NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Service ELEMENTS DF •THERAP1UTICS; OR A \ GUIDE TO HEALTH; BEING CAUTIONS AND DIRECTIONS IN THE TREATMENT OF DISEASES. DESIGNED CHIEFLY FOR THE USE OF STUDENTS. By the Rbv. JOSEPH TOWN SEND, M. a. Re<5tor of Pewfey, author of the PhyficiantTade Mecum, and of a Jourac through Spain. FIRST AMERICAN EDITION- '~'J NULLIUS IN VERBA MAGISTRI. .... .-*iv.l. BOSTON: PRINTED BY DAVID CARLISLE, For THOMAS & ANDREWS, J. WEST, WEST & GREENLEAF, J. WHITE, Sf CO. E. LARKIN, J. NANCREDE, W. P. & L. BLAKE, S. HALL, C. BINGHAM,MANNING GfLORING, Bofton; and THOMAS » THOMAS, Walpole, N. H. l8©2. I PREFACE TO THE SECOND EDITION. J. HE Work bow prefented to the Public, will aflift the Stu- dent, not merely in the pra&ice, but in the fcience of medicine; will teach him, by methodical arrangement, to diftinguifh difeafes with precifion, and by rational indications, not only to form his plans, but to purfue them with confidence. Caution is abfo- lutely needful, and a watchful attention is highly to be praifed; but timidity, if the offspring of ignorance, is, in a medical prac- tioner, mofl worthy of reproach. The mfologkal part of my work is founded upon the Nofologia Methodica of Dr. Cullen : the pratlical obfervations are derived from my own experience in the country, from converfation with the ableft phyficians in Britain, France, and Spain, and from the '•moft approved authors. It is much to be lamented, that Dr. Cullen did not leave an Englifh tranflation of his Nofology, for the benefit of country Apothecaries. To fupply the place of this, I do not hefitate to recommend my Work, in which they may learn, to detect not only Difeafes, but their Caufes, which is certainly the only foun- dation for a rational and fuccefsful practice. This Work will, I truft, be acceptable likewife to the country Clergy, whofe inclination to he ufeful among their poor parifhion- ers in times of ficknefs, has too frequently gone beyond their knowledge. I can venture to affure them, that, with moderate application to this Work, the impediment will be fpeedily re- moved, and they may have the comfort, not only of attempting to relieve diftrefs, but of feeing clearly the extent of their ability both to diftinguifh and to cure difeafes. In the practical part I have inferted a variety of forms, for many of which now added, I muft acknowledge myfelf obliged to Sir John Pringle, through his friend Dr. Ingen Houz, and to Dr. Smith, whofe valuable formulae merit particular attention; but 4 PREFACE. but I wifh the Student to underhand, that thefe require to be altered, as the age, the conftitution, and the circumflances, of the patient may require. Let the young practitioner learn the nofology ; let him ftudy the Indications ; let him be attentive to the Operation of every fimple medicine ; and he will be never at a lofs, having a flight knowledge of Chemiftry, for his Prefcriptions: but without this knowledge and attention, his blunders will be innumerable. If any one, not bred to fcience, fhould imagine, that by con- fulting this Work he may readily become his own Phyfician, he miftakes my meaning. Yet fuch has in general been the defective education of coun- try Surgeons, that families of fmall fortune, unable to feek the advice of a Phyfician, are not unfrequently reduced to the difa- greeable neceflity of confulting books. For their fakes there- fore chiefly I have" given mofl of the prefcriptions in Englifh, that in cafes of emergency they may not be wholly deftitute of help : neverthelefs, I mod carneftly exhort the heads of families not to tamper with their children, or others, and give that prefer- ence to books and their own judgment, which is-more properly due to the Medical Practitioner. It is much to be lamented that, in this enlightened age, the ..attention of the Public fhould ftill continue to be turned to- wards Specifics, when it is well known, that the fame difeafe not unfrequently proceeds from a variety of caufes, and therefore, properly fpeaking, no Specific Remedy can exift. What reafon can we affign then for the aftonifhing, and ftill increafing, demand for ghiack Medicines and §)uack Boohs P Whence is it, that ghtack Medicines and ghiack Books are to be found, not merely among the lower clafTes of fociety, but in re- fpectable families, and almolt in every houfe ? Is it, that they Wave a higher opinion of fuch Medicines and of fuch Books, than of the Judgment, the Skill, the extenfive Experience, of men devoted to the Science ; of men, who have been regularly taught, and who are in the daily habit of diftinguifhing difeafes ? No, certainly it is not.—But I leave this important queftion to be anfwered by Writers on Political Economy. r* CONSENTS. CONTENTS. Page CLASSES................. i7 ORDERS.............. . - tg Clafs I. PYREXIAE. Order I. FEBRES, GeDUS I. FEBRIS Contin'ua. Continued Fever - . - i 19' Obfervation on Heat and Cold - - - . 21 --------on Antimonials - . - - 24 --------on the Vecetable Astringents - 26 --------on Opium, Camphor, and Ether. - 28 --------on Light and Heat - - - 31 --------on Respiration and VitAl Air - 32 --------on Digestion - - - 35 ——----on Refpiration of Hydrogen Air - 39 ■ ■----on Stimulants - 40 ----——on, the Pulse - - 41 Of the Proximate Caufe of Fever - - 43 Indications of Cure uiSynocha - - - 48 -------------in Typhus - - - 52 Of the Plague - - - . « - 59 Of the puerperal FEVER - - ' 62 Gen. II. FEBRIS Intermittens. Intermittent Fever - 63 Gen. HI. FEBRIS Hectica. He8ic Fever induced by Worms. "67 Clafsl. PYREXIAE. Order II. PHLEGMASIA. INFLAMMATIONS diftinguifhed into aSive and pajfive 70 Se&ion I. Of aSive Inflammation, with its proximate Caufe - - - . - 71 Sect. II. Oi pqffive Inflammation, with its proximate Caufe - - 72 Sett. III. Of the Ocdajional Caufes of Inflammation 72 Sedi. IV. Indications of Cure in aSive Inflammation 73 Seft. V. Indications of Cure in pajfive Inflammation 74 Seft. VI. Of the Vires Naturae Medicatrices - 75 Seft. VII. Of the GENERA of Phlegmasia - 77 Gen. IV. PHLOGOSIS. Phlegmon&nd Eryjipelas - 77 Gen. V. OPTHALM1A. Inflammation of the Eyes - 79 Gen. .VI. PHRENIT1S. 'Phrenfy.- ... - 81 Gen. VII. CYNANC!*E. guinfey ' - - - - 81 Se&ion I. CynanChe tonfillaris - - - - 82 Sect. II. .^-j— maligna - - 83 Sect. III.-----L_g_ trachealisor Croup * - 84 Seci. IV. .--------pharyngaa - -" "85 Seft. V. —<-----parotklaa * - *- * - * 85 Gen. VIII. CATARRHUS. Catarrh * - ' - - 85 • ■ * s&. 1. * 6 CONTENTS. Page Sect. I. Of Colds and Cough - , ■- - 86 Sect. II. Of the proxirngp Caufe of Catarrh - 86 Seer. HI. Of the occaJMal Caufes of Catarrh * - 86 'Seft. IV. Of the Indications of CW in Catarrh - 9° Sea. V. OffympShetic Cough - - 91 Sea. VI. Of exantbematic Cough - 9* Sea. VII. Of Worm Cough - - 92 Sed. VIII. Of Teething Cough - - - 92 Sea. IX. Of Gout Cough - .-- 92 Sed. t X. Of Stomach Cough, with a Cafe 93 Sea. XI. Of the Indications of Cure'm Stomach CovGH 95 Genus IX. PNEUMONIA. * iV<™-£# - - 96 Sed. I. Diflintlions to be obferved - - 96 Sea. II. Indications of Can? in Pneumon i a - 97 Gen. X. CARDITIS. Inflammation of the Heart 100 Gen. XL GASTRITIS. Inflammation of the .Stomach - - - - 100 Gen. XII. ENTERITIS. Inflammation of the Bawds 101 Gen. XIII. HEPATITIS. Inflammation of the Liver 102 Gen. XIV. SPLENITIS. Inflammation of the Spleen 103 Gen. ' XV. NEPHRITIS. Inflammation oj'the Kidneys 103 Gen. XVI. CYSTITIS. Inflammation of the Bladder 104 G^n. XVII. HYSTER1TIS. Inflammation of the Womb 105 Gen. XVIII. ARTHROPUOS1S - - 105 Gen XIX. RHEUMATISM - - - 105 Sed. I. Caufes of Rheumatism, and Diflintlion * of Species - - 106 Sea. II. Indications of Cure in acute Rheumatism 106 Sea. 111. Chronic Rheumatism ... 107 Sea. IV. Indications of Cure in Chronic Rheumatism 108 Gen. XX. ODONTALGIA. Tooth ach - 109 Gen. XXI. PODAGRA. Gout. - - - no Sea. I. Of the remote Caufes of Gout, with Diflinc- tion into Species «— - - - - 11 r Sea, II. Indications of Cure m tonic or inflammatory Gout . - - - - <•* - 112 Seft. III. Indications of Cure'in atonic Gout - 113 Sea. IV. Of Prefervafives from Gout - -114 Chfs-I. PYREXIiE. Order IIL EXANTHEMATA. Eruptive Fevers - - - - - 115 Cta, XXII. VARIOLA. Smallpox - - 115 Sea* I. Of the different 5^« - - 144 Sea. II. Of the Species of Phthisis - 146 Sea. III. Of Tubercles and Predifpofltion to Haemop- tysis - . > . - 146 Sea. IV. Of the Treatment in Phthisis - - 147 Gen. XXXII. HiEMORRHOIS. Piles - - 154 Sed. I. Hemorrhoidal Flux diflinguifhed"into aSive and paflive ■ - - - 154 Seft. II, Indications of Cure in aclive Hemorrhoi- dal Flux - . . icj Sea. III. Indications of Cure in pajftve Hemor- rhoidal Flux „ - 156 Se6fc. IV. Remedy for Fistula * - - 157 Sea. V.,Of Rqloring the Hemorrhoidal Flux 157 Gen. XXXIII. MENORRHAGIA. Flooding - 158 Seft. I. Menorrhagia aSive zndpajive - 158 Seft. II. Indications of Cure in aclive Menorrhagia 158 Seft. III. Indications of Cure inpqfive Menorrhagia 159 _ Seft. IV. Of Menorrhagia Alba - - 160 Of PROFtUVIA as an Order of PYREXIAE - 161 Clafs II. o CONTENTS. A , - Page Clafs II. NEUROSES. Order I. COMATA. Gen." XXXIV. Apoplexia. Apoplexy - - 162 Sedion I. Of the proximate Caufe of Apoplexy, and Diflmcliori~ into Species - - 163 Seft. II. Of the Degrees of Apoplexy - - 163 Seft. HI. Of thejanguine Apoplexy and Carus 164 Sea. IV. Indications of Cure in fanguine Apoplexy and K * in Carus - - - 168 Sea. *. V. Offcfous Apoplexy and Lethargy - 170 Sed. VI. Indications of Cure in ferous Apoplexy and in. Lethargy - - 171 Gen. XXXV. HYDROCEPHALUS intemus - 173 Sea. I. Of the progrejjive Symptoms and Termination of Hydrocephalus - - - 173 Sea. II. Of the Clafs of Hydrocephalus - 174 Sea. III. Of the Treatment of Hydrocephalus - 174 Gen. XXXVL CATAPHORA. Catakpfy - - 175 Seaion I. Indications of Cure in Catalepsy - - 177 Gen. XXXVII. PARALYSIS. Palfy -- - 178 Sea. I. Dijlintlion of Species, with general Obfervalions 178 Sea. II. Of the remote zxid proximate Caufes of Palsy 179 Sea. III. Indications of Cure in PAlsy , - 180 Sea. IV. Cafes of Palsy - - - - 183 Clafs II. NEUROSES. Order II. ADTNAMIM. Gen. XXXVIII. SYNCOPE. Fainting - - 18c Sea. I. Of the proximate and remote Caufes of Syn- cope - * - - - 185 Sea. II. Of the Diftinclion of Species in Syncope 186 Sea. III. Of the Treatment of Syncope cerebralis 187 Sea. IV. Of the Treatment of Syncopepulmonea - 189 Gen. XXXIX. DYSPEPSIA. Indigeflion - - 195 Sea, •, I. Of the proximate and remote Caufes of Dyspep- sia " - - . - 195 Sea. II. Of the Indications of Cure in Dyspepsia 106 Gen. XL. HYPOCHONDRIASIS. Low Spirit** 199 Sea. 1. Of the Melancholic Temperament - ', - 199 Sea. II. Of the proximate and occqfional Caufes of Hypochondriasis ... 200 Sea. Wl..Indications of Cure in Hypochondriasis 204 Clafs II. NEUROSES. Order III. SPASMI. Sea.' I. Of Irritability . . v . 2o6 Sea. II. Of Stimuli . . . 2I. Sea. III. Of the predifponent Caufe of Spasm - 216 Sea. IV, Ofthe occqfional Caufe of Spasm - - 224. Sea. V. Of the Indications of Cure in Spasmodic Affections - . 227 Of CONTENTS. 9 Of the GENERAof Spasmi . . P'f! Gen. XLI. RAPHANIA . . - . 228 Sea. I. Of the ufual Symptoms of RaphaniA - 228 Sea. II. Of the Treatment in Raphania - 228 Gen. XLII. EPILEPSIA. Epikpfy . "_ 22g Sea. I. Of the attendant Symptoms . - 220 Sea. II. Of the Intervals and Effecls produced by Epileptic Fits - 2-0 Sea. III. Of thepredifponent Caufe of Epilepsy . 230 Sea. IV. Of the occqfional Caufes of Epilepsy rtit Seft. V. Of Habits* - ..." ^34 Seft. VI. Of the proximate Caufe of Epilepsy . 238 Sea. VII. Indications of Cure in Epilepsy1 - - 2ao Gen. XLIII. CONVULSIO. Convulfions ' . 2X Gen. XLIV. CHOREA. Dance of St. Vitus - 249 Sea. I. Of the remote Caufes of Chorea - . 249 Sea. II. Of the Indications of Cure in Chore a - 24.0 Gen. XLV. TETANUS.....251 Sea. L The Hiflory of Tetanus - . 251 Sea. II. Of the proximate Caufe of Tetanus - 253 Seft. III. Ofthepredifponent Caufe oi"Tetanus - 253 Sea. IV. Of the occaflonal Caufe of Tetanus - 254 Seft. V. Of the Indications of Cure in Tetanus - 256 Gen. XLVI. PALPITATIO. Palpitation of the Heart 260 Seft. I. Of the predifponent Caufe of Palpitation 260 Sea. II. Of the occaflonal Caufe of Palpitation 261 Sea. III. Of the proximate Caufe of Palpitation 261 Sea. IV. Of the*Indications of Cure in Palpitation 262 Gen. £LVII. DYSPNCEA - . 261 Gen. XLVI1I. ASTHMA. Spafmodic Aflhma . 265 Seft. I. Of the attendant Symptoms and Progrefs of Asthma - 26c Sea.. II. Of the Perfons moft fubjea to Asthma 266 Sea. III. Of the proximate and remote Caufes of Asthma - - - ' . 266 Sect. IV. Of the Species of Asthma - - 267 Seft. V. Of the Indications of Cure in Asthma 260 Gen. XLIX. PERTUSSIS ... . 2y2 Sea. I. Of the proximate Caufe of Hooping Cough 272 Sea. II. Of the Indications of Cure in Hooping Cough .... 272 Gen. L. PYROSIS. Water-brafh -• . 2?, Gen. LT. DYSENTERIA - - - 274 oeQt. I. Of the proximate Caufe of Dysentery - 274 Sea. II. Of the remote Caufes of Dysentery - 275 Sea. III. Of the Indications of Cure in Dysentery 277 Gen. LT1. COLICA. Colic - - - 279 Seft. I. Of the Species of Colic - - . 28» B Sea. IL 10 CONTENTS, Pag* Sea. II. Of the proximate Caufe in Colic, and Indi- cations of Cure - - - 280 Gen. LII1. CHOLERA - - 281 Sea. I. Of the Caufes of Cholera - - 282 Sea. II. Of the Cure of Cholera - . - 282 Gen. LIV. DIARRHCEA - - - 283 Sea. I. Of the Caufes remote and proximate of Diar- rhosea - - - - 283 Sea. II. Of the Indications of Cure in DiARRHceA 284 Gen. LV. t>IABETES - - - 286 Sea. I. Of the proximate Caufe of Diabetes - 286 Sea. II. Of the Indications of Cure - - - 289 Gen. LVI. HYSTERIA ... .290 Sea. I. Of the attendant Symptoms - - 29a Sea. II. Of the predifponent Caufe of Hysteria 291 Sea. III. Of the occqfional Caufes of Hysteria 29f Sea. IV. Of the proximate Caufe of Hysteria - 292 Sea. V. Of Hysteria as diflinguifhed from Hypo- chondriasis - 29^ Sea. VI. Of the Indications of Cure in Hysteria 293 Gen. LV1I. HYDROPHOBIA. Canine Madnefs - 300 Clafs II. NEUROSES. Order IV. VESANIjE. Gen. LVIII. ONEIRODYNIA. Incubus, or Night-mare 302 IntroduSion - - - - - - 302- Sea. I. Of the Species of Oneirodynia with Synonima 302 Sea. II. Of the Caufes remote and proximate of Oneirodynia Gravans Sea. 111. Of the Brain . . Sea. IV. Of Sleep - - . - 312 Sea. V. Of Vigilance - - - - 317 Sea. VI. On Dreaming - ... 322 Sea. VII. Of the Caufes remote and proximate of Onei- 4 rodynia Activa - - 324 Sea. VIII. Of the Indications of Cure in Cafes of Onei- rodynia - - . 32c Gen. LIX. MELANCHOLIA. Melancholy - 326 Introduction - - . _ -326' Sea. I. Of Delirium - - - . 327 Sea. II. Of the Hi/lory and Progrefs of Melancholy 330 Sea. III. Of the remote Caufes of Melancholia, with Cafes - - - 332 Sea. IV. Of the proximate Caufe of Melancholia 336 Sea. V. Of the Indications of Cure in Melancholia 34.2 Gen. LX. MANIA - . X*8 Sea. I. The ffifyry of Mania - . . ,T8 Sea. II. Of the Species of Mania / - 349 Sea. III. Of Mania Melancholica - - 1V2 Sea. IV. OfMANIA Phrenitoides 304 3°5 Sea. V, 35§ CONTENTS. II Page Se*a. V. Of Mania Hysterica - - 364 Sea. VI. Of the Mania MENTALisof Dr. Cullen - 373 Gen. LXI. AMENTIA . . .377 Clafs III. CACHEXIA. CACHEXIES. Introduction - - - _ . "379 Sea. I. Of the Abforbents and iCheix Ufe - - 379 Sea. II. Of Morbid Anion in the Abforbents - 384 Sea. III. Of the general Indications of Cure in Morbid Anion of the Abforbents - - 386 Clafs HI. CACHEXIA. Order I. MARCORES. Diflinguifhed by univerfal Emaciation. Gen. LXII. TABES. Emaciation and Debility with Hectic 392 Sea. I. Of Nutrition - - 392 Sea. II. Of the occaflonal Caufes ofEMACiATiONand Debility - - - 400 Sea. III. Of Hectic - - - - 402 Sea. IV. Of the Species of Tabes - . 403 Sea. V. Of the Indications of Cure in Tabes - 405 Clafs III. CACHEXIA. Order II. INTUMESCENTIjE. Diflinguifhed by general Swellings - - 408 Gen. LXIII. POLYSARCIA. Obefity - - - 408 Gen. LXIV. PNEUMATOSIS - - - - 409 Gen. LXV. TYMPANITES - - - - 412 Gen. LXVI. PHYSOMETRA - - - 416 Gen. LXVII. ANASARCA. Univerfal Dropfy - 4I6 Ska. I. Of the Caufes remote and proximate of Dropsy 417 Sea. II. Of the Indications of Cure in Anasarca 418 Gen. LXVI1I. HYDROCEPHALUS EXTERNUS 427 Gen. LX1X. HYDRORACHITIS - - 427 Gen. LXX. HYDROTHORAX. Dropfy in the Chefl 430 Gen. LXXI. ASCITES. DropflcalSwelling of the Abdomen 431 Sea. I. Of the Caufes of Ascites - - 431 Sea. II. Of the Indications of Cure in Ascites - 432 Sea. III. Cafes of Ascites - 433 Gen. LXXIL HYDROMETRA. Dropfy of the Womb 435 Gen. LXXIII. HYDROCELE. Dropfy of the Scrotum 436 Gen. LXXIV. PYSCONIA - - - - 437 Gen. LXXV. RACHITIS. Rickets - - 438 Sea. I. Hiflory and Progrefs of Rachitis - 438 Sea. II. Of the Caufes remote and proximate of Ra- chitis .... 439 Sea. III. Of the Indications of Cure in Rachitis 440 Clafs III. CACHEXIA. Order III. IMPETIGINES. Gen. LXXVI. SCROPHULA. Kings's Evil - 443 Sea. I. Hi/lory and Progrefs of Scrophula - 444 Sea. IIL is, * CONTENTS. Page Sea. III. Of the proximate Caufes of Scrophula - 445 Sed. IV. Of the Indications of Cure in Scrophula 445 Gen. LXXVIL SYPHILIS. Venereal Difeafe ' 449 Gen.LXXVlII. SCORBUTUS. Scurvy - - 453 Gen. LXXIX. ELEPHANTIASIS - - - 455 Gen. LXXX. LEPRA. Leprofy - - " 45 « Gen. LXXXI. TRICHOMA. Plica Polonica - - 459 Gen.LXXXII. ICTERUS. Jaundice - - 40> ,Sea. I. Of the Caufes remote and proximate of Icterus - - 4°° Sed. II. Of the. Species of Icterus - - 461 Seel:. III. Of the Indications of Cure in Icterus 467 Sed. IV. Cafes of Jaundice - - - 472 Gen.LXXXIII. CHLOROSIS. Greenflcknefs - - 475 Sea. I, Of the Caufes remote and proximate of Chlorosis - 475 Sed. II. Of the Indications of Cure in Chlorosis 476 Clafs IV. LOCALES. Local Difeafes 47% Order I. DTSA1STHESW - 479 Gen. LXXXIV. CALIGO. Darknefs - - 479 Gen. LXXXV. AMAUROSIS. Gutta Serena - 483 Sea. I. Hi/lory of Amaurosis . . - 483 Sea. II. Proximate Caufe of Amaurosis - 483 Sea. III. Indications of Cure - - 480 Gen.LXXXVI. DYSOPIA - - - 488 Gen.LXXXVII. PSEUDOBLEPSIS - - 489 Gen.LXXXVIII. DYSECOEA. Hearing diminifhed or deflroyed - - - 4O0 Sea. I. Of the Caufes of Deafness - - 400 Sea. II. Of the Cure of Deafness - - 401 Sea. III. Cafes of Deafness - 40.« Gen. LXXXIX. PARACUSIS . . . J;3 Gen. XC. ANOSMIA. Smell diminifhed ox deflroyed 407 Gen. XCI. AGEUSTIA. Taste diminifljed or de- flroyed - - J . _ 4Qg Gen. XC1I. ANAESTHESIA. Lofs of Feeling - 498 Clafs IV. LOCALES. Order II. DTSOREXIjE. The Appetites deficient or depraved - 4QO Gen. XCIII. BULIMIA. Appetite for Food, voracious or canine - . Gen. XCIV. PICA. Appetite depraved, ivithflrong De- flre for unnatural Food - _ _ Artn Gen. XCV. POLYDIPSIA. Exceffive Thirfl . 22 Gen. XCVI. SATYRIASIS. ExcTffive and violent De- fire for Coition in Men _ __ Gen. XCVII. NYMPHOMANIA - I *°* Gen. XCVIIJ. CONTENTS. 13 Page Gen. XCVIII. NOSTALGIA. Impatience when abfent from one's native home, and vehement de- fire to return, attended by Melancholy* Lofs of Appetite, and Want of Sleep - 504 Gen. XCIX. ANOREXIA. Appetite impaired - 50? Gen. C. ANAPHRODISIA. Impotence - - 507 Clafs IV. LOCALES. Order III. DTSCINESI3* Motion impeded or depraved, from an Imperfection of the Organ . 508 Gen. CI. APHONIA. Inability to utter Sounds, with- out either Syncope or Coma - - 508 Gen. CII. MUTITAS. Inability to utter articulate Sounds - - - - 5°9 Sea. I. Of the Species of Dumbnefs - - 509 Sea. II. Cafes of Mxjtitas - - - 510 Gen. CIII. PARAPHONIA. Depravation of Voice 512 Gen. CIV. PSELLISMUS. Vicious Articulation re- fpecling Sounds - - - 513 Gen. CV. STRABISMUS. Squinting - - 515 Gen. CVI. CONTRACTURA. A permanent and rigid Contra tlion of a Joint - - 516 Clafs IV. LOCALES. Order IV. APOCENOSES. Gen. CVII. PROFUSIO. Lofs of Blood - - C17 Gen. CVIII. EPHIDROSIS. A violent and morbid Sweating - - - -17 Gen. CIX. EPIPHOPRA. Lachrymation - - 519 Gen. CX. PTYAL1SMUS. A Salivation - ~ 522 Gen. CXI. ENEURESIS. Involuntary difcharge of Urine without Pain - - c2^ Gen. CXII. GONORRHOEA. A preternatural Flux from the Urethra in Men - " 52S Clafs IV. LOCALES. Order V. EPISCHESES. Suppreffion of Excretion - - - - 527 Gen. CXIII. OBSTIPATIO. Coflivenefs - - 527 Gen. CXIV. ISCHURIA. Suppreffion of Urine - 530 Gen. CXV. DYSURIA. Difficulty and Pain in dif- charging Urine - . ~ 53** Gen. CXVI. DYSPERMATISMUS - - 538 Gen. CXVII. AMENORRHOSA. Menfes wholly or partly obflruBed, without Pregnancy 539 Clafs IV. LOCALES. Order VI. TUMOURS. Partial Swellings, without Inflammations - - 541 Gen. CXV1II. ANEURISMA. A fofi Tumour on Arteries, with Pulfaticu - - 541 Ceii. CXIX. '4 CONTENTS. Page Gen. CXIX. VARIX. A foft Tumour on Veins with. ) out Pulfation - - - 543 Gen. CXX. ECCHYMOMA. A black and blue Swell- ing either from a Bruife, or from morbid Extravafation of Blood, as in Typhus, the Plague, and Scurvy - - td'i Gen. CXXI. SCIRRHUS. A hard Tutnour, commonly of a glandular Part, indolent, and not readily fuppurating - - - {44 Gen. CXXII. CANCER. A hard Tumour of a glan- dular Part, painful and objlinate, which terminates in thefoulefi Ulcer - ca6 Gen. CXXIII. BUBO. A fuppurating Tumour of con- globate Glands - - r 48 Gen. CXXIV. SARCOMA. A foft Excrefcence re- fembling Flefh, not painful - - C40 Gen. CXXV. VERRUCA. A Wart. A Tumour, hard, feabrous, and void of fenfation - ?int ' 553 l*en. CXXXL EXOSTOSIS. A hard Tumour on a none - 554 Clafs IV. LOCALES. Order VL ECTOPIA. Parts difplaced Gen• CXXXII HERNIA. A^pture ' . lff| Sea. I. IntroduBion, with Enumeration of the " Sea. II. Of Enterocete " ~ ? ~ SS6 Sea. III. Of Epiplocele - " ' SP Sea. IV. Of Caflrocele . ~ ~ ' ^ |CS* Y7r?lHr9atocek™*ty™ocele ' S _~ \%l Sea. VL Of Hyflerocele _ S$2 Seft. VII. Of Cyfiocele ' ' 5<>3 Sea.VIIL Of Encepfjalocele - ~- Z ~_ S%\ Gen. XXXll£ J CONTENTS. *s Page Gen. CXXX1II. PROLAPSUS. The Protruflon f a foft Part uncovered - - "5^4 Gen. CXXXIV. LUXATIO. A Diflocation, or disjoint- ing of a Bone _ _ - 568 Clafs IV. LOCALES. Order VIIL DIALTSES. Solutions of Continuity - - - . -570 Gen. CXXXV. VULNUS. A Wound . - 570 Gen. CXXXVI. ULCUS. An Ulcer difcharging Pus or Ichor - . - - 574 Sea. I. Of Inflammation and its feveral Species 574 Sea. II. Of Suppuration • - 576 Sea. III. Of Ulceration - - - 577 Sea. IV. Of Granulation - - - 578 Sea. V. Of the General and Special Management of Ulcers - - - "579 Obfervations on this Cafe - - - 585 Gen. CXXXVII. HERPES. Tetters - - 586 Gen. CXXXVIII. TINEA. A fcalded Head. Small Ulcers at the Root of the Hairs, which produce a friable white Cruft - 589 Gen. CXXXIX. PSORA. The Itch. Small Puflules with watry Heads, appearing firfl on the Wrifls and between the Fingers. It is contagious - - - 591 Gen. CXL. FRACTURA. The FraBure of Bones 592 Gen. CXLI. CARIES. The Exulceration of Bones - 592 A NOSOLOGICAL SYNOPSIS - - 595 1. CLASSES. 1 2. ORDERS. j .....S9S 3. GENERA......608 INDEX......608 ELEMENTS or THERAPEUTICS; OR A GUIDE TO HEALTH. INTRODUCTION. 1 JISEASES may be reduced to four Claffes. i. Pyrexia. | 3. Cachexia. 1. Neuroses. j 4. Locales. Of which the fubfequent are the diftin&ive charafters. 1. Pyrexiae. Febrile difeafes.—Adter cold fhivering a frequency of pulfe, with increafe of heat and thirIL 1. Neuroses. Nervous difeafes.—AfFeaions of fenfe and motion dis- turbed j without either idiopathic Pyrexia or topical difeafe. 3. Cachexia. 'Cachexies.—A depraved habit of body; without Pyr- exia or Neurofis, as original difeafes. 4. Locales. Local difeafes.—Morbid affeaions which are partial. When therefore a difeafe prefents itfelf, the medical ftudent mufl carefully examine to which clafs it may be referred. If, for example, he finds a frequency of pulfe, with in- creafe of heat fucceeding cold fliiverings, the difeafe muft be clearly referred to the clafs Pyrexia. Having thus traced it to the clafs, he will proceed to invefligate the order. C The I 8 INTRODUCTION. The Orders of this clafs have been reckoned five ; they mould be only four. i. Febres. I 3. Exanthemata. 2. Phlegmajia. j 4. Hemorrhagic. Of which the pathognomonic fymptoms are the fol- lowing : 1. Febres. Pyrexia, with lofs of appetite, and diminution of ftrength, but no primary local affeaion. 2. Phlegmajia. Pyrexia, with topical pain and inflammation. 3. Exanthemata. Contagious difeafes, beginning with fever, and fol- lowed by an eruption on the fkin. 4. Hemorrhagic. Pyrexia, with a difcharge of blood, without any ex- ternal injury. Let the ftudent, having traced a difeafe, for inftance, to the Clafs Pyrexia, fuppofe that with the frequency of pulfe and increafe of heat, after cold fhiverings, he meets with lofs of appetite and diminution of ftrength, not attended by any eruption'on the fkin ; in this cafe he would refer the difeafe to the Order Febres. Of the Order Febres we have-two genera. C 1. lebris Continua. \ 2. Febris Intermittens. 1. Febris Continua. Continued Fever.—No intermiflicn, yet fubjeft to ex- acerbations twice in one day. 2. Febris Intermittens. Ague. Intermittent Fever.—Cold, hot, and fweatino- ftages m fucceflion, attending each paroxyfm, and fof- lowed by an intermiflion. Quotidians ufually come on in the morning, at an in- terval of about twenty four hours. Tertians at noon, at an interval'of about forty ei<*ht hours. J b Quartans in the afternoon, with an interval of about leventy two hours. Although, CONTINUED FEVERS. I 9 Although, ftriaiy fpeaking, we have only two genera of the Order Febres, I fhall here venture, with moft nofologifts, to introduce a third; confefling at the fame time, that lofs of appetite, a charaaeriftic fymptom of the Order, is not eflential to this .Genus. 