm bath is 
the most effectual, and we have before advised the manner in 
which this should be conducted. In addition, the abdomen 
should be bathed in a spirituous tincture of opium and cam- 
phor. This may be followed by a large epithem of a decoc- 
tion of aromatic herbs ; or an emollient poultice ; and these 
may be alternated. 
A full bleeding should now be taken, and it will have a far 
more happy effect, if it should be attended with syncope. 
The bleedings should be free even in patients apparently fee- 
ble. The pulse should be but little regarded in the early 
bleedings, for the paresis of the heart and arteries is such, as 
not to indicate the danger of the case, nor the necessity of 
the abstraction of blood. However, after these organs act 
freely, the pulse should be the index to determine the amount 
to be taken to render the case safe. 
The pain may be mitigated by the first bleeding, but if it 
should return in an hour, more blood should be taken,'and it 
should be suffered to flow until the pain is removed, and 
without any additional dose of opium. Finally the bleedings 
should be carefully repeated as long as there is any return of 
pain, and until a free warm sweat appears. The sooner the 
bleedings are extended to the point of relief, the less amount 
of blood will be required to be taken, as is well remarked by 
Dr Abercrombie ; and we may add, it will tend to the great- 
er safety of the organs. Leeching at the epigastrium, es- 
pecially in children, is also advantageous. OUTLINES OF THERAPEUTICS. 
425 
From the commencement of the treatment, an adult pa- 
tient should take one grain of tartarized antimony every hour 
until emesis is effected. As soon as this occurs he should 
take about the same quantity every four hours, unless a favor- 
able change takes place, when it should be stopped. He 
may be supplied with simple and agreeable drinks, but not 
cold ones at this stage, even if he should desire them. 
It is probable the tartarized antimony will have moved the 
intestines, if not by the second day some gentle cathartic may 
be used, but nothing that is drastic. If there should be any 
difficulty in procuring a discharge, a large emollient injection 
may be used. The usual light diffusive cordials may be used 
as opportunity presents ; also, beef tea, broths, &c. 
If the above treatment should be early begun and properly 
persisted in, we have much confidence of success ; but it 
may not be likely to succeed if we wait for a full develop- 
ment of the disease,- and a full pulse ; for the most extensive 
organic changes may take place before this event. Often 
twentyfour hours decides the case. 
Ileus, or Intussusception. 
e. Every measure in relation to the treatment of ileus is of 
a doubtful character. It is often difficult to make accurate 
discriminations, and sometimes more so to remove obstacles. 
There is a concealed state of disease which gives origin to 
the local impediments, and this ought first to be removed, or 
moderated as far as circumstances may permit. 
It is questionable whether intussusception, or incarcerated 
hernia ever occurs without a previous constitutional change. 
Hernia may continue for a long time with impunity, but sud- 
denly a change occurs in the general habit, it becomes con- 
fined, and cannot be set at liberty by ordinary means, and all 
the connecting tissues have embarrassed movements ; the tis- 
sues have assumed a morbidly tonic state. Intussusceptions 426 
ENTERITIS MALIGNA, AND ILEUS. 
arise in a similar manner, and sometimes in the severest states 
of general disease, as in malignant fevers, in which, had it 
not been for this condition, they would not have occurred. 
Constipations are always aggravated by a general diseased 
state. 
The diathesis in ileus is of a concealed typhoid character, 
and it is sometimes not developed until the tissues are disorgan- 
ized. The pulse does not indicate the state of the parts, but 
this must be learned by the pain, and general aspect. The 
heart as an organ is deficient of nervous energy, and cannot 
act with much force until the susceptibility of the nervous 
tissues is restored. We have already endeavored to enforce 
the importance of early attention to this condition of the mor- 
bid system. We know of no more efficient measures than 
have already been detailed. The indications are the same as 
in other typhoid states, and are to be accomplished by the 
same means ; external warmth ; bleeding according to the 
circumstances of the case ; agreeable diffusive, but evanes- 
cent stimuli, often repeated ; moderate vomiting, &c. In 
case of extreme exhaustion some wine may be given. 
If cathartics should be indicated on account of constipa- 
tion, they should not consist of the more drastic kind. We 
may give six. grains of calomel with large doses of castor oil, 
oi' pure olive oil; or in infusion of senna, manna, and anise- 
seed, to which may be added sulphate of magnesia, &c. 
Tobacco injections may be used ; ten or fifteen grains infused 
in a large proportion of water. The effect should be con- 
stantly watched, and if no bad results are observed, the in- 
jection may be repeated every hour, for several hours. We 
have seen sudden and destructive effects from using tobacco 
injections too freely ; the dose ought to be weighed. In 
some instances after using purgatives to a considerable amount, 
a large dose of opium, three or four grains, has been known 
to procure discharges by relieving spasm. It is, however, OUTLINES OF THERAPEUTICS. 
427 
liable to be followed by injurious effects on the general state 
of disease. 
The impediments to intestinal movements in ileus may be 
of the following kinds ; 1st, ligamentary bands of old adhe- 
sions ; 2d, condensed collections of fecal matter ; 3d, ina- 
bility of some portion of intestine to act with peristaltic force 
on its contents ; 4th, intussusception of the intestine in some 
part, or several parts ; 5th, collections of gas producing me- 
teorism, preventing peristaltic action. If the case should 
otherwise do well the gas may be absorbed ; and perhaps, the 
invaginations removed. 
The first impediment admits of no other chance of relief 
than the removal of general disease, and this is doubtful. 
The second may be relieved by the means already proposed, 
but the effects are doubtful. When the means to remove 
constipation have failed, and there is good evidence to be- 
lieve it exists from collections of fecal matter, we recom- 
mend the employment of galvanism, as suggested in Dr Aber- 
crombie's fifty first ease of his collections. It consists in the 
application of galvanism to the part of the abdomen which 
may be hard and tense. It is said "the application was al- 
most immediately followed by copious evacuations from the 
bowels, and it was continued daily for about ten days with 
the same uniform result." The application was usually con- 
tinued about twenty minutes each time, but sometimes the 
discharges would take place sooner. "The tension, and 
tenderness of the right side of the abdomen rapidly subsided, 
and in a few days every feeling of uneasiness was gone." 
The feces were black and hardened. The patient recov- 
ered. 
This process merits further trials. If galvanism really 
possesses the power of exciting diseased tissues as in this 
instance, it may be an important remedial agent. That it is 
a severe excitant in the physiological, and even lifeless state, 
has been amply demonstrated. 428 
ENTERITIS MALIGNA, AND ILEUS. 
Removal of Intussusception by suction. 
f. It is probable this accident occurs more frequently than 
has generally been supposed, since it is often discovered in 
autoptic examinations when not expected. It is liable to oc- 
cur in cases that are called cholera morbus, and cholera in- 
fantum, and many affections of the bowels. It has been 
mentioned that invaginations occur in malignant fevers, but 
they also attend more moderate fevers, and sometimes with- 
out giving great uneasiness, as it is a fact that inflammation 
does not always attend it. Sometimes the inflammation first 
concentrates on the part, and is very intense, and effusion 
takes place in about two days. 
Various methods have been proposed to reduce these dis- 
placements. Very large injections of fluids, either warm or 
cold, have been tried, but so far as can now be recollected 
with very little success. Filling the intestines with air, and 
swallowing several ounces of quicksilver, we think have been 
alike unsuccessful. The invagination can sometimes be de- 
tected externally, and gastrotomy has at various times been 
practised, but with little success. One case in a child six 
months old, was readily detected externally, and after vari- 
ous expedients had been tried, Professor J. C. Warren per- 
formed gastrotomy, but it was unfortunate ; for although a 
recent case, inflammation and effusion had taken place. 
This has been the most common event of this operation, and 
yet a few have been successful. 
