? ' ■*-1v '. ,4^' =UA Surgeon General's Oifice «T ,_/'ec/ff>ie, h :* N-- It «"v A SYLLABUS OF THE LECTURES Delivered at THE MASSACHUSETTS MEDICAL COLLEGE TO THE Medical Student'&.■>$& HaWosrd) JJniversity. by JAMES JACKSON, m. d. Professor of the theory and practice of Physiclr. AD VER TISEMEJVT. With a good deal of labour I have prepared an imperfect syllabus of my winter course of lectures, which is delivered to medical students. It is designed only for those students. It is merely a syllabus and will be unintelligible to any, except those actually attending the lectures to which it refers. To them I flatter myself it will be useful. Un- der the head of Hygiene there is introduced more than is given in my winter course. This was done to accommodate the summer course which is delivered at Cambridge to the senior-sophisters, in which a large part of the lectures re- late to this branch of medicine. For medical students the limited period of their attendance is more profitably occu- pied on other subjects. The references to the various subjects in the syllabus do not bear any uniform proportion to the notice taken of them in the lectures. For this there are various reasons arising from considerations of expediency. I need not hesitate to avow however as one reason, that on some of the various subjects, on which the wisest and most learned physicians differ, my mind is not yet so fully made up, as to make me willing to commit myself upon them. J. J. Boston, October, 1816. a^.-. r/^^t^, *~? ~^~ ^ ep O" &Sj i^***~i *~*-£—\\K £~~<*~U o^ *" ~ ^~^~ ~ ' ^~^ SYLLABUS, &c. Subject of medical fcience. Its objects. Of the knowledge requifite to their attainment. Relates to matter and mind. Embraces their prop- er^, relations and laws. v'"Tne four great divifibns-of medicfeifeJ' I. PiEtyfi- % ©logy. II. Hygiene. III. ^Pathology. _ IV^ The- rapeutics. From thefe derived the rules* and pre- cepts of the practice of phyfick. The whole fcience not embraced in this courfe. How much belongs to Anatomy, Surgery, and Mid- wifery, to Animal Chymiftry, to Materia Medica. There remains to this courfe fomething in each di- vifion, I. PHYSIOLOGY. Extent in which the term may be em- ployed. Its reftri&ed ufe. It embraces a con- sideration of— i.(The compofition of our bodies. n. Their ftru&ure.^ in. The properties of our bodies and minds, iv. Their functions. Thus B [6 J far our race confidered in what is common to them. But confiderable differences are to be perceived among individuals. Of thefe we take notice under —v. Varieties. They all are influenced by and exercife an influence upon external things. Hence we confider—vi. The relation of the human fyftem to external things. It is by the agency of thefe that the functions of life are maintained. From a deficiency in them life may ceafe ; and, if it do not, it muft ultimately terminate by a lofs of the properties of vitality. Different modes of the termination of life confidered under—vn. Death. A very large proportioned!*what relates to this divifion [phyfiology] is taught in other courfes. Such parts will be confidered in this courfe as are not fo readily embraced in thofe. /. Compofttion of our bodies. * Elements ultimate and pro&imaje—the diftin&ion. "*- 1. Ultimate. Same as *n common matter Oxygen and certain combjiftible .mattejs. in cony pounds bimary, ternary, &c. Thefe combined alfcr in common matter, but not in the fame propor- tions, &c. Art cannot imitate their combination in living bodies. 2. Proximate. All the fubftances in our bodies compofed of the ultimate elements. The fimpleft combinations of thefe conftitute the proximate ele- ments. These elements compounded by living pow- a/' 6~~**^r **•/****"' -^"^'^ *-- [ 7 3 er, and when decompofed cannot be recompounded. Chymical compofitions remain perfecl,while defended from foreign influence';—vital compofitions the refult of life, and this requires foreign influence; and,how- ever aided, the vital compofitions are neceffarily tran- fient. If chymical compofition be deftroyed, the fame elements may be recombined and conftitute again the fame fubftance. Not fo vital compofitions, fuch as exift in proximate elements. The principal proximate elements to be found in blood. Albumen, fibrin, red globules. Fibrin fuppofed to conftitute one of the principal folids. In other parts the different proximate elements of blood not well diftinguifhed. Fluids derived from blood are exhaled, fecreted, excreted. Solids formed by analogous procefs. Exhalations nearly aqueous, fecretions alkaline, excretions acid. Secretions generally have the fame quantity of water as the " albuminous contents" of blood. Ex- halations have more. Secretions contain the albumi- nous contents and in each a peculiar animal matter. Excretions more compound. All contain free lac- tic acid, &c. 77. StruElure of our bodies. Taught in fchool of anatomy. Great importance. To be regarded as fimple and com- pound. 1. Simple. The ftrufture of the minute parts in different textures, as fibres, lamina, &c. [8] 2. Compound. The ftruaure of organs, in which ample parts, fimilar and diffimilar, are combined mechanically. In organs are alfo to be noticed their form and connections. 111. The properties of our bodies. Op two kinds, phyfical and vital. i. Phyfical, being properties which are alfo found in dead matter—.fuch as gravity, elafticity, electrical properties, &c. Likewife fuch as. are me- chanical, arifing from the configuration of organs, and their adaptation one to another. n. Vital. 1. Organic, belonging to all organ- ized beings; 2. Animal, peculiar to animals. Thefe not all found in every animal. 1. Organic. a. Mobility. b. Irritability. c. Vital affinity. d. Vivification. *f~ e. Synergy. ' • v*-"- «*»; ..... 2. Animal. In part corporeal, in part intellectu- al. The latter to be noticed only as they are con- nected with the former. f. Senfibiiity. g. Intellectual powers. h. Property of tranfmitting volition. i. Sympathy. ^u^^-^^^ -f:- _ 4^«-~i~^*/ &*~ Z* - iM^ZL *r [ 9 J a. Mobility, power of moving. Exhibited in mufcular fibres, in veffels and other parts. Generally confidered as derived from other organs. To be confidered in parts in which it is exhibited. The derivation of motion from nerves an hypothefis. If true, either motion takes place in nerves, in which cafe they poffefs mobility; or,if no motion takes place in them, they have not that property, but only the power to give it to other parts. In either cafe the property is diftinct from other properties. b. Irritability. The power of being affected by ftimuli, fo as that involuntary functions may be in- duced. Various in different organs. Poffeffed by all which have mobility and by fome which have not. c. Vital affinity. The power by which the ulti- mate elements of matter are united and kept in combination in living bodies. Exifts in fluids as well as in folids. Analogy with chymical affinity. Not inherent like that, but derived, and tranfient. Duration of life in individual particles very limited. d. Vivification. The power of bellowing vital properties on common matter. Whatever be the vital properties, they are given by the body enjoying life to that which was previoufly deftitute of life. This power exifts under different modifications in different parts. The matter afiimilated receives different properties in fuccefiion ; nor does all of this matter become endowed with every property. e. Synergy. The power whereby feveral or- gans, or parts of the fame, confpire to effect one ob- E 2 [ io] ject; acting either fimultaneoufly, or in fucceflion^ Diftinguifhed from fympathy. f. Senfibility. The power in our corporeal or- gans, on which external material fubftances act in producing perception. This property various, or modified in different organs. g. Intellectual powers. The mind may be con- fidered in a certain fenfe as uncompounded, or as a unit; yet it certainly performs various func- tions, and thefe by various powers. Thofe moft neceflary for us to regard are perception and volition. The firft enables it to recognize im- preffions made on the bodily organs ; the other to aft on bodily organs. h. Power of tranfmitting volition. In nerves going to animal mufcies. i. Sympathy. Etymology and original ufe. Ex- tenfion of the term to defcribe phenomena in living bodies. An influence exercifed by one part on others, more or lefs remote from it, without mechanical changes. Of Mr. Hunter's diftinction ;—continu- ous, contiguous and remote. Constitutional fympa- thy. Sympathy active, or paffive. IV. The funcJions of our bodies. The divifion of the functions and their relations. Of the divifion into vital, natural and animal.— Of Bichat's divifion ;—how preferable ; wherein defective—Two clafies. X J^ Sf XT'*' C n ] Fir ft clafs. Thofe appertaining to individuals.— Second clafs. Thofe appertaining to fpecies. Firft clafs. Two orders. Organic and animal. ■i. Organic ; common to all living organized .beings. In man thefe are ltf. Afiimilation, including a. Ma flic at ion. b. Deglutition. c. Digeftion. d. Abforptionof chyle. e. Sanguification. f. Circulation. g. Refpiration. id. Formation. a. Exhalation. b< Secretion. c. Nutrition. . 3d. Excretion. b. « a. Periftaltic motion. b. Lymphatic abforption. c. Perfpiration. d. Urinary evacuation. n. Animal; occurring only in animals; not all of them in every fpecies of animal. 1st. Senfation. a. Offmell. b. Of fight. c. Of hearing. d. Of tafting. e. Of feeling, including touch. 2d. Exercife of intellectual powers, as of— [ 12 ] a. Perception. b. Confcioufnefs. c. Attention. d. Memory. e. Reflection. f. Imagination. g. Judgment. h. Volition, &c. id. Exercife of bodily organs under the ob- vious control of the mind. a. Locomotion. b. Voice. Comparifon of organic and animal organs and functions. Animal organs divided by median line—their fymmetry and harmony. In two ftates—fleep and watching. Sleep perfect and total, or imperfect and partial. Subject to education and influence of habit. Organic differ in thefe refpedts—functions in a certain fuccefiion and dependence—liable to fympa- thy as the animal organs., but not fubject to control of mind—influenced by fleep, but not fubject to it. Some conftant, others occafional. How far influ- enced by habit. By animal functions external relations are main- tained and operations of mind performed. By or- ganic functions foreign matter converted to the ufe of the body, and internal economy of fyftem maintained. On them moft immediately depends the maintenance of health and of life. [ IS] Not independent of each other. Mind takes cog- nizance of the ftate of organic fyftem and controls fome operations neceffary to it. From the cog- nizance it takes refults appetite. The appetites con- fift in wants or defires, arifing from certain ftates of organic vifcera ; and though the mind does not dif- tinguifh what conftitutes thefe ftates, it has defires produced by them. Thefe appetites effential to prompt conduct, and the fource of very many of our actions. The mind alfo has fomething fimilar in this refpect—defire of knowledge, of ac- tion and of affection. * The mind controls fome operations of organic fyftem; as, particularly and principally, the evacua- tions. This control limited. Mind and body influence each other by fympa- thy ;—to be noticed hereafter. Second clafs. Three orders. Thofe of male, thofe of female, thofe common to the two. i. Thofe of male. a. Secretion of feminal fluids. b. Ejection of thefe. n. Thofe of female. a. Menftruation. b. Conception. c. Geftation. d. Parturition. e. Lactation. in. That common to both. Copulation. C 14 ] Relation of functions. Two kinds of relation. Firft. Mechanical ; depending on the connec- tion of organs, on their motions fuch as are obvious directly or indireaiy, and on the tranfmiffion of matter. Second. Vital; maintained by vital powers, and not depending on any known motion, or tranfmif- fion of matter. a. Where the connection between the parts re- lated is obvious, and the influence is always main- tained in a found ftate of the organs. Maintained by fenfibility and the power of tranfmitting volition. b. Where the relation is not obvious and the influence lefs conftant and uniform. Maintained by fympathy. Sympathy of fyftem with parts is moft obvious, when difficulty in them is greateft ; and this whether the difficulty arifes from the magnitude of the operation to be performed, or from inability to perform it with eafe. Of tone, or strength. Organs not equally prepared for performing their functions, at all times. At fome times they are more and at other times lefs readily excited. In moft healthy ftate mufcles maintain a certain de- C 15] gree of contraction, the capillaries a certain degree of fullnefs, and organs generally a certain turgefcence. In thefe cafes they are compared to mufical chords when fufficiently tenfe to produce by vibration their appropriate tone. The varying ftates of the organs arife immediately from different degrees and ftates of power. This may be meafured by its effects. Thefe effects to be regarded in three refpects, viz.—as to rapidity, perfection, and duration. The deficiency of ftrength, or debility actually gives rife to many embarraffments in the living body ; but has been charged with more evils than belong to it. Of direB and indireB debili- ty. The diftinction referred to by thefe terms is well-founded, but the expreffions may be criti- cized. V. Varieties among the human fpecies. Thefe may be ranked under four heads, i. SeX. n. Age. in. Race. iv. Conftitution or tempera- ment. i. Sex. Differences in ftructure and functions, thefe great and generally well-known.—Prop- erties alike in kind, different in degree ; as in mobility, irritability, fenfibility, fympathy. ti. Age. Of infancy and childhood, youth, man- hood, old age. Duration of life. in. Race. All mankind the fame fpecies. He- reditary differences. National differences ; L 16 ] fuch as to fhow unequivocal peculiarities as to race. This a matter of natural hiftory. The fource not eafily decided. Of the grada- tion of man. European, Afiatic, African. iV. Conftitution or temperament. Great diverfi- ty among the productions of nature. Indi- viduality. Refemblances more or lefi perfect. Hence thrown into groups ; their general peculiarities depicted by caricatures. The an- cient divifion into fanguine, choleric, melan- cholic and phlegmatic. The names founded in theory, the diftinctions in obfervation. How far the external marks are to be relied on. Of a new temparament, partly the refult of civilization. The nervous, or fympathetic.— Generally temperaments may be regarded as active, or paffive ; ftrong, or weak ; perfever* ing, or changeable. Derived from the vital properties, and thefe often difproportioned. Pi. Relations with external things. The relations of individual man are various. Con- fider only the phyfiological. Thefe dependent on i the peculiar properties in man himfelf and in thofe things, with which thofe relations are maintained. They depend \ft. On the phyfical properties in man. 2d. On his vital properties ; but not on all of thefe—on his irritability and fenfibility pri- marily. C 17 ] External things diftinguifhed by phyfical and chymical properties. But their relation to, or in- fluence on living fyftem not afcertained by thofe properties ; difcovered only by diftinct obfervation of their operation on the living fyftem. Stimuli- agents which operate on irritability. Effects al- ways local, but thofe of fome more readily propa- gated by fympathy than thofe of others. The fym- pathy general or local. Effects propagated by me- chanical, as well as by vital relations. Agents act- ing on fenfibility—Various. Caufes not explicable. Ultimate fads. The primary and immediate effects, produced on the properties by external things, difficult to afcer- tain. They are manifefted not in an affection of the properties, but in the functions of motion, vivification and perception. But fome articles have the effect to diminifh, or to fufpend ; and fome to deftroy the properties. Do any modify them ? We difcover the effects of external agents in an inverfe order, as the affection of the functions by changes in the compofition, or in the ftruclure, pro- duced by them ; and an affection of the properties by changes in the functions. PlI. Death. t)EATH, or the termination of life, not al- ways in the fame mode. In order to maintenance of our life two conditions neceffary. One that the C r re i body poffefs certain principles of vitality. This alone indeed occafions us to confider eggs, feeds, and fome dormant animals, as poffeffed of life.