3. Febris Hectica. Heaic Fever.—Has exacerbations at noon, but chief- ly in the evening, with flight remiflions in the morning after noaurnal fweats; the urine depofiting a bran like fediment. Thirft moderate. Should then a cafe prefent itfelf, which the ftudent, from the charaaeriftic fymptoms, has referred to the Clafs Pyrexia, and to the Order Febres ; and fhould he in this difeafe remark no intermiflion, although it be fubjea to exacerbations twice in one day, he cannot be at a lofs to afcertain the Genus, but will confider it as a Febris Continua. Should he obferve cold, hot, and fweating ftages in fucceflion attending each paroxyfm, and followed by an intermiflion, he will not hefitate to pronounce it Febris Intermittens. Should he with Pyrexia find moderate thirft, the even- ing exacerbations with the morning fweats, but no inter- miflion ; and fhould he obferve a bran like fediment in the urine ; he may be certain, that his patient has an Heclic. I have chofen thus to begin with fever, as being, 1 ft, the difeafe of all others moft incident to the human race; 2d, as being under improper management the moft deftruaive ; 3d, as throwing light on many other parts of Nofology. Clafs I. PYREXIA Order I. Febres. Genus I. Febris Continua. Continued Fevers. SECTION I. X HEIR fpecies have been diflinguifhed into ardent or inflammatory ; nervous ; putrid ; malignant ; jail and hofpital ; plague ; bilious; bilious autumnal; and yellow fever 20 CONTINUED FEVERS. fever of Jamaica. All thefe appellations have a degree of propriety annexed to them ; but I think it fufficient to diftinguifh two fpecies, Synocha and Typhus, becaufe, ftriaiy fpeaking, all continued fevers may be reduced to one of thefe. Synocha. Heat much increafed ; pulfe frequent, ftrong, hard ; urine high coloured ; fenfes not much impaired. Typhus. Heat moderate ;t pulfe quick, weak, fmall ; fenfes much impaired ; proflration of ftrength. Such are the definitions ; but in order to give a clear and diftina idea, it may be proper to ftate a cafe of what has been called the Bilious Autumnal Fever, which began, as Synocha, with inflammatory fymptoms, and termi- nated in Typhus, with fymptoms of putridity ; that hav- ing eftablifhed faas, we may introduce obfervations on thofe faas, and afterwards attempt fome rational theory of the difeafe. SECTION II. A CASE OF CONTINUED FEVER, WITH OCCASIONAL REMARKS AND OBSERVATIONS. A. B. of a fedcntary life and of a bilious habit, fubjeft for many months to coftiv^nefs, and liable upon every fudden application of cold, when he had been previoufly heated, to fymptoms of jaundice • fubjeft hkewife to the gqflrodyniaflatulenta of Sauvage,which fymptoms had always been removed by emetics and cathartics : fubjea alfo for fome confiderable time, previous to the attack of fever, to fuch debil- ity, that he could not without fweating work five minutes in his ear- den : and pafling reftlefs nights, unable to procure fleep without ca- thartic medicines. This patient..on the fourth of September, being bathed in ftveat, met a cold northern blafl He returned home however, without the leaft fufpicion that he had received injury. He patted a reftlefs night ; but when he rofe m the morning, he perceived no approach of fever tul the commencement of a folar eclipfe, at half after nine, during which he was feized, September 5th, with chills, followed by fhiver- ings, night dehnum, and lofs of appetite. He continued ftmW by cold for.above four hours after which a burning heat fucceeded, wmch wm followed by a fweat. During the cold ftage he took co drops of Huxham s effence of Antimony, which emptied his ftomach once ; CONTINUED FEVERS. 21 »nce ; but finding the fymptoms aggravated, and the gaftrodynia flat- ulenta making its approach, which was marked by a pungent pain un- der the right breaft ; finding likewife a cough, attended by a difcharge of phlegm ftreaked with blood ; he fent for medical affiftance, and took faline draughts, followed the fucceeding day by a cathartic of fenna and foluble tartar. OBSERVATION I. On the Power of Heat and Cold producing Changes in the Human Frame. i. That heat, like all other ftimuli, may have a debil- itating power, mufl be obvious to every one, who pays the leaft attention to plants and animals. During the fcorching heats of fummer, efpecially at midday, all na-^ ture languifhes, and her energy is loft.—The plants, ex- haufled of their vigour, hang their heads; their foliage droops: and among thefe the Mimofa pudica, the Dio- naea mufcipula, with the Hedyfarum gyrans, lofc their fenfibility and motion; whilfl the various tribes of ani- mals, panting for breath, feek fome cool retreat. Even in our northern latitude this cannot efcape our notice ; but to fee it in perfeaion, we mufl vifit the more fultry regions of the fouth, where the African, patient of heat, is obliged to intermit his labour, whilfl the inhabitants of more temperate climates, fuch as Italy and Spain, re- tire into fome dark recefs and fleep. In this cool retreat, the vital energy is foon renewed. i. When there is an accumulation of heat in the fyflem, the blood is determined to the furface, and the cutane- ous difcharge increafes; a fweat, ufually copious in pro- portion to the fuperabundant quantity of heat, breaks out; the evaporation carries off this furplus and the equilibrium is reftored. 3. Cold, that is to fay the abfence of heat, has an op- posite effea. When properly applied, it ftrengthens, giving vigour to the body, and energy to the powers of the mind. Thefe effeas are viable in high latitudes till you approach the poles, where all is torpid ; or till you afcend to thofe elevated regions, where eternal winter reigns. There no vegetable thrives except the Lichen ; no 22 CONTINUED FEVERS. no animal but the Reindeer of frozen Lapland, or the Chamois on the lofty fummits of the Alps. In thefe fit- uations we may fee in the greateft poflible perfeaion the fedative power of extreme and continued cold ; but the moderate, or the fud.den and tranfitory application of cold, has a different effea. Let us confider its operation, when applied to the fur- face of the body in the aa of bathing. The firft effea is a conftriaion upon the extreme veflels. This propels the blood towards the heart, with fuch increafe of quan- tity and velocity, as to augment in the fame degree its ftimulating power. In confequence of this, the reaaion of the heart and arteries fends back the blood with in- creafed velocity to the furface of the body, fo as in a healthy fubjea to overcome the ftriaure, diffufe a genial warmth, and create a keen appetite for food, with a fenfe of lightnefs, alacrity, and ftrength. 4. If cold be gradually applied, the conftriaion is more permanent; the internal fecretions are increafed, and the perfpiration is diminifhed ; yet fo far is this from produ- cing a difeafe, that health and vigour are thereby much improved. ^ 5. When cold and humidity fucceed to heat, more efpe- cially if the change befudden, the balance of the fyftem is deftroyed ; perfpiration is checked ; and the blood is determined to the internal furfaces, producing tenfion in the minuter veflels, and irritation in the arterial fyftem, with inflammatory fymptoms either partial or general, fuch as in Catarrh, Dyfentery, Rheumatifm, Fever. In this cafe, the deleterious effeas will be, to ufe the language of mathematics, inverfely as the force of circulation. This, however, will be once more confidered, when we come to Catarrh. 6. When Heat fuddenly fucceeds to cold, the blood increafed in volume is powerfully determined to the fur- face, where the extreme veifels being diftended beyond their tone, inflammation follows, and we have as before either Catarrhs, Rheumatic. Symptoms, or a Fever. In this cafe^ the deleterious effeas will be direcllv as th<- force or circulation. 7- The CONTINUED FEVERS. 23 7. The more intenfe the preceding cold, and the long- er its continuance, the greater is the accumulation of irri- tability, and the more violent are the effeas produced by fudden application of heat. To make this accumulation of irritability more fenfible, you need only handle fnow, or expofe vourfelf to the protraaed ftroke of a keen frofty blaft, and then ap- proach the fire, if the inflammation and the pain will per- mit you to draw nigh. Should you darken one eye for five minutes only, and then remove the covering, you will not merely be fenfi- ble of increafed fplendour in that eye, but the ftimulus of light will be exceedingly diftrefling. Or, fhould you retire from the glare of a meridian fun into a wide apart- ment, having only a glimmering of day, it will be a con- siderable time before you can diftinguifh objeas at a dis- tance ; that is, before the fenfibility of the retina is fuffi- ciently reftored to be affeaed by a weak impreflion. But, fhould you have continued for many hours in the dark, you will be able to read diftinaiy by the fee- ble light emitted from a glow worm : or, fhould you, after a long continuance in perfea darknefs, be Sud- denly expofed to the full blaze of day, with fuch an accumulation of irritability you would be deprived of fight. That you may with fafety be fufficiently convinced of this, you need but to obferve the pupils of a friend, and take notice to what extent the iris is dilated ; then let him for a few minutes clofe his eyes and cover them, fo as effeaually to preclude the light. The inftant he opens them again, if he looks towards a window, you will remark the iris contraaing, and the pupils fcarcely to be difcerned ; yet notwithftanding thefe avenues of light are fo nearly clofed, fuch is the degree of irritation, that he is unable to prevent his lids from {hutting, and he feels himfelf impelled to turn away his eyes. In a fhort time, however, this accumulated irritability is exhaufted, the pupils expand, and after a few min- utes he can without diftrefs look fteadily towards the light. From 24 CONTINUED FEVERS. From this accumulation of irritability it is, that veg©> tation in the fpring is rapid and vigorous, in proportion to the length and Severity of the preceding winter. When therefore in the human frame, the change from cold to beat is fudden, the firft injury is not derived from its exhaufting influence, but from its flimulating power ; which, with the ftimulus of diftenfion, meeting with ac- cumulated irritability in the fyftem, morbidly excites the larger arteries to aaion; and, as the consequently in- creafing diftention of the extreme veflels communicates by fympathy frefh ftimulus to them, aaion and rea&ion uninterruptedly proceed, and the injury, till fome cura- tive operation is commenced, mufl conftantly increafe. September 6th. All his fymptoms were much aggravated, and he was bent nearly double by thegaflrodyniaflatulenta. Pulfe no, full, hard, ftrong* Tongue very foul. The Euftachian tubes were clofed, and deafnefs enfued. He continued the faline mixture, with Spermaceti for the cough, • which was evidently fyntptomatic of irritation in the ftomach. With thefe medicines were added tartarized antimony, rhubarb, and contrayerva ; which procured in the fpace of three days 17 copi- ous evacuations by llool, with profufe fweating ; but the antimony did not ail as an emetic. OBSERVATION II. On the Introduction and the Ufe of Antimonials. Tartarized Antimony, known commonly by the name of emetic tartar, was long, like James's Powder, confidered to be a Specific in the cure of Fevers. Bafil- ius Valentinus, a Benediaine monk, was the firft who recommended antimonial preparations to the attention of, medical praaitioners. This he did in a treatife, which he entitled Currus triomphalis Antimonii, and publifhed at the clofe of the fourteenth century. Among the firft in modern times, who introduced the ufe of antimony in fevers, was the famous Dr. Lisle, from whofjpgrand- children I received his preparation, of which the follow- ing is the form : Boil a pound of hartfhorn fhavings fix hours in eight quarts of wa- ter, then take them out, di-v them and reduce them to a powder. To CONTINUED FEVERS. 25 "* To a given quantity of this add an equal weight of crude anti- mony, putting the whole well mixed into a crucible. Keep it eight hours on a briflc fire, frequently ftirring the mixture with a long thin iron : then reduce it to a very fine powder, and keep it in a bottle for ufe. The dofe is twenty grains. This nearly is the preparation adopted by the College of Phyficians, and, as I apprehend, was the prepara- tion ufed by Dr. James himfelf, with this exception, that he undoubtedly at firft combined with it calomel, for which he afterwards fubftituted tartar emetic in the proportion of one grain to nineteen of his powder. The preparation of this favourite medicine being kept a fecret from the world, and fold as a Specific, the medical prac- tkioners in Edinburgh endeavoured to make an imita- tion ; and for this purpofe, deflagrated feven or eight parts of nitre with four of crude antimony. This was found an efficacious preparation, but its operation was uncertain. Dr. Cullen firft fuggefled the idea, that in cafes of fever, emetic tartar in folution, adminiftered in naufea- ting dofes, would be a good fubftitute for James's Pow- der ; that it would determine to the furface, relieve the fpafm in the extreme veflels, and thereby remove the proximate caufe of the difeafe. Such was the theory ; but, in faa, as it was found efficacious in the cure of fever, it became almoft univerfally adopted. Subfequent to this, Dr. Huxham prepared his antimo- nialwine, of which the following is the form: §,. Glafs of antimony one ounce, infufe for fix days in 24 ounces of Madeira wine, and filtrate. What the glafs of antimony communicates to the wine is not yet difcovered, for it was obferved by the praai- tioners in France, that a cup formed of this wonderful fubftance, after having communicated virtue to fuch a quantity of wine as proved an emetic to a whole regi- ment, being accurately weighed, had not loft a lmgle grain, and the perpetual pill is fo little changed in it^ operJfcm on the ftomach as to be tranfmiflible from generation to generation. Tartarized antimony, in Small dofes, combined with contrayerva, determines to the furface ; combined with D rhubarb, 26 CONTINUED FEVERS. rhubarb, its operation is more immediately confined to the bowels. On the third day of the difeafe a clyfter was adminiftered, with a repetition of the tartarized antimony, antimonial wine and camphora- ted tincture of opium to promote the fweats. At the fame time the Peruvian bark withferpentaria was given in confiderable dofes. OBSERVATION III. On the,Peruvian Bark and Vegetable Aflringents. The nature and operations of the Peruvian bark fhould be rightly underftood, that this powerful medicine may be properly applied. Like the bark of the oak, of the falix, and of the asfchylus hippocaftanum, it is antifep- tic and it is tonic. Dr. Eveling, who fays nothing of the Englifh oak, places the cinchona, that is, the Peru- vian bark, when compared with eight other powerful medicines, in point of bitternefs, at the bottom of his fcale. As an antifeptic it ftands firft ; as an aftringdnt it comes after falix. M. M. Cofte and Willemet, who are equally Silent on the virtues of the Englifh oak, ftate the following barks as fubftitutes for the cinchona : i. Salix Alba, or, White Willow. 2. Salix Fragilis, or, Crack Wiilow. 3. Salix triandria, or, Smooth Willow. To be taken in dofes of from one to two drams in powder. Had they been acquainted with the Salix Ca- prea, they would have given this the preference. 4. iEfchylus hippocaftanum, or, Korfe chefnut. In dofes of two drams. 5. Prunus pardus, or, Bird's cherry. Dofe one dram. 6. Prunus Spinofa, or, Blackthorn. In dofes of two drams for a decoaion. 7. Fraxinus excelfior, or, ASh tree. 8. Geum urbanum, or, Avens. 9 Of which the root is recommended. We have feen, that the powers to be exerted bv the cinchona, and to be applied in medicines, are anti- feptic 27 feptic and aftringent. Let us then confider the opera- tion of our Englifh bark, when applied as an antifeptic and aftringent in the art of tanning, that we may dif- tinaiy comprehend its powers on the animal fibre even when deprived of life. The tanner takes his hides, and having deprived them of their hair by lime, he puts them in a pit covered with water, and expofed to the influence of the fun and air. There we have every thing which can tend to promote the putrefaaive ferment—air, heat, and moifture. How then does he preferve his hides from this procefs, which v/ould be deftruaive of their texture ? It is by the ufe $f bark ; the bark of our Englifh oak, feparated from the tree when it is full of fap. Here then we clearly fee the antifeptic power of this bark. The hides are continued in the pits for many months, where the fibres become more rigid and compaa ; and being at the fame time Somewhat fhortened in their di- mensions, the hide which was thin and flaccid becomes tough, ftrong, and thickened, but diminifhed a little in « its length and breadth. ^ This will give us an idea of the tonic power and aftringency of bark ; and I may add, that on the living fibre thefe powers have been proved, and that the decoaion of the oak bark has been given with efficacy equal to that of the cinchona in the cure of intermittents. With regard to the afchylus hippocqfianum, Dr. Cuf- fon, of MontpeHier, finding it equal in efficacy to the Peruvian bark, has not only adminiftered it in the cure of intermittents, but for reftoring tone to debilitated pa- tients, and for flopping the progrefs of gangrene. In my praaice among the poor, I confine myfelf to oak bark. From what has been faid the ftudent will obferve, that the cinchona fhould be adminiftered freely in c:;lcs of dehj|jty, and where it is required as a powerful anti- feptic. The following day the bark was again ordered, with camphc-, tin&ure of opium, and Hoffman's ether. By thefe medicines eve>y • fymptom 28 0ONTINUED FEVERS. Symptom was aggravated, more efpecially a violent and diftrefling fipafm in the caecum, which had continued, with fhort intervals of refpite, for two days, and for which thefe antifpafmodics were adminiftered. OBSERVATION IV. On the Ufe of Opium, Camphor, and Ether. The nature and effeas of opium have been too little underftood. It may be ufed either as a cordial reviving Slimulant, or a powerful fedative, according to the man- ner and quantity.in which it is adminiftered. ■As a Slimulant, it Hands at the head of all the Stimuli; being of the fame nature, but much more powerful than wine. It is well known, that whilfl Chriftians get drunk with wine, true Muffulmen, being forbid to touch the prod- uce of the grape, get drunk with opium, which ranks foremoft among the intoxicating powers. It is equally known, that wine quickens the pulfe, raifes the fpirits, increafes vigour, and gives more than common animation for the time ; but no fooner are the fumes of the intoxicating drink exhaufted, than the drunkard becomes weak, enervated, and depreflfed in fpirits. Here we diftinaiy fee the flimulant and the fed- ative power of wine ; and the fame may be obferved of opium. But if wine be given in lmall quantities, and adminiftered only as occafion may require ; or, when the fedative power has fucceeded to the flimulant, let it then be repeated as a generous cordial in cafes of debil- ity, and the good effeas will be vifible to every eye. The fame precifely may be faid of opium. In larger dofes opium naufeates and is cathartic • but wine, in Sufficient quantity, afts firft as an emet- ic. Camphor has fome of the fame properties, beinp; when exhibited in fmall dofes, diaphoretic, cordial, an- tifpafmodic, and moderately Soporific. In lamer dofes it is diuretic, cathartic, and emetic. In more consider- able quantity it produces hickup, delirious raving, deep deep, epileptic convulsions, death. What ........—------- 29 What has been faid of wine, opium, and camphor, ap- plies in its degree to ether, and to every fubftance which contains inflammable air, even the common articles of diet ; infomuch, that after long fafting a perfon will be intoxicated by a fmall portion of animal food, and effec- tually deftroyed by a full meal of meat. From what has been fap, it is evident, that in Syno- cha all thefe Stimulants are contraindicated as moft in- jurious ; whereas, in Typhus, properly adminiftered, they muft produce the befl effects, becaufe in cafes of debility alone they prove anodyne, fedative, antifpafmodic, and narcotic. When thefe ftimulants had failed to give relief, tim glyflers were adminiftered ; which foon produced a copious evacuation, and remov- ed the diftreffing fpafm ; but, as the fever was much increafed by the bark, opium, camphor, and ether ; the next day, being the fifth of the difeafe, thefe were omitted, and in their place were fubftituted contrayerva, nitre, rhubarb, and tartarized antimony, to quench the fire which had been raifed. On the feventh day of the difeafe towards evening a critical fweat took place, which lafted 14 hours. The pulfe funk down to 80. But the tongue continued foul. The day following the deco&ion and tinfture of the bark, with fait of wormwood draughts, and fyrup of althea, were given every third hour ; to which were added vitriolic acid, and compound tincture of lavender. On the ninth day a profufe and oily fweat broke out, and corttinu- ed for 12 hours. Powder and deco&ion of bark, with coJftmbo root, rhubarb, and Aromatic powder, were given every third hour, and repeated the fucceeding days, with the addition of Virginian fnake root. During the operation of thefe medicines, the bowels were gradually cleared, and, in the fame proportion, the tongue became moift and clean. The fifth, the Seventh, the ninth, and the eleventh days, confidera- ble remiflions of fever were perceived. But on the vourteenth day of the difeafe, the heat became moderate, the pulfe weak, fmall, and frequent; the fenfes were impaired, and the proftration of ftrength was remarkably mcrea&d. This change rapidly took place, after nine in the morning, precife- ly at the hour in which the cold chill had begun. From this time light became intolerable ; but, with regard to founds, fortunately, as the deafnefs, which took place on the firft day of the difeafe, contin- ued in fome meafure, they were not diftreffing. The ftudent muft particularly notice the change which happens in fuch circumllances, not merely in the pulfe and in the fenfes, but alfo in 3© CONTINUED FEVERS. in tjkc mind ; becaufe, the temper then becomes impatient of the leaft contradiction or delay. During the progrefs of the difeafe, our patient had taken for nour- ifhment, fago, with calves foot jelly, broth, and apples made into pafte. In proportion as his bowels were evacuated, his appetite returned. But notv he complained, that fago and jelly appeared to him like wa- ter poured into the ocean, without fatisfying in the leaft degree a ravenous appetite, and craving for more fubftantial food. Whilft, however, he was taking fa*go and jelly in confiderable quan- tities, he laughed inceffantly like one hyflerical, and remarked, that, in the rapidity of its vibrations, his diaphragm refembled the fails of a fhip when, having miffed her flays, they arc fluttering in the wind. When, however, he had picked the two fmall pinions of a chicken, his appetite was fatisfied, and he fell into a ftate of calm repofe. Yet whilfl fleep took pofTefiion of his limbs, he retained his coiifcioufnefs, and was feniible of every thing that paiTed. Previous to his awaking from this ftate, he perceived fpafmodic twitchings, firft in his limbs, then in the trunk, and laftly in his ftomach : after which he became perfe&ly awake, and inftantly called with eagernefs for food. The occafional caufe of thefe fpafmodic twitchings will be explained when I proceed to hyfteria. He remarked, that on the firft approach of fynocha, and for fome of the fucceeding nights, he was diftreffed with the moft frightful dreams. But in proportion as the alimentary canal was cleanfed, his fleep was more refrefhing and lefs difturbed, till at length he flept foundly and without a dream. The appetite now became voracious, and, for want of fome one to guide him, our patient eat two chickens, and drank nearly two bot- tles of Madeira, in the fpace of 24 hours. When he began to chew, fuch was his debility, that his under lip and cheeks were affefted al- moftfinceffantly with fpafms ; in confequence of which, they were at every moment drawn between his teeth. But wine foon removed the fpafms, and enabled him to eat without this inconvenience. Hence it was that the quantity was fo much increafed. On the fifteenth and the two following days of the difeafe, the «ableadofeSrPentana ^ C°ntinUed as before' with 0Piun> in confid- About this time of the difeafe, he had a remarkable fymptom, fre- quently obferved and complained of by the fick themfelves, but little noticed in the writings of medical praaitioners. Whenever he clofed his eyes in the middle of the day, he feemed to ^SJ a T1^,^ °f %lT' W minUte« -^ juvenile, dancing at a diftance ; others large aged, hideous in their appearance, nigh at hand „d empl d ,„ maki faces ^ ^ ^ JJP , g ten as he opened his eyes again. 