In the ninth volume of the Medical Recorder, a successful 
case is recorded, as occuring in the practice of a German 
physician in 1825 ; the patient was an adult. It had been 
of ten days' standing, attended with extreme periodical pains, 
and after the failure of all the common expedients, even the 
swallowing of five ounces of quicksilver, gastrotomy was 
practised. The invagination was detected externally a little 
above the umbilicus. This case is alluded to for the purpose OUTLINES OF THERAPEUTICS. 
429 
chiefly of showing, that although of so long standing, there 
was no inflammation, nor collection of fecal matter, only one 
worm; two feet of intestine were involved. This was 
easily reduced, and the case was prosperous. Perhaps other 
cases by an operation have been successful, but it is believed 
they are rare. 
The following case fell to our lot in 1833, the substance 
of wThich was published in the Medical Magazine at Boston, 
in July, 1835. It was in a robust man of about thirtyfive 
years of age ; he was attacked suddenly with a tormenting, and 
as he expressed it, a twisting pain in the right iliac, or rather 
hypogastric region. It was pointed out by him as being near 
the internal abdominal ring; however, upon a close examina- 
tion, it was judged to be a little higher up than the ring. 
Nothing like a tumor could be discovered upon the most ac- 
curate touch ; the adipose tissue was rather thick. In the 
course of two full- days, the usual measures of bleeding, 
sweating, attempts at purgatives, &c., had all failed, and still 
the pain continued, and vomitings were very frequent. By 
this time there began to be a failure of vital strength. Our 
attention began to be turned on the propriety of the opera- 
tion of gastrotomy ; but still opinion was divided between 
the case being intussusception, or hernia at the abdominal 
ring, between the muscular plates of the abdomen. The 
latter view was rather increased by the circumstance of his 
having had inguinal hernia on the left side for several years, 
although it gave him no trouble at this time. 
In the perplexity of the moment, the recollection came to 
mind, of having read in some journal an account of hernia 
being frequently reduced, in Russia, by means of heated 
earthen pots applied to the abdomen, so as to produce suc- 
tion. We have since found it to be in the seventh volume of 
the New England Journal of Medicine and Surgery, for 
1818. 
In this case the abdomen was distended, but not very 430 
ENTERITIS MALIGNA, AND n.EUS. 
greatly, yet so far as to present a considerable large surface. 
A four quart glass vessel, tumbler shaped, was procured. 
The atmospheric air in the vessel was rarified by burning a 
strip of bibulous paper dipped in common proof spirit. It 
was suddenly applied, by placing one margin about an inch 
and a half from the pained part above, and dropping the 
remainder upwards, so as to include a large portion of 
the umbilical region. The suction was powerful, and a large 
concavity of the peritoneal surface of the parietes must have 
been the effect. He bore the process without any inconve- 
nience after the first shock. The vessel was suffered to 
remain about half an hour. 
The event of the process was, that the patient complained 
but little or nothing of his former pain, but merely a soreness. 
He vomited only three or four times after, although very fre- 
quently before, and in twelve hours had intestinal discharges 
freely, which gave evidence of their perviousness. His 
febrile symptoms soon vanished, and he wTas immediately con- 
valescent. We cannot say with precision whether this was a 
case of hernia or intussusception ; but from all the circum- 
stances, think it was most probably the latter ; whichever it 
might have been, it is difficult to resist the evidence that the 
displacement was restored, by the process used making 
changes in the organs, or their position. Until some oppo- 
sing evidence may be adduced, we shall consider this method 
as a very efficient means of altering the displacements both in 
hernia, and intussusception. 
It may be well to notice, that the process can be conducted 
more safely and agreeably, by exhausting the air of the re- 
ceiver by an air pump, as this gradual manner may not be so 
likely to injure the intestines as a sudden displacement might, 
whilst at the same time the degree of necessary exhaustion 
can be better graduated. The diameter of the open end of 
the exhausting glasses ought to be in proportion to the size OUTLINES OF THERAPEUTICS. 
431 
of the abdomen, and the adipose thickness of the parietes. 
The intention is to produce a concavity of considerable size 
for the rush of the intestines into it, and increase the chances 
of the invaginations being drawn out. 
Receivers of different sizes will become necessary in dif- 
ferent subjects. It may be suggested, whether in intussus- 
ceptions it may not be well to apply one on each side of the 
supposed spot ? Still, perhaps a single large one may be 
better. The operation may leisurely be repeated until some 
change is produced, but if adhesions have already formed, it 
may not be available ; neither in the case of gangrene ; it 
ought, therefore, to be one of the early processes. 
May we not calculate on some further advantages in this 
process, than merely reducing misplacements ? One espe- 
cially may be, the influence it may have in exciting circula- 
tion in the minima vascula of the abdominal organs and 
tissues, at an early period, before much inflammation has su- 
pervened. It promises to be a safe and effectual excitant, 
bearing some relation to external frictions, yet still more pow- 
erful. In this view, it may be useful in some states of ente- 
ritis, by producing another kind of action. In every point of 
view, it ought to be one of the early remedies, not, however, 
to be used until preceded by the warm bath and bleeding. It 
will be likely to be more efficacious before much inflammation 
or meteorism supervene, in which last event a concavity of 
sufficient size cannot be formed. 
In some invaginations of the small intestines there may be 
fifteen or twentyfour inches of the tube involved, and such a 
state might require several applications, to be used leisurely, 
before an evolution might take place. It may need to be 
repeated in hernia, and commonly at a little distance from the 
part affected. Much will depend on many particular adjust- 
ments to suit the case. We have at present a decided confi- 
dence that many advantages will attend the process when 432 
HYSTERITIS TYPHOIDES. 
rightly conducted, but it requires to be tested by further 
experience.* 
A slow state of intestinal movement is liable to produce 
constipation, which aggravates every condition of disease to 
which these organs are liable, and which ought to be obviated. 
For the purpose of exciting easy movements, we continue to 
urge the employment of the following laxative pill : 
R. Aloes socot. . . . . 2 § 
Gambogise, . . . . 2 3 
Rhei, . . • • .43 
Sapo. Castil. . . . 2 3 
Ammonias Mur. . . .13 
Vin. antimonii, . . . q. s. ft. mas. pil. 
One pill of four or six grains, commonly acts mildly in the 
morning, if taken at bed time. It excites exhalation in dry 
states of the intestines, and may be used in slow pyrectic 
cases to much advantage. 
10. Hysteritis Typhoides. Puerperal Fever. 
a. The diseases of this order are of the graver kinds, and 
designated by the term typhoides. Still this disease like all 
other fevers, partakes oftentimes much of the manifest ap- 
pearance of the synochoid diathesis. We have heretofore 
insisted that these are only modified states of the morbid 
habit, and that they are convertible. In the present disease, 
the common synochoid grade, by the severity of causes, or 
Preliminaries. 
* Since writing the above, our attention has accidentally been turned to a 
notice in the Boston Medical and Surgical Journal, Vol. XVII. p. 163, enti- 
tled, Use of the Air Pump in Strangulated Hernia. " In five cases of stran- 
gulated hernia, lately treated by Dr Reuter, at Berlin, he assures us that he 
succeeded in reducing three by means of the air-pump, although the symp- 
toms of strangulation were of the most unequivocal nature." Why may it 
not as well succeed in intussusceptions? OUTLINES OF THERAPEUTICS. 
433 
by neglect, or ill advised treatment, &c., may be converted 
into the typhoid variety. The general plan of treatment must 
be nearly the same, with certain modifications ; for we can 
only view the typhoid as a more aggravated state of disease. 
This affection is peculiar to child-bed women, and al- 
though it is usually treated of in obstetrical works, it ought 
not to be separated from the order of diseases which mani- 
fest a malignant appearance ; and wre may thereby divest it of 
the mystery usually attached to it, and show that it ought to 
be subject to quite similar treatment. The more obvious ap- 
pearances are of a nature to deceive and mislead those, who 
chiefly confine their views to exterior circumstances, without 
bringing into the account the real state of the internal eco- 
nomy. 