—The other, that certain functions fhould be performed: thofe of circulation and thofe of refpiration. When thefe functions ceafe entirely, life has departed as far as common obfervations go. But in this cafe the parts often retain fome of their vital properties, thofe efpecially of organic life. The irritability con- tinues for a time ; ftill more does the vital affinity. Diftinguifti then death by expiration and abfo- lute death. Expiration may arife from failure 1st. In the refpiratory organs. 2d. In the encephalon. 3d. In the heart. Abfolute death occurs in confequence of expira^ tion after an undetermined period. This period varies at different feafons, &c. It occurs alfo in confequence of the action of external caufes, which deftroy the properties of vitality. This effect par- tial or general. An effect may be produced by a foreign agent fufficient to deftroy life in the part to which it is applied, and hy fympathy in the whole fyftem. Abfolute death may take place in extremi- ties and gradually extend to other parts, until it affects the heart, &c. life departing from each part gradually, as fhewn by the gradual diminution of energy in the functions. C 19] II. HYGIENE. Hygiene relates to prefervation of health and prolongation of life. Many fceptical as to this branch of fcience. So much diverfity among men, it is difficult to give precepts in detail. But certain general rules may be formed. We mujl choofe as to many things which operate on us ; according to our choice, health may be promoted, or injured. We cannot always avoid difeafe. In confidering the ftructure and functions of the body, it feems expofed to numberlefs evils. It is fo, but in many cafes they are obviated by natural proceffes. A large proportion of our difeafes and the premature termination of life may be referred to our own errors. Firft, fhall difcufs circumftances not under our control; then thofe which are, at leaft in fome meafure. Under firft head—1. parentage—2. birth—3. growth—4. form. Under fecond head—1. refidence—2. clothing —3. diet—4. evacuations—5. exercife and reft—6. fleep and watching—7. paffions. Firft. Circumftances not under our control. 1. Parentage. Man not only reproduces his fpe- cies ; but individuals produce offspring greatly fim- ilar to them. R^efemblance to one parent, or to both. Refemblance to collateral branches. Difpofition to particular difeafes often tranfmitted, and fo alfo to [ 20] long or to fhort life. Such difpofitions modified by various events. 2. Birth. Circumftances occurring during gef- tation and at parturition may affect the conftitution of the offspring. Evils to be counteracted by exact attention to the fubject of them. Of twins ; one or both often feeble, or imperfect. 3. Growth. Slow growth betokens long life. True within certain limits. Not fo true in refpeft to individual?, as in refpedt to fpecies. The effect of cold and warm climates on growth and duration of life. Evils of rapid developement increafed by early exertions. Bifhop Berkley's experiment. 4. Form. A certain form and certain propor- tions neceffary to each organ ;—but more important in fome organs than in others. Internal organs moft important; therefore good health cohfiftent with external deformity. If external perfect, and general form good, the internal are commonly the fame. External form has been ftudied by painters and ftatuaries. Their rules as to proportions. Neceffary to remark that we cannot rely on form alone to judge of the health. Regard appetites and functions. Second. Circumftances which are fubject to our control. 1. Refidence. Difference in falubrity of fitua- tions, arifing from various caufes. Man may live in various climates,but not in all without art. In choice of climate and of particular fituation, regard muft L 21 ] be had to temperature, drynefs or moiilure of atmof- phere, foil, vicinity to, or remotenefs from bodies of water, woods and forefts, &c.; to elevation and expofure to morbific exhalations; likewife to fitua- tion in town or country. a. Temperature. Effects of warm atmofphere— on fkin directly, on organic functions, on habits, on fenfual indulgences and on paffions. Facility of rearing children. Natives lefs fubject to difeafe than foreigners, but lefs vigorous alfo. Difeafes of warm climates, not all referable to direct effects of heat. General precofity. Effects of cold climates, on functions, &c. Dif- eafes from paucity and bad quality of food, and con- finement—chronic affections of lungs, &c. Children not fo eafily reared, but more vigorous and longer- lived. Longevity in Ruffia, Norway, China, &c. compared. The medium, as in temperate climates, moft favourable to health of man. But other caufes be- fides temperature occur in every climate, fo that the effects of temperature alone cannot be afcertained by obfervation. b. Drynefs or moifture of atmofphere. Moift atmofphere generally deprecated; yet very dry atmofphere alfo injurious. Egypt and Ireland com- pared. Simple moifture in moderate degree rather favourable. c. Soil. Marfhy exhalations-—in warm feafons and climates. Why wet feafons worft in certain places and dry in others. Calculations on life in C 2 C 22 ] Switzerland on high grounds and near marfhes. Peat ground. Of clay, fandy and chalky foils. d. Vicinity to bodies of water. Near the fea temperature more equable—fea-breezes thought falubrious. Of fea-breezes in this vicinity—their evils in fpring—more ungrateful than injurious. Lakes and ponds lefs favourable—from grounds on their margins. Of running water, its advan- tages—may have low banks which will be injurious. Vicinity to woods and forefts.—Ufeful when not too thick, nor too extenfive. By retaining moif- ture promote putrefa&ion. Effects on temperature of clypiate. e. Elevation. Benefits of high fituations—but *his with confiderable limitations. Tops of moun- tains unfavourable both to animals and vegetables. f. Expofure to morbific exhalations. Thofe from marfhes acknowledged. From various manafacto- ries, &c. thought to be bad. Gives rife to queftion whether putrefying animal matter is injurious. More experience for negative than might be expected. g. Town and country. Appearances of citizens compared with thofe of people in the country. Chances for life in great towns, moderate towns and country. The real fources of the evils of towns not inevitable; health affected by habits more than by atmofphere and exhalations, if foil good. 2. Clothing. Its ufes. What neceffary for hot climates, what for cold. Defence from light. Rules for our own climate. Of changes. Clothing, with- out proper habits, will not protect from inclemencies C 23] of weather. Of non-conductors in cold and in warm climates. Of ligatures, &c. 3. Diet. The tendency to indulge the appetite not confined to the vulgar. Falfe principles readily adopted when they favour this indulgence. The pleafures of eating not to be undervalued ; rather to be promoted. One effential for this pleafure is good appetite. But this deftroyed by abufe. The whole amount of pleafure greateft, when health is moft pro- moted. Confider, a. the quality of food ; b. pe- riods and frequency of meals ; c. quantity, d. condiments, e. drinks. a. Quality confidered in relation to the eafe of digeftion and the proportion of nutritious matter. Alfo, inquire whether the good be mixed with of- fenfive elements. The different taftes and powers of digeftion among animals. The articles employed by man improved by cultivation. Of the primary elements which are nutritious in vegetables, and of the articles which abound in thefe. Of the qualities which render animal food moft ufeful. Wheth- er vegetable, or animal food beft for man. Expe- rience muft be confulted. Life maintained by either. Evils from either alone. Of the proper mixture; not definite; the fyftem accommodates to cuftom. Rules for different conftitutions, feafons and ages. b. Periods and frequency. The reafons for fta- ted meals in civilized life; economical, focial and phyfical. Frequency of meals—confiderations re- garding it. Not fubject to precife rules. Common [ 24 ] practice has been fufficiently favourable to appetite in its decifion. How far the periods important. c. Quantity. Very important to be obferved. In countries of plenty errors on this point very com- mon. The lefs cautious we are on this point, the more fo we muft be on the others. Full feeders, who do not fuffer immediate evils, are very fufeep- tible of difeafes both acute and chronic. Certain limits in quantity propofed for the ftudious—to be re- garded by each individual until fair experience leads to their correction. On occafional fafts. d. Condiments. Ufe of them. Unneceffary to the temperate. Injurious in many inftances, efpec- ially if employed freely. Exceptions—in refpect to perfons living entirely on vegetable food ; alfo in refpect to common fait. e. Drinks. Neceffity for the ufe of liquids. This neceffity fupplied by water. Man only ufes any other beverage. In combination with water he ufes fubftances which are nutritious, or fuch as are fimi- lar in qualities to the condiments, or alcohol. How far it is advifeable to take nutriment in this form. Of faline and acrid fubftances in this form. Of liq- uors containing alcohol. The evils of excefs in thefe is generally acknowledged. Common opinion, as fhown by practice, favours a limited ufe. Of the operation of alcohol, &c. Confidered as ftimulants. Latitude in which this term is employed. Effects of alcohol on organic fyftem. Effects on animal fyftem. Not the fame as fimple ftimuli. Not proportioned to effects on organic fyftem. Effect of wine and opium [ ^1 when there is pain. This effect primary. The con* fequences of habitual and free ufie of alcohol,&c. Is the moderate ufe innocent ? 4. Evacuations. The occurrence of thefe not fubject to our control; yet we may influence the frequency and regularity of fome of them. Ordina- rily volition neceffary to permit alvine and urinary evacuations ; not fo for thofe from lungs and fkin. By diet and regimen the evacuations are influenced. It is the alvine evacuation which it is moft impor- tant for us to regulate. How frequent. Influence of habit. How far regularity or the contrary af- fects general health, of mind as well as body. Modes of influencing this evacuation without medi- eine. Of urinary evacuation ; how far it requires attention. Relation of this to the other evacuations from blood. All influenced by exercife and by diet. Of the firft and fecond concoction. Of bathing. 5. Exercife and reft. Influence of habit upon our active powers. The abufe injurious. Men, in general, are happily compelled to labour. But in fociety fome are exempted. Such, often profeffing to cultivate the mind, abufe the power of this over the body. In fome inftances labour too fevere and conftant. Thefe not frequent,except from occafional exertions. Evils from fedentary life more common; thefe among artizans, among the learned and among the wealthy. Powers loft and whole fyftem injur- ed ; mind as well as body ; the temper as well as the intellects. E 26 ] The mechanical explanations of the effects of ex- ercife not true. The effects analyzed. Exercife of mind has been thought a fubftitute for bodily exer- cife. In how limited a degree it is true. v The ex- tent of exercife neceffary for health. The kinds of exercife. To be connected with objects. 6. Sleep and watching. Nature has determined the neceffity of alternating thefe ftates, but not the proportion of time to each ; nor even the periods, abfolutely. She has given limitations however ; thefe not difregarded with impunity. Of the prop- er period. Evils of late hours. Of the time to be devoted to fleep. 7. Paffions. Bichat's theory of the paffions. True that their effects are demonftrated in organic fyftem. Even life fuddenly deftroyed by them. Effects fometimes very lafting. Influence in difeafe. How far paffions can be controlled. How far health requires this. Caution to be obferved when affected by violent paffions, from lord Bacon. Short fumm^ry of rules of hygiene. They do not demand a folicitious attention to minute detail; but generous and active habits, cheerful and kind affections, regulated defires, and thofe temperate indulgences which will not impair the power ef en= joyment. C 27 ] III. PATHOLOGY. Tliis branch of the fcience of medi- cine relates to the doctrine of difeafes. What do we underftand by difeafe ? Known only by contrail. Muft define health before we can de- fine difeafe. Of difeafe and diforder. In living body difeafe manifefted by fymptomS; in the dead body its veftiges feen in change of or- ganization, in unufual diftribution of the fluids, in unufual depofitions of them, in changes of the col- our of parts, and in the prefence of fubftances not commonly found in the body. During life, then, we recognize difeafe by fymp- toms. Diftinctions in refpect to thefe. Symptoms are—i. Such as the phyfician may as- certain by his own obfervation; n. Such as he can learn only from the report of the patient. i. Under this divifion, we have, 1. Such as are manifefted in the patient, and are afcertained by in- flection and examination; and, 2. Such as are man- ifefted in the evacuations. 1. Thofe of figure, colour, motions, pofition, temperature, drynefs and moifture of the furfaces, which can be examined—pulfe—refpiration—voice —cough jfneezing, gaping, hiccough; and thofe afcer- tained by touch, preflure and percuffion. 2. Evacuations. 1ft. Thofe common in health and ficknefs. 2d. Thofe peculiar to difeafe. [-88] lft. From fkin, lungs, mouth, kidneys, inteftines, teftes, &c. 2d. From mucous membrane, blood vef- fels, ulcerated furfaces. n. Under this divifion, thofe which regard fen- fation, appetite, intellectual powers, moral affections, emotions and paffions, when awake, or when afleep. Symptoms to be confidered in regard to the period of their occurrence, and to their order of fucceffion. Although each difeafe is neceffarily defcribed by its fymptoms and the order of their occurrence, yet to underftand the difeafe we muft inquire what are the actual changes on which thefe fymptoms de- pend. Thus we are led to the primary changes induced in the body by noxious agents, and then to the characters of thofe agents. This brings into view the doctrine of remote and proximate caufes. Of remote caufes. Predifpofing and occafional. Each caufe has properties in refpect to the living body more or lefs peculiar. How they act upon the body. Of proximate caufes. The real ftate of the part, or fyftem under difeafe. As difeafes fometimes confift in a fucceffion of changes, fo they fometimes have a fucceffion of proximate caufes, which are allied to each other. Mode of afcertaining proximate caufe. By con- fideration of remote caufes; by reference to phyfiolo- gy and consideration of the changes induced, as mani- fefted by fymptoms ; and by an examination of the effects to be noticed in the bodies of thofe who have [ 29 ] died under difeafes. The elements neceffary to de- termine the proximate caufe not always fufficient. Rules for the interpretation of fymptoms, fo as to afcertain the feat and proximate caufe. Of pathognomonic, diagnoftic and prognoftic fymp- toms, or figns. The termination of difeafes. In health, in other difeafes, or in death. The tendency in the fyftem to the recovery of health. The inftitution of pro- ceffes for the removal of offending caufes. The lofs of fufceptibility to caufes of irritation after a certain period. Difeafes differ among themfelves in various re. fpects. The moft obvious and important of thefe differences to be noted, and that chiefly to explain terras in common ufe. I. In refpect to their origin they are 1. Hereditary. 2. Congenital. 3. Family. 4. Adventitious, of which the caufes apper- tain to a. certain ages ; b. either fex ; c. particular feafons of the year ; d. modes of life and habits; e. climates; f. effluvia from particular fources ; g. circumftances acting on whole commfl- nities; D [ 30 ] h. idiofyncracy, or peculiarity of tempera ment; i. preceding difeafes. 5. Contagious. n. In refpect to their occurrence they are 1. Stationary. 