6 J!wcontinued for forae days without anyother fymptom of Here let us paufe to make fome obfervations. OBSERVATION CONTINUED FEVERS. 31 OBSERVATION V. % On Light and Heat. The defign being now to flrengthen, every thing which could debilitate or exhauft in any degree the vital energy, and thereby increafe the irritability of the fyftem, was ta be removed. ^* Of all the debilitating powers, in cafes of extreme ir- ritability, none is more .diftreffing than light. This is a matter of experience ; and every one, who has paffed through a nervous fever, can bear teftimony to the pro- priety of this obfervation. * Such in this patient was the fenfibility of the optic nerve, in confequence of extreme debility, that when his door was fhut and his windows perfectly darkened, he could, merely by the light defcending from a lofty chim- ney, difcern a pin lying on the floor in the moft diftant corner of his room. From this diftreffing fenfibility it is, that people of irritable fibres have an inclination to exclude the light. Poulterers, who never reafon, and who are not there- fore liable to be mifguided by fpeculative fyftems, have difcovered by experience, that the moft expeditious way to fatten poultry is to keep them in the dark. The connection between light and heat is too remark- able to efcape the notice of thofe who are inhabitants of warm climates. Hence, to cool their apartments, they not only fprinkle water, but they carefully exclude the light. It is not my intention to fuggeft the idea of identity between the elements of light and heat; although when reflected from a polifhed furface, they are governed by the fame laws ; nor, on the other hand, am I able to demonftrale the effeRtial differences between them. But certain it is, that in given circumftances heat is conftantly in proportion to the light ; and I have had occafion to remark in Spain, that by excluding light, during the fultry heats of a meridian fun, they enjoy'the moft refrefhing coolnefs. This I have particularly no- ticed in my travels, when I mentioned the fpaciou^, yet 32 CONTINUED FEVERS. dark; galleries, which run through the whole extent of the Jefuits* College at Salamanca. Even on the lofty fummits of the Alps, when the cool- ing procefs of evaporation is prevented, the fame law fubfifts, and the heat is in proportion to the light. In confirmation of thistruth, we have the beautiful experi- ments of M. de SatnTure, who, having lined a clofe deal box with black cork, and for a door placed three plates of glafs at the diftance of an inch and an half from each other, expofed his thermometers to the fun on the top of Cramont, foon after noon, of the 16th of July ; when that which he confined within|the box, flood at 70 de- grees ; whilfl one open, but hanging againft black cork, was at 21 degrees ; and a third, fufpended freely in the air, was at 5 degrees. ^ In the cafe of our patient, to exclude the light was eafy ; but to diminifh heat, it was found expedient, even at this advanced feafon of the year, that the room fhould receive ventilation from windows which opened to the north, and that thofe to the fouth fhould be cov- ered externally with mats, which were fpnnkled, from time to time, with water to promote evaporation, and thereby to abforb the heat. But as the heat ftill continued to diftrefs, although it did not rife above 56 degrees of Fahrenheit's thermometer ; the ceilino- and the floor were fprinkled, from time to time, with vinegar, whereit appear. ed, till evaporation had taken place, like the fineft dew. By thefe operations the thermometer in the patient's room flood commonly at 52 degrees. This effea might have been obtained by fprinkling the room with water ; but there being evident fymptoms of putridity, the preference was given to vinegar, as a powerful antifep- tic. The inftrument made ufe of for this purpofe was the hearth brufh ; and the quantity of vinegar confumed was fix gallons in twelve days. OBSERVATION VI. On Refpiration and Vital Air. ^ Besides the beneficial effect of cold, another was de- rived from this operation, which was, to oxygenate the air and render it more fit for refpiration. Every chemifl knows, that the atmofpheric air confifts of two parts ; of wljjch one is called vital, becaufe it contributes to 5 life ; continued fevers. 1 1 life ; the other azotic, becaufe, being refpired by ani- mals, it produces death. It is well known, that when thefe portions are feparated, and confined within differ- ent jars, a moufe will live a confiderable time in one, being lively, brifk, and active ; whilfl in the other, he foon languifhes and dies. In the -vital air, a candle burns with a moft vivid flame, but in azotic air it is in- ftantly extiftguifhed. In vital air iron kindles like a match, and is melted with rapidity, exhibiting as it con- fumes a luftre fcarcely inferior to the fplendor of the midday fun. This part, therefore, as contributing to life and flame, is with the utmoft propriety denominated VITAL AIR. « Vinegar contains this in abundance, and parts from it readilv. Being, therefore, fprinkled like dew upon the ceiling, the evaporation corrected that part of the air, which had been vitiated by the breathing of the patient, and ren- dered it again fit for refpiration. if moreover made refpiration pleafant, relieved the op- preffton of his chefl, and enabled him to breathe freely through the noflrils without the ajfiftance of the mouth, which he could not do before the vinegar was fprinkled. It greatly increafed, at the fame time, his apftetite, and quickened his digejlion. Dr. Ingenhousz difcovered by the eudiometer, that the atmofphere at Vienna contains a greater proportion of vital air than in Holland, and to this he attributes the remarkable increafe of appetite felt by ftrangers on their arrival at Vienna. In fome experiments tried upon him- felf, he had occafion to obferve, that after infpiring vital air, his appetite increafed, and he flept with greater tran- quillity than ufual, nor were thefe effects peculiar to himfelf, for all to whom he gave this air, had their ap- petite increafed. I have had frequent opportunities of remarking a kind of balance between refpiration and digejlion. In the cafe of our patient, it was too evident to efcape the obferva- tion even of his nurfes. When the ftomach was oppreff- ed, refpiration laboured ; and when the lungs'1 were E plentifully 34 continued fevers. plentifully fupplied with vital air, the fuperabundant quantity of food no longer was a burthen. I am happy to find my ideas on this fubject confirm- ed, not only by Dr. Thornton, to whom I firft com- municated them, but by a correfpondence between two of the moft ingenious medical practitioners and chemifts of the age, Dr. Withering and Dr. Beddoes. ^ The former, writing to the latter, fays, " The experiments you wifh for on this fubject have in part been made. The late Mr. Spalding, who did fo much in improving and ufing the diving bell, was a man of nice obferva- tion, and had he not fallen a facrifice to the negligence of drunken attendants, would have thrown much addi- tional light upon more than one branch of fcience. He particularly informed me, that when he had eaten ani- mal food, or drank fermented liquors, he confumed the air in the bell much fafter, than when he lived upon vegetables, and drank only water. Many repeated trials had fo convinced him of this, that he conftantly abftained from the former diet whilfl engaged in div- ing." To this correfpondence between the ftomach and lungs, between refpiration and digeftion, the changes to be noticed in the appetite, according to circumftances of health and ficknefs, or the feafon of the year, may be perhaps attributed. In the inflammatory fever,. in warm climates, and during the fultry feafon, when we are overwhelmed with heat, we have little inclination for animal food ; we cov- et vegetables, with acids, and acefcent fruits : but in winter we have a ftrong defire for thofe fubftances," which abound with hydrogen, and have little propenfity to take acefcent food. If the ideas I have ventured to fuggeft are agreeable to truth, the reafon for this change of appetite will be eafily explained. The heat which is generated in the fyftem appears to bear fome proportion to the quantity of oxygen air ab- forbed in refpiration by the blood. But animal food, and all the articles of diet, which abound with hydrogen, evidently continued fevers. 35 evidently contribute to increafe the vital heat. Does it not therefore feem probable, that this may be by dif- pofing the lungs to decompofe a greater quantity of common air ? If vegetable diet, with acids and acefcent fruits, cool the fyftem ; is it not from the fame fympathy between the ftomach and the lungs ? Thirft is fubject to the fame laws, being quenched fometimes, as in Synocha, by acids ; whilfl in other cir- cumftances, as in cafes of debility, it is fatiated by wine and brandy. As to thofe kinds of thirft, excited either by acrimo- ny in the fyftem, or by fuperabundant evacuations, they obferve a different law, and fimply call for diluent?. When animal food and wine have been received into the ftomach, no fooner is the digejlive procefs begun, even before any pordon is introduced into the circulating fluids, than the action of the heart is increafed, and the pulfe is quickened. But the fame effect is not obferved from vegetables. This might be attributed to a fympathy between the heart and ftomach ; but as I cannot imagine, in the cafe before us, any utility arifing from fuch a confent of parts, I am rather inclined to fuppofe it may arife from the fympathy already ftated between the ftomach and the lungs, in which cafe the frequency of the pulfe will fol- low as a neceffary confequence of this increafe of oxygen air by refpiration. OBSERVATION VII. On Digeflion. Boerhaave, neither fatisfied with the fyftem of di- geftion in the human ftomach by heat, as fuggefted by Galen, and adopted by his followers ; nor yet better pleafed with attributing this procefs to the vital energy of the foul refiding in the ftomach, as conceived by the fertile imagination of Van Helmont; invented a fyftem of his own, in which he attributes the digeftion of our food partly to fermentation, but principally to triture, preffure, 36 continued fevers. preffure, and powerful quaffation. He defcribes the rugas of the ftomach as grinding the more folid parts of the aliment; and, to aflift in this procefs, he calls in the aid of its external coat, with the diaphragm, and the numerous mufcles of the abdomen. Not fatisfied with thefe, he takes into his account the violent pulfations of the fubjacent aorta, with the vibrations of innumer- able furrounding arteries, which he eftimates at no lefs than three thoufand fix hundred pulfations in the hour. This diflinguifhed anatomift reafoned by analogy, and took particular notice of the oftrich, which he had ob- ferved to fwallow pieces of iron and of glafs, evidently for the purpofe of triture, becaufe the found of grinding was perceptible to thofe who liftened. In the granivorous birds he had remarked, befide the crop, furnifhed with falivary glands to mollify their food, a gizzard, or fecond ftomach, provided with ftrong mufcles to triturate the grain$ and the avidity with which they fwallow gravel to aflift the operation, had not efcaped his notice. Having examined the ftructure of a lobfter, he faw at the mouth of the ftomach a curious mechanifm, three teeth, of which one, moved by a ftrong mufcle, tritur- ates the food againft the other two. In the larger craw- fifh of the fea, he might have noticed a ftructure fome- what different, where, to anfwer the fame intentions, in- flead of three teeth, we obferve a peftle fupplied with a ftrong mufcle, and placed between two mortars. This philofopher examined attentively the ruminating animals, fuch as the fheep and cow, in which he remark- ed, that the food, after having been conveyed into one ftomach, is thrown up again to be triturated before it is returned into a fecond. No wonder, then, that this great mechanic on the fub- ject of digeftion had mechanical ideas. Succeeding phyfiologilts were convinced, that the di- gestive procefs was conduced by fermentation only, and this they fuppofed to be promoted by heat and moifture, as moft undoubtedly would happen, were it not for the preience continued fevers. 37 prefence of a fluid whofe property it is to prevent that procefs. A true notion of digeftion never occurred to human thought, till firft Reaumur, then John Hunter, had tried experiments, and Dr. Stevens had rendered the fubject more familiar to the mind, by his moft judicious obferva- tions on the ftone eater, when he vifited the metropolis of Scotland. One of the former, after having caufed his dogs to fwallow various kinds of food, both in a frefh and in a putrid ftate, opened their flomachs at different periods from the time of deglutition. The latter confined the fubftances to be fwallowed by the man within fmall filver fpheres, which prevented trituration, and, being perforated, readily admitted the gaftric juice ; but, as the ftomach could not be laid open, emetics, after a fufficient time had been allotted for the procefs of digeftion, were employed to bring thofe fpheres to light. As the refult of their experiments, thefe gentlemen conclude, that the gaftric juice is the proper folvent of our food ; and their inductions have been confirmed by the fubfequent experiments of the Abbe Spalanzani. Jt appears, then, that the teeth are to triturate the food, and that the falivary glands fuppiy it with a peculiar flu- id, whofe property is, not merely to moiften it and ren- der it fit for deglutition, but to prevent both the acetous and the putrefactive fermentation ; befide which, the fal- iva is detergent, and acts as a moderate cathartic. The gaftric juice anfwers the fame intention of im- peding fermentation, infomuch, that a piece of putrid flefh, being thrown into the ftomach of a dog, loft its putridity. But independent of this property, it has been proved to be a powerful folvent, both of animal and vegetable fubftances, more efpecially of the former, vet upon this condition, that they be firft deprived of ilfe. ' The pancreatic juice Applies any occafional defect in the falivary glands, being perfectly fimilar in its nature to laliva : and it may be obferved, that in proportion as the 3§' CONTINUED FEVERS. the loaded ftomach preffes on the fpleen, blood is emit- ted from that vifcus to fupply the pancreas. The bile, which enters the duodenum with the pan- creatic juice, is not only detergent and cathartic, but an- tifeptic alfo. Such is the well known procefs of digeftion : but we cannot leave the matter here. The attentive obferver may take notice, as already ftated, that there is a certain balance between the quan- tity of vital air received into the lungs, and of food which can be digefted in the ftomach ; and will fee one reafon, why cold air, every kind of exercife, even fcating and failing, increafe the appetite ; and why men, who are oppreffed with food, pant for breath ; and why, in a clofe room, when they are confined within the curtains of a bed, where the air is vitiated by paffmg frequently through their lungs, they open their mouths wide to breathe, and therefore why they fnore. I have had occafion to converfe with miners in Corn- wall, who had been almoft deprived of life by meph- iticair, and have been informed by them, that on re- viving, they have conftantly been feized with naufea, and that commonly the ftomach has rejected its con- tents. When John Hunter was at Belleifle, in the beginning of the winter, he conveyed worms and pieces of meat down the throats of lizards, when they were retiring in- to winter quarters, and when he opened them at differ- ent periods, he always found thefe fubftances entire and perfeaiy unchanged. Nothing, he adds, can fhew more clearly, that the fecretion of the gaftric juice is increafed in proportion to the call for nourifhment, than what happened to admiral Biron and his affociates, when they were fhipwrecked on the weftern coafl of South Ameri- ca. After thefe gallant officers had fuffered months of hunger and fatigue, and had been reduced to fkin and bone, they eat every one of them voracioufly, both night and day, for months, yet an ever craving petite evin- ced that they digefted all their food. ' OBSERVATION CONTINUED FEVERS. 39 OBSERVATION VII. On the Refpiration of Hydrogen Air. In cafes of debility, unlefs the quantities of food ex- hibited are fmall, well chewed, and not given till the ap- petite is keen, flatulence will be the confequence ; and where animal fubftances and fermented liquors conftitute the principal portion of the aliment, inflammable air will be extricated and difcharged in confiderable quantities. Suppofing, then, the patient to be confined to bed, this, being twelve times lighter than atmofpheric air, will conftantly afcend, and, from the fituation of the patient, will be infpircd as it paffes. The effect of the hydrogen, that is, of inflammable air, as a fedative, when received into the lungs, is well known to modern chemifts ; and will be manifeft to any one, who confines a moufe, only for a fhort period, in a jar replete with it ; for he quickly dies. Having made thefe obfervations, let us return to our patient. On the eighteenth day of the difeafe, his friend Dr. Thornton, came from London to vifit him. Upon examination he perceived, that the pulfe was feeble, rapid, fluttering ; that the tongue was black and furred ; the countenance dark and funk ; that there was much reftleffnefs, and fome delirium. He obferved white fpecks in the fauces ; that the room, notwith- ftanding the vinegar and ventilation, was offenfive, and the breath ex- tremely putrid. In this fituation, the patient told him, " That he felt like a watch, when the chain is broke ; that the wheels moved quick, but had only a fhort time to run." Dr. Thornton faw very clearly, that, under the quartan type, no crifis was to be expected for three days. In thefe diftreffing circumftances, he ordered the quantity of wine to be increafed, as occafion might require, to a quart, or more if needful, in four and twenty hours ; leaving a commiffion with the nmfc, to give him a glafs full whenever fhe perceived him finking. Inftead of half a dram of bark, every three hours, which the patient had been taking, he ordered two fcruples to be adminiftered every two hours, with its proportion of the wine ; and that, during the inter- vals, foodin different forms fhould be freely given. Of thefe he thought the fubfequent were the moft agreeable, and leaft fubject to put:.J::v : No. I. Frefh buttermilk. 40 CONTINUED FEVERS. No. II. Take a pint of good buttermilk ; leave it to be four ; then put on it a quart of warm new milk in a wooden bowl, in the bottom of which are holes large enough to tranfmit the whey, but not the buttermilk. In twelve hours a rich fubacid curd of eafy digeft- ion will remain. No. III. Leave a quart of new milk three or four days in a bowl, till it be- comes a jelly. No. IV. Put fkim milk into a deep wooden veffel, which muft have a peg at the bottom. Place this in a veffel of boiling water, and there leave it till the milk coagulates ; then draw off the acid whey, reftore the peg, and furround it once more with boiling water. At the end of twenty four hours, draw off more whey, and beat the curd with a wooden ftick. It is then fit for ufe, and may be mixed with fugar. No. V. In a bafon, or a foup plate, containing half a pint of water moderate- ly warm, put thirty or forty fnails, previoufly ftript of their fhells and wafhed ; there let them difcharge their flime. To half a pint of this flime, add a quarter of a pint of hartfhorn jel- ly, with the whites of four eggs. Let thefe be beat up ; then add one glafs of Madeira wine or fherry, and the juice of half a lemon, with a little lemon peel and cinnamon. No. VI. Infufe oatmeal in a wooden veffel till it ferments, and begins to ac- quire fome degree of acidity. Strain off the liquor from the oat- meal, and evaporate by boiling to the confiftence of a jelly ; this may be eaten mixed with white wine and fugar. Thefe with chicken panada and boiled mutton, tender, and full of juice, were the chief articles of diet. OBSERVATION VIII. On Stimulants. In regulating the quantity of ftimuiating medicines and food, in dividing thefe into fmall portions to be aiv- en at the diftance of fhort periods, Dr. THORNTON°an- ticipated their fedative effea, and uniformly fupported the vital powers. Thus the prudent gardener, under the guidance of his thermometer, fupplies fuel to his ftove, and preferves his hot houfe at a regular and cer- tain temperature, without fuffering the heat to be too much diminifhed, or violently andfuddenly increafed. In CONTINUED FEVER-S. 41 In the human frame, the pulfe is this thermom- eter. ► OBSERVATION IX. On the Pulfe. .Without underftanding the pulfe, no one can be a good phyfician. That the pulfation of the artery arifes principally from the action of the heart is evident, becaufe, as you in- creafe the action of the latter, you increafe in the fame proportion the pulfation of the former. But the action of the heart, and, therefore, the pulfa- tion of the arteries, being caufed by ftimulus, bear pro- portion to the irritation, which again depends on, both the quantity of ftimulus applied, and the degree of ir- ritability in the fyftem ; fo that by increafing either, you equally excite and quicken the action of the heart. The ftimulus of the blood bears proportion to its quantity, its velocity, and its degree of oxygenation, that is, to the quantity of oxygen which in a given time it can communicate to the irritable fibre. Hence it is that patients, who breathe a vitiated air, have a fluggifh pulfe ; whilft they, who either infpirc air more copioufly charged with the vital principle, or who from difeafe derive too much oxygen air from the atmofphere, have always a quick pulfe. The former, as well obferved by Dr. Beddoes, may be feen in fcurvy ; the latter in phthifis. I have faid, that the action of the heart depends on its irritability ; but then it muft be remembered, that ir- ritability bears proportion to debility. In making obfervations on the pulfe we have to notice, 4. Its fulnefs- 5. Its regularity. 1. Its frequency. 2. Its ftrength. 3. Its hardnefs. 1. The frequency is governed not merely by the ftim- ulus of the blood, and the irritability of the heart, but by the quantity of blood to be kj>k in motion. F All 4* CONTINUED FEVERS. All thefe circumftances muft be confidered. ^ Thus in Synocha we have fome degree of irritation to quicken the circulation ; but as the vital ftream is undiminished in quantity, the celerity is moderate, feldom exceeding i oo or 110 : whereas in Typhus, with increafed irritability of the arterial fyftem and diminifhed quantity of blood, it rifes to 150 or 200 pulfations in a minute. In a ftate of health, in adults, we may reckon it from 60 to 70 ; but in hypochondriafis, it is often obferved as low as 50, or even 40. The irritability of the heart is diminifhed by age, by fleep, by opium, and by fympathy with the alimentary canal, when it is oppreffed by vifcid mucus or relaxed by grief. Hence indolence and poverty of diet fink the pulfe. 2. The ftrength depends on the powers of life ; for where debility prevails it will be manifeft in the arterial fyftem by the weaknefs of the pulfe. 3. The hardnefs of the pulfe marks either inflamma- tion in the coats of the arteries, or refiftance in the ca- pillaries, arifing either from fpafmodic ftricture or from denfity of blood. Uncommon foftnefs of the pulfe de- notes relaxation in the arteries, with penury of blood. 4. Thefulnefs indicates the quantity of blood thrown out at each contraction of the heart, which is regulated by the degrees of irritability ; for when this is morbidly increafed the ventricles either contract before they are replenifhed, or from debility are unable to overcome the mufcular action and elaflic refiftance of the arteries, and to fend out a copious ftream. Hence venous plethora prevails, and the arteries are fmall. 5. The regularity is pincipally governed by the fame caufe, and where the pulfe, as in the progrefs of Typhus, of Hyfteria, and of other difeafes, fails in regularity, we muft, independent of organic affections of the heart, at- tribute this to morbid irritability. From what has been faid we may underftand, why in Synocha the pulfe is full, hard, ftrong, but moderate in frequency ; and why in Typhus it is fmall, weak, quick, and in the worft ftate of that difeafe irregular. Hence CONTINUED FEVERS. 