A woman in the puerperal state, appears in a prostrate 
condition. Truly she has borne many oppressions in the 
progress of gestation and parturition, both in body and mind. 
She is suffering the customary discharges ; her general aspect 
declares some considerable degree of exhaustion, which is 
often styled debility, and draws forth the finest sympathetic 
feelings in presenting her restoratives for her comfort and 
support. Active but misplaced benevolence is obtrusive in 
offering the choicest viands and richest caudles to obviate the 
debility, and ensure energy of body, land hilarity of mind. 
Prima facie evidence may give some occasion for such 
usage, but a review of the morbid economy will present a se- 
ries of facts, which strongly militate against this kind of man- 
agement. An inquiry into the condition of child-bed 
women, will develop a state of increased susceptibility, which 
fully demonstrates the incompatibility of using even the ordi- 
nary stimulations of health. Not only the hypogastric organs, 
but those of the whole abdomen, and the entire system, are 
suffering a state of morbid excitation. An intense state of 
predisposition actually exists, bordering close on disease, and 434 
HYSTERITIS TYPHOIDES. 
which requires vigilance on the part of the attendants to ob- 
viate. Disease is now readily excited. 
Predisposition. 
b. It may not be amiss to advert to some of the circum- 
stances which serve to form this state of predisposition. The 
first periods of gestation are connected with a state of irrita- 
tion. The new stimulations set up by the change of func- 
tions and dilatations of organs, although a natural process, 
produce a state of universal excitation. The phenomena all 
indicate an approximation to a pyrectic habit, such as costive- 
ness or diarrhoea, anorexy, vomiting, dryness and paleness of 
surface, pains in the back, head, and otherwise ; hyperaemia 
from retention of menstruation not required for foetal nourish- 
ment for the three first months ; dizziness, fulness and hard- 
ness of the pulse, &c. Blood taken at any period shows the 
phlogistic pellicle on cooling. 
A part of the foregoing circumstances continue the whole 
term of gestation, whilst others are occurring which have a 
tendency to keep up a state of excitation. The uterus greatly 
enlarges, it becomes highly vascular, it suffers much irritation, 
sometimes acquires too much hardness, at other times a state 
of mollescence, and liable to rupture on the approach of par- 
turient pains, or give occasion to severe hemorrhage on 
separation of the placenta. The elevation of the uterus into 
the abdomen carries on its surface a great extension of its pe- 
ritoneal covering, and displaces the viscera, producing com- 
pression, and often retarding their functions. There is liable 
to be but a small secretion of bile, pancreatic fluid, &c., for 
the greatest physiological energies are directed to the uterus 
to support its functions. Costiveness exists, with collections 
of fecal matter accumulating in the colon and csecura, partly 
from the compression they experience ; and sufficient care is 
not usually bestowed to obviate this circumstance. OUTLINES OF THERAPEUTICS. 
435 
Consider for a moment the condition of things at the time 
of parturition. The convulsive throes have agitated the en- 
tire system, and perverted, more or less, many functions. 
The circulation has been deranged ; the entire muscular sys- 
tems exerted to their utmost ability, followed by exhaustion 
for a time, and left in an irritative state with soreness. The 
uterus after the most severe exertions, suddenly colapsing on 
itself, and leaving the abdominal organs directly to resume 
their former positions, whilst they partly lack the support of 
the abdominal parietes. The peritoneum has suffered many 
frictions on itself, and now suddenly contracts; that portion 
covering the uterus suffers immense alterations. The uterus, 
os internum, vagina, labiae, and urinary bladder, have suffered 
necessary and sometimes unnecessary contusions. 
The recuperative powers become active in every restora- 
tive process, and in effecting alterations in the economy for 
the sustenance of the offspring from without. A new series 
of physiological movements take place, directed to the mam- 
mae, within fortyeight hours, and these organs become filled 
with a lactescent fluid. This natural process is necessarily 
attended with some commotion in the general economy, 
more or less nearly allied to a pyrectic habit. Still the sub- 
ject of our charge may do well, provided the strict rules of 
hygiene are well observed. But, how often are the salutary 
rules of prophylactics disregarded, and even obnoxious mea- 
sures intruded ? Instead of repose, gentle warmth, a mild 
fluid and farinaceous regimen, there often are obtruded 
spiced and spirituous cordials, opiates, high-seasoned food, 
and exposures to cold, with neglect of the alvine discharges. 
Surely under these circumstances, there exists a high degree 
of predisposition, which requires only a slight excitation to 
light the burning torch of the pyrectic habit. 
The various feminine idiosyncrasies modify the gestative 
phenomena. Some enjoy better than ordinary health ; but 
the greatest number, especially those of sanguine tempera- 436 
HYSTERITIS TYPIIOIDES. 
ments, suffer from hyperaemia, and the irritations resulting 
from it. To be in part secured from the probabilties of con- 
tracting puerperal fever, such subjects should be careful to 
preserve an open state of the intestines, and occasionally have 
some blood abstracted during gestation; and especially at the 
commencement of labor pains ; provided there should be 
pains about the body, with dry skin and thirst; and also when 
parturient pains make slow progress, with a rigid state of the 
os internum. Emollient injections and a dose of castor oil 
will afford facilities for a more easy labor. An attention to 
these circumstances will lessen the chances of an attack of 
the disease. 
The subsequent pains, called after-pains, are of a repul- 
sory kind, and excited for the removal of coagula, which are 
liable to collect in the uterus from the want of sudden con- 
traction. These ought not to be suddenly suppressed, but 
require to be moderated. Warm camphorated spirituous 
embrocations will do much in relieving these, if followed by 
a large piece of cotton batting over the abdomen, and mode- 
rately secured by a broad swathe. It may sometimes be 
justifiable to give a small dose of an opiate in such cases, but 
in seasons when puerperal fevers are rife, a conscientious and 
intelligent practitioner will be very cautious in this particular, 
and avoid as much as possible the probability of doing injury, 
for the sake of present ease. The liability to an attack will 
be increased by opiates, notwithstanding many have often used 
them with seeming impunity. These pains have considerable 
resemblance to the pains of puerperal fever, but they have 
evident remissions, whilst the pains of this state are more 
constant, and attended'with a more frequent pulse, and ten- 
derness in the hypogastric region. 
Phenomena. 
c. The previous sketch of the circumstances attending 
gestation and parturition, has brought us within a period of OUTLINES OF THERAPEUTICS 
437 
two or three days after delivery, when the system has got 
wrought up to the highest state of predisposition. This is 
the most common time for the attack of the disease, and 
whilst the system is most susceptible of extraneous impres- 
sions. Sometimes, however, it commences a little before 
delivery, or immediately after. Yet, there are some in- 
stances of its not occurring for a week afterwards. Most 
commonly there has been a slight exposure to cold air, espe- 
cially with dampness, a very short time before ; or after 
using cold drink, or handling cold damp clothes, or stepping 
on to a cold floor. 
A rigor more or less severe first takes place ; or a succes- 
sion of chills over the body. These are soon followed with 
pains in the hypogastric region, and perhaps in other parts of 
the body. The uterus soon enlarges and rises upwards, at- 
tended with a sensation of soreness on pressure. There is 
sometimes pain in the head, with nausea and vomiting. 
Sometimes costiveness exists, but diarrhoea is soon liable to 
attend, and may continue in a severe manner. A change in 
the lochia takes place, sometimes being wholly suppressed, 
and these are usually the worst cases. A return of this dis- 
charge is favorable, as it helps to disburthen the organ of its 
congestive state. Soreness and tenderness exist over the 
whole abdomen, with considerable enlargement. If the milk 
had been secreted, it ceases to be furnished. The general 
aspect is fallen, and indicates suffering ; mind is anxious, and 
full of solicitude. If delirium shows itself early, it is an un- 
favorable sign. The common phenomena of fever attend, 
with intumescence of the abdomen. 