2. Intercurrent. in. In refpect to their prevalence they are 1. Sporadic. 2. Pandemic ; and thefe a. endemic; b. epidemic. iv. In refpect to their feat they are 1. General, or local. 2. Idiopathic, or fymptomatic. 3. Fixed, wandering, or retrograde. 4. External, or internal. S. Placed in parts of different ftructure, or tex- ture even in the fame organ, as a. in mucous membrane ; b. in cellular membrane ; c. in ferous membrane ; d. in fibrous textures, &c. v. In refpect to their nature, or character they are 1. Light, mild and fmall ; or grave and great. 2. Regular, or irregular. 3. Benign, or malignant. 4. Difguifed, or manifeft. vi. In refpect to their event they are 1. Dangerous, or fafe. C 31 ] 2. Depraved and injurious, or falutary. 3. Curable, incurable, or mortal. vn. In refpect to their form and conftitution they are 1. Simple, or compound and complicated. 2. Acute, peracute, fubacute. 3. Chronic. 4. Continued, remittent and intermittent. 5. Periodical. Of arrangement of difeafes. Nofology. The lift of complaints various, yet perhaps there are few ele- mentary difeafes. The variety produced by differ- ence in feat and in degree, and by the combination of two or more elementary difeafes. Of the fyftems of nofology which have been publifhed. Of the princi- ples common to them all. Why difeafes cannot be arranged like the articles of the vegetable and ani- mal kingdoms. The difficulty infuperable, while we attempt to arrange difeafes in a fingle table. Obviated by two tables. The firft to contain fymp- toms methodically arranged and referring to the difeafes in which they appear. The fecond tc contain thofe difeafes. In the firft table fymptoms arranged under five claffes, viz. 1. Symptoms of compofition (i. e. manifefted in a change of compofition); 2. of ftruc- ture ; 3. of properties ; 4. of appetites ; 5. of functions. Orders relate to the different organs. Genera to the different textures in each organ. Species to the particular kind of affection. Varieties to differences [88] ot each affection in degree, and perhaps in other refpects. The fecond table to contain the actual difeafes which affeft the human body, confidered as fimple, or elementary in regard to their proximate caufes. There may be fome queftion. as to certain affections, whether they fhouid be admitted into this table. It is beft to admit thefe, and to diminifh the table here- after, if the advance of fcience fhall permit. Alfo in this table fhouid be included thofe fympathetic affections which occur in the whole fyftem, or in any fubordinate fyftem in confequence of different local difeafes. Laftly, fhouid be included certain difeafes arifing from the prefence of certain remote caufes lodged within the body. In denominating difeafes it is beft to take the names moft common- ly employed, fo far as they are appropriate. I. Febres. II. Phlegmafise. III. Hemorrhagic. IV. Profluvia. V. Adynamia. VI. Dolores. VII. Spafmi. VIII. Dyforexise. IX. Vefaniae. X. Morbi organici. XI. Morbi ex adventitiis in corpore incluuse XII. Morbi fympathetici. 1 C 33 ] IV. THERAPEUTICS. The fourth branch of medical fcience relates to the treatment of difeafes. Two general modes; active and watching, or ex- peBante. Thefe confidered generally. Difeafes moftly compound. We muft analyze and thus fhall be led either to direct our treatment to moft important part, or to moft dangerous affection, or to combine means fo as to effect feveral purpofes at once. Of intentions, and indications. The diftinction between rational and empirical practice. Indication* furnifhed by fymptoms, by remote caufes and by proximate caufes. Indications furnifhed by fymptoms-the leaft fatif- factory. When to purfue them. Always with caution. Indications from remote caufes. More fafely purfued ; but often inadequate. In fome cafes ef- fential to regard them. Indications from proximate caufes moft important and fatisfactory. If a fucceffion of proceffes thefe may fometimes be interrupted ; but not always with impunity. The indications may be clear, but our powers limited. The agents for removal of difeafes act agreeably to D 2 [34] principles confidered in treating of relations of the human fyftem to external things. How far we can increafe and leffen, or fufpend properties. How we can influence functions. Remedies fometimes employed to leffen the dif- pofition to difeafe. The operation of fome remedies not underftood. Employed empirically. On the mode of operation of fome of the prin- cipal remedies employed in difeafes. Of bloodletting, general and local. Of the medicines called ftimulants, tonics, aftringents, alteratives, fedatives, refrigerants, emetics, cathartics, fudorifics, diuretics, emmenagogues, anthelmintics, lithontriptics. C 35 ] THE DESCRIPTION AND TREATMENT OF PARTICU- LAR. DISEASES. As the preceding parts relate more efpecially to the theory, fo this to the practice of phyfick. Yet as practice has been referred to in thofe, fo muft theory be in this. Difeafes to be confidered in the order which will render them moft intelligible; and, as all cannot be confidered, the moft important will be felected. Par- ticular difeafes to be grouped in fuch mode as will render the confideration of them moft convenient, or advantageous. [ 36 j FEVER. In this difeafe we fee the functions varioufly de- ranged, the powers and appetites fufpended, or altered and modified, the mind affected as well as the body, and the whole appearance more, or lefs changed. Phenomena of the fame general defcrip- tion are to be noticed in fympathetic affections of the fyftem, yet they depend on a local difeafe, and if that be removed they difappear. In the difeafe to be defcribed, it does not appear that any fuch local caufe exifts. Unfettled ftate of opinion in refpect to fever, although debated fince the earlieft days of medicine. Can we not prefent the naked fa£ls without refer- ence to theory ? The facts fo numerous, fo various, fo greatly differing in arrangement in different cafes, that to prefent them alone in all their modifications, &c. would be an endlefs talk. Some method necef- fary in difplaying them. But every method muft have relation to fome theory. We fhall adopt the method of higheft authority and which involves leaft theory;—which alfo begins with moft fimple and dif- tinct views and proceeds to thofe more complicated. Of the fubjects of fever. Idiofyncracies in this refpect. Common acceptation of the term fever;—applied to various affections; thefe thought to have fome- thing in common. What is this ? Not agreed. Term restricted to a clafs of difeafes thought to [87 ] refemble each other in effential characters. Idio- pathic affection of whole fyftem. Confifts of one or more paroxyfms; but in many cafes thefe not dif- tinct. Each paroxyfm confifts of certain ftages; but again not all in every cafe. The difeafe as a whole has diftinct periods, as a paroxyfm has diftinct ftages. Plan to be purfued. Of ephemera;—a fingle and perfect paroxyfm. Accefs, cold ftage, hot ftage, crifis. Symptoms of ace.efs. Thofe of animal fyftem; thofe of organic fyftem. This ftage of various du- ration. Not noticed in all cafes. Cold ftage. Symptoms. The fame in kind which occur in various cafes where new actions are to be performed, or the fyftem is thrown into a new ftate. Hot ftage. Symptoms. Thefe fucceed gradually, and for a time mixed with thofe of cold ftage. This lefs frequently wanting than either of the others. But even this not diftinctly prefent in all cafes. This terminates in haemorrhage, inflammation, or crifis. Of the haemorrhage and inflammation. How far favorable. Of Crifis. Favorable, or otherwife. The fymp- toms, when favorable ;—when unfavorable. Dura- tion of the ftages. The defcription given may be confidered as re- ferring to a model, rather than to any actual cafe. This inevitable in endeavoring to give diftinct and juft ideas of all the parts. In almoft every cafe fome fymptom wanting; and no fymptom which C 38 ] may not be. The difeafe fhows itfelf in the whole fyftem, but unequally. Of compound fever. More than one paroxyfm.—Intermittent, remit- tent and continued fever. In general, fever ap- pears to regard diurnal period. Of intermittents. Thefe have paroxyfms recur- ring daily, every other day, &c. The interval, from commencement of paroxyfm to that of anoth- er. The intermiffion from end of one to beginning of another.—Of types, quotidian, tertian, &c. The tertian moft common. The paroxyfm of intermittent refembles ephe- mera generally. The cold ftage more formal than in continued fever, more fevere and longer. This not to be relied on entirely. Some epidemic con- tinued fevers are characterized in part by feverity, &c. of cold ftage. Crifis in firft paroxyfm of in- termittents lefs perfect than in ephemera. What exception there is to this. Second paroxyfm on 3d day from firft, and fo afterwards. Not precifely at the fame hour; how far it varies.—Symptoms remaining after imperfect paroxyfms.—Of the in- diftinctnefs of early paroxyfms;—the ordinary changes in this refpect; and common duration of the difeafe. Modes in which death may be produc- ed by the difeafe. Difeafe often terminates in health, fuddenly, after a fevere paroxyfm. [ 39] Of quotidians;—they preferve the intermittent character lefs perfectly, than tertians. Of double tertians, &c. Of quartans ;—double quartans. Of ftmple continued fever. Accefs very com- monly and often occurs for many days before formal appearance of the difeafe. Cold ftage commonly flight, and indiftinct, continuing into hot ftage; chills recurring irregularly for one or two days, but more at certain periods. Hot ftage more fevere, yet heat not commonly fo great as in intermittents. Of the temperature as afcertained by thermometer. Of the tongue, ftomach and bowels. Of the fecretions and excretions. Of the circulation,—and the refpiration. Of the ani- mal functions. Of the progrefs of the difeafe. How far par- oxyfms can be diftinguifhed. Exacerbations—fup- pofed to occur at evening—not confined to that pe- riod. Of the febrile day. Common period of re- miffion. Of the increafe, height and diminution of the difeafe ; the courfe and changes of fymp- toms during thefe periods. Of the termination in death ; very rare if the difeafe fimple and nearly regular. Duration of the difeafe. Termination fudden by favorable crifis after fevere exacerbation. More commonly the return to health gradual. Ter- mination by haemorrhage, or by inflammation. Sometimes continuance of fever with thefe. Symp- toms of low and exhaufted ftate of the fyftem in fever. - Of the appearances after death. Infrequency of L 40] opportunity to afcertain thefe in refpect to fimple fe- ver, whether ephemera, intermittent, or continued. Negative evidence on the fubject. How minute examinations ought to be, to quiet all conjectures; and by men well-verfed both in difeafe and in anatomy, morbid as well as healthy. Of the caufes. Many phenomena noticed in hif- tory of fever have not been defcribed. A diftinc- tion has been made, which is theoretical. But this not only tends to give diftinct views, it facilitates the communication of facts, even if it be incorrect. As much as is commonly thought effential to the difeafe has been defcribed. The remainder may be ftated more diftinctly after difcuffing caufes. Importance of regarding diftinction of proximate caufe in fever, for the very reafon that it is not fat- isfactorily afcertained. Of the remote caufes. In refpect to fome of thefe there is fuch abundant evidence that they cannot be doubted. Yet they often occur without producing fever, and even produce other difeafes. They are the occafional, or exciting caufes. They are gener- ally caufes which tend to interrupt the regular per- formance of the functions. The difeafe gets its character principally from the predifpofing caufe. The predifpofing caufes not well known; yet fomething known in refpect to them. Of the fea- fons in which they act moft ftrongly. How the fenfible changes in the weather operate either as caufes, or as developing caufes of fever. Of the influence of heat and moifture in producing fever. [41 ] Of marfh-miafmata. Whether thefe from veget* ble or animal decompofition ? The extent to which they act. Refpecting caufes of fever from animal matter From apartments over-crowded by the healthy,— by the fick ;—from perfons affected by fever,—- infection ;—from animal matter in procefs of de compofition. Intermittents appear long after expofure to caufe. It may be fo with continued fever. The embar- raffment which this creates in determining the caufe. Of the proximate caufe. Of the number of opin- ions and of errors on this point. Of one opinion maintained by a large portion of pathologifts,— that fever is, in part or in whole, a falutary effort to remove fome evil. A general reafon in favor of this doctrine. The difficulty of drawing the line between the morbific and the falutary procef- fes. If this be done we probably fhall afcertain the proximate caufe. The various opinions refpecting the proximate caufe may be reduced to fuch as place it, 1. in the compofition, 2. in the ftructure, 3. in the prop- erties, 4«. in the functions; or in two, or more of thefe at once. General confiderations, concern- ing relations between living body and external things, ferve to fhow that the caufe cannot be either in the compofition, or in the ftructure. If they be affected it is fecondarily, E [42] Confederation of Cullen's opinion which places the proximate caufe in the properties. The evi- dence in favor of his opinion examined. Confideration of that part of Cullen's opinion which was derived from Hoffman, and which places the caufe in the funBions. Confideration of fome other opinions. Unfatis- factory character of them all. How far the anal- yfis has led. To fhow -that the proximate caufe confifts in an affection of the powers, or proper- ties of vitality. Evidence. Certainly it is pofiible that more may be known hereafter, but not very probable. The utility of going thus far is chiefly to difcountenance erroneous opinions. Remarks in refpect to fome of the principal fymptoms in fever;—in the cold ftage; in the hot ftage; in the crifis. Of varieties in fever. Not any precife form which is regular—a beau ideal—it is only when the devia- tion is confiderable that it can be called an irregu- larity, or variety. Diftinction of varieties from type. The principal varieties of fimple fever founded on the unequal affection of the fyftem. Lines not def- inite. First, the animal fyftem particularly affected. Symptoms. Second, the chylopoietic vifcera particularly affect- ed. Symptoms. Third, the circulating fyftem affected. Difficulty of forming an opinion on this point. Symptoms* \ [ 43 ] Fourth, the power of vital affinity particularly affected, as manifefted in tendency of fluids tc putrefaction. Symptoms. Of other varieties ;—thefe perhaps lefs diftinctly marked. Of irregularities in fever. Thefe to be noticed in fymptoms and in paroxyfms. Of the irregularities defcribed by Fordyce—remarks on them. Chiefly included under our divifion of varieties. Of general inflammation. Of injury of vital organs with, or without inflammation. Of unequal affection, in which one part is not affected by fever. Of hy- fteric fymptoms. If the opinions of Dr. F. on thefe points be not well founded, yet they lead to an examination and difcrimination of facts. Irregularity of paroxyfms in intermittents. Of paroxyfms, occurring without refpect to diurnal pe- riod ;—of their prolongation. Of epidemic fevers. The occafional prevalence of fever in particular diftricts, more or lefs extenfive; during a fingle feafon, or for feveral feafons in fuc- ceffion. Often preceded by epidemic difeafes of inflammatory kind. Thefe epidemics often referred to previous ftates of the feafons;—but continue through feafons of different characters ;—and the fame difeafe not always preceded by the fame courfe of weather. Rather than acknowledge ignorance men will find caufes in the motions of the heavenly bodies, or in exhalations from the earth. Caufes not known. Of the opinion advanced by Sydenham that an [ 44] epidemic converts and expels other difeafes. This opinion well grounded to a certain extent, but has been adopted with too little limitation. How far is it true that epidemics have characters quite diftincl? Do we not find evidence that in the fame