43 Hence alfo we may comprehend* why the rapid pulfe in Typhus and Hyfteria is rendered flower, as well as ftronger, by animal food, wine, opium, and the Peruvian bark. * On Monday, the nineteenth day of the difeafe, towards evening, every bad fymptom was increafed. Singultus, with fubfultus tendi- num, came on, and whenever he awoke from fleep, it was with fpaf- modic twitchings, firft of the lower extremities, afterwards of the whole body, followed by a fhort hecking cough. Thefe fymptoms evidently arofe from the ftimulus of the gaftric juice on the hving fibres, when the digeftion was completed, and the ftomach was void of food ; for they inftantly ceafed when he began to eat. Tuefday, September the 24th, being the twentieth day of the difeafe, at five in the morning the pulfe was fluttering, and fo rapid as not to be counted ; and the patient feeling himfelf finking into the arms of death, begged with eagernefs for wine. Two full glaffes of Madeira were given him with good effe&. At feven he began to fink again ; no moifture was any where perceptible ; and he was feized with vomiting; but warm wine and water foon gave relief. At ten his countenance was funk and black ; yet his lower ex- tremities were warm. His urine was pale, and its flow confiderable. Plenty of Madeira wine was given ; and his pulfe by degrees became foft, though feeble, and not more than 80 in a minute. At twelve his hearing item to be concocted and expelled, is the proximate caufe of fever ; what in the place of thefe fhall •we fubftitute as the foundation of rational indications and a fuccefsful practice ? Shall we borrow from our modern Hippocrates the idea of atony and fpafm ? With the utmoft deference to his fuperior talents, I muft beg leave to differ from him ; and, without repeating the arguments, by which he has recommended his fyftem to the attention of the world, I muft obferve, that fever continues after the fpafm of the extreme veffel s, as frequently appears by copious fweat- ing, is relieved ; whereas, when we feek a proximate caufe, we muft find fomething, which being once re- moved, the diforder ceafes. For the proximate caufe of fever, therefore, I would aflign the morbidly increafed irritability of the heart a;;d arteries ; and this with either ftrong marks of vafcular excitement, or with fymptoms of nervous weaknefs and diftrefs : the former conftituting Synocha, and the latter Typhus. In Synocha we have, indeed, a frequent pulfe, but it is full, ftrong, and hard ; whereas in Typhus the pulfe is quick, fmall, and feeble ; whilft, at the fame time, the difeafe is attended with every fymptom of debility. If it be inquired, what produces the increafed irritability of the heart and arteries in fever, I fhall not hefitate to offer another conjecture to the world ; happy, however, in not being the firft publicly to hazard that opinion, although it has been deeply impreffed upon my mind for thirty years. It appears to me, that the increafed irritability of the heart and arteries in fever arifes from confent of parts and the ftimulus of acrid bile, indigefted food, vif- cid and corrupted mucus, worms, virus, and other ftim- uli in the ftomach and firft paffages ; becaufe in propor- tion as thefe have been removed, fever has been reliev- ed, either ceafing altogether, or being made to intermit, cr at lead rendered mild and tractable, whilft it has proceeded in its deftined courfe. Should we in Typhus fuffer putrefcent colluvies to ftagnate in the alimentary canal, we fhall have, then, no longer what is called a nervous, but a putrid fever. . I CONTINUED FEVERS. 45 I am ready to allow with Dr. Cullen, that for the occafional caufe of fever, we muft look to fedative pow- ers, fuch as contagion, fpecific effluvia, putrid exhala^ tions, driving fog's, and ftagnant vapors, fear, and the viciffitudes of heat and cold. Debility, whether arifing from heat, intemperance, fatigue, previous diforders, inanition, the operation of medicine, or any other*fource, may be juftly confidered as the predifponent caufe. But, as for the proximate caufe, no other, in my opinion, can with juftice be af- figned, than the one which I have already ftated. Dr. Cullen in his Materia Medica has a moft inter- efting obfervation. He remarks, that fome kinds of fifh, fuch as eels, fal- mon, herrings, and, in peculiar conftitutions, mufcles, or even lobfters, independent of their putrefcency, give a fingular irritation to the fyftem, and, during their di- geftion in the ftomach, occafion a confiderable effloref- cence on the fkin ; fometimes partial, at other times over the whole body ; fometimes with a confiderable febrile diforder, but at other times with very little. It is feldom of long duration, and commonly ceafes when the matter is entirely digefted and paffedoutof the ftom- ach. He adds : " I have had it in fome cafes immedi- ately removed by bringing up the contents of the ftom- ach ; by which it appears, that this phsenomenon depends upon an operation exerted in the ftomach, and not upon any matters being mixed with the blood." Whoioever will take the pains to confult Sir John Pringle, on the difeafes of the army, will find my ideas reflecting the alimentary canal confirmed ; and may ob- ferve, moreover, a connection clearly marked, fuch as can arife only from identity of caufe, between flux and fever ; for, it appears, that all who, in fimilar circum- ftances, were attacked by diarrhoea, efcaped the autum- nal fever of the camp, and that in cafes of fever, when- ever a diarrhoea fupervened, the fever vanifhed, frequent- ly, however, to return when the diarrhoea ceafed. In addition to this remark I muft obferve, that any one, who is converfant with practical writers, may col- 4-6 CONTINUED FEVERS. lect from their united obfervations, that fever, whatfoever type it may affume, depends upon one common caufe ; becaufe he will remark, that the various fpecies run into each other. The continued are apt to remit and inter- mit ; whilft intermittents, by bad'management, become continued fever. The firft effect of vifcid mucus in the alimentary ca- nal is fedative, as appears by the flow and feeble pulfe, languor and depreflion of fpirits, coldnefs of the extrem- ities, coftivenefs and deficiency of perfpiration, which it conftantly produces. But as the retention of perfpirable matter proves a burthen to the fyftem, therefore the firft effort of nature to relieve herfelf appears to be, by exciting the action of the kidneys, and limpid urine flows in remarkable abundance. Moft of the enumerated fymptoms may continue for years ; as in the cafe of hypochondriafis ; or, be- ing fuffered to increafe, the difeafe may terminate in melancholia. The fedative effects of bile, when it is abforbed into the fyftem, are ftill more remarkable, as appears in all the functions, natural, animal, and vital. The pulfe is languid in the extreme ; the fpirits are depreffed ; drow- finefs, with proftration of ftrength enfue ; the bowels are conftipated ; the urine is deficient ; and the perfpi- ration is obftructed. Nature, in fuch circumftances, appears to be retreat- ing before fome powerful invader; but when the fedative powers are violent and fuddenly applied, fhe makes ftrong efforts to relieve herfelf, and the gates of this tu- multuous city are Barred, whilft fhe is affembling all her forces to expel the enemy ; for, during the paroxyfm of fever* the pores are ftrongly clofed, whilft the vital energy is evidently concentrated and collected in the heart, which propels the blood with renewed vigor through the arterial fyftem in its whole extent. In the cafe of intermittents a copious fweat fucceeds. But as the effort is not confined to the external furface of the body j if, at the fame time, the mucous follicles, with CONTINUED FEVERS. 47 with the exhaling arteries, pour forth their copious ftreams in the inteftinal canal, a diarrhoea follows, and this frequently puts a period to the original difeafe. When nature fails in this firft effort, fhe repofes, ac-' cording to her ufual practice in other cafes, to recruit her ftrength, and we have either i. a Quotidian, i. a Tertian, or 3. a Quartan, according to the degree of vigour in the fyftem. Thefe may degenerate and affume the continued form; yet, when thus modified, they retain fomewhat of their original type, as marked by their quotidian, tertian, or quartan exacerbations, which are only renewed efforts to produce a termination of the fever. Thus commonly during the firft week they conform to the quotidian, during the fecond to the tertian, and after that to the quartan periods; at firft with fymptoms of ftrong vafcular excitements, and at laft with evident tokens of extreme debility. Such is the progrefs of Synocha. But, when the vital energy is weak, the efforts of na- ture will be feeble, and the patient will complain of fre- quent chills with fiufhings of heat; liftleffnefs ; fatigue; heavinefs and dejection of fpirits ; difrelifh of food ; nau- fea ; reftlefihefs ; anxiety ; and difturbed fleep : the pulfe will be quick, weak, unequal, fluttering ; the urine pale or limpid ; and the thirft will be moderate. Thefe fymptoms may creep on for many days, but will make way for thofe that are more urgent, when faint- nefs, flarting of the tendons, ftupor, delirium, with dif- treffing marks of fpeedy diffolution, leave no room to doubt refpecting the diagnofis ; for the fever is evident- ly Typhus. In fever we conftantly infpect the tongue as a faith- ful index of the alimentary canal. When that is dry and covered thick with mucus, the attendant deficiency of appetite clearly indicates a fimilar condition of the ftomach. When the tongue becomes clean and moift ; when the faliva flows freely and is abundant, a keen appetite returns, and fufticiently evinces, that the gaftric juice is 4§ CONTINUED FEVERS. is neither deficient in itfelf, nor prevented by a vifcid mucus from everting its ftimulatinp- power on the itomach. SECTION IV. Indications of Cure in Synocha. From what has been faid, I truft it will be clear to the ftudent, that to prevent or to cure'a Synocha, his firft intention muft be to cleanfe the alimentary canal ; and, from the experience of more than thirty years, I can venture to affure him, that by this means the fire may be quickly extinguifhed in the firft paffages before it has had time to fpread ; and the fever may be either ftifled in its birth, fhortened in its duration, or at leaft, in its type, rendered more benign. For this purpofe, agreeable to nature's firft effort for relief, an emetic, or repeated emetics of ipecacuanha, gr. 5—10, with tartarized antimony one grain, fhould be adminiftered with the utmoft expedition ; after which a mffcurial pill of calomel, three grains, with foap, fhould be thrown into the bowels at night, to be car- ried off by rhubarb and fenna the fucceeding morning, or one grain of calomel, with from three to feven grains of antimonial powder, may be ordered every evening. Having cleanfed the alimentary canal, the bark may be fafely given in fufficient quantity to anfwer the fecond intention, which is to reftore the tone, and to invigorate the fyftem. Without this, illdigefted, acrid, and irri- tating matters, would be again collected and prove the fornes of frefh fever. If the ftomach will bear it, a dram of the Peruvian bark in fubftance may be given every three hours, or the following : & Pulv. Cort. Per. $j. Tinft. Cort. Per. 3j. DecocL Cort. Peru v. §ifs. Syr. fimp. 3j. m. ft. hauft. 3a quaque hora fumendus. That is, Powder of bark one fcruple, tin&ure of bark one dram, and decoc- tion CONTINUED FEVERS. 49 tion of bark one ounce and half, with fimple fyrup one dram ; to be taken every three hours. Should the bark affedt. the bowels, eight or ten drops of laudanum may be added to each dofe. Should you, however, fail in this firft attempt, you muft ftill proceed to cleanfe by calomel and antimonials, that you may fpeedily prepare the bowels for the recep- tion of Peruvian bark ; or the fubfequent may be occa- fionally ufed with good effect: & Kali Tartarifat. 3ifs. Infuf. Sen. ^ifs. Tinft. Sen. 3ij- Mann. 3j. m. f. h. m. f. That is, Tartarized kali a dram and half, infufion of fenna an ounce and half, tinfture of fenna two drams, manna one dram ; mix for a dofe to be taken in the morning. Should you neglect to cleanfe, and thereby fuffer a Synocha to continue, and to exhauft the powers of life, I know not how you are to avoid a Typhus ; becaufe the fever, which in the beginning. obferves clearly the quotidian type, with ftrong action in the vafcular fyftem, paffing through the tertian, may affume after the elev- enth day, if not more rapidly, the quartan form, with its ufual fymptoms of debility. Stationed in a country parifh, my practice has been confined chiefly to the rigid fibre of laborious peafants; and, among thofe of them, who made an early applica- tion for afliftance, I never fuffered fever to continue. I have one aged fervant, who in the thirty years, dur- ing which he has lived with me, has frequently been at- tacked by fever. I have often found him in the chimney corner, with a dry and parched fkin ; foul tongue ; pulfe frequent, hard, and ftrong ; no appetite ; thirfty ; coftive : yet the very firft emetic, difcharging a quanti- ty of bile, of phlegm, and of indigefted food, aflifted by a mercurial pill at night, and followed by rhubarb with fenna in the morning, has fent him after the fecond day to work, without even the ufe of the Peruvian bark. Dr. Rush,- of Philadelphia, in the yellow fever of 1793, gave every day, whilft the fever lafted, Calomel, gr. 10—15, with Jalap, gr. 10, to procure five or fix G ftools. y-> CONTINUED FEVERS. (tools. By this evacuation the low pulfe was raifed, and the ftrong pulfe reduced, and the patients were fo much ftrengthened, that fome who had ftaggered to the clofe- ftool, walked back again to their bed ; the febrile par- oxyfin was abated ; vomitingjwas checked, and fweating was produced. Dr. Rufh, by this practice, cured 99 out of 100 who applied to him at the commencement of the fever. A fimilar practice proved equally fuccefsful at the Havannah, under the care of M. Holliday, in the putrid bilious fever of that inhofpitable climate. He gave Glauber's fait and manna in fuch dofes as to procure plentiful evacuation ; and when he had thereby got the fever to remit, he poured in the bark and fnake root. In cafe of coftivenefs and accumulation of faeces in the laft of the inteftines, a clyfter gives relief, without the weaknefs commonly induced by the operation of more powerful cathartics. * During the progrefs of a Synocha, animal food is in- admiflible ; fpices, fpirits, and fermented liquors, muft be forbid. Ripe fruits and vegetables may be freely ufed, and the craving for fubacid liquors muft be indulg- ed. Lemonade is good : the common faline draught is excellent. It is compofed of lemon juice half an ounce, fait of wormwood one fcruple, nutmeg water and fimple fyrup of each one dram, with two or three ounces of diftilled water. This may be taken every three or four hours, and in the intervals vinegar and water with honey may be ufed. When heat is accumulated in the fyftem either by fever, by ftrong exercife, or by a fcorching fun, nature cries aloud for* acids ; and to thofe who have turned their minds to chemiftry, the reafon for this ftrong defire is obvious. They know that animal heat originates in the decom- pofition of vital air, when received into the lungs ; and they obferve, that the quantity decompofed and vitiated, or, in other words, the generation of heat, bears direct proportion, as before explained, to the quantity of com- buftible CONTINUED FEVERS. 51 buftible matter, whether animal or vegetable, whether fugar, oil, or fpirit, received into the ftomach. They obferve likewife, that acids received into the ftomach check and reftrain the generation of heat; or, in other words, that, when the fyftem is faturated with oxygen, lefs vital air is decompofed by the lungs, and confequently lefs heat is generated. On this fubject the ftudent muft recollect what I have faid on refpiration, and particularly the experience of the celebrated diver Mr. Spalding. It is upon thefe principles, that the reapers in the fouth of Spain covet their gazpacho, compofed of bread, oil, and Vinegar : the two firft articles for nutriment, and the latter to moderate the heat. On the fame principles, obedient to the voice of na- ture, during the fultry heats of fummer, we equally de- fire our gazpacho, compofed of lettuce, oil, and vinegar. Agreeable to this ftrong defire we may remark, that in warm climates, and in fummer, the acefcent fruits abound, but in the autumn we have chiefly thofe which produce oil and fugar. Should delirium fupervene in Synocha, attended by ftrong pulfe, inflamed eyes, with fulnefs and flufhing of the countenance, fix or eight leeches muft be applied to the temples, and the legs muft be put into a warm bath, heated to 96 or 98 degrees of Fahrenheit's ther- mometer. This will make a derivation, and with plen- tiful evacuation from the temples, will relieve the affec- tion of the head. When I was lately at Bath, my old friend and fellow ftudent, Dr. Fothergill, communicated to me his method of treatment in cafes of Synocha, and, from my high ef- timation of his experience and abilities, I fhall be incli- ned to adopt his practice. The medicine on which he places his principal depend- ance is Clutton's Febrifuge. It is thus prepared : Take oil of fulphur by the bell, with oil of vitriol reclined, and fea fait, of each one ounce j re&ified fpirit of wine three ounces ; digeft for a month, then diftil to drynels. T« 52 CONTINUED FEVERS. To half a pound of this fpirit add angelica root, ferpentaria, and cardamoms, of each a dram and a half, for a febrifuge tmfture. Spring water acidulated with this, and fweetened to the tafte, makes a cooling diaphoretic and diuretic julep, of which the patient muft drink five or fix pints in the four and twenty hours. Clutton, who made no fecret of the compofition, affures us, that a recent^ fever is cured by it commonly in two days. If not given early in the difeafe, he joined with it fome antimonial. SECTION V. Indications of Cure in Typhus, In Typhus the intention muft be, i. To cleanfe the firft paffages. i. To fupport the powers of life. and 3. To obviate any tendency to putrefaction in the fyftem. The firft of thefe indications is, I truft, deducible from what has already been delivered ; but the importance of the fubjed will be my juftification, if, in its fupport, I avail myfelf of an opinion delivered by one of the ablefl practitioners in Ireland. Profeffor Macbride, of Dublin, has well obferved, that the moft common fource of difturbance in the ner- vous fyftem is acrid and offenfive matter in the aliment- ary canal, either in the ftomach or flexure of the du- odenum. The propriety of this obfervation muft be obvious to every one, who in Typhus, whether it obferve fimply the nervous, or affume the putrid form, pays attention to the foul tongue, the bitter tafte, the defective ap- petite, attended by naufea and anxiety. But it will be more evident when he remarks, that in proportion as the firft paffages are cleared, thefe fymptoms, with ail the other diftreffmg and nervous affections, are re- lieved. . Should no fymptoms of putridity appear, Typhus will be a nervous fever ; but fhould putrefcent fordes con- tinue in the bowels, it will certainly become a putridfever. The continued fevers. 53 The principal caufe of irritation is in the alimentary canal. Impreffed with this idea, the young practitioner will fee the neceflity of cleanfing the 'firft paffages by emet- ics ; and although to give draftic purges would be rafh in the extreme, and perfectly inconfiftent with the prin- cipal intention, yet he will once a day procure a flool, ei- ther by thedecoctum tamarindorum cum fenna,or by fuch gentle cathartics as prudence may fuggeft. The defign is merely to evacuate putrefcent fordes, and thereby to ftrengthen, becaufe thefe fpeedily induce extreme debil- ity ; but, at the fame time, it is well known, that noth- ing, in nervous difeafes, confumes the vital powers more .effectually than ftrong cathartics. In the beginning of a Typhus, or at a later period, if the pulfe is tolerably firm, my friend Dr. Nankivell does not hefitate to order, ]$> Pulv. Glycyrrhiz, gr. iv. Pulv. Antimonial. gr. vij. Calomel, gr. i. m. f. pulv. h. ^a vefp. fumen. This he occafionally repeats if the pulfe will warrant it. This perfectly agrees in principle with the practice of Mr. Holliday and of Dr. Rufh, as ftated in the pre- ceding fection. The decoction of tamarinds with fenna is thus pre- pared : Take tamarinds fix drams ; cryftals of tartar two drams ; water a pint and an half. Boil thefe to one pint. In this decoftion, infufe for twelve hours one dram of fenna ; ftrain off the liquor, and add fyrup of violets one ounce. This may be taken for one dofe, and tincture of rhu- barb may be occafionally joined with it. Should there appear, by the fulnefs of the lower bel- ly, to be a congeftion of fasces in the laft of the intef- tines, a clyfler may be injected to advantage. This may be compofed of milk with fome oil, fugar, and fait. The fecond indication is to fupport the powers of Ufe, always remembering, that debility and irritability are as intimately connected, as the caufe with its effect. When, during the German war, the French were fhut up in Prague 54 continued fevers. Prague by the Auftrians, they fuffered by a putrid fever, for whjch their phyficians bled them freely. The confe- quence was fuch as we may readily imagine, for they loft from 80 to 100 every day. To fupport the powers of life, the chief dependance will be on pure air, a gen- erous diet, port wine, and the Peruvian bark. The bark muft be adminiftered in fuch dofes as the ftomach will endure ; not once, nor yet eight times, in the four and twenty hours ; becaufe, thus given, the needful quantity might overload the ftomach, and pro- duce a naufea. Wheri taken every fecond hour, the dofe may be re- duced. The bark may be combined with antimonials, aromatics, opium, as occafion may require. §. Pulv. Cort. Per. rub. gifs. Pulv. R. Serpent, virg. gfs. Coq. ex aq. pur. q. f. ad Colat. J^j. I£> Hujufce Decocti, gifs. Tinft. Cort. Peruv. 3jj« Tinft. Opii, gtt. 15. Syr. Cort. Aurant. 