The pulse becomes accelerated from the first, and soon 
amounts to 120 or 140 pulsations in a minute. It has some- 
times considerable fulness and hardness, but in many cases 
partaking more or less of the typhoid diathesis, it is quite 
small at first, and soon becomes very frequent and smaller. 
Hiccough is liable to occur, which aggravates the soreness in 438 
HYSTERITIS TYPHOIDES. 
the abdomen ; petechiae sometimes appear, also miliary erup- 
tions. The stools are commonly dark colored and fetid, and 
often hardened ; they are voided unconsciously in the worst 
cases. All the phenomena proceed rapidly, and the case 
terminates commonly in two or five days, either by a salutary 
crisis, or in death. 
A second chill or rigor sometimes occurs at uncertain in- 
tervals, which is a very unfavorable sign ; it shows that effi- 
cient measures have not been employed to remove the general 
state of disease, or that warmth has not been sufficiently 
maintained on the surface ; or that some imprudent exposure 
has occurred, when the case may be doing well otherwise. 
Organic changes. 
d. Autoptic examinations reveal extensive lesions in most 
of the abdominal viscera, which are produced in a short time, 
commonly in two or three days. The uterus and its appen- 
dages are found in a state of inflammation, sometimes, how- 
ever, only slight. It is usually encrusted with a dense effu- 
sion from the peritoneal surface, with a milky serosity diffused 
in the cavity, and commonly flakes of floating albuminous 
matter; it is enlarged and spongy ; a sloughy state of the os 
internum, and internally at the place of placental adhesion ; 
its veins sometimes distended with purulency. The ovaria 
softened in texture and livid. 
The bladder is often inflamed ; the omentum and intestines, 
with the mesentery, manifest traits of inflammation, by 
effusions and adhesions generally. The most imposing phe- 
nomena appear of course on the peritoneal coat, which has 
induced some to consider this tissue as the chief seat of the 
disease, and they insist it should be styled peritonitis instead 
of hysteritis. Still, the most important and leading pheno- 
mena point out, that the latter is the primary diseased organ. 
The associability of the serous tissue when inflamed, received 
what attention we could give it, Sect, xlviii. Art. 1st. OUTLINES OF THERAPEUTICS. 
439 
Pathological Remarks. 
e. it is a consideration of the first importance, that puer- 
peral patients should receive attention, not only during partu- 
rition, but for a sufficient length of time afterwards, for the ir- 
ritated state of the tissues to subside. It is a critical period, 
for whilst laboring under a state of. predisposition so intense, 
the most trifling circumstances may excite a morbid habit of 
much severity. Cold, spirituous drinks, opiates, high season- 
ed animal food, affections of the mind, and many other cir- 
cumstances may excite it^ 
When this takes place under all these circumstances, the 
changes occur in the minutest tissues extensively, the same 
as in other conditions of fever, which have been illustrated. 
There is a morbidly dynamic state induced. The vital tis- 
sues suffer an incredible state of condensation at the attack ; 
the vascular system is immediately contracted. Previous to 
the occurrence of this state, the subject would have suffered 
much inconvenience from the loss of more blood ; but under 
these morbid alterations, she bears large proportions of blood 
to be abstracted ; from thirty to fifty ounces, or even more, 
with advantage, as discovered by our own observation, and 
declared by Denman, Heys, and many other practitioners. 
Finally, the pathological alterations are quite similar to other 
severe states of disease. 
Although puerperal fever most commonly fixes its seat di- 
rectly on the organs above mentioned in the abdomen, yet 
certain idiosyncrasies determine the focal points to other or- 
gans and tissues. It is sometimes determined to the ence- 
phalon, producing insanity. At other times to various parts 
producing inflammation and abscess. Sometimes to the 
mammae, by which the uterus and its appendages are saved ; 
so also, if it essentially affects the bladder. Dr Denman 
says, "It is remarkable, that not one instance has been ob- 
served of any woman who had an abscess in the breasts being 440 
HYSTERITIS TYPII01DES 
attended with this fever ; nor of one in consequence of her 
labor, who had such an affection of her bladder as to occa- 
sion a suppression of her urine." 
So, again, in the instance of phlegmatia dolens attacking 
puerperal women in one of the lower limbs in its peculiar 
characteristic manner ; this never fails to save the uterus, and 
peritoneum from the dangers of puerperal inflammation, un- 
der suitable management. As this topic has been quite fully 
illustrated in Section xlvi. 10, under the article 'phlegmatia 
dolens, we need pursue it no further. 
JWethodus medendi. 
f. After having made the preceding expositions in relation 
to hysteritis puerperalis, and traced its analogy with other 
kindred affections, and as we have heretofore found that sim- 
ilar pathological derangements are removable by similar 
agents, in different habits of disease, it might appear unneces- 
sary to make much rehearsal of the measures to be pursued, 
except by general reference. Still so much depends on time, 
place, and quantity, together with the adaptations to individ- 
ual habits, it seems proper to make some specifications, and 
without intending to exhaust the subject. Furthermore, the 
early sympathies excited in years gone by for the casualties 
of that sex, which is doomed to much suffering and danger, 
in the propagation of the human kind, are still vivid, and 
prompt to the fulfilment of every imposing duty, and to leave 
as little chance for error, or misconception as possible, 
Our therapeutical notices will be very brief, and partly on 
the supposition, that every medical attendant will be able to 
make certain definite modifications, and substitutes according 
to his best judgment; never forgetting to discipline nurses 
agreeable to the strictest rules of hygiene. We will then 
take our departure from the moment the chill or rigor shows 
itself; and we may be assured the pathological changes in OUTLINES OF THERAPEUTICS 
441 
tissues are now formed, although the disease may require fur- 
ther time for its development. The intensity of disease will 
bear much proportion, if left to itself, to the severity of the 
rigors ; still not exactly in all cases. The rigors should be 
shortened as far as convenient by the use of external warmth, 
and internally by warm aromatic drinks, as sage, hyssop, cat- 
mint, &c., but without the use of spirituous cordials ; unless 
in small quantities in the more depressed conditions, when 
the recuperative powers are slow in reacting. Strong stimu- 
lations are liable to produce an unnecessary amount of res- 
ponding* action, and do violence to the organs before it can 
be restrained ; or to suddenly exhaust the vital force. No 
narcotic should be used, for it is our duty to aim at a radical 
and speedy cure, without stifling the disease, but rather let it 
show all its rage at the earliest period. 
The feet, legs, and arms should be bathed in warm water, 
well rubbed, and afterwards kept warm by substances applied 
in the usual way. The abdomen should be freely and re- 
peatedly bathed in warm tincture of opium and camphor, then 
covered with epithems made of hop flowers, leaves of tansy, 
&c. Care should be taken that the heat be not so severe as 
to become very oppressive, but some inconvenience will be 
experienced until sweat appears, after which they will be 
borne with ease. Reference may be had to the method of 
conducting sweats heretofore described. They must be 
steadily continued when once effected, but not so severely but 
that the patient can sustain them without much inconvenience. 
After about twelve hours the epithems may commonly be 
dispensed with, and large pieces of cotton batting laid over 
the abdomen, and moderately secured by a broad swathe. 
As soon as the patient is prepared for sweating, she should 
take either four grains of ipecacuanha every hour until emesis 
takes place, or two grains of tartarized antimony with ten of 
prepared chalk ; we prefer the latter. This should be done 
whether there is nausea, or even some vomiting, or not. 442 
HYSTER1TIS TYPHOIDES 
These should be continued until three or four vomitings have 
occurred. The process of vomiting is very efficacious in re- 
storing tissual derangements, as has been heretofore shown. 