epidemic there are feveral varieties of fimple fever," and alfo cafes of fever combined with inflammation, &c. ? If the remarks fuggefted be correct, a uniform method of treatment not to be adopted. Of the epidemics common in fummer and au- tumn, in our climate. Of the fevers which'often occur in the cold fea- fon amongft us. Of the Britifh typhus. Of the epidemics called malignant. Of the epidemic called yellow fever. Of the epidemic called fpotted fever. Of the prognofis. Fever various in feverity and duration;—fometimes fatal. Have we any princi- ples to direct our judgment on thefe points at an early period of the difeafe ? So far as we have it requires experience and fagacity to apply them. General mildnefs of fymptoms favorable. How far we are liable to deception in this refpect, efpe- cially from mildnefs of particular fymptoms. Appearances of the evacuations afford fome rules for prognofis. How prognofis affected by combination of other difeafes with fever. Of the diagnofts. Shall point this out when treat- ing of other difeafes, which may be confounded with fever. L 45 J Of the treatment. On a fubject fo interefting and" involving complicated confiderations, there has natu- rally been much difference of opinion. Some de- lighted by obferving the relief fpontaneoufly enfu- ing, even after the moft formidable appearances in fevers, have infifted on the dangers of interference and have thought proper to " wait on nature." Others impreffed by the fufferings and dangers of the difeafe, have urged the ufe of the moft power- ful remedies to arreft its progrefs. Intentions of cure have varied with the theories refpecting the proximate and remote caufes. Thus a great variety of meafures have been tried. The fame remedies, however, by different perfons with very different views. From the experience thus attained let us inquire what intentions we fhouid adopt, and what we are taught by experience refpecting the means of fulfilling them. An ephemera, when we know it to be fuch, may commonly be left without remedies. In intermit- tents and. continued fevers remedies are more ufeful. The remedies not the fame for both. The princi- ples to be regarded will be hrought into view moft: conveniently by firft confidering continued fever, afterwards intermittents. Firft then we confider the treatment of fimple continued fever ; fecond, the treatment of intermit- tents ; third, how far this is modified in the varieties of the difeafe ; fourth, the treatment adapted to the irregularities and accidents. E2. [ 43 ] First, treatment of fimple continued fever. Expe- rience has fhown that fever may be arrefted at an early period. This early period has greater, or lefs extent, according to the character of the difeafe. A general defcription of the method, which experi- ence has fhown to be ufeful. Hence is derived an indication. The methods not equally good. Evac- uations have been moftly employed. The different evacuations confidered. Blood-letting the moft general. In fimple fever not commonly efteemed ufeful. Source of deception to thofe, whofe experience feems to fandtion it. Have they treated fimple fever ? Sweating not great at any one moment; but takes place on an extenfive furface. The impreffion made on the cutaneous organ as much to be regarded, as the evacuation. Of theoretical arguments in favor of fweating in fever. The old diftinction of crude and concocted matter. The benefits derived from fweating are not inconfiderable; but experience does not allow to this evacuation fo high a rank, as to fome others in fimple fever. Evils which may arife from it. The remedies beft adapted for promoting it. Vomiting, as a mode of evacuation merely, inferior to the foregoing and to purging. An unnatural evac- uation in health; but not in difeafe. The matter evacuated is more morbid oftentimes. The principal efficacy probably arifes from the violence of irritation m an important organ. The fympathetic effects great and extenfive. The teftimonies of experience in its favor. The remedies to be employed and (. 47 1 the management of them. Advantages of combin- ing emetic fubftances. How powerful the effects thould be. Purging more powerful as an evacuation than vomiting. Employed either to carry off fcecal mat- ter, or to get evacuations from the mucous mem- brane, the liver, &c. Like vomiting it is ufeful not merely as an evacuation. As a remedy inferior to vomiting, but a very ufeful auxiliary. Not always to be pradtifed with impunity. Of the combination of emetics and cathartics. The articles to be ufed. Other evacuationsnotto.be directly attempted j yet when effected may aid. They may be pro- duced at the fame time with vomiting and purg- ing, or directly after them. If the indication be not perfectly fulfilled, yet the difeafe may be mitigated by thefe practices. Caution in purfuing them. A mode of fulfilling the principal indication at an early period, without evacuations ; or of completing the object propofed by ufing them. This by cold water, or other liquids. Different methods of ufing thefe. General modes in which they operate. Cafes proper for fuch treatment. Cautions to be regarded. Of the treatment at a later period of the difeafe. The intentions to be adopted. Experience fhows that a crifis may be induced by art; and that, if it be not, the difeafe may be mitigated. How late in the difeafe fuch remedies may be employed. Of evacuations after the early period. The greater caution requifite. Of the articles fuppofed to pro- [ 48] mote a crifis. In what way they probably operate. On the ufe of cinchona and various other articles often employed in fever. Second, the treatment of intermittens. To be con- fidered as fimple, or uncombined. The general efficacy of cinchona well known. Experience has fhown that this and other remedies given during intermiffion will often arreft the difeafe. The fears once entertained from this practice. The inference to be drawn from its fuccefs, in refpect to the fup- pofed falutary effects of fever. Cinchona not always effectual. Rules to be ob- ferved in ufe of it. The principle, refpecting perfect crifis, on which they are founded. Exception to it. Why the cinchona fhouid not be ufed, where the good effect would probably be fmall. Quantity of cinchona to be adminiftered, &c. If cinchona cannot be ufed three queftions arife. 1. Are there any fubftitutes for it ? 2. Muft any regard be paid to crifis in the ufe of thefe ? 3. Can the crifis be rendered more perfect by art ? 1. There are many fubftitutes; but moft of them inferior in power, and lefs eligible in common cafes. Of the vegetable tonics and aftringents which have been ufed. Of opium. Of charcoal. Of mineral articles ufed for this purpofe. The confid- erations which fhouid induce the ufe of thefe, and the mode of ufing them. Of the preparation of arfenic particularly. Refpecting the external appli- cation of cinchona, &c. r 49 j 2. The limited experience in refpect to theie does not furnifh a fatisfactory anfwer. What is probable. 3. It can be. Indirectly, by removing caufes which prevent the crifis from being perfect. Di- rectly, by the fame remedies which promote crifis in continued fever. Of diet and regimen in fever, both intermittent and continued. Two confiderations in refpect to diet;— one regarding ftomach; the other the fyftem at large. The articles which may not be ufed, and thofe which may be, in continued fever ;—in inter- mittents. Under regimen, of clothing, bed, air, tempera- ture, &c. Of the treatment when active meafures are for- bidden, either by the late period of the difeafe, or by any peculiarities of the cafe. Third, how far the treatment muft be modified in the varieties of fever. General confiderations. Par- ticular treatment. i. Where the animal fyftem is particularly af- fected. u. Where the chylopoietic vifcera are particu- larly affected. in. Where the circulating fyftem is paaticularly affected. iv. Where the power of vital affinity is particu- larly affected. Fourth, the treatment adapted to the irregularities, and accidents. Active treatment to be adopted in thofe cafes, of which the nature is obvious, and for which [50] we have remedies that can reach,or control them. In doubtful cafes the waiting, or expeBante method pre- ferable to the active. Of great fpontaneous evacua- tions without relief. Of embarraffment of the fto- mach. Of powerful fpafmodic affections. Of hy- fteric affections. Of fudden and unexpected chan- ges. Of irregularities in the paroxyfms in intermit- tents. Brief review of the points to be regarded in the treatment of fever. Confiderations in regard to the treatment of epidemic fevers. The general charac- ter and effect of remedies to be ftudied in each. Rules drawn from thefe not to be followed too uni« verfally. Advantages in this refpect from the meth- od here followed in difcuffing the fubject, even though imperfectly executed. C 51 ] PHLEGMASIA. Restricted ufe of the term by nofologifts. Employed here as fynonymous with the general term inflammation, when applied to difeafes. This is a term of extenfive application. It does not bring to the mind a precife, fimple and definite idea. Various difeafes arranged under this head ; -—various as to their caufes; as to their period and courfe; from diflerences in the ftructure and importance of the parts affected ; as being com- mon, or fpecific; as influenced by different con- ftitutions. It may be fhort and flight, or moft grave and lafting. It is a local difeafe, but it probably arifes fometimes from a general affection of the fyftem, and often produces general affec- tions. The moft frequent of difeafes. Simple, or combined with other difeafes. Inflammation confifts in a train, or fucceffion of changes, or proceffes, of which all need not oc- cur to conftitute it; even though it paffes through only one procefs the difeafe may be recognized, It muft be defcribed in its moft fimple and regu- lar forms, and afterwards in thofe more compli- cated and lefs regular. Firft, it will be defcribed in thofe parts, in which its procefles are the moft fimple. Second, in parts, in which they are lefs fo. Third, as being compli- cated by affe&ing at once and together parts of various ftructures. Fourth, the moft common ii> regularities in the feveral proceffes will be defcribed L 52 ] Fifth, the caufes of inflammation generally will be difcuffed. Sixth, the different fpecies of in- flammation will be defcribed. Seventh, the confti- tutional affections arifing from inflammation will be defcribed. Eighth, the principles of treatment. To be premifed an enumeration and a fhort defcription of the fymptoms confidered moft pe- culiar to inflammation. Then, as propofed, Firft, inflammation will be defcribed in thofe parts, in which its proceffes are moft fimple. This is the cafe in the membranes, which are leaft connected with other parts. The proceffes on the mucous membrane moft fimple. They may be traced moft diftinctly on the tunica conjunBiva. The fymptoms in the order of their occurrence, when the inflammation appears to go moft perfectly through all its proceffes.——The changes gradual, yet the difeafe diftinguifhed into different proceffes. Of the formative, fuppurative and reftorative proceffes. The fymptoms arifing from the fame proceffes, when in mucous membrane of internal parts. Second, inflammation in thofe parts, in which it: proceffes are lefs fimple. May be traced in ferous mem- branes. The fymptoms in their order. Of changes afcertained by diffecting the parts. The proceffes— formative, adhefive, fuppurative, ulcerative and reftorative. The difeafe does not neceffarily pafs through all thefe. The courfe of inflammation in the cellular mem- brane effentially the fame. A defcription of cafes, [ 53] in which a foreign fubftance is lodged in cellular membrane :—of cafes where this is not the caufe. The fame general courfe in all circumfcribed cavi- ties. General remarks on inflammation in parts of other ftrudtures. Does it occur only on membranes ? Not very eafy, nor very important to anfwer. Prac- tically it may be cenfidered as anfwered in the negative. The principal object thus far has been to make the feveral proceffes underftood. They have been con- fidered as confined to parts of one ftructure, except in defcribing the ulcerative procefs. We have Third, to defcribe inflammation when complicated by affecting at once and together parts of various struBures. Thefe united by cellular membrane. On that the difeafe is propagated. Adhefive procefs unites them, extending even into blood-veffels. Under fome circumftances we find parts of different ftructures do not enter equally well, nor at the fame time into the proceffes of inflammation. Of the extenfion of the adhefive procefs from one texture to another, while the fuppurative takes place only in the firft. Of the occurrence of the fuppurative procefs in the texture not originally the feat of the inflammation. Fourth, the moft common irregularities in the fev- eral proceffes will be defcribed. Prolongation of the formative procefs. Prolongation of the adhefive procefs. Imperfect performance of this procefs. Occurrence of this procefs on the mucous mem- F t 54 J brane. Variations as to the quality of the pus hi the fuppurative procefs; and as to quantity. Pro- longation of this procefs. Effufion of watery fluid, fometimes containing albumen, fometimes not. How far dropfical effufions generally may be referred to an inflammatory procefs. Ulcerative procefs on mucous membrane. Undue fixtenfion of this pro- cefs. The reftorative procefs, often interrupted,does not fo readily take place. Inflammation may termi- nate, without going through the regular proceffes, either by refolution, or by mortification. Both modes defcribed. In what fenfe the proceffes are confidered irregu- lar in the foregoing cafes. Of inflammation which is rapid and violent, the proceffes as if hurried. Of the fudden extenfion of inflammation. Of inflammation attended with de- bility. Of chronic inflammation generally. How far this differs from acute. Will be more fully illuftrated in confidering particular difeafes. Fifth, on the caufes of inflammation. Predifpofing caufes. Inflammation may be produ- ced in all cafes, unlefs the powers be exceedingly reduced. In fome cafes however by very flight caufes. General defcription of the caufes which in- creafe the difpofition to inflammation. Violent, of undue exertions, or fuch as are long continued and are fomewhat greater than the fyftem has ftrength to fupport, often induce a difpofition to inflamma- tion. This particularly obvious in the cafe of func* [55] tions, which are only occafional. Of caufes which difpofe one part of the body more than others to be affected by inflammation, and which give peculiar characters to the difeafe. Influence of different feafons. Exciting caufes. Very numerous, but may be. claffed under a few heads, i. Such as affect the ftructure. n. Such as affect the properties of vital- ity, m. Such as affect the functions. Exciting caufes not always known, but probably are always of the above defcriptions. i. Caufes which affect the ftructure. Chymical, or mechanical. Efforts for restoration. To effect this, under ordinary circumftances the parts muft be brought into the ftate of a fuppurating ulcer by the proceffes of inflammation, and then the reftorative procefs enfues. The final caufe here underftood j and this favors the fuppofition of an analogous final caufe in other cafes of inflammation. n. Caufes which affect the properties of vitality. Difficult to decide pofitively when thefe are affected. The opinion entertained by fome that many common inflammations, as catarrh, are referable to an accu- mulation of vital power. Does not appear to be fupported by facts. Doubtful whether any caufes act in this way. Distinction between caufes which «j what changes are wrought in the properties;—third, what changes in the organization, or ftructure;— j \ [57] fourth, what changes in the functions of the parts affected. As to firft,—the inftruments to be looked for among parts common. The phenomena of inflam- mation analogous in many refpects to thofe of growth and fecretion. Inftruments the fame. What thefe are. Confirmation. Inftruments in ulceration. How far nerves have an agency. As to fecond,—Mr. Hunter's opinion. What powers are affected, and how. Changed in degree and in