3j- Sp. Ammon. Comp. gtt. 20. Confe£t. Damocrat. gr. 15. m. f. h. 6» q. h. f. In horii intermediis capiat aeger cochl. iv. feq. mift. Tfio Camphor, gr. 16. Mucil. gum Arab. §fs. Tere peropt. & adde Decoct, com. Cor. Per. ?vj. Tinft. Cort. Per.gj. Sp. Ammon. comp. 3ifs. Syr. Cort. Aurant. gfs. m.'f. mift. The ftudent fhould remember, that according to the experiments of Drs. Hunter and Stevens, confirmed by the experiments of Spalanzani, animal fubftances are digefted more readily than vegetables. That the latter are lefs nutritious than the former, mufl be evident to every one, who confiders the debility of thofe who are confined to vegetable diet, when compar- ed with the ftrength of thofe who have plenty of animal food. Whatever may be the articles of diet, they fhould be adminiftered frequently, in fmall quantities, to be in- creafed as the appetite requires and the ftomach can di- geft. It may confift either of butcher's meat, fuch as beef continued fevers. ss beef and mutton, of eggs, of milk, or of the compofi- tions already mentioned, as being leaft fubject to putre- faction, or of broth made exceedingly rich and very fa- vory, with pepper, fait, and potherbs. The meat fhould be well chewed to increafe the quantity of faliva. By way of change, half a pint of good milk, with a large fpoonful of brandy, and fome fugar, may be interpofed. The wine to be adminiftered fhould be at all events fuf- ficient to maintain the vital energy. This muft be determined by the pulfe. Should the pulfe be rapid, weak, and fluttering, the quantity muft be increafed, but commonly a wine glafs full every hour will be fufficient. The ftudent will obferve, that in proportion as he throws in a proper quantity of nutriment, with wine and bark, the pulfations will diminifh in number, whilfl they increafe in ftrength. The falutary effects of vital air received into the lungs have been already noticed, and the fubject will be re- fumed hereafter. Delirium in Typhus muft be confidered as a fymp- tom of debility ; for it muft not be confounded with the delirium of a Synocha, from which it differs, as far as the eaft is from the weft. The diftinction is of the laft importance, becaufe it leads to practice, which, if erroneous, muft be fatal. In the delirium of Synocha we have the pulfe full, ftrong, hard ; the countenance flufhed ; the cheeks red; the eyes inflamed. In the delirium of Typhus we have the fmall, quick, feeble, fluttering pulfe ; the countenance funk ; and the eyes either ftupid and vacant, or moift and quick in motion ; with other fymptoms of debility and irritability, fuch as cold fweats, flow of tears, purging, plentiful dif- charge of urine, trembling and twitching of the ten- dons, coldnefs of the extremities, and, towards the clof- ing of the fcene, infenfibility, with involuntary evacua- tions by urirle and by ftool. To relieve the delirium of Typhus, the legs muft be fomented for many hours with flannel dipt in hot water, and rS ■ CONTINUED FEVERS. and renewed every half hour ; or, which is preferable, * let the legs be bathed every hour, for ten or fifteen min- 4 utes at a time, in water heated to 94 degrees of Fahren- heit's thermometer, and repeated till fleep comes on. Should this fail to give relief, recourfe muft be had to wine, brandy, camphor, opium, with this precaution, that if there be fymptoms of foulnefs in the firft paffages, thefe cordial ftimulants muft, at all events, be preced- ed by five or fix grains of James's powder, or fome of the antimonial calces, which muft be repeated every four hours, as occafion may require. If the cordial ftimulants relieve the head, ftrengthen the pulfe, leffen the number of vibrations, diminifh heat, remove third, and bring on a gentle moifture on the fkin; the ftudent will be fatisfied, that he has made no miftake in his diagnofis, and will be encouraged to pro- ceed. Sometimes it is expedient to unite antimony with the opium and camphor as in this form : §, Tina. Thebaic, gtt. 40. Miftura camphprat. |j. Vin. antimon. gtt. 20. m. p. r. n. s. That is, Take Thebaic tinaure forty drops, camphorated mixture one ounce, antimonial wine twenty drops, for one dofe, to be repeated as occafion may require. . The third and lafl indication is, to obviate any tenmn- cy to putrefaclion in the fyftem. - To fulfil this intention, the ftudent, reflecting that the alimentary canal is the ftorehoufe of putrefaction, fhould, under the cautions and in the way fuggefted, evacuate the bowels. But as this cannot be always per- formed with fufficient fafety, it will be neceffary to re- (train the putrefactive procefs. ^ In a late publication of Dr. Beddoes, we have a rela- tion, tranfmitted to him by the Rev. Edmund Cart- wright, of moft aftonifhing cures in putrid fevers ac- complished by yeft, The patients, from being reduced to the laf? extremi- ty, were in four and twenty hours fo far reftored to health, CONTINUED. FEVERS. SI health, as to leave not merely their beds, but the houfe alfo, and to purfue their ufual occupations. He gave two large fpoonfuls vof yeft in three hours, interpofing bark, wine, and nutriment. In ten minutes from taking the yeft, he perceived an alteration for the better in the pulfe, which became more compofed and regular. The operation of the yeft, like that of the bark, was evidently to check the progrefs of putrid fermenta- tion in. the alimentary canal, which is moft undoubtedly the fomes of the fever. Mr. Cartwright, on whofe ve- racity we may place the moft implicit confidence, affures us that it never failed with him. No fooner had Dr. Thornton, who inherits the ac- tive and benevolent temper of his father, the celebrated Bonnell Thornton, perufed the extraordinary nar- rative of the Rev. Mr. Cartwright, on the efficacy of yeft, than he anxioufly waited for an opportunity of trying its virtues ; efpecially as its operation feemed to be, by imparting Jixed air immediately upon its entering the warm ftomach. One day, by accident, as he went paft a fhop in Tot- tenham court Road, he heard the fcreams of a mother, who was agonized on feeing her child expire. Thefe fcreams renewed the ftruggles of the child, and the nurfe who attended, threatened to take away at this moment the child, thatf it might die in quiet. Dr. Thornton got down immediately fome tartar emetic, which quick- ly acted as a vomit; and after the operation was over he gave rhubarb, which cleared the inteftines ; he then ordered the child every two hours yeft and water, with wine and bark, and in three days the dying child was up and well. This practice he continues with remark- able fuccefs. The food, with the fame intention of reftraining the putrefactive procefs, fhould' be chiefly of the acefcent kind ; yet, that it may contain a fufficient quantity of nutriment, and, at the fame time, may have little ten- dency to flatulence, it fhould be taken from the animal kingdom. Milk, therefore, in its various forms, alter- nating with the fnail mixture, as before mentioned in H the 58 CONTINUED FEVERS. the cafe of bilious autumnal fever, will be moft de- ferable. Should, notwithftanding, a colliquative diarrhoea in- tervene, with an aggravation of the fymptoms, this muft be reftrained, by wine, fpices, opium, and Anguftura bark, either feparately ufed, or united in the following form : jg, Infuf. Cort. Anguftur. gvj. Tina, ejufdem, gfs. Pulv. ejufdem, ^j. Tina. Opii. gtt. 20. Tina. Lavend. Comp. gtt. 40. m. c. Co. 3. o. 4 h. That is, J Take infufion of Anguftura bark fix ounces, tinaure of the fame half an- ounce, powder of the fame one fcruple, tinaures of opi- urn twenty drops, and of lavender forty. Mix. and give three fpoonsful for a dofe, to be repeated every four hours. * "When nurfes or medical practitioners perceive, by fhivering and ficknefs, that they have taken the infection? of Typhus, they fhould, without lofs of time, aflift the efforts of nature to relieve herfelf, and clear the flomacK by emetics, not fatisfied with one, nor even two, if they are determined to run no hazard of the fever. Three hours may be interpofed between the exhibi- tions. The emetic; as ufed and recommended by Dr. Saunders in this cafe, may be five or fix grains of ipe- cacuanha with one of tartarized antimony. When the infection is thus refifted at the threfhold, its ravages in the fyftem are effectually prevented, for no fever forms : but even when it is formed, its prog- refs may be flopped, or its fymptoms, by the praftice I have recommended, may become fo mild, that none but the moft difcerning eye fhall be able to recognize its prefence. When the peafants in Bohemia, after three bad harvefts, had fuffered the extremity of famine, they came in multitudes to Vienna, where they died in the hofpitals of a putrid malignant fever. Here my vener- able friend Dr. Ingenhoufz attending them, took the infection. His cafe, which he obligingly communicated to me, was fo remarkable, that I fhall here relate it, as • he CONTINUED FEVERS. 59 he himfelf defcribed it in a letter to a friend. Behold, fays he, the practice by which I preferved myfelf and others. Having rafhly expofed myfelf to the contagion of a moft infectious fever, I was feized in the middle of the night with cold fhivering, pain in the head and loins, naufea, pulfe tremulous and fo frequent, that I could not count its vibrations. The tongue rough, dry, and parched, fo that I could fcarcely articulate my words. When my fervant came to attend me in the morning, he was terrified by the palenefs of my countenance and by my ghaftly looks. I made him inftantly diffolve twenty grains of tartarized antimony in fix ounces of lemonade, and of this I took a fpoonful every four min- utes till vomiting came on. I then repeated the dofe once or twice, that I might clear my ftomach from eve- ry kind of filth. A purging fucceeded to the vomiting, and the*difcharge was copious. The faeces were ex- ceedingly offenfive ; but in proportion as the bowels were evacuated, every fymptom was relieved, and a fweat fucceeded, which continued for eight and forty hours. When the fweating and the purging ceafed, I was free from fever, and foon recruited the ftrength which I had loft. SECTION VI. Of the Plague. I might now proceed to the confideration of inter- mittents ; but I choofe rather to fay fomething in this place on peftilential fever, that I may connect it more immediately with Typhus, of which it is undoubtedly a fpecies. Following the footfteps of my mafter, I placed Peftis in my nofology under the order Exanthemata, of the clafs PYREXIAE, with the fubfequent defcription. Pestis. The Plague.—Typhus, contagious in the extreme ; proftration of ftrength ; buboes and carbuncles ; pete- chias ; haemorrhage and colliquative diarrhoea. Such €o CONTINUED FEVERS. Such are the fymptoms. Dr. Guthrie, of Peterfburgh, in his communieation-s with Dr. Duncan, has favoured us with a clear and dif- tinct idea of this difeafe, tranfmitted to him by Baron Afh, Phyfician General to the army of Moldavia and Walachia, A. D. 1772, in the Turkifh war. The firft fymptoms are a dull pain in the head, with fhivering and univerfal debility ; a bitter tafte ; naufea ^ a heavy inflamed eye j a dejected countenance ; and a white foul tongue. Thefe are followed by vomiting, and by buboes in the inguinal, fubaxillary, or parotid glands. To thefe fymp* toms fucceed livid coloured carbuncles in different parts of the body, delirium, with fmall quick pulfe, convul- fions, death. - - The ingenious Dr. Gardiner fays, that in the opinion of Dr. Mackenzie, who lived eight years at £>myrna, our jail fever is the fame with the common endemic peftilential fever of Conftantinople, which, when rifing. to a great height, and when to the ordinary fymptoms are joined buboes and carbuncles, is called the plague. In fupport of this opinion, Dr. George Fordyce, whole fuperior knowledge and accuracy of distinction merit our attention, has remarked, that the plague and ma- lignant fever have t,he fymptoms of the firft ftage vio- lent ; fuch as, languor, coldnefs, trembling, pain in the back, horripilatio, palenefs, drynefs of the tongue, thirft, tranfparent urine, coftivenefs, fmall pulfe fometimes in- termitting, delirium, anxiety, quick laborious refpira. tion, rigor, horror, naufea, vomiting. Dr. Gardiner thinks, and I perfectly agree with him, that contagion, whether marfh or human, is taken by the faliva into the ftomach, and may be inftantly ejected by emetics.^ The experience of numberlefs practitioners confirms this idea. Agreeable to this, Baron Afh and the moft fuccefsful practitioners in peftilential fever begin their operations fry cleanfing the alimentary canal. The following is their plan of cure : 1. They adminifter emetics. And for this purpofe they CONTINUED FEVERS. 6l they prefcribe, ipecacuanha half-a dram, tartarized anti- mony one grain, with one fcruple of vitriolated tartar, for a dofe. This emetic they work off with acidulated drinks ; and flioukUhe naufea with bitter tafte remain after the adminiftration of the firft emetic, they give a fecond, a third, or even a fourth, in the fpace of twelve hours. And it is highly worthy of our notice, as applying equally to Typhus, that emetics are not fubject to the fame objection as brifk purges, which a man in the plague is unable to fupport. When the infected have dropped down fuddenly, as if fhot with a mufket ball, they have been perfectly reftored by one emetic, and returned to duty within four and twenty hours from the firft ftroke of the infection. With this practice Giovanelli, as we are informed by Mr. Howard, perfectly agrees. 2. The Ruffian phyficians, having cleared the ftom- ach, order the following powder to be taken every morning : Rhubarb and flowers of fulphur of each one fcruple, ipecacuanha three grains. In cafe of coftive- nefs they prefcribe, by way of clyfter, a decoction of camomile flowers with vinegar ; then, every hour, they give the following mixture : Camphor two grains, nitre five grains. # 3. Thefe are followed in two days by a mixture, of the Peruvian bark one ounce, and flowers of fulphur two drams ; of which the patient takes two fcruples ev- ery fecond hour. 4. They adminifter acidulated drinks, and diffufe acetous vapour in a well ventilated chamber. Dr. Guthrie concludes his account by a remark, that a man may be in perfect health when he goes to reft, and the next morning the nervous fyftem may be in fuch a ftate of debility, that he can fcarcely anfwer the quef- tions of his phyfician. Hope and confidence, he adds, are the moft powerful prefervatives from the infection of the plague. SECTION €2 CONTINUED FEVERS. SECTION VII. Of Puerperal Fever. Dr. Cullen has been thought deficient for not hav- ing mentioned Puerperal Fever as a diftinct fpecies of Febris Continua ; but, in his vindication, we may be permitted to obferve, that the difeafe in queftion muft, through its various forms and progrefs, be reduced either to Synocha, to Typhus, or to the order of Phleg- masia. From the works of the moft eminent practitioners it appears, that of puerperal fever we may trace varieties dependant on the occafional caufe j and to this, partic- ular attention muft be paid. The occafional caufe may be, i. Infeclion.—This has been diftinctly traced in hof- pitals, and has been prevented by cleanfing the wards wherein it had appeared. 2. Inflammation of the omentum, injured, as fuppofed, by preffure from the gravid uterus.—This inflammation may, however, be an effect, and not the caufe ; although, while prefent, it requires particular attention. That in reality it is fo, I am inclined to think, becaufe in thirty years I have never #iet with it among my parifhioners. 3. Suppreftfion of the lochia. The fever ufually begins with inflammatory fymptoms j but it very foon terminates in Typhus. The indications of cure are, 1. To cleanfe the alimentary canal. 2. To reft ore the lochia. 3. To fupport the powers of life in the progrefs of this fever. The firft intention may be anfwered by emetics and cathartics, which muft be ufed till the firft paffages are clear. The fecond by emmenagogues. The moft fuccefsful practitioner I ever met with in this fever was the,late Mr. Jenny, of Truro in Cornwall, who was not afraid to reftore the lochia even by aloetk preparations. Thefe intermittent fevers. 63 Thefe certainly ftimulate the rectum, and act power- fully by fympathy on the veflels of the uterus. But as nature is, with certain intermiffions and intervals of re- pofe, conftant in her efforts to relieve herfelf; when the alimentary canal is cleared, fhe ufually effects herfelf a reftoration of this needful evacuation. Should, however, her ftrength fail."and her efforts therefore be defeated, we muft proceed to our third intention. The third intention may be anfwered by the Peruvian bark, with wine ; and in the laft itage of the difeafe, when a colliquative diarrhoea fupervenes, by the bark united with columbo root and opium. Genus II. Febris Intermittens. Intermittent Fever. Intermittents, whether they appear in the form of quotidians, tertians, quartans, or whatever be their type, have clearly an affinity and ftrong connection with continued fevers. They run into each other with re- markable facility ; and the difeafe which begins under one genus, frequently terminates in the other. Inter- mittents, with bad management, become continued fe- vers ; and thefe, properly treated, are foon made to in- termit. • Intermittents, like the continued fevers, may be diflin- guifhed into two fpecies, bearing a ftrong refemblance to Synocha and Typhus, and equally with the latter may be attended by fymptoms of putridity. The predifpofing caufe of intermittents is clearly de- bility, with penury of blood ; becaufe the robuft, and fuch as have a generous diet with a fufficient quantity of wine, are moft free from this difeafe. The occafional caufe is ufually marfh miafma, and ex- pofure to cold with humidity, more efpecially if alterna- ting with heat. The fedative and deleterious effects of marfh miafma appear from the teftimony of Sir John Pringle, reflect- ing foldiers fainting and dying fuddenly, as they march- ed through moraffes during the campaigns in Flanders. As D4 IN TERM IT TENT FEVERS. As to the proximate caufe of intermittents we muft refer to what has been advanced already on continued fever. From this it will be evident, that the indications of cure muft be, i. To clear the firft paffages from bile, undigeftedfood, and vifcid mucus. i. Toftrengthen the fyftem, and to brace the fibre. To anfwer the firft intention, and to prevent congef- tions in the abdominal vifcera, we muft frequently have recourfe to powerful emetics, followed by calomel. Let the ftomach and bowels be evacuated, let them be freed from fordes and from vifcid phlegm, and the intermit- tent ceafes; yet without tonics, the fordes may collect again, and if fo the fever will return. I frequently com- bine the calomel gr. 4 with antimon. tartarifat. gr. j. at night, and repeat it in the morning. To anfwer the fecond intention we prefcribe a gener- ous diet, with wine and exercife, affifted by aftringents, either vegetable, fuch as biftort, tormentil, the Peruvian bark, and the barks of oak, of willow, and of horfe chef- nut ; or mineral, fuch as alum, with the preparations of iron, zinc, and copper. To thefe vegetable and metallic aftringents, may be united, bitters, with* aromatics, according to the fubfe- quent forms. §, Cinchon* gj. Aq. frigid, vel Vin. alb. Hifpan. fci. poft 24 horas,Colatune gifs. addas Aq. Cinnamon. Syr. balf. ii £j. m. 1. Hauft. oram bihorio s. abfente febre. That is, Take Peruvian bark one ounce, infufe 24 hours in a pint of water or flieny wine, ftnun, and to an ounce and a half of this infufion add cinnamon water and balfamic fyrup of each one dram. Mi* and take this every two hours in the abfence of feve- $ Cinchon* *j Myrrh 3j. Extr. Glycyr. 5ij. Syr. Cort. aurant. q. s. f. Eleft. c. M. N. M. om. bihor. That is, ^domr rCC Vmyrrh 0ne,dram ; extra Calomel, Pil. Run, aa gr. x. 01. Abfinth. effent. gtt. ij. Pulv. Jalap, tys. Syr. com. q. s. ut ft. Pil. v. primo mane fumend. et, hora una elapfa, repetantur. Omni femihora capt. quadrantem partem fequentis mifturae cum plena po-: tatione Decocti Avenacei. §> 01. ricini recenter exprefs. £ifs. vitel. Ov. q. s. folut. Ol. Abfinth. gtt. viij. optime terantur fimul jet adde Aq. Menth. Piper. 3 v. Tinct. Cardamom. Comp. ^j. Syr. Zinzib. §fs. m. Take Calomel and Pil. Rufi, of each ten grains; effijntial oil of wormwood two drops ; jalap ten grains ; fyrup^lufficient to make 5 pills to be taken very early in the morning, and to be repeated in an hour. After which, every half hour, take a fourth part of the following mixture, with a draught of water gruel. Caftor oil one ounce and an half, diffolved with yelk of egg ; oil of wormwood eight drops, well rubbed together; pep- permint water five ounces ; compound tincture of cardamoms one ounce j fyrup of ginger half an ounce. When worms have been deftroyed, bitters and aftrin- gents muft be adminiftered, to prevent the accumula- tion of vifcid mucus in the inteftines. Chalybeates anfwer this intention beft, particularly iron filings, which, at the fame time, act mechanically, and wound the worms, when prefent in the bowels. Of thefe JO INFLAMMATIONS. * thefe fix or more grains may be given twice a day, for a fortnight or three weeks. Order II. Phlegmasia. Inflammations. INTRODUCTION. The character of this order, as already mentioned, is Pyrexia, with topical pain and inflammation. This order differs effentially from Febris, becaufe, i. The fymptoms of the firft ftage of fever do not of neceffity precede it. 2. It neither intermits, nor is it fubject to regular ex- acerbations and remiflions. The ftudent muft be careful to diftinguifh the pain of inflammation from that of fpafm, which is adiforder of an- other clafs; and he muft take efpecial notice, that to conftitute a difeafe of Phlegmafia, there muft be not merely topical pain, but Pyrexia. It will be needful likewife to remind him, that the buff coat on the blood, unlefs fupported by more fub- ftantial evidence, is a fallacious teft of inflammation. If with topical pain, the pulfe is ftrong ; full; hard; frequent ; and if the urine is fmall in quantity and high coloured, he may be certain that there is inflammation. In this cafe, the blood will be fizy, and its furface will be confiderably cupped; for fuch a pulfe indicates ftrong powers of coagulation in the vital fluid, and ftrength in the contracting folids. But if the pulfe is fmall, although frequent and hard, and if the urine is both pale and abundant, the ftudent may be fatis- fied, that the pain is fpafmodic. Should the pulfe be foft, he can have no room to doubt. This order contains many genera ; but, if he attends to what has already been delivered on Synocha and Ty- phus, he will find no difficulty in the management of thefe. b The inflammations. 71 The termination depends, 1. on the nature of the diathefis ; 2. on the conducl of the medical practi- tioner. When there are fymptoms of ftrength in the nervous and arterial fyftems, this ftate, adopting an expreffion derived from the Greek, we may call the fthenic diathe- fis : but fhould there be fymptoms of debility in the nervous and arterial fyftems, this condition of the human frame, by taking the Greek privative, muft then be call- ed the afthenic diathefis. Should any one, however, choofe in preference to call the former the inflammatory diathefis, the latter, in my opinion, to make the contrail, fhould be denominated the hyfterical diathefis ; but the expreflions fthenic and afthenic appear to me belt fuited to the improved ftate of fcience. This diftinction, reflecting the diathefis, lays the foundation for a correfpondent diftinction to be noticed in all the difeafes of this order ; for inflammation in its prefent acceptation requires to be confidered either as aclive or pajfive. SECTION I. Of Aclive Inflammation, with its Proximate Caufe. Aclive inflammation is the difeafe of the fthenic diathe- fis, and has for its proximate caufe local irritation, with morbidly increafed action and excefs of ofcillatory mo- tion in the arteries of the part affected. It may be con- fidered as a local Synocha, unlefs when, by confent, the general fyftem is affected, for then the attendant fever is decidedly a Synocha. In this fpecies of inflammation the pulfe is hard, ftrong, full, and frequent, about 100 in a minute. The natural termination is, 1. by refolution ; 2. by fuppuration and granulation, unlefs where a union of divided parts takes place by inflammation only, and the healing is effected, as we exprefs it, by the firft intention; or unlefs by its violence it induce debility, in which cafe it may terminate in fphacelus and death. SECTION 72 inflammations. SECTION II. Of Pajfive Inflammation, with its Proximate Caufe, Pajfive inflammation is a difeafe of the afthenic diathe- fis. The proximate caufe is, not local irritation, nor morbidly increafed action, and excefs of ofcillatory mo- tion in the arteries of the part affected, for thefe can be merely the occafional caufe of paffive inflammation ; but it is lofs of tone, relaxation, debility, a deficiency of vital energy, and diminution of refiftance. It may be confidered as a local Typhus ; unlefs when the general fyftem is affected, for then it ceafes to be local. In this fpecies of inflammation the pulfe is fmall and frequent, from 120 to 140 in a minute. It is attended by ficknefs, reftleffnefs, and want of fleep ; faintnefs, proftration of ftrength, fpafmodic contractions of the mufcles, and every fymptom of debility. The natural termination is by Houghing, or by the fpreading of fphacelus, till it ends in death. , In both thefe fpecies of inflammation we have congef- tion of blood and diftention of veflels, with this differ- ence, that in the latter the pain ceafes, the fluids ftag- nate, and the part affected, if vifible, is obferved to be of a dark or livid hue ; whilft the former has much pain, and the blood flows quicker than ufual through the diftend- ed veflels ; increafing heat, and augmenting both the natural fecretion by the glands affected, and the dif- charge of lymph from the exhalants ; and the part in- flamed is of a florid colour. When this complexion changes ; when the Pyrexia runs high ; when the pain is violent, and the heat ad- vanced to no degrees of Fahrenheit's thermometer ; we may be certain that the former fpecies will foon be fucceeded by the latter, and that a mortification is ap- proaching. SECTION III. Of the Occafional Caufes of Inflammation. The occafional caufes of inflammation may be, 1. Excefs inflammations. 73 i. Excefs of heat or cold, or of heat alternating with cold. 2. Cauftics of every kind. 3. Stimuli, either chemical, mental, or mechanical ; particularly the ftimulus of diftention, which produces fenfibility and irritability, where it did not appear before, and increafes them in ligaments and membranes to a moft aftonifhing degree. 4. Mechanical injuries by laceration, divifion, com- preflion. The indications of cure mufl be either to diminifh ac- tion, or to increafe the tone, according to exifting cir- cumftances, and the fpecies of inflammation. SECTION IV. Indications of Cure in Aclive Inflammation. These are, 1. To obviate the occafional caufe of the difeafe. If ftimuli or any acrid fubftances irritate the fyftem, thefe muft be either removed, fheathed by oils and mu- cillage, corrected by fuitable antidotes, or the part itfelf muft be deftroyed. 2. To leffen the irritability of the fyftem. This may be accomplifhed by the tepid bath and fed- atives locally applied ; by tonics ; by aftringents; by acids ; and by the infpiratio.n of the carbonic acid, and azotic -"drs. 3. To excite a ftronger inflammation in fome adjoin- ing, but fafer and more manageable, part. Hippocrates has well obferved, that greater pain de- ftroys in a confiderable degree the feeling of a leffer one. Agreeable to this Dr. Whytt informs us, that the muf- cles of a frog immediately after decollation are infenfible to ftimuli; but after ten minutes, on pricking the toes, the whole body will be violently moved.