As soon as the chills have ceased, and even before, if they 
continue long, blood should be taken from the arm. The 
amount must be determined by the case ; at any rate it ought 
to be sufficient to make a decided impression on the circula- 
tory system; say from twelve to twenty ounces. It will be 
a fortunate circumstance if syncope should take place. Res- 
toration is sure to follow, and along with it probably, vomit- 
ing and sweating, succeeded by relief. 
By this proceeding, in two or three hours we have gained 
a decided advantage over the diseased condition. The ener- 
gies of the morbid state begin to be employed in the estab- 
lishment of the natural processes, instead of destroying the 
internal organism. The amount of morbid tonicity acquired 
at the access of the disease is incredible, compared with ex- 
terior appearances, and not to be appreciated, without strict 
observation of the intensity of the phenomena, when the dis- 
ease is universally diffused ; or on an observance of the ex- 
tensive ravages done to the organism, when allowed to pursue 
its course. 
Notwithstanding the severity of the measures proposed, 
the patient does not lose either in muscular or vital force ; 
she will speak with more freedom, turn more easily in bed, 
and the pulse increases in force and fulness, provided warmth 
is still sustained on the surface. In either grade of this af- 
fection, whether synochoid or typhoid, we have the solemn 
trust of altering the state of the system in twelve hours at far- 
thest ; and it can be often done in six. By altering the state 
of the system we mean, to sever the morbid catenations tend- 
ing to the destruction of the organism, and exciting the natu- 
ral, physiological movements, and sustaining these, until the 
easy and equable motions of health are established. 
We mean to help and encourage the natural processes ; OUTLINES OF THERAPEUTICS 
443 
but, we mean to be expressly understood in cases of this 
character, that it is our duty to snatch such out of the con- 
trol of perverse physiological actions, tending to destruction, 
and turn them to safe courses ; as much so, as it is the duty 
of a guardian to oppose the bent of a froward child going 
precipitately to moral ruin. We are now prepared to say, 
we have not succeeded in sufficiently diminishing the morbid 
tonicity, and re-establishing the normal movements, until the 
centripetal, absorbing processes have obtained an ascendancy 
over the centrifugal, distributing processes. When this is 
once effected, and suitably sustained, the labor of future 
treatment becomes easy. It consists in merely guarding 
against excess of salutary processes ; for nature in her re- 
sentment as it were, for injuries received, becomes vindic- 
tive,-and now requires restraint. The most efficient agent 
we possess for this purpose is blood-letting, and this should 
be used to the necessary point of safety to the organism. 
The pathological investigations heretofore discussed, will af- 
ford sufficient illustrations for the comprehension of this para- 
graph. 
The amount of means to be used, depends altogether on 
the condition of the individual case. What we do to save 
the case must be soon done ; and it cannot be certain of 
being accomplished unless early begun. The disease should 
be opposed on the first access of the chills, or rigor. Every 
hour of neglect is invaluable time lost. Still the practitioner 
is too often denied this privilege, but exertions should be made 
to redeem the time, and this can be often done. The rapidity 
of abnormal movements is sometimes so great, that in six or 
eight hours from the rigor, the case becomes irrecoverable, 
or at any rate, success is rendered very doubtful ; whilst at 
the access it might have been controlled. In such events, we 
have to divide, the chances of success with the disease, by 
using more internal stimuli of an evanescent kind in cases of 
great exhaustion, with a hope of aiding the recuperative pow- 444 
HYSTERITIS TYPHOIDES. 
ers more than the morbid fixity. Then as occasion presents, 
in weakening the last by the first mentioned remedies, as far 
as the enlightened judgment of the adviser may direct. The 
condition of the medical attendant is not enviable, his respon- 
sibility is great, whilst the event so depending on contingen- 
cies may be doubtful. At all events the case must not be 
abandoned, so long as respiration continues ; for sometimes 
even in the struggles of apparent death, the recuperative 
powers gain an ascendancy, unless the organism is already too 
greatly spoiled. 
From these casual remarks, we may now turn back to the 
treatment begun in ordinary cases, and in good season. The 
first process of treatment will raise an indication for the 
second. If the patient at the end of three or four hours 
from the commencement of the treatment, should be free 
from pain, sweats moderately with a warm surface, and has 
inclination for repose, she ought not to be disturbed with any 
thing further for the present, except light nourishing drinks, 
and to see if all necessary adjustments are as they ought to 
be. Still she should be watched from hour to hour. If 
finally, at any time during the first twelve hours there should 
be abdominal pain, with tenderness on pressure, and espe- 
cially some slight inturhescence, then another bleeding should 
be taken, without having so much regard to the pulse as in 
many other pyrectic cases. The rule should be, to suppress 
the disease as early as possible, by a sufficiency of bleeding 
to render the case safe, and no more. Some experience is 
necessary in these cases, in order to conduct the treatment 
to the greatest advantage. Sometimes, one, at other times 
two, three, or four bleedings may be required in a short time, 
say two or three days. We have pursued such treatment 
with the highest satisfaction, and patients so treated almost 
invariably become convalescent by the third day. If not, the 
previous treatment has prepared the system to bear further 
depletion, if a continuance of severity of the disease should OUTLINES OF THERAPEUTICS. 
445 
require it. Action on the surface should be steadily sustain- 
ed ; if the circulation is not free it should be aided by exter- 
nal warmth. 
As soon as vomiting has ceased, and the patient had some 
respite, and if diarrhoea does not attend, a cathartic should 
be given of sufficient force to effect three or four operations. 
It will not be proper to give the most drastic kinds ; yet, the 
intestines are commonly loaded. Perhaps three grains of cal- 
omel, with half an ounce of castor oil; or an infusion of rhu- 
barb, senna, and anise-seed, to which may be added sulphate 
of magnesia. Even if some diarrhoea should be present, the 
upper intestines should be unloaded by cathartics. If these 
should seem to go to excess, still the discharges should not 
be suppressed by opiates and astringents ; nothing more than 
demulcents should be used ; for, this is often a critical dis- 
charge, and as such are the efforts of the recuperative powers, 
they ougl^t to be respectfully regarded. In ordinary cases 
there should be an evacuation of the intestines every six or 
eight hours for several days. 
In the early stage of this affection, there is seldom much 
opportunity for alterative medicines as they are called. Cam- 
phor in powder, or emulsion, may be used at any time 
when it seems agreeable to the patient. If thirst should 
be considerable after the disease has made some pro- 
gress, the patient may take thirty or forty drops of nitrous 
ether in tepid water, every hour or two ; or small and suita- 
bly adjusted proportions of carbonate of ammonia and vine- 
gar. Small doses of evanescent cordials may be given in 
cases of lowness, or faintness, as heretofore proposed ; also 
beef tea, chicken water, gruel, &c., but nothing of this kind 
should be much urged. 
Warm emollient injections are oftentimes useful ; not so 
much for aiding the catharsis, as an internal bath to ease pain 
and excite absorption. They may be made with linseed 
meal, oatmeal, slippery elm, or even milk and water. They 446 
HYSTERITIS TYPHOIDES. 
should be retained as long as may be convenient. If pains 
should persist in the abdomen, apparently spasmodic or in- 
flammatory, an emollient poultice may be used along with the 
embrocations at later periods. There is but little opportuni- 
ty for epispastics, and neither have we much confidence 
in them ; they are very troublesome, and more advantage 
may be gained by the embrocations, epithems, and poultices 
in exciting perspiration and absorption. In order to relieve 
any pains at a late period, after general bleedings have been 
extended as far as may be judged prudent, leeching would be 
preferable to epispastics. 
The termination of hysteritis is speedy, but uncertain. 
Ordinary cases may have an unfavorable termination between 
the second and seventh day. Successful cases may have a 
crisis between the second and fifth day. A favorable crisis 
is attended with ease, mild perspiration, yet sometimes pro- 
fuse sweat, or diarrhoea; renewed secretion of milk, and 
commonly some appearance of the lochia. Much depends on 
the treatment, and the time it was begun. Every case ought 
so to be treated, that in twelve hours from the rigors, the 
absorbing processes are steadily conducting the case to a 
favorable termination in two or three days, and without pain 
or any distressing symptom. 