kind. Whether thefe changes are effential. As to third,—enlargement of veffels. Whether new veffels are formed. How the dilatation of vef- fels is produced. How the tumour is formed. Of the fuppurating furface and of granulations. Of the extent and limits of the change in organization ; to what they have relation, As to fourth,—thefe have been neceffarily refer- red to under the other heads. Recapitulated. The ftriking analogy between inflammation, when the proceffes are perfect, and certain natural changes occurring in health. Of the relation of thefe pro- eefles to an object, or final caufe. Why refolution cannot be produced in fome cafes. How far the inquiry refpecting the proximate caufe is fatisfied. Remarks on the common opinion refpecting increafed action. The indefinite and loofe ufe of the terms. Sixth. Defcription of the different fpecies of inflam- mation. The exciting caufes laft difcuffed lead to this; but the courfe not long enough to permit a 12 [ 58 ] full defcription of every fpecies. The particular characteriftics to be looked for in fpecific inflam- mations. Not all marked by characteriftics of the fame kind. Of the fcrophulous inflammation. Not produced by fpecific ftimulus. Referable to peculiarity of confti- tution. Sometimes induced without any obvious exciting caufes, fometimes by fuch. Suppofed to affect particular parts at particular ages. Character- iftics of a fcrophulous conftitution. Thefe not al- ways found in thofe, in whom this inflammation occurs. This conftitution' hereditary; but not al- ways inherited. Parts efpecially liable to fcrophula. The characteriftics of this inflammation. The indi- cations of cure. The treatment, fo far as it is medical. Rheumatic and arthritic inflammations to be con- fidered hereafter. Among the inflammations more decidedly fpecific the vaccine to be confidered firft, becaufe fo fimple. This feen by us only when produced by defign. Brief account of its introduction. Of the accidental inoculations among milkers. Of the artificial inoc- ulation. Appearances at different ftages and confti- tutiona-1 fymptoms. Of fpurious veficles. Period for taking the virus. Treatment. Variolous inflammation. Modes of production. Of the natural fmallpox. Symptoms, in the fyftem, on the fkin, &c. Comparifon with the vaccine difeafe. Prognofis. Indications. Treatment. The inflammation of rubeola. Modes of production j fymptoms; treatment, £cc. [ 59 ] The inflammation of fear I at ina. Symptoms, &c Syphilis and fome other difeafes not to be confid- ered at this time. Seventh. The constitutional afifeBions arifing from inflammation. Not neceffarily univerfal affections of the fyftem. Under what circumftances inflamma- tion is without fuch affections, and under what they do occur. Thefe affections fympathetic. Various in degree and in kind, and apparently not propor- tioned to caufe. Firft of thofe attending acute, then of thofe attending chronic inflammation. Thefe constitutional affections often complicated with fec- ondary affections of particular organs. They occur from other caufes befides inflammation. The conftitutional affections attending acute in- flammation may be confidered as of two general de- fcriptions ; yet in fact thefe are often mixed. The firft active, the fecond paffive. The active fympathetic affection. By what names it is known. All liable to objections. That of gen- eral inflammation preferred. Of fympathy extending from an inflamed part to large artery fupplying it, to the arteries of the vicinity, and thus to the heart. Symptoms of general inflammation enumerated and defcribed. Not conftantly prefent, nor uniform in degree. The modes in which this general affection terminates;—fometimes in death, when the local affection itfelf would not be mortal. The paffive fympathetic affection. Perhaps better defcribed, as an affection in which the powers are depreffed. With what difeafe it has been confound- [ 60 7 ed, and by whom diftinguifhed. Called «fymptoms of morbid irritation" Objections to the name. Re- marks on the term irritation, fhowing how it has become nearly fynonymous with morbid affection. On what occafions this affection takes place. The fymptoms enumerated and defcribed. Of tetanus as conftituting a part of them. Various in degree. Sometimes directly fatal. Termination, like other * fympathetic affections, depends moftly on the caufe; —but fometimes by death. Do thefe two fpecies of general fympathy occur diftinctly, fo that every cafe belongs decidedly to one, or the other ? They do not; the ufe of diftin- guifhing them, notwithftanding. Diagnofts. How far thefe affections are to be diftinguifhed from fever. In what they refemble each other, and in what they differ. Although the refemblances are greater than the differences, yet the diftinction is important in practice. Prognofis. How far this depends on the circum- ftances of the local affection ; how for on thofe of the general affection. The constitutional aflfeBions attending chronic inflam- mation. Not uniform in character even in fame cafe, varying according to local proceffes which are taking place. Many other fources of differences. At fome times partaking more the character of the active* and at others that of the paffive affections, which occur in acute inflammation. More particular de- fcription of the fymptoms, diftinguifhing generally thofe moft appropriate to difeafes of particular or- [ 61 ] gans •, including defcription of what has been called heBic fever. Termination. The whole affection modified by particular fymptoms, arifing from the interruption in the functions of the difeafed organ. In fome inftances the constitutional affection ap- pears without any local difeafe. Whether in any cafe the local difeafe is actually wanting. Certain other caufes which may produce the constitutional affection ; caufes of a moral, as well as of a phyfical nature. The evidence that local affections influence the fyftem in fome inftances, before the local difeafe has become manifeft. Internal organs may be much difeafed without either increafed fenfibility, or pain ; and even without any obvious derangement in their functions. Eighth. The principles of treatment in cafes of inflammation. In difcuffing particular inflammations the treatment to be confidered more in detail; but certain general principles may be difcuffed now. Different objects to be effected in different cafes, and thefe are to be kept distinctly in view. We may attempt to produce refolution ; or to diminifh the force and extent of the difeafe ; or to enable the fyftem to fupport and undergo it; or fimply guard againft caufes which may increafe, or interrupt it. Regard muft be paid to the conftitutional affection, if any fuch exift ; and fometimes to this alone. The circumftances, under which thefe different objects refpectively fhouid be kept in view. The means of effecting each of them, moft efpecially the firft. In [ 62 ] - i confidering thefe means the following fubjects are difcuffed, viz. The removal of the exciting caufes; The removal, or diminution of irritating caufes; Evacuations, the modes in which they operate in producing partial or entire refolution, the cafes in which they are proper, the conftitutions by which they are moft eafily borne, &c.; The mode of maintaining and reftoring vigour, j when too much impaired, without aggravating the difeafe; The mode of diminifhing morbid irritability; The ufe of medicines called alteratives; The influence, which a regard to the conftitutional affection fhouid have on the treatment. Having treated of inflammation in general we proceed to the inflammatory difeafes of particular parts. j Inflammation may occur in any part of the body, j and that with all the variations defcribed and in very different degrees. Except by having a general knowledge of the difeafe, the particular affections . j cannot be underftood. Yet proper to confider many of thofe affections diftinctly. Thofe will be de- 1 fcribed, with which from their importance, or from their frequency it is moft neceffary to be acquainted. Refpecting each fo much faid as practically im- portant. Generally look firft for common fymptoms j of inflammation ; then for thofe arifing from inter- ruption in the functions of the part; then for thofe from affection of organs related to the difeafed part; lastly for thofe from conftitutional affeClion. [ 63] , Phrenitis. Clafs I. Or. II. G. X. Cullen. His definition. Includes inflammation of brain and membranes; of encephalon. Rare with us. Subjects moft liable. Common fymptoms;—pain, its kind;—heat, how far it appears;—tumour and rednefs, evidence of them during life and after death. Symptoms in the func- tions of the parts, as regards the fenfes, the exercife of volition, the other intellectual functions;—the changes in thefe fymptoms in the progrefs of the -difeafe. Symptoms in organs related to difeafed part. All parts fo related, but fome more inti- mately. Hence appearance of the countenance, xonvulfions, affection of ftomach and abdominal ^ifcera, of refpiratory organs, &c. Conftitutional affection. Brogrefs of the difeafe •—how various, arifing from eparts affected, from violence and from extent. Often flow and fymptoms gradually developed. Termina- tions. appearances after death. Turgefcence of "veffels, effufion of lymph and of ferum, induration, abfcefs. Caufes. The remote—fuch as common to inflam- mation ;—fuch as peculiar to this. The proximate'— already ftated. Diagnofls—between this and fever—between this and fympathetic affections. In fome cafes the order of the fymptoms to be regarded, as well as the char- acter of them. Prognofis—unfavorable, when art does not relieve. Worfe in proportion to advanced period of the dif- C 64 ] eafe when art is employed. The fymptoms which may be confidered as fhowing a fatal tendency. Treatment. Indications. 1. To procure refolu- tion—as directed under general head of inflamma- tion. This a difeafe, where every thing to be facri- ficed to that object, when taken early. 2. To pro- mote removal of effufed fluids; means confidered. Catarrhus, Etymology. Not commonly ranked among in- flammatory difeafes ;—placed by Cullen among Pro- fluvia. Why it fhouid be among difeafes from inflammation. Not ordinarily a fevere difeafe, ye,t occafionally acquires importance. SubjeBs moft liable to it. Seafons and climates in which it prevails moft. Symptoms—local,—their fucceffion. Extenfion of the difeafe from the part firft affected,—the fymp- toms marking this. Termination. Conftitutional fymptoms. The difeafe various in feverity. In whom moft , fevere, and in whom moft protracted. The influ- enza, or catarrhal fever ; how different from catarrh. Chronic catarrh under Phthifis Pulmonalis. Caufes. Predifpofition at certain feafons, &c.; in fome perfons conftantly. Occafional caufes.—Cold fo frequently as to give a name to the difeafe. Diagnofls. Liable to be confounded with inflam- mation of other parts when in the lungs. How diftinguifhed. t \ "/ I [65 ] Treatment. Generally not active. Occafionally is fo. Early, produce refolution—in protracted cafes to bring to termination. Important to prevent in perfons very liable to it—the means. Cynanche Tonsillaris. Of the name Cynanche in general;—applied to difeafes very diverfe from each other. Seat of cyn. tonfillaris. The kind of inflammation. Termina- tions. Sometimes extends. Diagnofis. Treatment, —moftly expeBante; active in the early ftage. It very often recurs in the fame fubject. Prevention, Ctnanche Maligna. The diftinCtion between this and the preceding. Its frequent connexion with fcarlatina. The confti- tutional affection. Whether this be fympathetic. The occurrence of this as an epidemic. Of its con- tagion. Treatment—how far different when fpo- radic and when epidemic ;•—how far different in different epidemics. Cynanche Trachealis. Its fubjects. Its feat. Symptoms—different ftages. Conftitutional affection—in the early ftage, in the fecond ftage, in the laft ftage. Thefe ftages not always diftinguifhed. Appearances after death—in the larynx and tra- chea,—in the lungs. Caufes—remote, proximate. Diagnofis—bet ween G [ 66 ] this and the two laft preceding difeafes. Prognofis —in the feveral ftages. Treatment—indication, to produce refolution ear- ly, and later to diminifh the force and extent of the inflammation. In laft ftage to promote expectora- tion. Means at the commencement—within the firft or fecond day ; in the laft ftage. Cynanche Laryng2ea. Subjects. Seat of the difeafe. Diagnofis between this and the laft. Appearances after death. Prog- nofis. Treatment. Cynanche Parotidjea. Very different in character from the other fpe- cies of cynanche. Seat of the difeafe. Symptoms. Tranflation of the difeafe. Caufes. Remote—propagated by contagion. Prox- imate—fpecific inflammation. Whether the fecon- dary affections be alfo fpecific, or only fympathetic ? Treatment. ExpeCtante, except when teftes, or brain are affected. Then active to produce refolution. Pneumonia. Inflammation of the contents of the thorax, both acute and chronic, very common in our climate. Firft of the acute. At what feafons it occurs. Symptoms, when lungs alone inflamed. Local— of the pain, heat, tumour and rednefs,—the two former may be flight, the two latter not afcertained during life. The kind of pain. Difficulty in the [67] functions;—how affected by pofition. Cough and expectoration. Progrefs and change of fymp- toms. Examination by percuffion. Conftitutional fymptoms—early, and in advanced period. Of fever in combination, preceding or accompanying the inflammation. Duration; and termination—1. by refolution, entire, or partial; 2. by expecto- ration from fuppuration on mucous membrane; 3. by diarrhoea ; this feldom entire, but often pro- ducing great mitigation; 4. by copious difcharge of urine;—feldom, if ever entire ; 5. by fuppura- tion in fubftance, or cellular membrane of the lungs; 6. by carnification, or induration. This indeed not a termination, but a prolongation of adhefive ftage. If not removed, this caufes vari- ous, chronic fymptoms; 7. by gangrene. The three firft modes the moft common. Death in early ftage from interruption of func- tions, or from conftitutional affection. Later, from injury of the organ and exhaustion of vital powers. This may happen at various periods af- ter the commencement ; and when late, the dif- eafe gets the name of phthifis pulmonalis. Of the concealed pneumonia; local fymptoms very flight, and conftitutional fymptoms indiftinct until the fuppurative period. Little fenfibility of the lungs alone. Termination fometimes in death. appearances after death—partly anticipated in de- fcribing the difeafe. The ftate of the lungs when ! death takes place early—when late. The part of the lungs moft frequently affected. L 68 1 Of this difeafe in young children. The fymp- toms—diftinguifhed from catarrhal affections. Sometimes produced by inflammation fpreading from the mucous membrane. Frequently fatal. Rarely protracted. Termination. Caufes—Remote—derived from the climate and feafon in fome meafure. Proximate—pointed out in what has been ftated. Prognofis—moft dangerous periods. What kind of conftitutional affection is moft favorable. Signs in the refpiration, cough and expectoration—from percuffion, and from pulfe. From ftate of animal powers and functions;— from tongue, flcin, urine, &c. Treatment. ExpeBante method very rarely, un- lefs in advanced period. Active method, with va- rious force according to fubject and to fymptoms. Firft indication—to promote refolution. Second, to moderate conftitutional affection when violent. In healthy fubjects thefe may be effected in the great majority of cafes fo far as to make the pa- tient fafe, if early in the difeafe. For this pur- pofe vigorous meafures often neceffary, particular- ly evacuations. Blood-letting—what fhouid deter- mine its extent and repetition—in fubjects of dif- ferent ages, &c. Of vefication.