—Nature feems to pay her firft attention to the loudeft call. 4. To leffen the tenfion of the arteries, and thereby promote a refolution. K As 74 inflammations. As the morbid irritation, and action of the arteries is occafioned by diftention, and the diftention itfelf is in proportion to the action of the larger arteries ; it muft conftantly and progreffively either diminifh or increafe, till it ends in either refolution, or fuppuration. To fe- cure the former, we muft diminifh the tenfion of the vef- fels by bleeding, either general or partial, according to the nature and urgency of the difeafe. The fame intention may be anfwered by cathartics ; and for this purpofe practitioners combine calomel with tartarized antimony, adding either opium or foluble tar- tar, according as they wifh, either, at the fame time, to promote perfpiration, or folely to evacuate the bowels. Or the fubfequent may be adopted. I£> Calomel, gr. ifs. Pulv. Antimon. gr. vj. m. f. pulv. h.' s. s. But here a caution will be needful. The young practitioner, who meets with cafes of vio^ lently active inflammation, muft be upon his guard left, by fudden and copious evacuations, carried to excefs, he, fhould induce debility with its train of evils, fuch as Ty- phus, gangrene, hyfteria, dropfy ; for in this cafe. Incidk in Scyllam, qui vult vitare Charybdin. In addition to what I have here delivered, let the ftu- dent confult the indications of cure in Synocha. SECTION V. The Indications of Cure in Pajfive Inflammation. * It js fimply to fupport the vital powers. This may be done by cordial ftimulants, fuch as opi- um wine, and aromatics ; by tonics with aftringents, fuch as bitters, bark and fteel; and by the infpimtion oi oxygenated air mixed in due proportion with atmof- pnenc air. m But fee more ur3on this head in the indications of cure in Typftus. SECTION inflammations. 75 SECTION VI. Of the Vires Naturae Medicatrices. The efforts of nature to relieve herfelf have, in all ages, exercifed the attention of fpeculative minds. It is not my intention here to introduce the Archaeus of Van Helmont to the ftudent; but I fhall ftate fome facts, which will give him an idea of thofe efforts, which na- ture can exert for warding off approaching evil, for removing whatever difturbs her economy or func- tions, and for repairing any injury the fyftem has re- ceived. When cantharides, fpread on a plaifler, are applied to the furface of the body, they firft excite a genial warmth with inflammation of the fkin. A fenfe of burn- ing follows, and nature diftreffed goes inftantly to work, feparates the cuticle to form a bag, interpofes ferum be- tween the nerves and the offenfive matter, then prepares another cuticle, that when the former with the adhering fubftance fhall fall off, the nervous papillae may be again provided with a covering. If a grain of fand falls into the eye, tears flow in great abundance to-float it off,-that it may not mechanically injure that delicate and moft irritable organ. The fame reafoning will apply to the operation of emetics and cathartics ; for not only is the periftaltic motion, either greatly quickened or inverted, according to the urgency of the diftrefs, but both the mucous glands, and the exhalant arteries, pour forth their fluids in abundance, to wafh away the matter that chemically, or even mechanically, offends. When a jhorn is lodged in fome irritable parf, the firft fuggeftion of the mind is by the fingers, or by the afliftance of the nails, to extract that thorn. But it is perhaps beyond our reach. The defign of nature, in the confequent inflammation, is to produce fuppuration, and thereby to remove the thorn. Should this effort be effectual, fhe next proceeds to the yS INFLAMMATIONS. the granulation of new flefh. The arteries and the veins, the lymphatics and the nerves, extend them- felves, unite, and renew their communication, and, without the afliftance of a furgeon, nature effects a cure. Suppofing her efforts to float off the offending mat- ter, whatever it may be, fhould"be infufficient after the fuppuration is Complete, fhe then proceeds to furround it with a wall ; a hard and infenfible callus is produced; or, in the language of furgery, a.fiftula is formed, and here, as I apprehend, her efforts ceafe. In cafe of pleuritic inflammation, nature* pours forth coagulating lymph, and, without the phyfician's aid, forms a new membrane, fupplied, like the renovated flefh already mentioned, with arteries, veins, lymphat- ics, nerves, ^ and thereby preferves the fubftance of the lungs from injury. Van Swieten makes mention of cafes in which calculi in the gall bladder, being too large for the common duct, had, after producing inflammation, adhefion, and fuppuration, found their way by fiftulous ulcers to the external furface of the body, and thus effefted their ef- cape. Comment. § 950. Among the moft aftonifhing efforts of nature to re- lieve herfelf, are thofe exerted in fome cafes of extra u- terine conception. For when a child has been lodged within the cavity of the abdomen, from which it cannot be extraded in the ufual way ; nature, by inflammation, ufually forms adhefion, and in -procefs of time an abfcefs, ' fo as to eject the foetus, either through the teguments of \ the abdomen, or by the rectum; and this frequently* without confiderable injury to the mother's health. Yet more aftonifhing are her refources in cafes "of ne- crofts. For fuppofing fome portion of a bone (for ex- ample of the tibia) to be deprived of animation, this fhe envelops with new bone, united at each extremity with the fibres of the living bone. Here it proves a ftimulus, and calls forth renewed efforts of the vital principle. Inflammation is produced ; fuppuration follows ; fiftu- lous openings are formed in the new bones, and the dead portions, INFLAMMATIONS. 77 portions, if not extracted by the furgeon with the chiffel and the faw, are cliffolved by the pus and floated off. Thus, nature in almoft innumerable cafes, even with- out afliftance, is able to effect a cure. I have already mentioned, in cafes of inflammation, the efforts to relieve herfelf by refolution and by fuppu- ration ; but when the vital energy in a part has been to- tally exhaufted, and fphacelus enfues, fhe has ftill one expedient left, and this frequently effects a cure. Frefh inflammation is excited, and makes a feparation between the living and the dead. The part deprived of anima- tion is caft off by Houghing ; a kindly fuppuration fol- lows ; and granulation with a new cuticle completes the cure. This interefting fubject will be refumed under the clafs Cachexia, when we proceed to examine the laws by which the abforbents regulate their action, and the difeafes peculiar to that fyftem. SECTION VII. The Genera of Phlegmafiae, This order in my nofology contains eighteen genera; they fhould be nineteen. Phlogofis, Ophthalmia, Phrenitis, Cynanche, Catar- rhus. Prieumonia, Carditis, Peritonitis, Gaftritis, En- teritis, Hepatitis, Splenitis, Nephritis, Cyftitis, Hyfteritis, Arthropuofis, Rheumatifmus, Odontalgia, Podagra. Of thefe I fhall fpeak in focceflion. Genus IV. Phlogosis. This for its fymptoms has Pyrexia with rednefs ; heat ; pain ; and tumor on the furface of the body. This genus contains two fpecies. i. Phlegmone.—A phlegmon with inflammation of a bright red colour ; tumor pointed ; throbbing and tend- ing to fuppuration. 2. Erythema.—St. Athony's fire, or the rofe, with inflammation of a dull red colour, vanifhing upon pref- fure, 7& INFLAMMATIONS. fure, fpreading unequally, with a burning pain, and tu- mor fcarcely perceptible, ending in defquamation, or ve- ficles of the fcarf fkin. Eryfipelas is a variety of Erythema preceded by Syn- ocha, during which drowfinefs and delirium are not un- common fymptoms. The face, if it be as ufually the part affected, becomes bloated ; the eyelids fwell ; and the furface of the fkin is bliftered. If the fev«r, inflam- mation, and delirium, are fuffered to run high, the pa- tient dies appoplectic on the feventh, ninth, or eleventh, day of the difeafe ; or fymptoms of irritation fupervene, the type of the fever then changes, Typhus is formed, and the progrefs ends in gangrene. Nothing is more diftreffing to a writer than methodic- al arrangement. The divifion*into clafs, order, genus, fpecies, and variety, is artificial; but nature fcorns to be confined within fuch limits ; and as in the animal and vegetable kingdom it is difficult to mark the boundaries, fo in the claffing of difeafes, nofologifts will ever be per- plexed when they undertake to afcertain where one or- der fhould begin, or another terminate. With Dr. Cullen I had placed Eryfipelas in the third order Exanthemata. But with thefe it cannot agree, becaufe, i. it is not contagious ; 2. it is evidently inflammatory, as appears by the pulfe, the blood, the treatment required, and its termination, which is fome- times in fuppuration. I have therefore reftored it to the Phlegmafiae. It may be remarked, that although the natural ten- dency of phlegmon is to fuppuration, and of Eryfipelas to gangrene ; yet in our indications of cure we muft be ' guided by the diathefis, whether fthenic or afthenic ; for it has been frequently obferved, that by injudicious treat- ment and want of attention to the ftrength or weaknefs of the fyftem, phlegmon has terminated in gangrene, and eryfipelas has been rendered more rapid in its race to fphacelus and death. In both thefe fpecies, if the pulfe is full, hard, and ftrong, we muft attend to the fourth general indication mthe cure of inflammation, and muft be particularly careful INFLAMMATIONS. 79 careful to evacuate the bowels, more efpecially by calo- mel with rhubarb, that we may leave no fomes of the fever there. This may be effected by the refrigerant and emollient fpecies of cathartics mentioned in my Phyfician*s Vade Mecum. Some practitioners have been fo apprehenfive of Ty- phus and gangrene, that they have rejected evacuants, with every part of the antiphlogiftic regimen, and,fuffer- ing the attendant fever to run high, they have thereby haftened the evil they were anxious to avoid. If the pulfe is fmall, weak, and frequent, riling to 120 or 130 in a minute, with fymptoms of nervous weaknefs and diftrefs, we muft conform to the indications of cure already mentioned in paflive inflammation. In cafe of delirium, attention muft be paid to what has been faid reflecting it in Synocha and Typhus. Should gangrene fupervene, bark, wine, and opium, muft be freely given till its progrefs is checked by active inflammation. For this purpofe the dofe of opium muft be increafed and repeated frequently without fear, fhould even one grain be requifite every fifteen or twenty minutes for fome hours, or, in a word, till it procures repofe. Genus V. Ophthalmia. Inflammation of the Eyes, Ophthalmia may be readily diflinguifhed by the rednefs and pain of the eye, intolerance of light, with ef- fufion of tears. It is divided into two fpecies. 1. Ophthalmia IMembranarum, with inflammation in the coats of the eye, moft commonly in the tunica con- junctiva. 2. Ophthalmia Tarfi, by doctor Darwin called Tarfitis, with fmall ulcers in the fubaceous glands of the tarfus difcharging a glutinous matter. For the proximate caufe I muft refer to what has been already faid on inflammation ; and with refpect to the So inflammations. the indications, the ftudent may look to thofe recom- mended in active inflammation. But to be more particular I muft obferve, that the cure of ophthalmia membranarum may be effected in four ways. i. By the application of cold water promoting evapo- ration and abforption of heat, to be continued for half an hour at a time. 2. By eleclricity. Either drawing fparks, or by fend- ing the electrical aura to the part affected. This gently ftimulates the living fibre ; but violent fhocks would fuddenly exhauft its vital energy. When this operation has cleared the eye from inflam- mation, fome tonic application muft be ufed to brace the fibres and prevent relapfe. This may be a weak folution, either of white vitriol, or of fugar of lead in rofe water ; to which may be ad- ded a few drops of brandy. 3. Mr. Wathen puts a drop or two of tinctura thebai- ca once or twice a day into the eye. 4. From long and moft fuccefsful experience I recom- mend the following ointment: Take hog's lard four ounces, with the finefl powder of lapis ealam- inaris one ounce. Let thefe be intimately mixed over the fire, then add honey two ounces. A bit, as big as a pea, muft be rubbed upon the in- tenor furface of the eyelid, at the time of reft, and warn- ed off the next morning with milk and water. The patient, in the application of this ointment, will have need of patience; for at night the fcalding tears will run down his cheek in copious ftreams, and the next morning his eye will be much weaker than it was before. » But theeonfequenceof this difcharge will be a dimi- nution of the inflammation, and in two or three nights at moft the cure will be effected. As for the ophthalmia tarfi, which Mr. Wathen very juftly calls glandule febace* exulcerata, I can fey with truth, that his mode of applying the uriguentum citri- num of the Edinburgh Pharmacopoeia has never failed * with inflammations. 81 with me. From his grandfon, one of the beft operators in Europe, Mr. Wathen Phipps, I learnt the mode of application. A little of this ointment, melted by a can- dle, is taken upon a pencil brufh and fpread along the eyelids. If it be done in the morning, the patient may take a walk in the air foon after the ointment has ceafed its operation. All hoods fhould be avoided. Genus VI. Phrenitis. Phrenfy. The fymptoms are ftrong fever, violent head ach, rednefs of face and eyes, impatience of light and noife, watchfulnefs and furious delirium. Thefe fymptoms evidently require copious bleeding, blifters to the head, the antiphlogiftic regimen, evacuants of the refrigerating fpecies, and wa/m fomentations, with finapifms to the feet. • Genus VII. Cynanche. Quinfey. The fymptoms are pain and rednefs of the fauces ; deglutition and refpiration difficult. It is accompanied by Synocha. Five fpecies are comprehended in this genus ; but the generic defcription applies in ftrictnefs only to thetwo firft. i. Tonfillaris, affecting the mucous membrane of the fauces, but more efpecially the tonfils. 2. Maligna, deglutition lefs difficult ; a mucous cruft of whitifh or afh colour covers the tonfils and mucous membrane of the fauces, which are affected \vith fpread- ing ulcers. Thefe fymptoms are accompanied with Ty- phus, and followed by Exanthemata. 3. Trachcalis. Refpiration difficult : cough loud ; no apparent tumor in the fauces. 4. Pharyngcea, affecting the, pharinx and cefophagus. «;. Parotidaa, affecting the lower jaw. I. The 82 inflammations. The two firft fpecies, tonfillaris and maligna, have dif- ferent diathefes, and muft be carefully diftinguifhed. For this diftinction we are much indebted to the late Dr. Fothergill, who by it has laid the foundation for ra- tional indications, and a fuccefsful practice, in the treat- ment of them both. SECTION I. Of Cynanche Tonfillaris, or Quinfey, This, called by fome angina inflammatoria, and Ton- fillitis by Dr. Darwin, is a difeafe of the fthenic diathefis, with the pulfe full, hard, ftrong, and about iooina minute. The attendant fever is Synocha. It is an active inflammation, of which I have ftated the proximate caufe to be local irritation, with morbidly in- creafed action and excefs of ofcillatory motion in the ar- teries of the part affected. This being the proximate caufe,* the inclinations of cure*muft be precifely fuch as* have been already men- tioned generally in Synocha and in active inflam- mation, with the addition of cooling and detergent gar- gles. Thefe may be compofed of either honey and water, or a decoaion of figs lightly acidulated with vinegar, or in- ftead of vinegar, a few drops of fpirit of hartfhorn may be ufed. A flannel, moiftened with volatile liniment, compofed of fweet oil two parts, with fpirit of hartfhorn one part, as recommended by Sir John Pringle, may be appli- ed to the throat at night, or a blifter may fupply its place. , During the day, fal prunel. may be frequently kept melting in the mouth, and for this at night may be fubftituted fugar of liquorice to moiften the throat. Should an abfcefs be formed, which the lancet cannot reach, an emetic will aflift to break it. SECTION * inflammations. *3 SECTION II. Cynanche Maligna. Ulcerated Sore Throat. This, called by fome angina maligna, is a difeafe of the afthenic diathefis, with the pulfe fmall, weak, and about 130 in a minute. The attendant fever is a Typhus, and trie difeafe itfelf fhould-properly appear under fcarlatina as an accidental fymptom. It is a paflive inflammation, of which I have ftatedthe proximate caufe to be lofs of tone, relaxation, debility, a deficiency of vital energy, and diminution of refiftance in the vdfels of the part affected. It is, perhaps, not, properly and ftrictly fpeaking, in- flammation, but diftention. It requires the general treatment recommended in the cure of Typhus and of paflive inflammation, with the ad- dition of antifeptic gargles, Thefe may be compofed of myrrh, alum, tincture of rofes, &c. in the fubfequent forms : §, Tinft. Rofar. ? 8. Acid. Vitriol, gtt. 10. Alum. 5fs. Tin&. Myrrh, gj. M. fT gargarifmus. That is, Take tin&ure of rofes eight ounces, vitriolic acid ten drops, alum half a dram, tincture of myrrh one ounce. Mix for a gargle. Emetics are fometimes neceffary to clear the firft paf- fages j but cathartics increafe debility and aggravate the fymptoms. The principal dependence muft be on bark and port wine. In the beginning of this difeafe, Mr. Wathen touch- ed the ulcers with a folution of mercury, which is thus prepared : Take quiakfilver and corrofive fublimate of each one ounce; trit- urate and mix them well together. ^ Put this into a tall phial, and cover it with diftilled vinegar, and fhake it for an hour. Let it fettle, and then, pouring off the clear folution, put on more vinegar as long as the frefh folutions precipitate a white cloud, with fpirits of hartfhorn. A 84 inflammations. A bit of lint rolled on a probe, and made wet with this, muft be applied to every ulcer, and repeated the next day, uniefs they look red. Should the floughs by neglect have been fuffered to become large, and fhould they caft off flowly, they may be touched with either the mercurial folution, or with Mel. iEgyptiacum. SECTION III. Cynanche Trachealis. The Croup. The pathognomonic fymptoms are, refpiration diffi- cult ; cough ftridulous and loud ; no apparent tumor in the fauces. There cannot remain a doubt, that this fpecies of cynanche, fo fatal to young children, is inflammatory ; and that the membrane, which covers the trachea, is concreted mucus. I have met with it in Scotland, and feen it treated with fuccefs; but I never obferved a fingle inftance of it in the vale of Pewfey. In Dr. Hunter's mufeum you may fee a beautiful fpecimen of this membrane ; which evidently covered the upper part of the trachea, and extended into its ramifications, fo as to merit the appellation, which Dr. Michaelis has given it, of polypofa. The feat of the difeafe appears to be the mucous mem- brane, which produces a kind of exudation, fimilar tONthat which we obferve on the furface of inflamed vif- cera. The method of cure which hitherto has been found moft effectual, has been that firft recommended by Dr. Home. Copious bleeding and emetics, with a large blifter applied as near as poffible to the part affeaed, followed by every part of the antiphlogiftic regimen.— But Dr. Thornton has lately difcovereda more expe- ditious method of checking the inflammation by the in- fpiration of azotic air. Mrs^ inflammations. 85 Mrs. Tovey, of Charles ftreet, Tottenham court Road, having loft one child in this fonorous and terrific diforder, anxioufly brought her only remaining boy to Dr. Thornton for his advice. He immediately made the child inhale the azotic air with a proportion of com- mon air, and the father and mother were furprifed, when they obferved that the hands, which were before "parch- ing hot,11 foon felt " cold** to the touch ; the pulfe was rendered 20 beats lefs in a minute ; the child no longer coughed as through a brazen trumpet, the fever feemed fmothered, and the formation of the fatal membrane was prevented. SECTION IV. Of Cynanche Pharyngaea. This fpecies, compared with cynanche tonfillaris, ap- pears to me, as far as relates to medical practice, to be a diftinction without a difference. Dr. Darwin names it tonfillitis pharyngea. SECTION V. Cynanche Parotid^ea. The Mumps. This very properly, by doctor. Darwin, is denomina- ted parotitis. It is a fwelling under the jaw, extending over the neck, and declining the fourth day ; epidemic and con- tagious. As the attendant fever is flight, no medicine is requir- ed. Should delirium fucceed, what has been faid above upon that fubject muft be confulted. Genus VIIL Catarrhus. Catarrh in my nofology was genus XXXIV. and flood in the fifth order, Profluvia, of this clafs. There, in fubmiffion to my mafter, I had placed it. But, as it evidently 86 inflammations. evidently belongs to the Phlegmasia, I have reftored it to its proper order. The fymptoms are, increafed excretion of mucus from the membrane of the nofe, fauces, and bronchiae, with pyrexia, attended by cough, thirft, laffitude, increafed fenfibility to cold, and want of appetite. SECTION I. Of Colds and Coughs, Catarrh, by a metonymy, putting the fuppofed caufe for the effect, has been called a cold. The expreflion is improper ; becaufe to the fame a- gent we* are equally indebted for Synocha, local inflam. mations, dyfentery, and a vaft variety of evils. It has been called by fome a cough, taking the denom- ination from one fymptom. This expreflion is equivo- cal, becaufe a cough is a fymptom common to a variety of oppofite difeafes. SECTION II. Proximate Caufe of Catarrh. The proximate caufe of a catarrh, as it appears to mc, is the fame with that of active inflammation. The morbid irritation, and excefs of ofcillatory mo- tion in the arteries, with quickened circulation of the fluids, produce increafed difcharge of mucus from the glands of the nofe, fauces, and bronchiae. This difeafe is therefore with propriety reftored to the order of Phlegmafiae. SECTION III. Occafional Caufes of Catarrh. As to one occafional caufe Dr. Brown has faid, Ca- tarrhum igitur efrigore eje, calore folvendum, graviffimus error eft. Contra frigus nunqua?n nocet, nifi ubi ejus ac- tionem calor excipit. And inflammations. 87 And a riung Genius, equally diftinguifhed for his ar- I dour in purfuit of fcience, for his chemical knowledge, F and for medical abilities, has fuggefted, that neither ca- 1 tarrh nor inflammation are the confequence of wet and I cold, either fudden or continued, but that both are in- S duced by fubfequent heat, and ftimulants. He is of opinion, that keeping quiet and cool for fome time, after being wet in fummer ; by avoiding a fudden transition into a warm temperature in cold weather; | and by temperance in both cafes, thefe inflammatory { difeafes, for which cold only prepares the fyftem, may j be eafily avoided ; and that any perfon by acting on I thefe principles may have a flight, a violent or no ca- tarrh. I have already hazarded fome obfervations on the powers of heat and cold in the production of difeafes ; I but, in addition to what I have delivered on that fubject, I muft venture to fuggeft fome further hints to the con- fideration of philofophical practitioners. The heat of the body is ftated to be 98 degrees of Fah* |! renheit's thermometer, finking, however, by difeafe to 94 degrees, or perhaps lower; and rifing to no de- grees, and in certain circumftances higher. This temperature nearly, is preferved when the fur- rounding medium is either 120 degrees below blood I heat, or 160 degrees above it ; as appears by the beauti- ful experiments of Dr. George Fordyce. It is evident, therefore, that this temperature, fo ob- ftinately maintained, muft be effential to the well being of the fyftem, and that the body has fome inherent power in itfelf to regulate and preferve it, within cer- tain limits, from noxious extremes of either heat or cold. The generation of animal heat, as I have already hint- ed, and as it has been proved by others, is from the de- ] compofition in the lungs of vital air. Now, in propor- I tion to the condenfation of the atmofphere by cold, the \ quantity of vital air inhaled by every infpiration is in- creafed ; and, in proportion to the cold, the appetite for fubftances which abound with hydrogen is equally | increafed. ] 88 inflammations. ( increafed. But, as it is evident, that animal heat, with- in certain limits, rifes in proportion to the quantity of thefe fubftances received into the ftomach, does it not, therefore, follow, that hydrogen, abounding in the fyf- tem, promotes decomposition of vital air ? By thefe means, therefore, nature endeavours to pre. ferve the temperature of the body when that of the fur- rounding medium is below 98 degrees. As to the procefs by which the generation of fupera- bundant heat is prevented, that may be readily con- ceived by what has been fuggefted refpecting cold.