Yet sometimes by some accident, the disease will suddenly 
be renewed, with a chill. In this event, we have to repeat 
the treatment. We need oftentimes to bleed ; we have taken 
full bleedings in some relapses, after we had but a day or two 
before taken as much as the system could reasonably bear. 
We have before expressed our surprise at the sudden replen- 
ishment of the sanguineous vessels, and also, their quick con- 
tractions in the production of a morbidly plethoric state. 
We insist, that the phenomena, treatment, and autoptic 
examinations all agree in establishing the character of this 
disease ; and its pathology cannot without violence be separ- 
ated from other affections of acute inflammations of the vis- OUTLINES OF THERAPEUTICS. 
447 
cera, and often partaking of the malignant, or typhoid grade. 
We need not therefore pursue the treatment through all its 
minutiae, as these have been often repeated. 
We need only advert to the employment of opiates or 
narcotics for a moment, as these are recommended by some, 
and liable to be used to give relief of pain. We have re- 
frained from advising them in any instance for many years, 
because the character of the disease, and our own observa- 
tions actually forbid them. Much opinion might be brought 
on both sides. We have conducted many successful cases 
for a succession of years, without using a dose of opium ; and 
always feel the most confidence of success by so doing; 
when especially considering our early trials of it, and observ- 
ing the practice of others. Those who have made the most 
use of opium have done it, either with false views of the 
pathology of the disease, or of the properties of the article. 
Believing that opium is a mere sedative, they give it to 
relieve pains, and do not look for its stimulant effect ; but 
they consider every increase of fever, as the necessary result 
of the diseased state. 
Drs Gordon and Heys, both bled very largely to twenty, 
thirty, and even sometimes to seventy ounces, at or near the 
onset, according to circumstances, that is, to the point of effec- 
tual relief. The former occasionally, but especially " every 
night," gave a full dose of opium; whilst the latter seldom gave 
any, and he expressly says, " the respite they afforded was but 
an insidious truce, and rather tended to prolong the disease." 
And again, " I frequently tried opiates, (in hysteritis^) but I 
think never with advantage."-The results were, that Dr Gor- 
don's patients generally had crises delayed to the fifth day, 
whilst Mr Heys' patients had almost uniformly favorable cri- 
ses " within two days." 
It is rather extraordinary, that Dr Armstrong should place 
as much reliance on opiates as on bleeding ; the last he car- 
ried to the utmost extent, and at the same time gave large 448 
HYSTERITIS TYPHOIDES. 
doses of opium. A contravention of the nature of things. 
Blowing hot and cold at the same time. We cannot discover 
why opium is of any more use in inflammation of the uterus 
and serous membranes of the abdomen, than in the serous 
tissues of the head, which are liable to terminate in hydro- 
cephalus. It is believed but few* would employ it in this case, 
if any. 
It is believed that some have been deceived by certain 
spasmodic, or neuraglic pains, colics, and after pains, which 
puerperal women are liable to, and which are relieved by 
opium. These ought to be discriminated from hysteritis. 
The spasmodic pains have intermissions, andtare destitute of 
the severe state of fever, frequent pulse, enlargement, and 
tenderness of the uterus, which occur in hysteritis ; whilst 
in this the pains are rather constant, or only with very slight 
remissions, and the pulse frequent and small. 
Some writers have divided this disease in the manner it 
appears, into sporadic and epidemic. The same division 
might be made jn almost all diseases. When it appears 
epidemically, that is, more extensively, it is proof that the 
remote causes act with greater intensity ; so, not only more 
cases occur, but the morbid diathesis is more severe, and of 
course inclines more to the typhoid state ; and further, that 
this state requires a more early and efficient treatment. This 
was noticed by that decided practitioner Mr Hey, and he 
came to the conclusion in this disease, however contrary to 
the notions of some, that in its epidemic form, it requires 
much larger bleeding than in the sporadic. This is in accord- 
ance with our own observations. It is the opinion of some, 
that in its epidemic form it is really contagious ; but, at 
present we are extremely sceptical on this subject, as we 
cannot trace such an analogy in the whole nomenclature of 
disease. INDEX 
Absobption, by external surfaces, 193. 
of gases by the skin, 194. 
by the nose and fauces, 195. 
pulmonary, 195. 
of azote, 196. 
of oxygen, 197. 
by the digestive mucous tissue, 198. 
by veins and lacteals, 205. 
by lymphatics, 2U. 
Acrotismus, 222. 
Adstrictive state of capillaries, ii. 349. 
Adynamia, 274, ii. 347. 
Alcohol, 374. 
producing narcotism, 374. 
injures intellect, 376. 
Aliment, 363. 
Albumen, 33. 
Alternations of heat and cold, 398. 
Anomalies in phenomena of disease, 309, ii. 7. 
in chronic affections, 310. 
in typhus gravior, 311. 
in gout, cholera, &c.,313. 
Antimony, 383. 
Antimonial pill, ii. 278. 
Antiphlogistic regimen, ii. 192. 
Arsenic, 383. 
Association of ideas, 88. 
Ataxia, 308, ii. 346. 
Attention, 88. 
Atmosphere, 396. 
Atmospheric pressure, removing, ii. 360. 
Atomic composition of primary animal substances, 36. 
Auxiliary constituents of animal bodies, 36. 450 
INDEX. 
Bile, inordinate flow of, ii. 24. 
Blood, 144. 
Blood-letting, weakening, 271. 
removes morbid tonicity, and restores energy, 272, ii. 370. 
Brain, plurality of functions, 82. 
experiments on, by Orlando, and others, 83. 
Broussais, remarks on his views of local irritation, 291, 297. 
Burns as exciting causes, 407. 
Caloric, deficiency of, ii. 353. 
Calorification, 215. 
Camp fever, ii. 372. 
disease, ii. 411. 
Canker rash, ii. 385. 
Capillaries, erectile state of, 162. 
Cardiac quiescence, 158. 
action, ii. 353. 
and arterial action, ii. 25. 
vacuum, 160. 
Carditis, ii. 209. 
Catarrh, ii. 240. 
Causes of disease stimulating, 268. 
predisponent or remote, 319, 322. 
exciting, 320, 388. 
primary, remarks on, 319. 
Cellular tissue, 103. 
Centrifugal circulation, 149. 
Centripetal circulation, 187. 
pathological notices of, 301. 
Cerebral masses, 80. 
destitute of sensibility, 81. 
plurality of function, 82. 
experiments on, 83. 
relative proportions, 86. 
functions disordered, ii. 355. 
Changes in the fluids, ii. 39. 
Chillsand rigors, ii. 11. 
Cholera, ii. 399. 
pathology of, ii. 400. 
remarks on, 313, ii. 53. 
Chronic morbid habit, ii. 251. 
Chyle, 201. 
Circulation, forced state of, 155. 
modified by age, 161. 
centrifugal, 149,300. 
centripetal, 187, 300. 
Climatic influences, 354. 
remarks on, 402. 
Clothing, 369. INDEX. 
451 
Cold sweats, ii. 21. 
Cold, 389. 
applications, 403, ii. 380. 
drinks, ii. 190, 381. 
dash, ii. 195. 
a positive agent, 389. 
condensing, 392. 
a tonic, 392. 
Coma, primary, ii. 26. 
Congestions, venous, 207. 
formation of, 303. 
of ganglia, 302. 
removing of, ii. 360. 
Conservative power, 315- 
Constitutional diseases, 280. 
arguments on, 282. 
Contagions, their access into the system, 241. 
Contagions and infections, 410. 
Contingent phenomena, ii. 8. 