—Of evacuation from alimentary canal. Third indication,—to promote fuppuration by mucous membrane and expectoration;—when to be attempted;—means of effecting it. [69] Treatment of fevere and protracted cafes. How far evacuations are proper ;—of tonics and cordials. Diet at the different periods of the difeafe. Pleuritis. Does fometimes occur without inflammation of lungs. Often fo flight as not to give pain, or not fo much as to be remarked. Reafons for this opinion. Symptoms when fevere—how diftinguifhed from inflammation of lungs. Appearances after death. Treatment. Of empyema, as a confequence of pleurify. Symptoms. Treatment. Pericarditis and Carditis. Rarely noticed in fevere form and fingle. But combined with inflammation of lungs, both acute and chronic, not very rare. Symptoms and progrefs. Termination—in refolution, adhetion, ferous effufion, or fuppuration. Death early from general fympa- thy and embarraffment of the functions of the heart; —or late from effufion, &c. Prognofis" not always unfavorable. Treatment. Pneumonia Notha. Varioufly applied. The fuffocative catarrh of Morgagni (in feats and caufes of difeafes, epift. xm. art. 4.) Here mucous membrane moftly affected, without any confiderable increafe of fenfibility. The concealed, irregular inflammation of the lungs, and that which is hurried and violent, both called by this g2 [ 70 ] name. Symptoms, appearances after death, &c. de- fcribed. Importance of regarding as grave every difeafe in which there is either much derangement Of organs of thorax, or flight derangement with dif- proportionate affection of fyftem.—This, whether the affeCtion of the fyftem be active or paffive. Treatment. In which cafes bleeding is proper, and in which to be omitted. Of vomiting and purging, of blifters, of ftimulating expectorants, of tonics. Phthisis Pulmonalis. Confider chronic inflammation of lungs under this name. Cullen's definition. Good when the difeafe is formed; but it muft be recognized at its rife to combat it. In late period it is very fimilar, but in early period varies. Of the actual changes in the lungs common to moft cafes in laft period. Thofe fpecies of the difeafe to be enumerated, which are moft certainly recognized. Many other fpecies de- fcribed, but are rare, and not generally well marked. It follows common inflammation, or it arifes from a peculiar difeafe, thought to be fcrophulous, in which actual inflammation follows the organic changes. Thefe changes exifting, but the parts being deftitute of inflammation, this fupervenes from accident, and the difeafe is developed. 1. Common inflammation in cellular membrane. How this, leads to phthifis in healthy conftitutions. Difeafe protracted by accident, or bad treatment. Courfe of fymptoms. [ VI ] 2. Common inflammation in mucous membrane. ProtraCted by accident, &c.; or by debility, efpe- cially in old age. Courfe of fymptoms. 3. Protracted phthifis from fiftula in lungs, con- tinuing many years ; conftitution flightly affected at firft, occafional accefs* of inflammation, eventual wafting, &c. 4. Tubercles and fcrophulous inflammation. Hereditary tendency, counteracted or favored by circumftances. Difeafe very flowly and gradually developed, and not recognized, until far advanced ; or haftened by accident. Of the form and characteriftics of 'thofe moft prone to this fpecies of difeafe. Period of llife at which it moft commonly appears. Symptoms. The firft in cheft, little noticed. Followed often by dyfpepfia* Of the pains in cheft, dyfpncea, mode of fpeaking, cough. Commencing emaciation, pulfe, countenance, ftate of temper. Increafe of fymptoms and more full developement with hectic paroxyfms; thefe irregular, fevere for a time apparently from accident, then fubfiding. Change in the pulfe. Drowfinefe at evening, im- perfect fleep at night, difficulty of pofture in bed, morning fweats. Changes which have now taken place in cough and expectoration. Of the matter expectorated in the morning, and in the courfe of the day. Increafed dyfpncea, change in voice, pal- pitation. Duration of thefe fymptoms. Thus far two ftages or periods, the forming, the fuppurating. Followed by the ftage of general exhauftion, in which L 72 ] very probably ulceration is conftantly extending. General appearance in this ftage from emaciation and debility. Entire failure of organic funftions, occafional perfection of animal functions and bright- nefs of intellectual faculties. State of temper, felf deception, how long continued, and often fuddenly abandoned. Maintenance of mufcular power, how much influenced by treatment and habit. Expref- fion of countenance in advanced ftage of the con- fumptive, efpecially in thofe poffeffed of great fenfi- bility and intelligence ;—attempt to analyze this expreffion. The termination of the difeafe, hidden, flow, or greatly protracted. Of the aphthze, colli- quative night fweats and diarrhoea, general oedema, occurrence and occafional removal of fwelling in feet. Final exhauftion, fits of extreme dyfpncea, delirium and diffolution. The two firft ftages differ according to the kind of phthifis and mode of produ&ion. The laft differs in different cafes, but not fo much in reference to the kind and caufes. Occafional fufpenfion of the difeafe by pregnancy and other caufes. Frequent acceleration of its pro- grefs by medicine and other caufes. Hamoptyfls. Frequent occurrence in early and late ftages. In fome firft fymptom, but perhaps prece- ded by confiderable internal changes, fuch as forma- tion of tubercles, &c. The importance given to this fymptom by Cullen in his nofology. The opinions entertained refpefting the kind of hemorrhage, or the fource of the difcharge. Of I ?S ] the phenomena preceding and accompanying has- moptyfis. The quantity of blood difcharged and repetitions,—how far this is important. The con- clusions to be adopted. Of different kinds of hsemoptyfis. Of the frequent recurrence in fome perfons,—not inconfiftent with the maintenance of health and long life. Appearances after death. Externally—emaciation, excoriations, oedema. In the cheft—tubercles,— their different fizes and ftages. Adhefive inflamma- tion uniting them in clusters. Vomicae, in what part they are ufually found to be 'largest. State of the blood-veffels. Adhefions of pleura. State of the heart and pericardium. In the abdomen,—ap- pearances fometimes noticed in the peritoneum and intestines. Caufes. To a certain extent thefe are given in the hiftory of the difeafe. Imperfect cure in cafes of common inflammation will account for the three firft fpecies mentioned. The cure may be rendered im- perfect from various caufes. Parts lofe the difpofition to the reftorative proceffes, veffels around habitually diftended, and occafionally congeftions take place. In refpect to the fourth fpecies, in which, for the moft part at leaft, tubercles are formed, the caufes are to be looked for in an original difpofition in the fyftem, and in the formation ojF tubercles. It has never been afcertained that any particular caufe pro- duces the tubercles. When formed, their progrefs is influenced by many exciting caufes; generally fuch as produce derangement in the ordinary fun&ions, [ 74] The difeafe fometimes follows rheumatifm both acute and chronic. In this cafe is the rheumatic inflam- mation transferred to the lungs, producing in them effects different from thofe in other structures ?—or does the rheumatifm ferve only to occafion the in- flammation of tubercles previoufly exifting ? Obfer- vations wanting on this point. Tubercles may prob- ably remain without change through a long life. Diagnofls. Pulmonary confumption is liable to be. confounded with other difeafes which occafion ema- ciation. The difficulty in the diagnofis is increafed by this circumftance, that a cough arifes from debil- ity alone. The difcrimination to be made, in difficult cafes, principally by attending to the early hiftory of the complaint. Source of deception even in fo doing. How far the different fpecies may be diftinguifhed from each other. This chiefly from the early hiftory alfo; but aided by a confideration of the conftitution and of the difeafes in the family. Prognofis. Univerfally known to be unfavorable. Yet it is not fo without exceptions. In the firft and fecond fpecies defcribed, particularly in the fecond, recoveries do take place when the difeafe has far advanced, and often when not very far. In the third the difeafe may continue very long without destroying life; but inftances of this kind are too rare to permit the formation of pofitive opinions. In the fourth, when the difeafe is developed flowly from a conftitutional tendency, the difeafe is not perhaps ever removed; but,when fuddenly developed by accident, it may fometimes be arrefted in an [ 75] early ftage, and fufpended for an uncertain period. Yet in one, who is evidently difpofed to this fpecies of the difeafe, its occurrence is not inevitable. In cafes of haemoptyfis the prognofis depends on the degree of embarraffment in the functions of the lungs, on the effects produced in the general fyftem, and on the evidence of previous difeafe in the lungs, or of tendency to difeafe in them. Treatment. In the firft and fecond fpecies defcri- bed we have to remove the diftenfion of the veffels, to guard againft occafional congeftions, and to induce the reftorative proceffes. Thefe purpofes effected in part by regulating the functions generally, by proper exercife in the open air, by diet and by pro- moting regular evacuations. They are further ef- fected by overcoming the inflammatory difpofition by general and local bleeding and by counter-irrita- tion. They are effected by tonics, where the difeafe has had its origin in debility, or where it is prolonged by that caufe. The difpofition to the reftorative proceffes is fometimes promoted by the ufe of thofe general ftimulants, which have been called altera- tives ;—fometimes by fedatives. In the third and fourth fpecies, though very dif- ferent from each other, we cannot by any known means remove the effential obftacles. In both how- ever much may be done by preventing the occafional occurrence of inflammation around the difeafed parts. This is done by guarding againft the caufes of the inflammation, and by diminishing the fufcep- tibility of the fyftem to the action of thofe caufes. [ 76 ] In cafes of hsemoptyfis the treatment muft have reference to the other fymptoms. If in an early ftage, we adopt active meafures to prevent the occur- ^ rence of inflammation. This fubjeft better explained ) in difcuffing hemorrhages generally. If in a later ftage, we guard only againft temporary evils. This by articles which have been called aftringents and refrigerants. In moft cafes medical aid is not employed in feafon to effeft a cure; in fuch cafes palliatives fhouid be ufed to leffen fuffering and to prolong life. The remedies which will ferve thefe pur- pofes are various, and muft be accommodated to fymptoms and to the peculiarities of the conftitu- tion. Inflammation in the mucous membrane of the stomach and intestinal canal. Certain general confiderations apply to this fubject. The fymptoms from occafional irritation and from inflammation very fimilar ; exemplified in affections of the tunica conjunctiva. Review of the functions of the ftomach, &c. and confideration of circumftances influencing thofe functions. Increafed ftimulus, the irritability being the fame, or common ftimuli, tht irritability being increafed, produce fimilar effects. Inflammation increafes the irritability. Symptoms vary according to the feat of the inflammation, its extent, and its character, and according to the con- ftitution of the patient and the particular ftate of that conftitution at the time. The parts when ht* [77 ] flamed are lefs able, than when irritated only, to perform the actions to which they are excited and which they attempt. Hence the fecal contents wholly, or partly retained in many inftances, in which the fecretions are difcharged abundantly. Thefe confiderations ferve to explain many of the fummer and autumnal difeafes. Many varieties; but they pafs, moftly, under the names of cholera. . morbus, colica, diarrhoea and dyfenteria. In young chil- dren under one other name, viz. cholera infantum. Each to be defcribed ; but it is to be noted that there are many intermediate gradations. Cholera Morbus. Sudden, violent and fhort. Seat of pain. Vom- iting of bile, &c. Origin of the name. Affection of fyftem. Duration. Termination,—fometimes in health after a fhort period; at other times in diar- rhoea; and not very rarely, in warm climates, in death. Appearances after death. Caufes. Prognofis. Treatment. Certain indications to be regarded in this and colic, &c. but not equally in each, nor ia the fame order always. 1. To remove irritating fubftances from, the canal. 2. To leffen fenfibility and irritability. 8. To remove inflammation. 4. To reftore the tone of the organs. Methods of fulfilling thefe indications generally, and particularly in cholera morbus. H • [ 78 ] COLICA. Symptoms few and fimple. Pain, its feat, degree and character. How the functions of the canal are affected. Affection of the fyftem. Caufes. Occurs with and without inflammation. The fummer colic certainly allied to cholera morbus, &c. Is there an affection of mufcular "coat? The predifpofition produced by the fea- fon, fo that flight occafional caufes will induce it. Changes of weather, indigeftion, fatigue. , Frequent and habitual colic from oeganic difeafes 1 in alimentary canal, or in parts connected with it. Occafional congeftion and irritation in- the canal. "How far there is proper fpafm. Treatment—deduced from confiderations before .." ftated. How far the fame applies in habitual colic. J The organic difeafe to be removed. DlARRHiE. Symptoms. Varioufly graduated. The discharges ^ differing in kind, and hence inferences to be drawn. \ The difeafe fometimes chronic. Caufes. The general remarks on affections of \ alimentary canal apply particularly to this difeafe. ,! Inflammation in fome cafes. How diftinguifhed. Chronic diarrhoea often arifes from organic affec- j tions, and from indigeftion. Treatment—founded on principles already difcuffed. Methods detailed. [79] DVSENTERIA. This difeafe acute and chronic, fimple and com- plicated with others, various in degree. In flight cafes the fyftem not difturbed, in others greatly difturbed. Symptoms,—duration,—terminations. Appear- ances after death ;—-thofe effential to the difeafe in the mucous membrane of large inteftines. Thofe in the chronic fpecies. Of the abfence of thefe appearances. Treatment. On principles already ftated. How applied to this difeafe. Methods detailed. Of the tendency to relapfe, the caufes of it, and means of preventing it. On the various affections of teething children paffing under the names of diarrhoea and cholera infantum. Thefe derive peculiarities of character from the frequent irritation of the gums, and from the difpofition to inflammation during the period of dentition ; and from the ufe of food, to which the digeftive powers at that period are not adapt- ed. The feafon of the year has a manifeft influence. The principles already ftated applied to thefe affections. Methods of treatment detailed. Peritonitis. Subjects in whom it is moft common, and feafons. Symptoms. Pain varying in extent, its character, how affected by preffure, by coughing, &c. Effects on ftomach and other abdominal vifcera. Effects on [80] fyftem. Progrefs of fymptoms, figns of fuppuration, exhauftion and death. Symptoms in more favorable cafes. Sometimes chronic, and produces various effects on the neighbouring parts and on fyftem. Appearances after death. Such as are common to inflammation in ferous membranes. Adhefion, fup- puration, ferous effufion, ulceration and fphacelus. The parts moft commonly affected. i Caufes. All which are known may be deduced from principles difcuffed under inflammation in general, &c. Diagnofls. This not very eafy, as may be inferred from frequent errors. Confounded particularly with colic, when acute. The chronic fpecies often over- looked, the fymptoms being referred to debility, or fome other caufe. Signs by which to diftinguifh this difeafe. They may fail in certain cafes of vio- lent inflammation of mucous membrane in bowels; but the error then unimportant as regards treatment. Prognofis. Unfavorable in the acute fpecies, when unaffifted. At an early period it may be controlled by art. The unfavorable figns are the marks of fuppuration, great difficulty in refpiration, and ap- pearances of finking in the general fyftem. Treatment. The great object is to produce refolu- tion. Remedies applicable in this difeafe. Thofe adapted to the chronic fpecies. The inflammation of various other parts will be con- v fidered in the courfe, but there would not be any advantage in referring to them in the fyllabus. [ 81 J Rheumatismus. Uader this name great variety of affection?