— But the principal refource is from copious perfpiration, evaporation, and the confequent abforption of the gen- erated heat. Let us now return to cold, allowing to Dr. Brown and highly approving what he has faid refpecting heat. When the application of cold is fudden, as when tht body is immerged in water, the means of generating heat, already ftated, can give no help. What effort then does nature make to relieve herfelf? The pores are ftrongly clofed ; a conftriaion takes place in the ex- treme veflels on the furface of the body ; the blood is propelled with increafed momentum to'the heart, and, fuppofing the body to be now emerged, the readion of the heart, fending back the blood to the furface, diffufes a genial warmth, and removes the ftriaure. The ene- my is repelled; he has retired to a diftance, and the gates are again fet open to the citizens. Should the ftriaure continue, this effort of nature to releive herfelf will terminate in fever. ^ Such is the effea of fudden cold, when its applica- tion is univerfal: but fnould the application be partial, what will be then the confequence ? The effeas alrea- ay ftated will be partial. Conftriaion will take place m the extreme veffels fubjeaed to the accefs of cold, and the blood will be propelled with increafed momentum into the adjoining veffds, where tenfion will prove a itimulus, and be, as already ftated, the proximate caufe of inflammation. This for reafons afligned above, mufl be afterwards increafed by heat. When \ inflammations. 6*9 When a lady, who has been heated by*lancing, either fits near to a window, through which penetrates a cold and partial draught of air, or, although wrapMip in furs, infpires, inftead of warm, ^ a cold and humid air : or when a reaper reeking with fweat, either drinks cold water, or lies down to fleep upon the humid grafs ; the injury is perceived before the cold has alternated with heat, although the fubfequent heat, in proportion to its intenfity, increafes the difeafe. It is allowed, and has been ftated, that the accumula- tion of irritability as the predifponent caufe may with heat produce inflammation : but I apprehend, that a ftate of exhauftion, whether induced by poverty of diet, fatigue, previous difeafe, copious evacuations, or by any other means, as a predifponent caufe,pvith cold fuddenly and partially applied, if continued, may produce the fame effea. On the whole then it appears, that if the change be gradual, nature between wide extremes can accom- modate herfelf to her condition ; but that when the change is partial, fudden, and continued, it generates difeafe. In catarrh the parts immediately affeaed are, the mucous glands of the nofe, the fauces, and the bron- chias ; but by confent the ftomach fhares with them in the difeafe, and its glands pour forth a vifcid mucus in abundance. Hence the febrile fymptoms, thirft, laffi- tude, and lofs of appetite. Hence alfo, by the progrefs of fympathy, the increafe of irritability which fhuns every breath of air. Although heat and cold are moft frequently the oc- cafional caufes of catarrh, yet they are not always fo j for fometimes it is contagious. The epidemical catarrh, whenever it appeared, fpread from province to province till it had extended over Eu- rope, or even crolfed the Atlantic to America. In the laft of thefe I had the moft ftriking demonftration, that it was contagious; for during its progrefs from the Eaft, I was at St. Agnes in Cornwall, but before it reach- ed us I removed with all my family to Lanlivery. There M we 90 INFLAMMATIONS. we continued fafe while-the difeafe was fpreading in the parifh of St. Agnes, and on our return we found that few perfons had efcaped ; but that it had quitted them and was extending weftward to the extremity of Corn- wall. Dr. Cullen has colleaed a regifter of epidemipal catarrhs to the amount of twenty five between the years 1323 and 1767 ; but other praaitioners have greatly increafed this lift. SECTION IV. Indications of Cure in Catarrh. These are the fame as in aaive inflammation ; but as, unlefs by improper treatment or neglea, it feldoll puts on a formidable afpea, it is moft frequently fuffi. cient to avoid the occafional caufes of the difeafe, and gently to evacuate the alimentary canal. Various expeaorants have been recommended by praaitioners, fuch as oily emulfions and the like; but thefe tend rather to aggravate, than to relieve, the fymp- toms. The only medicines, which can render effential fervice in catarrh, are fuch as, 1. Determine to the furface. 2. Cleanfe the alimentary canal. Both thefe intentions are efteaually anfwered by the fubfequent prefcription. $, Flor. Sulph. Pulv. Enulae. ----Glycyr. aa un. 1. Mel. defpumat. un. 4. M. c. c; M. N. M. ter in die. That is, Take flowers of fulphur, powders of elecampane and liquorice, of each one ounce, clarified honey four ounces. A bit as big as a nutmeg is to be taken three times a day. This, in the fpace of five and thirty years, I have pre- ferred to many hundred patients, and in fome protraft- ed, obftmate, and moft diftreffing cafes ; yet I can af- firm, that in no inftance, as far as I can recollea, has it ever railed to cure. SECTION INFLAMMATIONS. 91 SECTION V. Of Sympathetic Cough. Doctor Whytt, in his treatife on nervous difor- dets, makes mention of a cough proceeding, not from phlegm, obftruaion, or other irritating caufe in the lungs themfelves, but from fympathy with fome other part, whofe nerves are difagreeably affeaed. In con- firmation of $iis, he relates feveral curious and moft in- terefting cafes, to which I muft refer the ftudent. And Sauvage informs us of a lady, who, having what he calls paracufis oxycoia, with tuffis hyfterica, was feized with coughing inftantly as fhe heard the found of the human voice. Nofologia, vol. i. p. y$6. In my compendium of nofology, under catarrh I have made mention of, i. Tuffis exanthematica, 2. Tuffis verminofa, 3. Tuffis a dentitione, 4. Tuffis arthritica ; which are the only four I thought it expedient to no- tice. Thefe are taken from Sauvage ; but I fhould have ad- ded from his ineftimable work, 5. Tuffisftomachalis. SECTION VI. Tussis Exanthematica. This fpecies Sauvage has taken from Fr. Hoffman, who calls it Tuffis Ferina, and attributes it to eruptions fuppreffed by ill timed repellents, as in cafes of the fcald head and itch. The fymptoms are violent in the ex- treme, and the convulfive cough produces the moft direful effeas, fuch as apoplexy, palfy, lofs of memory, and phthifis pulmonalis. For this, Hoffman recommends blifters ; bathing the feet in warm water ; and flowers of fulphur with di- ■ aphoretic antimony, to be taken at night. q2 inflammations. A moft ingenious friend of mine, a young phyfician, effeaed a cure by inoculating a patient of his, who ap- peared in the laft ftage of a confumption, with the itch, which he knew had been injudicioufly repelled. SECTION VII. Tussis Verminosa. Of the worm cough I have already fpoken at large in the cafe of Thomas Winter. SECTION VIIL Tussis A Dentitione. The teething cough may be relieved by frequent do- fes of rhubarb with magnefia, or cured by cutting through the gum to give an eafy paffage for the tooth. SECTION IX. Tussis Arthritica. The accurate inveftigation of this cough, as fympto- matic of retrocedent gout? and not a primary difeafe, brought into extenfive praaice a friend and fellow ftu- dent of mine, eftablifhed for thirty years in Chefler, where he difpenfes health, whilft, by communicating freely his ideas and medical improvements to the world, he extends the boundaries of fcience. Dr. Ferriar had a patient in whom all the fymptoms of phthifis fhewed themfelves, till he coughed up fome chalk ftones and recovered. Dr. Percival had under his care a gentleman with in- ceffant cough, purulent expeaoration, and night fweats, who was cured by plenty of wine whey, with dofes of hartfhorn and fpermaceti, which produced a gentle fit of the gout. For the ufual mode of treatment I muft refer the flu- dent to Arthritis. SECTION inflammations. L>3 SECTION X. Tussis Stomachalis. Professor Hoffman has well eftablifhed both the diagnofis and the cure of ftomach cough. This difeafe may be diftinguifhed from catarrh, by not having the cough and difficulty of breathing excited, either on deep infpiration, or on mufcular exertion ; by abfence of hf arfenefs ; by facility of lying indifferently upon either fide ; by long intervals between the fits of coughing ; by violence of coughing and expeaoration after taking food ;. by indigeftion, naufea, vomitting, and depraved appetite ; by coftivenefs, acidities, flatu- lence, and fpafmodic affeaions. Sauvage remarks that Lindanus, who firft defcribed theftomach cough, diftinguifhed it from the true pulmo- nary cough by its deep and hollow found. Of this fpecies of cough Hoffman has defcribed two varieties, the humid and the dry ; but as thefe arife near- ly from the fame caufe, and require the fame indications of cure, I fhall confider them as one difeafe. He fubjoins a very valuable praaical remark : Gen- eratim vero illud monendum eft, quod omnis tuffis quae eft periodica ; a Saburra in ventriculo, vel potius inteftino du- odeno ftabulante, fuos ?nutuatur natales. From attentive obfervation I muft here obferve, that this affeaion of the ftomach is fometimes complicated with a primary affeaion of the lungs. Such is the fympathy between thefe organs, fuch their correfpondence and confent, that a difeafe, feated originally in one, may be quickly injurious to the other. If the mucous glands of the one are morbidly excited, thofe of the other may be drawn into aaion by confent. But here it is needful to confider in thefe affeaion j, what are the efforts of nature to relieve herfelf. When any acrid or offenfive matter irritates the fau- ces, if it is near the larynx, a cough is excited, that by a full, a fudden, and a violent expiration it may be re- moved. «4 inflammations-. moved. But if it is in the pharinx, vomitting enfues, that by a copious ftream it may be warned away. When vifcid mucus ftimulates the bronchiae, the irri- tation is communicated along the larynx, and a cough, that is aconvulfive expiration, clears the paffages. ^ But when the ftimulus is in the ftomach, the irritation is communicated along the cefophagus, and either vomiting immediately enfues, or, this irritation extending by the fauces to the larynx, a violent fpafmodic cough precedes, a vomiting enfues, and, the ftomach being freed from the offending matter, the cough fubfides. This effea is viable, both in chin cough and in worm cough, and may be equally remarked in the difeafe be- fore us. Of this I have feen many inftances; but I fhall refer only to the cafe of a lady, whom I had lately the honour to attend. The difeafe began with a fenfe of cold and fhivering, foon folio*'. ed by heat. The pulfe was fmall, weak, frequent; and there was. fome degree of forenefs on the cheft. Thefe fymptoms were fucceeded by a cough, with increafed excre- tion of mucus from the nofe, fauces, and bronchiae. The cough was violent, and remarkable for its deep and hollow found. No thirft* No appetite. Rather coftive. Weak, and con- fined to bed. In this cafe, the judgment which I formed was fupported by pre- vious knowledge of the lady's conftitution, whom 1 had frequently attended. I began with a powerful emetic. This brought off near a quart of mucus, fo vifcid, that it might have been drawn out to a great extent. ■The next morning I repeated the emetic with fimilar effeft ; but towards evening the cough was again aggravated, although the de- fxuxion from the noftrils and the forenefs on the breaft had ceafed. In this way fhe paffed a fecond and a third fleeplefs nights, for the cough became inceffant. Early on the fourth day, I repeated the emetic, which, brought off a fubftance, to appearance membranous, and bearing refemblance to the fineft leather of which French gloves are made. Inftantly the cough ceafed ; every uneafy fymptom vanifhed ; her appetite return- ed, and, without any other medicine, in two days from this fhe was ■iowa flairs again. The confent of parts, and more efpecially the confent between the ftomach and the lungs, is of fuch impor- tance INFLAMMATIONS. 95 tance to the medical praaitioner, that I muft requeft the ftudent to coirfult the incomparable treatife of Frederic Hoffman on this fubjea, particularly § 28. Poro ex- quifitam ventriculus cum diaphragmate & pulmonibus fovet'communicationem, &c. vol. 1, p. ^08 top. 318. This communication is clearly marked in a cafe' which is quoted by Sauvage. Fredericus Archiepifcopus Bre- menfis ob tuffim ficcam, maciem, aliaque fymptomata pro phthifico apud medicos habebatur : in cadavere pul- mo fanus repertus, fto?nachus vero corruptus quafi fpha- celus, & ita fcetidus, ut nihil magis, vol. 2. page 451, The cough in queftion is by Dr. Stoll, of Vienna, in his Ratio Medendi, called Tujfis Stomachica, and ap- pears to be the fame with that defcribed by Dr. Perci- val, under the name of Tuffis Convulfiva, which fuc- ceeded the croup in a boy of, three years old. He re- marks, that fuch a membrane as is formed in the tra- chea of a patient, who labours under cynanche trachea- lis, is fometimes generated in the inteftines. I faw the membrane, which came from the ftomach of my patient, and in fubftance it perfeaiy refembled that which Dr, Hunter exhibited in his clafs, when he was defcribing cynanche trachealis. SECTION XI. Indications of Cure in Tuffis Stomachalis. In many difeafes the efforts of nature to relieve her- felf are fufficient, without the aid of medicine. In fever, in the exanthemata, in catarrh, even left to themfelves, the courfe of a few days may put a period to the difor- der : but the duration of the ftomach cough, without affiftance is ufually" protraaed, and the termination may be either atrophy, or, if the lungs are injured by the violence of reiterated cough, it may end in phthifis. From what I have faid it will be clear that the indica- tions of cure muft be, 1. To. cleanfe the ftomach and firft paffages from in- digefted food, and more efpecially from vifcid mucus. 2. To 9& inflammations. 2. To reft6re the tone. m The firft intention may be anfwered by emetics. Td this nature points by her repeated efforts. But fhould thefe be infufficient to cleanfe the duodenum, calomel will give relief, or this may alternate with rhubarb, fenna, and fbluble tartar. Or the prefcriptions, 12, 13. 18. in my compendium of therapeutics, may be employed. The fecond intention may be anfwered by bitter^ bark, and fteel, combined. For the bitter we may take, either the tinaura amara, or a ftrong infufion made either of quaffia or of hore- hound, with half the quantity of caffia lignea. Or to thefe may be joined the bark, either in fubftance or infufion ; or we may combine them in the following form: ]$> Cinchon. un. 1. Limat. ferri, dr. i|. Myrrh, dr. 2. Syr. Cort. Aurant. q. s. f. Eleft. c. c. M. N. M. ter in die. That is, a Take bark one ounce, iron filings a dram and an half, myrrh Wo drams, fyrup of orange peel fufficient to make an eleftuary. Dofe the fize of a nutmeg three times a day. }$, Cinchon. Ferri Rubig. aa un. i. Pulv. Aromat. dr. 2. Conferv. Cort. Aurant. un. 2. Syr. Zinzib. q. s. f. Ek& c. c. M. N. M. ter in die. That is, Take bark and ruft of iron of each one ounce ; aromatic powder two drams ; conferve of orange peel two ounces ; fyrup of gin- ger fufficient to make an electuary. Dofe as in the former. Or the ftudent may adopt any one of the prefcrip- tions, j6. 78. 80, 81, 82, 83. from4 my compen- dium. Genus IX. Pneumonia. Pleurify and Peripneumony. The fymptpms are, Pyrexia, difficult refpiration, , cough, pain in the thorax, pulfe frequent and hard. SECTION I. Of the Diftinclions to be Obferved. The ftudent muft not be deceived by pain in the re- gion inflammations. 97 gion of the thorax, for if there fhould be no Pyrexia and no cough, it is not pneumonia, but fpafm. Should any doubt remain upon his mind, after he has felt the pulfe, he may apply a little ether to the part af- feaed, with his hand, which will generally relieve fpafm, if it is in the intercoftal mufcles; and let him give the patient fome*magnefia with mint water, which, if the - fpafm fhould arlfe from flatulence and an affeaion of the ftomadh, will caufe an eruaation and relieve the pain. If he ftill continues to doubt, let him pay attention to the urine, as recommended in the introduaion to this order. I am the more earneft in this caution, becaufe I have been witnefs to a number of miftakes, and fome of them rendered very troublefome, by the injudicious condua of ignorant praaitioners. SECTION II. Indications of Cure in Pneumonia. It might be fufficient to fay, that the indications are the fame as already ftated generally in the cure of aaive in- flammation ; but for the fake of younger ftudents I fhall be more particular, ftill requefting them to confult what has been there delivered on that fubjea. Since then Pneumonia is a difeafe of the fthenic dia- thefis, not of the afthenic, and rather conneaed with Synocha than Typhus ; it is clear, that the tenfion of the veffels muft be diminifhed. This intention may be fulfilled * i. By bleedings, to be repeated till the tenfion is re- moved. Topical bleeding ought naturally to be preferred to general; but as a fufficient quantity of blood cannot fud- denly be obtained by leeches, or by cupping, we are obliged to ufe the lancet. . Whilft the blood is flowing from a vein, let the ftu- dent put his finger to the artery, and if he finds the pul- fations 1efs frequent, and the pulfe itfelf becoming full* er and fofter under the touch ; if he finds at thefams JSf time 9$ INFLAMMATIONS, time the pain in the affeaed part diminifhed, aitd the cough lefs troublefome ; he may be certain that he is right, and may with confidence repeat the bleeding, fhould a repetition be required. 2. By cathartics taken from the refrigerant and de- mollient orders. Thefe anfwer a two fold intention; by diminifhing the tenfion of the veffels, and by removing the fomes of the fever; for we have feen that fordes in the alimenta- ry canal proves a powerful ftimulus to the arterial fyf- tem. Such cathartics, therefore, muft be reforted to ; and although at firft they may increafe in fome degree the general irritation, yet by the evacuation' they will fink the pulfe. But in the progrefs* of the difeafe emollient clyfters muft fupply their place. Praaical authors will inform the ftudent, and expe- rience will confirm their obfervation, that in this difeafe blifters are highly beneficial. *» ' They muft be large, and applied as near as poffible to the part affeaed. It is remarkable, that in pneumonia a large blifter lef- fens the number of pulfations more, after the veffels have been properly emptied, than a copious bleeding. Cooling and attenuating medicines muft, at the com- mencement of pneumonia, be adminiftered with a liber- al hand. Such may be, the faline julep ; the fp. minde- reri (ammonia acetata) ; rofe water, with nitre, vinegar, and fugar j or the prefcriptions from 84 to 90, in the clafs Demulcentia, may be taken from my Phyfician's Vade Mecum. JJ The patient fhould be like wife plentifully fupplied with barley water, buttermilk, whey, and acidulated drink. He muft abftain from animal food and from ferment- ed liquors. Thefe direaions relate principally to the five firft days . of the difeafe, for if the fever has been fuffered to run nigh, fuppuration, or gangrene, or hydrothorax, will then take place, and therefore bleeding would be injuri- ous INFLAMMATIONS. 99 ©us in the extreme. A near approach to thofe dreadful terminations may be difcerned, by ceffation from pain, ihivering, cold fweat, and a weak intermitting pulfe. Should the patient about the third or fourth day fpit up a concoaed matter, bleeding would flop this faluta- ry evacuation j but fhould he either expeaorate pure florid blood, or fhould he relapfe after having been relieved from the moft diftreffing fymptoms, bleeding will be indifpenfably needful. In the condua of evacuations, but more efpecially of bleeding, the ftudent muft be governed by the pulfe, the ftrength of the patient, and the urgency of the fymp- toms. Under proper management pneumonia fhould yield in feven days ; but fhould the diforder be protraaed, it may either terminate about the fourteenth day in empye- ma, or produce a heclic with phthifis pulmonalis. When expeaoration comes on, the fulphur eleauary recommended in catarrh, or any of the formulae from 48 to 51 of expeclorantia in my compendium, may be ad- ded. I have never had an opportunity of trying the method of cure recommended by Dr. Hamilton of Lynn, who, after bleeding and having emptied the bowels by clyf- ters and gentle purgatives, give calomel and opium twice or three times a day. To thefe he fometimes adds cam- phor and tartarized antimony. From obferving the effeas of atmofpheric air, when either fuperoxygenated, or when mixed with azotic air, as adminiftered under the fkilful direaion of Dr. Thorn- ton, I am perfuaded that the infpiration of either azotic of hydrogen, or of carbonic acid air, mixed in due pro- portion with common air, may be highly beneficial in ca- fes of pneumonia. , This opinion has been confirmed by the fuccefsful praaice of my friend, and by the experiment which Dr. .Garnett tried upon himfelf, when he felt the fymptoms of Pneumonia, after hard exercife in a frofty air, fuch as flufhing of countenance, dry cough, tightnefs on the breaft, and difficulty of breathing, all which were reliev- ioo INFLAMMATIONS. ed by infpiring fulpburated hydrogen gas, procured from hepar fulphuris. See Dr. Gafnett on Harrowgate water, fub fine. Genus X Carditis. Inflammation of the Heart. The fymptoms are, Pyrexia, pain in the region of the heart, anxiety, difficult breathing, irregular pulf^ palpitation, fainting. The inflammation of the heart and that of the perito- naeum have been diftinguifhed by nofologifts ; but the medical praakioner needs no fuch diftinaions where the indications are the fame. What, therefore, has been delivered on pneumonia is equally applicable to carditk and peritonitis. Genus XI. Gastritis. Inflammation of the Stomach. The fymptoms are, Pyrexia j anxiety ; heat and pais in the epigaftrium, increafed when any thing is taken into the ftomach ; vomiting ; hickup ; pulfe fmall, fre- quent, hard, and contraaed ; proftration of ftrength. It has been diftinguifhed into two fpecies ; i. Phlegmonic, affeaing the external coat. 2. Eryfipelatous, feated in the interior and villoui membrane. The proximate caufe is the fame as that of aaive in- flammation ; but fuch is the irritability of the part af- feaed, that the tendency is rather to gangrene than te fuppuration. The occafional caufes may be, i. Contufion. 2. Cold liquids drank, when the body has been heat. ed by exercife. 3. Acrid fubftances, received into the ftomach and aaing chemically there. 4. Something aaing mechanically and lacerating the coats of the ftomach. 5. Diftention INFLAMMATIONS. IOI 5. Diftention. For the indications of cure I muft refer the ftudent to what has been faid on aaive inflammation. But as twelve hours may bring the. patient to his grave, it is evident that no time is to be loft in diminifh- mg the tenfion of the veffels in the moft fpeedy and ef- fectual manner, which is by copious bleeding. To this the fmallnefs and hardnefs of the pulfe will be no objeaion ; for it will become fofter and fuller by the lofs of blood. i A blifter fhould be applied to the region of the ftom- ach. Emollient clyfters muft be injeaed often, and if the ftomach will receive them, demulcents fhould be given in abundance. The nature of the acrimony, if acrimony fhould be the caufe, muft be underftood, and its antidote muft be applied. In cafe of mechanical injury demulcents muft be adopted, whilft whatever can irritate muft be carefully avoided. Genus XII. Enteritis. Inflammation of the Bowels. The fymptoms are, Pyrexia, fixed pain in the abdo- men, coftivenefs, vomiting, pulfe as in gaftritis. This difeafe, diftinguifhed from the preceding by nof- ologifts, can fcarcely be diftinguifhed by the medical praaitioner ; yet in addition to what has been delivered on gaftritis, I muft add, that many "eminent phyficians, after bleeding as occafion may require, and having emp- tied the bowels by clyfters and emollient cathartics, give calomel, nearly in the manner recommended by Dr. Hamilton, who combines it with opium in this form : g> Calomel, gr. 5. Opii, gr. 1. bisterve in die. With this plenty of tepid and demulcent drink muft be adminiftered. Genus I©? rNTLAMMATIONS. Genus XIH. Hepatitis. Inflammation in the Liver. The fymptoms are, Pyrexia ; tenfion and pain, more ©r lefs acute, in the right hypochondrium, ufually refer- red to the top of the right fhoulder and extended to the clavicle ; increafed by lying on the left fide j urine high coloured ; pulfe frequent, ftrong, and hard. Bilious evacuations increafe, unlefs jaundice takes place. It acknowledges the fame proximate caufe with aftive inflammation. * It is common in warm climates. With regard to the method of cure, as it tends to fuppuration, it will admit of bleeding freely, and of the antiphlogiftic regimen without reftraint. Here, as in other cafes of inflammation, calomel has been ufed with remarkable fuccefs ; but bleeding, the refrigerant cathartics, and the antiphlogiftic regirnen, muft conftantly precede it. 3$> Infuf. Sen. un. i. Polychreft. Rupel. dr. 4. M. c. m. That is, Take infufion of fenna one ounce, fal. polychreft half an ounce, in the morning. Or foluble tartar about half an ounce may fupply its place ; unlefs the ftudent fhould prefer to both,'the com- bination of fulphur and cremor tartari, as in the 18th prefcription of my Vade Mecum. ^ Blifters muft be applied to the right fide on the re- gion of the liver, and all the directions given above for the cure of aaive inflammation muft be ftriaiy obferved. Doaor Darwin fays, that when inflammations of the liver are fubdued to a certain degree by venefeaion," with calomel and other gentle purges, fo that the arteri- al energy becomes weakened ; four or eight grains of iron filings, or of fait of fteel with the Peruvian bark,, have wonderful effea in curing the cough, and reftor- ■ mg the liver to its ufual fize and fanity. Zoonomia, vol. 2. p. 723. The natural tendency of inflammation in the liver, is, f inflammations. 