Contusions, as exciting causes, 407. 
Converging circulation, 187. 
equable in health, 190. 
Convulsion, ii. 9. 
Cortical substance of the brain, 82. 
Crisis, 307. 
mild, ii. 57. 
severe, ii. 62. 
Critical days, ii. 61. 
Cynanche maligna, ii. 385. 
Debility, 268, 267. 
does not cause disease, 279. 
Dermoid tissue, 117. 
Diarhcea serosa, ii. 22. 
Diabetes simplex, ii. 23. 
Diathesis, typhoid, 306,jii. 64. 
phlogistic, 243. 
Diatheses, their disparity, ii. 66. 
convertible to typhoid or synochoid, ii. 68. 
factitious, ii. 71. 
Diathetical remaks, ii. 70. 
Digestion, history of, 198. 
Disease, what is, 234. 
definition of, 235. 
exists in solids and fluids, 238. 
of simple vegetative structure, 245. 
of nutritive tissues, 246. 
of nervous tissues of external relation, 248. 
antecedent to local affections, 280. 
Diurnal and sol-lunar influences, 413. 452 
INDEX. 
Division of capillary circulation, 153. 
Dothinenteritis, ii. 314. 
Dreaming, 225- 
Dropsy, ii. 332. 
character of diathesis, ii. 334. 
acute and chronic, ii. 334. 
remarks on, ii. 335. 
following scarlatina, ii. 343. 
Dysenteria maligna, ii. 411. 
Elevated orgasm of sense, intellect, and muscular power, ii. 87. 
Emesis, ii. 9, 276, 363. 
Emotions as exciting causes, 386, 408. 
Engorgements, ii. 348. 
Enteritis, ii. 210. 
maligna, ii. 416. 
Entity, 89. 
Epidemic lung fever, ii. 390. 
Epispastics, ii. 185. 
Epistaxis, ii. 305. 
Etiology, remarks on, 317. 
divisions, 319. 
Exciting causes, 319, 388. 
remarks on, 409. 
Excitations, increase vital movements, 69. 
in excess produce paresis, 70. 
Exercise, 367. 
in excess, 368. 
Exhalations, 168. 
gaseous, 170. 
pulmonary, 178. 
serous, 172. 
Faintness, ii. 11. 
Fatigue as an exciting cause, 405. 
Fever, hectic, ii. 254. 
Fibrin, 34. 
Fibrous tissue, 105. 
harmonies in, ii. 214. 
Fluids, proportions of, 31. 
morbid changes in, ii. 39. 
Force, vegetative, nutrient, and nervous, 96. 
Ganglia, ii. 353. 
Ganglial system of nerves, 63. 
Gaseous fluids, 172. 
dermoid imbibition of, 194. 
Gastritis, ii. 209. 
Gelatin, 32. 
Georg, DF, experiments, 304. INDEX. 
453 
General disease, 282. 
Dr Sanders' views of, 285. 
Glandulae solitariae, (Brunner,) ii. 55. 
agminatae, (Peyer,) ii. 55. 
Gout, ii, 212. 
a state of modified rheumatism, ii. 214. 
combined with a lithic diathesis, ii. 216. 
increased susceptibility, ii. 217. 
misplaced, or atonic, ii. 217. 
regular, and retrocedent, ii. 218. 
temporary treatment, ii. 210. 
radical treatment, ii- 228. 
Harmony of movements, 63. 
existing in disease, 246, ii. 5. 
Hemorrhage, ii. 301. 
Haematemesis, ii. 308. 
Haemoptysis, ii. 264, 306. 
Haemorrhagia intestinalis, ii. 308. 
Heart and arteries, 149. 
morbid action of, ii. 29. 
Heat, 389. 
an expanding force, 390. 
considered pathologically, 395. 
animal, modified by evaporation, 396. 
as a remedial agent, 403. 
morbid, ii. 31. 
Hectic fever, ii. 254. 
Hemorrhagic effort, 361. 
Hepatitis, ii. 211. 
Hernia, ii. 423. 
Hippocratic aspect, ii. 63. 
Hip sloughings, ii. 331. 
Hooping cough, ii. 295. 
Hospital fever, ii. 372. 
Humoralists and limitarians, 240. 
Hydropic diathesis, ii. 332. 
Hysteritis typhoides, ii. 432. 
predisposition, ii. 434. 
phenomena, ii. 436. 
lesions in, ii. 438. 
pathology of, ii. 439. 
treatment, ii. 440. 
sporadic and epidemic, ii. 448. 
Ideas, simple and complex, 88. 
Idiosyncrasy, 358. 
constitutional, or connate, 358. 
adventitious, 358. 454 
INDEX. 
Idiosyncrasy, purulent, 361. 
Idio-miasmata, 352. 
Ileus, ii. 416, 425. 
Impaired state of the exhalations and secretions, ii. 32. 
Inanition rarely causes disease, 278. 
Indications in severe typhus, ii. 357. 
Infections, 410. 
Inflammation, exanthematous, ii. 33. 
membranous, ii. 33. 
parenchymatous, ii. 33. 
Influenza, ii. 240. 
Inherent force of animal structures, 96. 
Injections, of brandy, tobacco, ii. 361. 
Instinctive susceptibility, 66. 
Intellect, 91. 
Intermittents, ii. 16. 
Intense thought, 385. 
Internal faculties, 87. 
Intussusceptions, ii. 425. 
their removal by suction, ii. 428. 
Iodine, 383. 
Iron, 333. 
Jail fever, ii. 372. 
Judgment, 89. 
Kidneys, their function, 173. 
Kaino-miasmata, 352. 
Lacteal absorption, 203. 
Laryngitis, ii. 197. 
Laxative pill, ii. 432. 
Lead, 383. 
Lesions, intestinal, in typhus mitior, ii. 316. 
in phthisis, ii. 322. 
in cholera, ii. 322. 
in scarlatina, ii. 322. 
in the encephalon, ii. 47. 
in the thorax, ii. 48. 
in the abdomen, ii. 50. 
Libidinous excesses, 376. 
Life and death forced states, 60. 
Limitation of diseased action, ii. 44. 
Linguitis, ii. 197. 
Liver, remarks on, 213. 
Local affections, 256. 
liable to metastasis, 289. 
M. Broussais'view of, 291. 
Dr S. Smith's views of, 291. INDEX. 
455 
Local concentrations, u- 351. 
Local atmospheric contaminations, 332. 
sensible effluvia, 332. 
insensible effluvia, or miasm, 335. 
Lumbago and rheumatalgia, ii. 234. 
Lymph, 212. 
Lymphatic absorption, 212. 
Malaria, 335. 
its non-existence, 337. 
Maculae, ii. 348. 
Medulla oblongata, 74. 
Memory, 89. 
Meningitis, ii. 193. 
treatment of, ii. 194. 
cold dash in, ii. 195. 
Mercury, 381. 
Miasm, 335. 
negative suggestions of, 337. 
Mineral poisons, 380. 
Modification of diseased capillaries, 305. 
Modified diatheses, 256. 
Modem pathological doctrines considered, 260. 
Morbid habit, 252. 
phenomena of, 255. 
Morbid action, grades of, 305. 
Mucus, 35. 
Mucous tissue, 112, 298, ii. 51, 55. 
Muscular tissue, 124. 
Mutations of disease, 350. 
Narcotism, 375. 
Narcotics, 372, ii. 282, 
Nerves, simple and compound, 92- 
of external relation, 73. 
Nervous force not a secretion, 71. 
liable to concentrations, 72. 
fluid, remarks on, 77. 
function, plurality of, 73. 
Nosodynamia, 263,269. 
treatment in proof of its existence, 270. 
its persistiveness, 273. 
its influence, ii. 67. 
Nutritive system of nerves, 62. 
their function persistive, 65. 
three orders, 65. 
distribution, 67. 
tissue, 136. 456 
INDEX. 