* What is common to them all. Etymology of the term, and theory oh which it was founded. The difeafe diftinguifhed as acute, or chronic; and names appropriated to the affection of different parts. It is general, or local. Firft of that which is acute and general. SubjeBs,—fanguine and choleric more than others^ Seafons, the damp and cold, and the changeable. Symptoms: Diftinguifhed as local, or belonging, to the fyftem. The local firft in order. The common feat of them. They are thofe of inflammation in the formative and adhefive ftages, particularly the former. Of the pain, its kinds and degrees. Con- sequent embarraffment in motion. Of the tumor, the heat and the rednefs. Neither of thefe effential. Suppurative and ulcerative proceffes do not enfue. Explanation of the cafes in which they have been fuppofed to do fo. The frequent metaflafls, or change in the feat of the affection. Qf the parts occafion- ally affected in this difeafe ; £he eyes in their various parts, the heart, &c. The affeCtion of jhe heart fometimes truly rheumatic, fometimes more refem- ~ bling common inflammation. Inflammation of lungs alfo. Converfion to dy fernery, or metaftafis to mu- cous membrane of large inteftines, and vice versa. Suddennefs in the attack and in the fubfidence- Tumefaction remaining in fome cafes after the dif- eafe ;—in fome cafes permanent. Tendency, to recurrence. h2 [ 82 ] Constitutional fymptoms. In moft cafes thofe of general inflammation, at leaft until the difeafe has continued for a confiderable period. But occafion- ally thofe of morbid irritation. In cafes much pro- trated fomething like heBic fever. The conftitu- tional affection commonly fupervenes upon the local; —often after two,or three days,or more. Sometimes the former is fimultaneous with the latter; occafion- ally it precedes. Influence exercifed by the chylo- poietic fyftem in this difeafe. Duration of the difeafe. Local affections often remain after the conftitutional affection and the general tendency to the difeafe have fubfided. Appearances after death. Few obfer vat ions record- ed ; opportunities rare. A cafe by Morgagni. Caufes. Predifpofition fometimes hereditary. Moft common in perfons of a certain conftitution. Produced by habits of living. Occafional caufes. Cold and moifture the moft frequent. Irregularities in diet and regimen. Proximate caufe. » A fpecies of inflammation. The feat of the difeafe%fuppofed by fome to be in mufcles, by others in fafcia, &c. Evidently not con- fined to parts of any one texture; though moftly about mufcles, or membranous parts connected with them, and about ligaments. Diagnojis. Liable to be confounded with common inflammation and with fever. How diftinguifhed. In the earlieft period cannot always be distinguiflied from common inflammation. '1 . [83] Prognofis. Rarely fatal; but long and tedious,5. unlefs early remedies be employed. Falfe appear- ances of amendment. Effects to be expected on the fyftem and on particular parts. Favorable and un- favorable figns. Treatment. The diathrfis to be overcome. In early period this by relief of urgent fymptoms; in later periods the relief of fymptoms cannot always be effected without injury, and we muft inquire whether experience fupplies any remedy. Of evacuations;—how far and when ufeful. Bloodletting. Sydenham's practice. Fordyce's ob- jection to bleeding. Vomiting and purging. Ali- mentary canal to be kept free from irritation and tone to be preferved. For this purpofe, in certain cafes, confiderable evacuations required. Sweating. How far the hiftory of the difeafe would authorize a reliance on this remedy. Of the benefits attribu- ted to it. How far they may be attributed to fome other effects of the remedies. Rules for the ufe o£ thefe remedies. Of the treatment at an advanced period of the difeafe. Of evacuations. Opium and ipecacuanha. Guiacum, mezereon, &c. Cinchona—Haygarth's reports. Digitalis and other narcotics. Friction, bathing and vefication. Mercurials. In protracted cafes, where the ftrength is much proftrated—attention to diet and regimen. Tonics* [ 84 1 , Means of prevention for thofe much fubject to the difeafe. Second, of chronic rheumatifm. Symptoms. Some- times a confequence of the acute fpecies; but not in all cafes. Diftinguifhed from the acute. Treatment. Of occafional rheumatic pains which may be call- ed acute, yet entirely local. Treatment. • Arthritis. Etymology of the term. Limited ufe of it at the prefent day. SubjeBs. Children of thofe who have been affect- ed with the difeafe. The luxurious,—but not ex- clufively. Among the luxurious thofe of a certain defcription more than others. Males more than fe- males. At what age. Symptoms. The difeafe not conftant in ordinary cafes; nor ever, if diftinguifhed from its confe- quences. But for the moft part continues through life, occuring at certain feafons in fits. Defcription of a fit, or paroxyfm. Local fymptoms, conftitution- al affection. Duration. Difference between early and later paroxyfms. Effects of frequent recurrence —on the limbs—on the conftitution. Of irregular gout,—the atonic, retrocedent and mifplaced. Of the opinions which have prevailed on this fubject. Statement of the facts. Caufes. Remote caufes to be inferred from ftate- ment made in refpedfc to the fubjects. Irregulari- ties of various kinds aCt as occafional caufes. • L 85 ] ' Proximate caufe not fo well afcertained. The language ufed in refpect to this difeafe is derived from the humoral pathology. Is there evidence of a morbific matter ? Is it to be called a fpecific in- flammation ? Mr. Hunter's opinion that it is a con- ftitutional act. There is not merely a fpecific local affeCtion. Diagnofts. Diftinguifhed from fprains and other accidental injuries ;—and from rheumatifm. Occa- fional difficulty in making this laft distinction. Prognofis. Regular gout not fatal, but exhausting. Irregularities increafe the danger. Apoplexy, palfy, &c. often terminate life in the gouty. Treatment. Great apprehenfions among moft men as to active treatment during the paroxyfm. The foundation of thefe apprehenfions. More juft after frequent returns of difeafe than at firft. Of remedies which may be employed during paroxyfm to leffen its violence,—and to fhorten its duration. Of the ean medicinale cT Hufifon, and its fubftitutes. Treatment in irregular gout;—where the ftomach is affected; where the head,or the breaft is affected. In the intervals, how to leffen the frequency and moderate the violence of paroxyfms. Impropriety of uniform rules in refpect to the diet and regimen. Conftitution to be consulted. Nodositas Articulorum. A difeafe firft distinguiflied by Dr. Haygarth, General refemblance to gout and to chronic rheu- matifm. Rare in its occurrence. C 86 ] SubjeBs. Women more than men,—and at a cer- tain period of life. Symptoms. Their feat. Tumefaction, manner of its formation, and its duration. What cohftitutes the nodes. Pain, its characteristics. Progrefs of the difeafe. Caufes. Not well afcertained. The remote caufes which have been fufpeCted. Proximate caufe—may perhaps be faid to be an inflammatory procefs of a peculiar kind. Diagnofls,—in refpect to gout;—in refpect to rheumatifm. Treatment. A new fubject. Probably medicine cannot avail much. Of the remedies which were tried by Hay garth and their effects; fuch as guia- cum, mezereon, &c; cinchona, antimonials, mercu- rials, baths of various kinds, leeches. Bardfiey's ex- perience. Erysipelas. The diftinCtion made between Eryfipelas and Erythema. The local affection only to be confider- ed. The connection with an affection of the fyftem rather accidental, than effential. Symptoms. Inflammation of fkin -T the formative procefs only effential. Its propagation from part to part. The conftitutional affeCtion. Caufes. Various fubftances applied to fkin act as remote caufes. Thefe moftly or entirely of animal or vegetable origin. Substances received into the C 87] ftomach alfo produce it. The difpofition in certain perfons very great. Of what defcription they are. Of contagion. Proximate caufe, the fame in kind as that of oth- er inflammations, but modified. Treatment, Of evacuations. Of cinchona. Of local applications. Of the danger apprehended from repulfion, where the face and head are affected efpecially. How far experience warrants fuch ap- prehenfions. C 88 J HEMORRHAGE. General definition. Four modes of occur- rence commonly enumerated ;—thefe called rexis, diabrofis, diapedefts and anaftomofis. 1. Rexis,—by mechanical violence. Belongs to furgery. 2. Diabrofis,—by rupture in the coats of the blood\ effels. This very rare in large veffels, unlefs ulceration, or fome change of ftructure has preced- ed ; yet occafionally from violent contraction of the heart. The heart itfelf may be ruptured. Symp- toms attending hemorrhage of this kind. Of ulceration extending from other parts to the blood-veffels. Why hemorrhage does not enfue. 3. Diapedefts,—tranfudation through the coats of the veffels. Such tranfudation often noticed af- ter death ;—why it does not occur conftantly during life. Inftances in which it has been noticed during life .—from veffels of what order, and under what circumftances. Can this kind of hemorrhage be diftinguifhed, if from internal parts. 4. Anaflomofls,—from the orifices of the extreme veffels. The caufes which prevent fuch an occur- rence in the healthy ftate. By what changes in the parts does it take place in difeafe ? By a relaxation of the veffels ? In confequence of increafed impetus ? Or in confequencie of an aCtive dilatation of the vef- t fels ? Reafons for attributing the moft important fpontaneous hemorrhages to this caufe. [89] Of the diftinCtion of fpontaneous hemorrhages into aBive and paffive. The fymptoms by which they are fuppofed to be diftinguifhed. How far the diftinCtion is well grounded. Of the caufes which prevent the difcharge of blood from the extreme veffels in health. How are they made to do fo under difeafe ? To anfwer this inquiry, firft attend to fymptoms and appearances after death. Frequently precurfory fymptoms,—fuch as denote turgefcence of veffels. Pain, tenfion, pulfation, in- terruption of functions. During hemorrhage thefe fubfide, if it be confiderable. Precurfory fymptoms fometimes wanting. But very often inflammation enfues. Appearances after death ;—difficulty in at certaining the ftate of the parts. All evince an unufual determination of blood to the part. Of the immediate caufes of this determi- nation. How the explanation accords with the oc- cafional abfence of precurfory fymptoms ; and with the connection of inflammation with hemorrhage, in certain cafes. Further explanations and arguments in favor of the opinion advanced. The frequent recurrence of hemorrhage in vicinity of parts affected with chron- ic inflammation. Of paffive hemorrhages. Rare. Confiderations in refpect to them. Of the parts moft fubject to hemorrhage. Of the perfons moft liable to them. The parts moft liable I [ 90 ] to be affected at the different periods of life refpect- ively. The feafons in which they are moft com- mon. Remote caufes of hemorrhage. The circumftan- ces under which it is beneficial, and the contrary. Treatments General confiderations only. Refer- ence muft be had to the part affected, to the force of fymptoms and to the confequences to be appre- hended, in determining whether to adopt an active courfe. How far it is important to prevent the lofs of blood. Moft fo, when frequently repeated. The immediate danger not fo great as that from enfuing inflammation, when important organs are concerned. To avert this danger the hemorrhage may even be promoted. Means of promoting the hemorrhage. Means of . arrefting it. Very fimilar to thofe employed in in- flammation. Remedies for paffive hemorrhage. Unneceffary to confider particular hemorrhages in this place ■--/ \ [91 ] PROFLUVIA. General idea. Many difeafes might be in- cluded if we regard fymptoms only. But in great majority of inftances they are not idiopathic. Prob- ably never fo, excepting affections of a very moment- ary kind. Yet one difeafe, certainly, in refpect to which we have not evidence that it is fymptomatic. This is diabetes. Remarks on the other profluvia which are con- fidered by fome as idiopathic, fuch as ephidrofls, pty- alifmus, diarrhoea, C5V. The reafons for hefitation in refpect to diabetes. Diabetes Mellitus. SubjeBs. Males more than females, thofe who fweat profufely, certain families, fuch as err in regi- men and diet. Symptoms. The urine,—its quantity, characterif- tics, analyfis Appetites, and ftate of chylopoietic organ', and functions. Skin,—emaciation. Pulfe. Other fymptoms often noticed.4 Their order and connection. Termination. Appearances after death. None peculiar and con- ftant. Thofe of en noticed in myfenteric glands and ki.ineys. Caufes. Remote,—to be found in the hiftory given. Proximate,—not afcertained. Of the dif- ferent opinions. Whether in kidneys, in ftomach, or in the other aflimilating organs. [ 92 1 Diagnofts. Quantity and quality of urine. Af- fifted by ftate of fkin, of mouth and of appetite. Prognofis. Unfavorable without remedies. How far thefe can be relied upon. Treatment. The different methods lately purfued by Rollo, Ferriar, Bardfley, and Watts.- [93] ADYNAMIC. General defcription. Various parts liable to loss, or confiderable diminution of power. The affection very often secondary, but not always ; at leaft not known to be fo. It is not defigned to treat of all the difeafes which might be included under this head. A diminution, or lofs of power in the animal fyf- tem may be attributed in a large proportion of caf- es to preffure on the brain, or its appendages. In fome cafes however, the lofs of power would feem to be produced by the direct agency of external caufes. In other cafes it is fympathetic. To illufc trate this fubject a general view will be taken firft of Sauvages' fixth clafs, Debilitates, and then of Cul- len's fecond order in his fecond clafs, Adynamia. The following are the orders in Sauvages* fixth clafs. I. Dys^sth^sije. Impotentia dare ac diftinBe fentiendi. II. Anepithymije. Appetituum fenfltivorum de- bilitas notabilis, vel fuppreffio infolitai III. Dysinesi^ Impotentia motus ac fiepe fen*' sits in organis libertati fubditis, ut lingud, larynge, ar*- tubus. IV. LElPOPSYCHm. Motuum, viriumque vita/U urn debilitas. V Comata. Senstts omnis, appetitus, mot&s libe- rty phantafla, memoriaque feriationes, feu morbi foportft* C 94 ] The following are the genera under adynamia, the fecond order in Cullen's fecond clafs. Syncope. Motus cordis imminutus, vel aliquamdia quiefcens. Dyspepsia. Anorexia, naufea, vomitus, inflatio, ructus, ruminatio, cardialgia, gajlrodynia, pauciora fal- tem vel plura horum fimul concurrentia, plerumque cum alvo adflriBa, etftne alio vel ventriculi ipftus, vel alia- rum partium morbo. Hypochondriasis. Dyfpepfla cum languore, moef- titia, et metu, ex caufls non aqjiis, in temperamento mel- ancholico. Chlorosis- Dyfpep/ia, vel rei non esculenta deflde- turn ; cutis pallor vel decoloratio ; vena minus plena f. corporis tumor mollis ; asthania i palpitatio ; menstruo- rum retentio. Obfervations on each of thefe in refpect to its. character and treatment. Dyfpepfia to be confider- ed more fully. Dyspepsia. Gfneral idea. Relations of digeftive or- gans4, particularly of ftomach, to the other parts of the fyftem, and powerful influence on them. The difeafe may be in various degrees, may be acute or chronic, may he idiopathic or fymptomatic. The importance of regarding it when fymptomatic, ef> pecially in chronic difeafes. Of the opinions of thofe, who regard this affection almoft alone in chronic difeafes. Evils and benefits thence refult- ing. Occafional indigeftion, or acute dyfpepfia briefly confidered. Then of chronic dyfpepfia. [95] SubjeBs. The indolent, luxurious and intemper- ate, &c. Symptoms. May be divided into thofe which ap- pertain to the alimentary canal, and thofe in other parts of the fyftem. Firft, in the alimentary canal. Of the appetite ; ftate of the tongue, mouth, fauces and pharynx ; eructations ; fenfe of oppreffion arid of diftenfion j heart-burn ; diftrefs at the ftomach ; vomiting of food, of watery fluids, of mucus and of bile ; pain,. flatulence, &c. in the bowels.; alvine difcharges,. their quantity, quality, &c. Second, in other parts of the fyftem. In the head, pain, &c. ftate of intellectual powers. In the organs of fenfation and motion. In the thorax, fenfations> refpiration. In the heart and circulating fyftem. In the fkin and extremities-, This is an enumeration of fymptoms. They da- not all occur in every cafe. Variety from many eauies. First, of cafes where- errors in diet operate as the principal caufe, the powers of the ftomach not being impaired except by them. Second, of cafes where the principal remote caufes are of other kinds. In truth caufes of both defcriptions co-operate in moft cafes, but generally not with equal force; First, where errors in diet operate as the princi- pal caufe. Thefe may be, I ft. in the ufe of articles of nutriment, or 2d. in the ufe of condiments, cor- dials, &c. lft In the articles of nutriment the error may be in quantity, or quality* [96 ] Effects of error in quantity confidered ; both thofe which are immediate, and thofe which are re- mote. Thefe effects fhown in alimentary canal and other parts of the fyftem. Effects of error in quality. In this refpect the fame articles not equally injurious to all perfons. The-difference referable in part to different degrees of vigour in the ftomach, in part to idiofyncracies and in part to habit. Comparifon of the different articles of food commonly employed. Caution in refpect to circumftances to be noticed in deciding on the qualities of different articles. 2d. Condiments, &c. confidered as they act on- the ftomach chiefly, or wholly ; and as they act on the general fyftem. Frequent caufes both of tem- porary indigeftion and of chronic dyfpepfia. Second, where the principal remote caufes are not errors in diet. Chronic dyfpepfia always arifes from inability in the ftomach to digeft food* This may be produced by errors of diet, but alfo from othe» caufes. 1ft. From affections of the mind. 2d. From want of exercife. 3d. From labour too long continued; or too fevere. Caufes of each kind con- fidered. Proximate caufe already ftated, now more diftinct*- ly explained. Progmfls. The degree of danger to life. The^ chance for perfect recovery. Circumftances which aggravate the difficulty and danger. Treatment. The indications arranged under three heads, ift. Thofe which relate to matters contain- I 97 ] ed in and offending the ftomach. 2d. Thofe which; relate to the articles of diet to be employed. 3d. Thofe which relate to the ftate of the organ itfelf. Under I ft. head, indications to evacuate the con- tents, to neutralize them. Modes of evacuation con- fidered generally. The particular confiderations re- quiring an emetic arranged under five divifidns and minutely ftated. On the modes of producing vom- iting, choice of emetics, regard to idiofyncracies. The confiderations requiring purgatives ; fuch as re- late to the ftomach diftinctlyt,; fuch as relate to the inteftinal canal. Cafes in which we can neutralize the offenfive contents. Circumftances which fhouid determine the choice of articles. Under 2d. head the indications regard the quali- ty of the food, its quantity, and the frequency and periods of taking it. Under 3d. head the indications are to increafe- the tone, or vigour of the ftomach, and to remove its morbid irritability. Thefe to be effected by due attention to all the preceding indications ; alfo by tonic medicines adminiftered to the ftomach ; by applications to other parts of the body ; and by the careful regulation of all the functions of body and mind, which are the fubject of controul. The means of fulfilling thefe indications difcuffed and confidered. [ 98] DOLORES. Pain a fymptom in moft difeafes, and by differ- ence in kind and degree often helps to diftinguifh them. Probably it is always fymptomatic j yet we meet cafes, not very rarely, in which it is difficult to refer the fymptom to its caufe. Two difeafes, which are well marked, in which we have not any evidence of inflammation or of other caufe, and in which the pain is excefiive, viz. : neuralgia and hemi- tonia intermittens. Neuralgia. SubjeBs. Of what age and fex moftly. Symptoms. The kind of pain, its feat, its exten- fion, occafions of its occurrence, its degree. Effects on the general fyftem. Its origin and termination. Caufes. How little is known except as to the or- gans directly affected and the pain itfelf. Of irri- tating cau^e* difcovered in fome inftances. Wheth- er the newee are in a ftate of chronic inflammation ? Prcg'fl; On the chance of fpontaneous amend- ment i )n that of artificial relief. Treatment. Indications—from the pain ;—from its pcGi'de caufes Remedies which have been ufed. Narco- ics, metallic ftimulants and alteratives, divifion of the nerves. Hemicbania Intermittens. Symptoms. The feat of pain, its character and de- gree, its periodical recurrence. By what circum- I £99 ] ftances it is preceded. Effects on the fyftem. Du- ration. Caufes. The probability that it is fymptomatic How far fimilar to intermittent fever. From this fimilarity called Cephalaa febricofa. Diagnofts. Diftinguifhed from common hemicra- nia and from neuralgia. Prognofis. Derived from the hiftory given. On the relief to be promifed from medicine. Treatments Founded on the refembiance to inter- mittent fever. ij£ Cinchona, arfenical preparation, opium. Inefficacy of remedies from which pallia- tion at leaft might be expected. A few remarks on Otalgia and Odontalgia, with reference to their various caufes, and to their cure. SPASMI. General idea. Proper feat of fpafm* Inaccuracy in the ufe of the term. Spafmodic difeafes moftly fecondary, perhaps al- ways. Refult from difeafe in, or preffure on the brain or its appendages ; or from fympathy. The diftinCtion of tonic and clonic fpafm. 1 he following fpafmodic affeCtions, as diftinguifhed by Sauvages, briefly confidered, viz. : Crampus, Trifmus, Tetanus, Catochus, Convulfto, Tftmor, Eclamffta, Epilepfia, Hy- terta, Scelotyrbe. As, alio the following, included un- der fpafmodic difeafes by Cullen, viz. : Asthma, Pertuffts, Colica piBonum. f ioo 3 DYSOREXIA. General idea. May arife from fome inflammation ©r change of ftructure in the organs, which are the feat of appetite ; from an affection of the nerves be- longing to thofe organs ; from an affection of other parts of the fyftem with which thofe organs main- tain vital relations ; perhaps from difeafe of the mind ; and perhaps from other caufes. In moft in- ftances, if not in all, the dyforexia muft be feconda- ry, or fymptomatic. Yet where the difeafe, to which it belongs, is not underftood, it muft in the prefent ftate of our knowledge be confidered by itfelf. Un- der this head will be briefly confidered the follow- ing difeafes, included under the order of dyforexia, by Cullen, viz, : Bulimia, Polydipfla, Pica, Satyriqfts, Nymphomania, Anorexia, Adipfta, Anaphrodifla. lime cannot be afforded for any thing more than a very brief and general confideration of thefe dif- eafes. [ 101 ] VESANIiE. General defcription. Difeafes of the mind evi- dently fymptomatic in many cafes. How far we are authorized to confider them idiopathic in any cafe. Of the ground on which we feel authorized to con- fider the vefaniae as difeafes of a diftinct clafs. The diftinCtions not of the fame kind which exift in re- fpect to the other claffes. Difficulties in refpect to the arrangement of the vefania, as evinced by the contradictory opinions of nofologifts. An arrangement adopted from confid- erations of convenience, not meaning to decide final- ly on this fubject at prefent. Two genera, viz. : Delirium and Amentia. Each defined. Species of Delirium. Mania furibunda. Mania mitis. Melancholia. Species of Amentia. Fatuitas, in omnibus vel fingulis facul- tatibus. Symptoms of thefe different affections in their va- rious ftages ; and their termination. Appearances after death. In what manner this fub- jeCt has been inveftigated. Under what difadvanta- ges for the elucidation of it. The fum of what has been learnt. The facts are worthy to be recorded, but as yet the inferences they afford are of the moft general nature only. K [ 102 ] Caufes. How far the predifpofition is hereditary. In the fame family may be noticed various difeafes referable to the affections of the brain. How far the predifpofition may depend on the character of the mind. Exciting caufes. Thofe which may be called moral. Confider the paffions more than the intel- lect. How they operate. The fame effects produ- ced on the predifpofed by phyfical caufes. A de- fcription of thefe. Proximate caufe. If in moft inftances thefe dif- eafes are fecondary, or fymptomatic, we muft look to the primary difeafe. Can we find however any proximate caufe for thefe difeafes confidered as pri- mary ? This queftion confidered in refpect to the different mental difeafes which have been enume- rated. Diagnofts. In ordinary cafes not difficult. At leaft this is true when the queftion is general; lefs fo, if we would diftinguifh fpecies and varieties with accuracy. The moft important diftinCtions pointed out. In certain cafes the diagnofts difficult. Infani- ty may be fimulated from interefted motives. For legal purpofes nice difcrimination is fometimes necef- fary. General rules. Neceffity for perfonal expe- rience in fome cafes. Prognofis. To be confidered in refpeCt to the dif- ferent mental difeafes. How much it muft be found- ed on a knowledge of the caufes. How far we may be guided by fymptomr. The violence of fymptoms not to be much relied upon. :eVM|i^8PJ>^'1 C 103 ] Treatment. This is both moral and phyfical. So as to other difeafes in many inftances ; but particu- larly fo as to difeafes of mind. On the importance of moral treatment both where the difeafe has orig- inated in affections of the mind, and in many cafes, where it has originated in affections of the body. This importance too much infifted upon by fome au- thors. Phyfical treatment almoft always neceffary in fome meafure, although inefficacious alone. The phyfical treatment muft have reference to the caufe where known. Where it is not, urgent fymp- toms to be relieved and the organic functions to be regulated. Of bleeding, bliftering, evacuations from the ali- mentary canal, alteratives, diuretics and tonics. r 104] MORBI ORGANICI. Impropriety of fuch a clafs of difeafes. Con- fiderations of convenience led to its admiffion as well as to that of the two remaining claffes. General defcription of the difeafes which might be included under this head. Brief remarks on organic difeafes of the brain, o£ the lungs and air-paffages, and of the cefophagus and rectum. Organic difeafes of the heart and large blood-veffels, of the ftomach, of the liver and its ap- pendages, of the pancreas, of the fpleen and of the myfenteric glands confidered more particularly. In the prefent fyllabus organic difeafes of the heart and large veffels only, will be referred to. Morbi Cordis Organici. General confiderations in refpect to the functions of the heart, the caufes ordinarily influencing them, and the difeafes of that organ induced by thofe caufes acting with unufual power. Of inflammation, which may affect the heart, &c. as well as other parts. Of inflammation in different parts of the organ ; effects differing from kind and rapidity of the inflammation. Of certain changes of ftruCture often noticed in the heart, aorta, &c. Of the embarraffment in the functions of the heart arifing from thefe various changes of ftructure, and of fecondary organic changes often reflating from fuch embarraffment. The fame changes produced by embarraffment in the functions, occasioned by oh- ftacles external to the heart. [ 105 ] EffeCts refulting from changes of ftructure in the heart, &c. are modified"by many circumftances. The principal circumftances pointed out. Confideration of the effects confequent upon orig- inal changes of ftrufture in the heart, &c. Thefe effects to be attributed to the failure of the heart to perform its mechanical office ; and thus a general refemblance may be noticed among the effects arif- ing from its different organic difeafes. Thefe effefts claffed under three divifions, viz.: I. Thofe on the heart itfelf: 2. Thofe on the pulmonary circulation : 3. Thofe on the general, or aortal circulation. 1. Effects on the heart itfelf. Thefe have been partially difcuffed. They confift in changes in the functions, and changes in the ftructure. Thefe con- fidered in detail, fhowing how far they vary in the feveral diftinct organic changes, and how they are modified in confequence of the fucceffive organic changes. How we may afcertain fome of thefe changes by percuffion. 2. Effects on the pulmonary circulation. Thefe complicated by various circumftances. Thofe arifing from the interruption of the mechanical office of the heart differ according to the part of the heart affect- ed. The obstructions almoft always in the cavities on the left fide, and thence the return of blood from the lungs is prevented. t he immediate and more remote effects from the diftention of the pulmonary veffels The diftention arifes from a mechanical caufe and is a mechanical effect ; but occuring in living parts it gives rife to changes in functions, &c. [ 106] which are varied by many circumftances affecting the living fyftem. How inflammation and effufions from different parts are produced from the caufes mention- ed. Hence pulmonary catarrh, pneumonia, hsemop- tyfis and hydrothorax. Of the dyfpncea under thefe circumftances ; how influenced by pofition and by fleep. 3. Effects on the general circulation. Thefe anal- ogous in fome refpects to thofe on the pulmonary circulation. Under this head we confider the ef- fects on a. The arteries, their pulfations, and on the veins. b. The countenance. c. The brain and functions dependent on it. d. The functions and ftate of the abdominal vifcera.' e. The fecretions generally. f. The urine. g. The cellular membrane, particularly in the ex- tremities. After this general view of the effects of organic affections of the heart, the hiftory of the fymptoms arifing from each diftinct affection might be given, fo far as known. Reafons for not doing this. Some obfervations however to be added in refpect to thefe difeafes, particularly the occurrence of their fymp- toms in paroxyfms to be explained. Then a gener- al view of their fymptoms in the moft common order of their occurrence in thofe affections which are fre- quently feen, particularly with a view to teach how the affections of the heart may be difcovered at an early period. Laftly, the different modes inwhich death is produced in the difeafes under difcuffion. [ 107] Appearances after death. Thefe anticipated from the particular mode in which the fubject has been treated. Such general remarks now added as to render the view of the fubject more perfect. Diagnofts. This likewife has been moftly antici- pated. The diagnoftic fymptoms of different affec- tions of the heart ftated, fo far as afcertained. Prognofis. Generally unfavorable ; but not uni- formly. In what cafes this may be faid. The fudden changes to be adverted to, in confequence of which danger is never abfent. Treatment. How farcertain general directions may be applied to moft, or all cafes, although differing in their origin. In the treatment we are limited moft- ly to the removal of effects arifing from the original difeafe ; yet fometimes our remedies may influence the original difeafe itfelf. The fame remedies will influence various parts ; but to acquire diftinct views we muft confider the treatment in relation, 1. To the heart itfelf. 2. To the lungs and cavities of the thorax. S. To the other parts of the body. Having confidered how the morbid effects in thefe various parts may be counteracted, we muft inquire how far a recurrence of the fame may be prevented. Laftly, the ufe of palliatives muft be defcribed. Note. Under the head of Morbi ex adventitiis in corpore inclufts will be noticed the effeCts of biliary calculi and of worms. Under the head of Morbi fympathet- [ 108 ] ici, fome practical remarks will be made in additioa to thofe which have been given in relation to the fame fubject in other parts of the courfe. But it does not feem expedient at this moment to prepare a fyllabus of this part of the courfe. '^^^^^^^ J , j M 7* M^cL Hist, WZ. J 13s 1*1 (• c-A E.W" ■>.& 1 «*«*JF