Opium, 377. ii. 187, 225, 298. 
Orchitis, ii. 211. 
Organic formations and apparatuses, 40. 
Osseous tissue, 142. 
Pain, does not excite disease, 293. 
Paleness, ii. 11. 
Pancreas, ii. 56. 
Parenchymatous tissue, 130. 
Paroxysms, periodical return, ii. 14. 
of intermittents, ii. 16. 
of neuralgia, ii. 15. 
of epilepsy, ii. 16. 
Passions, as exciting causes, 408. 
Pathogeny, 317. 
Pathological notices, 229. 
expositions, 232. 
theorem, 232. 
thesis, 287. 
Periostitis, ii. 211. 
Peripneumonia notha, ii. 241. 
Peritoneum, morbid states of, ii. 50. 
Pertussis, ii. 295. 
Pestilent afflatus, 322. 
its extensiveness, 323. 
its origin, 323. 
modifications, 326. 
mode of impression, 327. 
of cholera, 329. 
Pharyngitis, ii. 197. 
Phenomena, of acute disease, 253. 
of the chronic morbid habit, 255. 
primary in disease, ii. 10. 
at the acme of disease, ii. 28. 
resulting, third series, ii. 43. 
resultant in the internal tissues, ii. 46. 
in the encephalon, ii. 47. 
in the thorax, ii. 48. 
in the abdomen, ii. 50. 
in the mucous tissue, ii. 51. 
two trains, ii. 67. 
Phlegmatia dolens, ii, 228. 
Phlogistic diathesis, 243, ii. 41. 
Phrenology, remarks on, 95. 
Phthisis pulmonalis, ii. 43. 
causes, remote, ii. 246. 
exciting, ii. 248- 
proximate, ii. 249 INDEX. 
457 
rntmsis, cnronic, mornia naoit, u. 26i. 
hectic fever, ti. 254. 
history, ii. 254. 
mucous tissue affected, ii. 255. 
tubercles, ii. 257. 
pulmonary vomicae, ii. 261. 
g trachealis, ii. 262. 
ulterior haemoptysis, ii. 264. 
on avoiding it, ii. 264. 
treatment, ii. 267. 
typhoid state of, ii. 273. 
cases, ii. 262, 274,276, 287, 291. 
Physiology, definition, 29. 
Physiological thesis, 285. 
Pill, laxative, ii. 432. 
hellebore, ii. 233. 
antimonial, ii. 278. 
Plague, ii. 382. 
Pleuritis, ii. 205. 
Pneumonia typhoides, ii. 390. 
Pneumonitis, ii. 205. 
Pneumo-thorax, ii. 207. 
Pneumogastric nerve, 66. 
Predisponent causes, 319. 
Predisposition, ii. 10. 
Primary animal constituents, 31. 
Primitive tissue, 54. 
Primary changes in disease, 264. 
removed by mental excitations, 265. 
illustrative cases, 265. 
Prognosis, ii. 63. 
Puerperal fever, ii. 432. 
Pulmonary circulation, 176. 
structure, 176. 
depuration, 178. 
Putrid fever, ii, 372. 
Rale, ii. 63. 
Reaction, 315. 
Reason, 89. 
Reanimation, 61. 
Recuperative powers, 315. 
Reflex action, 288. 
Reiteration of epidemic diseases, 328. 
Relative portions of nervous matter, 86. 
hyperaemia, or plethora, ii. 30. 
Remarks, on the functions of the lymphatics and the liver, 212. 
desultory, on M. Broussais' doctrine, 297. 458 
INDEX. 
Remarks on cholera, and venous absorption, ii. 53. 
in reference to the study of patnoiogy, ii. 75. 
Remote causations, 322. 
Respiration, 182. 
Resuscitation, ii. 408. 
Rheumatalgia, ii. 234. 
Rheumatism, ii. 212. 
affinity to gout, ii. 214. 
method of treatment, ii. 219. 
chronic, case of, ii. 222. 
remarks on narcotism in, ii. 225. 
Rheumatismus cruralis, ii. 228. 
treatment, ii. 232. 
Rigors, ii. 11. 
Scarlatina, ii. 385. 
Sclerotitis, ii. 196. 
Scorbutic habit, remarks on, 242. 
Sedation, 276. 
Semeiotice, ii. 5. 
Sensations, 78. 
Serous tissue, 109. ii. 309. 
Shrivelled aspect, ii. 11. 
Simple tonic property of tissues, 38. 
Sleep, 219. 
Solids most to be regarded in disease, 240. 
Sol-lunar influences, 413. 
Spinal cord, 74. 
Spleen, ii. 56. 
Spotted fever, ii. 394. 
State of predisposition important, 295. 
Sthenia and asthenia, 258. 
Stimulants, 268, 373. 
evanescent, ii. 361, 398. 
Subtonic state, 279. 
Suction for removal of invaginations, ii. 428. 
of hernia, ii. 429. 
Sudoresis, 272. 
Sudor-anglicus, ii. 21,406. 
Sun-stroke, 396. 
Suppression of urine, ii. 211- 
Surfeiting as an exciting cause, 405. 
Syncope, ii. 9. 
Synocha, ii. 177. 
treatment, ii. 179,. 
remarks on blood-letting, ii. 180. 
on epispastics, ii. 185. 
on opiates, ii. 187. 
on tartarized antimony, ii. 189. INDEX. 
459 
Synocha, remarks on cold water, ii. 190, 
Synochus, ii. 237. 
Synoptical view of the vital tissues, 99. 
Synthetical method, 29. 
Tartarized antimony, ii. 189, 278. 
Temperament, the movable, 274. 
Thesis, pathological, 267,269, 270, 287. 
physiological, 285. 
resulting, 297. 
Therapeutics, ii. 175. 
Therapeutical remarks, 307. 
Thought, 88. 
intense, 385. 
voluntary, 385. 
impressive, 386. 
Tissual irritation, 280. 
Tissues, their origin, 37. 
simple elementary, 102. 
vital, synopsis of, 99. 
cellular, 103. 
fibrous, 105. 
serous, 109. 
mucous, 112. 
dermoid, 117. 
muscular, 124. 
parenchymatous, 130. 
nutritive, 136. 
osseous, 142. 
which most affected in disease, 244. 
simple vegetative, 245. 
of nutritive susceptibility, 246. 
nervous of external relation, 248. 
Tonsillitis, ii. 197. 
Tracheitis, ii. 197. 
mitis, ii. 243. 
Tubercles, ii. 49, 257. 
Tubercular idiosyncracy, 363. 
Typhoid diathesis, ii. 345. 
Typhoid fever, ii. 314. 
treatment of, ii. 323. 
Typhus mitior, ii. 314. 
gravior, ii. 372. 
icterodes, or yellow fever, ii. 382. 
petechialis, ii. 394. 
Ultimate composition, 30. 
Urea, 173. 
in the blood, 175. 460 
INDEX. 
Urethritis, and suppression of urine, ii. 211. 
Venous absorption, 205. 
Venesection, 271, ii. 180, 272, 365. 
Virus of the viper, 241. 
Vitality, 42. 
contrast between living and dead animals, 43. 
synonyms of, 43. 
not the result of organization, 44. 
its origin and universality, 47. 
compared with other aurae, 50. 
vegetative grade of, 54. 
in superadded nutrient nerves, 58. 
suspension of, 61. 
extensive influence, 62. 
Vital entity, 76. 
force, gradations of, 40. 
essence, its attachment, 77. 
quietus, 222. 
tonic property of tissues, 39. 
Vomiting, ii. 9, 363. 
Water, cold, washing with, ii. 265. 
Watching, as an exciting cause of disease, 405. 
White arterial capillaries, 167. 
Winds, as modifiers of sensible heat and cold, 398. 
Wounds, as exciting causes, 407. 
do not necessarily excite general disease, 29.1