103 to fuppurate ; and fhould this take place, the difcharge may be, by the lungs, by the inteftines, by the cavity of the abdomen, or through the peritona:um to the furface of the belly. In thefe cafes heaic enfues, and the patient without affiftance dies. When the inflammation is on the convex furface of the liver, the effort of nature to relieve herfelf is, to form an adhefion with the peritonaeum, that fhe may difcharge the pus externally, then to granulate new flefh, and heal the wound. In this, her efforts muft be affifted by fomentations, and the abfcefs muft be opened by the lancet. To fupport the powers of life during the fuppuration, the Peruvian bark muft be freely ufed ; and the dofe muft be increafed to the utmoft the ftomach can endure. Should a fchirrus be formed in the liver ; a gentle falivation, continued for a length of time, will. often prove fufficient to remove it. Genus XIV. Splenitis. Inflammation of the Spleen. The fymptoms are, Pyrexia ; tenfion, heat, tumor, and pain, in the left hypochondrium, increafed by prek fure. The proximate caufe and the indications of cure muft be derived from what has been above delivered general- ly of inflammation. The ftudent muft be guided by the pulfe ; and judg- ing of any cafe that may occur, whether it belongs to the fthenic or afthenic diathefis, he muft condua himfelf accordingly ; adopting, in the former inftance, bleeding with the antiphlogiftic regimen ; whilft in the latter he muft have recourfe to tonics. Genus XV. Nephritis. Inflammation of the Kidneys. Thi fymptoms are, Pyrexia ; pain in the region ©f the 104 inflammations. the kidneys, and fhooting along the courfe of the ureter ; drawing- up of the tefticle ; numbnefs of the thigh; vomiting ; urine, commonly of a deep red colour, but pale and colourlefs as the difeafe increafes, is difcharged very often, and both with pain and difficulty ; coftive- nefs, and fome degree of colic ; pulfe frequent, hard, and fmall. The proximate caufe and natural termination are the fame as of inflammation in general. The occafional caufe may be, either heat or cold ; it may be, either fome acrid fubftance aaing on the kid- neys, or fome external injury ; but it is ufually the ir- ritation of calculi, which may be either in the kidney it- felf, or in the ureters. As the tendency is to fuppuration, it admits of bleed* ing with the antiphlogiftic regimen ; and calls for emoit lient clyfters, not merely to evacuate the bowels, but as a warm fomentation to the part. When the pain is great, and has been long continued, tinaure of opium may be added to the clyfters. 3$> Terebinth, (in V. O. folut.) gij. Tinft. Opii. gtt. 60. 100. lnfuf. Lini. ^vj. m. f. Enema. Refrigerants and demulcents are required in abun- dance with the tepid bath. When the diftrefs arifes from calculi obftruaing the ureters, relief may often be obtained from elearicity. For this purpofe fmall and repeated fhocks muft be fent through the loins. Thefe have powerful effeas, and generally promote the paffage of the calculi into the bladder. For further direaions confult the Introduaion to this order, with the firft five Seaions on the diftinaions, «aufe, and cure, of inflammation. Genus XVI. Cystitis. Inflammation of the Bladder. The fymptoms are, Pyrexia ; tumor and pain in the hypogaftnum ; frequent and painful difcharge of urme j coftivenefs j tenefmus j pulfe frequent and hard > extremities INFLAMMATIONS. 105 extremities cold ; ficknefs, vomiting, and delirium en- fue. For the cure I muft refer the ftudent, as in the pre- ceding article, to my obfervations on the order, remind- ing him at the fame time, that the internal furface of the bladder is feldom ulcerated, although we have often a purulent difcharge arifing from the excitement of the mucous membrane. Hence it appears, that the demulcent plan of cure is to be preferred to venefeaion. Genus XVII. Hysteritis. Inflammation of the Womb. The fymptoms are, Pyrexia ; heat, tenfion, tumor, and pain, in the hypogaftrium ; pain in the os uteri, when touched ; vomiting ; delirium ; and ftarting of the tendons. Of this genus I may fay precifely what I have already faid on the preceding. Genus XVIII. Arthropuosis. The fymptoms are, pain of the joints or mufcles, deep, blunt, and of long continuance. The Pyrexia is flight at firft, but commonly terminates in fuppuration and heaic fever. It is produced by the common caufes of internal in- flammation, or by ftrains and bruifes. The indications are the fame as in hepatitis. Genus XIX. Rheumatismus. Rheumatifm. The fymptoms are, Pyrexia ; pains in the joints in- creafed by the aaion of the mufcles belonging to the joint ; heat on the part. The blood after venefeaion exhibits an inflammatory cruft. O SECTION iq6 inflammations. SECTION I. Caufes of Rheumatifm and Difiinclion of Species. Rheumatism feems to acknowledge the fame prox. imate caufe with the preceding genera, and to require nearly the fame indications of cure. But doaor Dar- win thinks, and his opinion appears to be well founded, that rheumatic inflammation is not a primary difeafe, but the confequence of morbid aaion tranflated from one part of the fyftem to another. It is diftinguifhed into acute and chronic. The acute rheumatifm is preceded by fhivering, heat, thirft, and frequent pulfe ; after which the pain com- mences and foon fixes on the joints. The predifponent caufe muft be fought for in rich blood, full veffels, and a rigid fibre. The occafional caufe may be, either the fudden ap- plication of cold, with reft, after long continued heat and exercife, in conftitutions not accuftomed to fuch changes ; or it Camphor. 3j. Opii. gr. 5. Ol. Caryophyl. gtt. 10. Alcohol. 3'j- disrere & cola. That no INFLAMMATIONS. That is, Take camphor one dram ; opium five grains; oil of cloves ten drops ; fpirit of wine two drams : digeft, and ftrain. Four or five drops on a bit of cotton may be put into the ear, and renewed in a quarter of an hour. Or you may apply the following : ]$> Opii. Camph. aa. gr. 2. 01. Caryophyl. 01. Mcnth. piperit. aa. gtt. 2. M. f. Pil. ad dentem applicanda. That is, Take opium and camphor, each two grains ; oil of cloves and oil of peppermint, each two drops ; made into a pill, and put into the tooth. Should thefe applications prove ineffeaual, the pain muft be treated as rheumatic. Dr. Lifter was often troubled with the toothach, and he perceived it always arofe from what he had eat not digefting well. Half a glafs of brandy would generally remove the pain. A young lady, who had been for fome days exceed- ingly diftreffed and almoft diftraaed with a toothach, applied to me for advice. She had tried Boerhaave's Tinaure, and had put a blifter behind the ear, without the leaft relief. Her tongue was white, her pulfe fre- quent and feeble ; but the moft remarkable fymptom was the aggravation of pain, when her ftomach was emp- ty, and the freedom from it, when fhe had taken food. ~ The teeth appeared found. Confidering this cafe not as rheumatic, but fymptomatic, I gave her an emetic, which brought up fome undigefted fordes with a quan- tity of vifcid mucus, and immediately the pain was re- lieved ; and by proper management has not fince re- turned. Laft fummer, I had a cafe at Southampton exaaiy fimilar to this, which was inftantly and effectually reliev- ed by an emetic. Genus XXI. Podagra.. The Gout. The fymptoms are, Pyrexia ; pain in the joints, chief- ly in the great toe, and efpecially of the hands and feet, returning INFLAMMATIONS. Ill returning at intervals; previous to the attack the func- tions of the ftomach are commonly difturbed. SECTION I. Of the Remote Caufes of Gout, with the Diftinclion intt Species. Of this difeafe, four fpecies are commonly enumera- ted. i. The regular. I 3. The retrograde. 2. The atonic. | 4. The wandering. But I fhall confider them merely as tonic, or inflam- matory ; and atonic, or nervous. After multiplied difcuffions, it appears to be univer- fally agreed, that the predifponent caufe of gout is de- bility, and the occafional caufes fuch as induce debility. It feems to have fome relation to Neuroses, a clafs of difeafe to be confidered in its place. The conneaion between difpepfia and the gout are too remarkable to efcape the obfervation of praaitioners, for they muft have noticed, 1. That the latter is almoft univerfally introduced by fymptoms of the former. 2. That the fame organ, the ftomach, is the feat of both. 3. That both require the fame indications to effea a cure. It has been doubted, whether the latter is hereditary; and a phyfician of eminence, with the moft benevolent intention, has laboured to fupport the negative. I am inclined to think that, ftriaiy fpeaking, he is right; be- caufe the difeafe itfelf is not inherited : but, at the fame time, it muft be confeffed, and he would be ready to ac- knowledge, that the difpofition to both gout and difpep- fia are tranfmitted from parents to their offspring. The predifpofition may be tranfmitted, but if the oc- cafional caufe is wanting there is no difeafe. The inflammation of gout is evidently an effort of na- ture to relieve herfelf; yet not, as many have imagined, by calling off a peccant humour ; becaufe when a regu- 112 INFLAMMATIONS. lar periodical fit has fpent its rage, and left the patient with a comfortable hope of freedom from diftrefs and pain for fix, twelve, or four and twenty months to come, the application of any debilitating power, fuch as intem- perance, fatigue, exceffive evacuations, cold and humid- ity, or even the paflions of the mind, will fuddenly bring back all the fymptoms, with trie fame degree of violence and duration, as if no previous fit had happened. But whilft it is thus demonftrable, that nature does not relieve herfelf by cafting off a morbific matter ; it will not be eafy to trace her footfteps, and precifely to point out the manner in which fhe accomplifhes her pur- pofe. We cannot but obferve, that the pain and inflamma- tion of the gout produces cheerfulnefs and freedom from all the fymptoms of dyfpepfia. But beyond this we are not able yet to proceed. SECTION II. Indication of Cure in Tonic or Inflammatory Gout. If it is allowed, that pain and inflammation are the means made ufe of to relieve the habit from more dan- gerous and diftreffing fymptoms, it muft be evident, that thefe fhould be fupported. And, as we have nothing here to apprehend from fuppuration or from gangrene, it muft be clear, that we have the lefs inducement to haften refolution. Yet, as pain and inflammation have a tendency to exhauft the vital powers, thefe muft be kept within proper bounds. To fulfil thefe intentions, little more is needful than t© liften attentively to the voice of nature. To bleed is hazardous in the extreme, and to give ca- thartics is far from fafe ; cold is injurious, and every part of the refrigerating plan has a tendency to convert the inflammatory into the atonic gout. Yet to force the appetite with fpices, or, under the idea of keeping the gout from the ftomach, to drink a great quantity of wine, is adding fuel to fire, which may perhaps burn too fiercely at the time. The INFLAMMATIONS. "3 The body fhould be kept moderately open ; the part affeaed fhould be wrapt in flannel, and gentle perfpira- tion fhould be carefully encouraged. To keep the body open, the Analeptic Pill may be adopted, the form of which I received from the moft in- timate friend of Dr. James. R> Pil. Run, dr. 2. Pulv. Jacobi, G. Guaiac. aa. dr. I. Balf. Peruv. q. s. M. f. Pill. 48. Cap. j. h. s. That is, Take Rufus's Pill two drams ; James's Powder and gum guaia- cum, of each one dram ; Peruvian balfam fufficient to make forty eight pills. Take one at night. Gout has been incidentally cured, whilft in nephritic cafes gouty patients have taken aqua mephitica alkalina. Neither need this excite our wonder, when we confider that gout and gravel are kindred difeafes, and that the elements of urinary and of gouty concretions are the fame, for both contain calcareous, earth and phofphoric acid. By a double eleaive attraaion, the alkali combines with the phofphoric acid, and the carbonic acid is taken up by the calcareous earth. SECTION III. Indication of Cure in the Atonic Gout. It is fimply, as in paflive inflammation, to fupport tHe vital powers. This, according to the urgency of the fymptoms, may be done by cordial ftimulants, fuch as mufk, opium, camphor, ether, wine, and aromatics; by tonics with a- ftringents, fuch as bitters, bark, and fteel; by the infpi- ration of oxygenated air. as praaifed by my friend Dr. Thornton ; by animal food ; by exercife, and by bathing jn the fea. A gentle emetic, interpofed occafionally during the ex- hibition of thefe tonics, by clearing the ftomach and firft paffages from vifcid mucus, relieves the dyfpeptic fymp- toms, and eventually promotes both digeftion and nutri- tion _ P *n 114 INFLAMMATIONS. In cafe of coftivenefs, either the Analeptic Pills fhould be ufed as occafion may require, or, with Sir John Pringle, give tinaure of fenna, and tinaure facra, of each fix drams at night. If the gout attacks the ftomach or the head, give the following: §> Miftur. Camphorat. un. I. Ether gfs. Capt. ftatim. That is, Take inftantly camphorated julep one ounce, with ether half an ounce. Sir John Pringle ufed the fubfequent eleauary : I£> Conf. Cort. Aurant. 3vj. Conf. Aromatic. 3iij. Piper Nigr. 3j. Syr. Cort. Aur. q. s. f. Eleft. c. c. M. N M. 4a. q. hora. Take conferve of orange peel fix drams ; aromatic confection three drams ; black pepper one dram ; fyrup of orange peel fufficient for an electuary. The fize of a nutmeg is the dofe to be taken every 4 hours. „ In order that he might draw the gout into the feet, he applied a cataplafm of oatmeal, with muftard feed and horfe radifh. IJoFarin. aven. unc. 1. Sem. Sinapi. Rad. Raph. ruft. aa. unc. i. Aceti q. s. M. fiat cataplafma talis imponenda. SECTION IV. Of Prefervatives from Gout. Various fpecifics have been recommended to the public, and have attraaed attention for a time ; but in the iffue they have all been proved to be either danger- ous, or, at leaft, inadequate to the purpofe for which they were intended. The effea of bitters, if long continued, is to deftroy the vigour of the conftitution ; but bark and fteel, if joined with regular exercife and ftria temperance, may be ufed with fafety, and bids fair, by obviating the pre- difponent caufe, either to prevent the return of gout or to render it kindly. Order ERUPTIVE FEVERS. "5 Order III. Exanthemata. Eruptive Fevers. The charaaer of this order Hands thus; contagious difeafes, beginning with fever and followed by an erup- tion on the fkin. INTRODUCTION. The genera of this order have been reckoned feven : Eryfipelas, Peftis, Variola, Varicella, Rubeola, Milia- ria, and Scarlatina. Of thefe Eryfipelas and Peftis have already been con- fidered under Febres and Phlegmasia, to which they have been transferred. The remaining five will be taken in fucceflion. But previous to this, I muft requeft the ftudent to rec- ollea what has been delivered on Synocha and Typhus compared with aclive and paffive inflammation ; becaufe fuch is the confiflency of the plan purfued by nature in her efforts for relief; fuch the unity of defign in all the laws, to which the fyftem is made fubjeel; fuch the analogy be- tween difeafes, although of different orders ; that of thefe, every one throws light upon the reft. Whenever febrile eruption appears upon the fkin, it will be of greater importance to determine, what is the nature of the attendant fever, than to afcertain the name of the difeafe. To this fever the attention fhould be turned, becaufe from hence principally the indications of cure muft be taken. Should the fever be typhoide, tonics and cordial ftim- ulants, in every cafe of exanthemata, will be needful; but fhould the fever be Synocha and run high, the anti- phlogiftic plan muft be preferred: yet in both modera- tion and a quick difcernment are required. Genus XXII. Variola. Small Pox. The fymptoms are, Synocha; eruption of red pimples on ii6 eruptive fevers. on the third day, which on the eighth contain pus, and drying fall off in crufts. SECTION I. Of the Different Species of Variola. The fmall pox has been confidered as either diftincl or confluent. In the diftina fmall pox the fever is manifeftly Syno- cha, ufually moderate, attended by fweating in adults, by fpafms, convulfions, or epileptic fits, in children. On the third day commonly, fometimes on the fourth or fifth, the eruption makes its appearance in red fpots on the face; and during the two fucceeding days whilft thefe from pimples become puftules, the body and the legs receive their portion. From this time the fever ceafes ; the puftules fill, each furrounded with ,a margin of a florid hue ; the face begins to fwell; and on, or before, the eighth day, from the e- ruption, the puftules come to their maturity. At this period the fwelling of the face fubfides ; both the hands and feet begin to fwell; and the fecopdary fe- ver, equally benign, under proper management, with the eruptive, comes on, but foon declines again. In the confluent fmall pox the fever is evidently typho- ide. All its preceding fymptoms are violent, aiid are at- tended, fometimes by delirium in adults, or commonly by ftrong epileptic fits in children. The eruption always appears on the fecond or third day from the attack:; and the fever never ceafes, al- though it fuffers fome remiflion, for two or three days after the eruption has appeared. The eruptions, frequently preceded by an erysipela- tous efflorefcence, are numerous, fmall, never pointed, but flat and filled, not with good matter, but with either water, degenerated pus, or blood and ichor. A falivation follows, and the throat is fore, Inftead of the red circle round the puftules, which makes aaive inflammation, we obferve the fkin, where it eruptive fevers. 117 it can be feen, pale and flaccid, and when the puftules burft, the exuding matter forms black cruris. The fluids often fhew putrefcency ; petechia, that is black or livid fpots, are feen among the puftules; ery- fipelatous veficles appear, under which the fkin is difpo- fed to gangrene ; and fometimes bloody urine is difcharg- ed. It is on the eleventh day that the patients generally die ; yet fome furvive till the fourteenth, and others to the feventeenth, day of the difeafe. It is the fecondary fever ufually that proves fatal in the fmall pox. For fuppofing the fever not to have been originally typhoide, but Synocha with ftrong vafcular excitement, the puftules will be numerous, and the ac- tive inflammation will be confiderable. This naturally tends to exhauft the vital energy and to induce debility. But when the fuppurated cruft is extenfive on the fur- face of the body, independent of abforption which pro- duces heaic, the irritation there, which always bears proportion to the furface, will not only, by confent of parts, increafe the irritability of the heart, and keep up the fecondary fever, but, by exhaufting the powers of life, convert a Synocha to Typhus. SECTION II. The Hiftory of Inoculation. The fmall pox, fo deftruaive to preceding genera- tions, is now, under proper management, no more to be dreaded than fire on the hearth. For this change we are indebted to inoculation, intro- duced at the commencement of the prefent century ty Pylarini, an eminent praaitioner of Italy, who being then refident at Conftantinople, fent to our Royal Soci- ety the firft account both of the operation and its ef- feas on the inhabitants of that metropolis. By his relation it appears, that to them originally the praaice had been derived from Greece, where it was found not in the hands of phyficians, but of the peafants. And by a fubfecment account, tranfmitted to the fame ' * fociety I IS ERUPTIVE fevers. fociety by Timoni, A. D. 1713, it is evident, that the Circaflians and Georgians had been long in the habit of performing this kind office for their female children, in order to preferve their beauty. Their principal intention was, however, to increafe their value, when at the age of maturity, they were to be fold to the Turkifh officers. A. D. 1717, the fon of Wortley Montague, then at Conftantinople, was inoculated, and Lady Mary, on her return to England, introduced the praaice in our Ifland, where it was firft tried on the malefaaors then in New- gate under fentence of death. In confequence of the propitious iffue of that effay, it was adopted by the royal family. Dr. Jurin, Phyfician to the Court, having obferved, . fo early as the year 1722, that, inftead ofoneinfive, the ufual proportion loft by the natural fmall pox, not more than one in ninety failed under inoculation ; he commu- nicated the information to the public, gave a defcription of his praaice, and firmly eftablifhed it in Britain. For the modern improvement in the treatment of this difeafe, we are indebted to Mr. Sutton, who taught us the benefit of the antiphlogiftic regimen. This information, I imagine, was derived about A. D. 1760 from America, where they conftantly, before the infertion of the matter, cleanfed the alimentary canal by antimonials and mercurials. The American praaitioners reftriaed their patients chiefly to a vegetable diet, and inftead of confining them to bed, permitted them to walk in the open air, and by no means fuffered them to approach a fire. SECTION III. Of the Benefits derived from the Afthenic Treatment. The fcope of all their preperations was to moderate the eruptive fever, becaufe they always obferved a pro- portion between it and the eruption; and faw clearly, that the fecondary fevef, from which they had moft to apprehend, was governed by the number of the puftules. The idea formerly and univerfally received was, that ERUPTIVE FEVERS. U5 a certain quantity of variolous matter exifted in the blood to be concoaed and expelled by the eruptive fever. This opinion is now univerfally exploded, excepting fome villages, more efpecially in Cornwall, where they continue to give brandy, or, in the place of brandy, with aftonifhing fimplicity, they fubftitute gin and gunpow- der. They conceive, that a ponderous load is to be heaved, and, confidering that in their mines they have no agent fo powerful as gunpowder, they adminifter it to patients on the firft appearance of the fmall pox, and exult when the fkin is covered with a multitude of puftules. That the benefits derived from inoculation depend upon keeping down the eruptive fever, and thereby di- minifhing the burden on the furface of the body, is ftrikingly evinced by one inftance, among a thoufand that might be mentioned. It is recorded by Dr. Mudge. Mr. Sutton, in the vicinity of Plymouth, inocula- ted a lady, who on the third day after the commence- ment of the Synocha, had five or fix red pimples, which formed gradually into puftules. During the progrefs of the difeafe, as fhe fat at table, fhe expreffed uneafinefs, and wifhed to have ftronger ev- idence, than yet appeared, that fhe had the fmall pox. Mr. Sutton told ner, that fhe had only to eat a portion of hare, which was on the table, and drink one glafs of wine, and fhe would have fufficient evidence to fatisfy her mind. She accepted the propofal; the fever increafed ; and the fmall pox, from being difcrete, became confluent. Suttort then took fright, and delivered her to the care of Drs. Mudge and Huxham, by whofe watchful atten- tion fhe was carried fafely through the fecondary fever. SECTION IV. The Conducl of Inoculation. The praaice of Sutton, as improved by Baron Dims- dale, is highly interefting ; becaufe, if it does not re- veal the arcana offever, nor trace them to their moft re- condite 120 ERUPTIVE FEVERS. condite receffes, at leaft it diffufes much light upon the fubjea. The Baron, by way of preparation, recommends from five to eight? grains of calomel, combined with aS much compound powder of crab's claws, to which he adds tar- tarized antimony gr. ■$> to be taken at going to reft, and to be purged off in the morning with Glauber's falts. This cathartic procefs he generally repeats three times, at the diftance of three or four days, prior to inocula- tion ; and as foon as the inflammation of the wound ap- pears, he gives about half the former dofe of calomel and crab's claws, with one tenth of a grain of tartarized an- timony. He commonly forbids the ufe of wine, and reftrains the robuft to a vegetable diet. He recommends cool air, and is careful to keep the paffage of the bowels free. By thefe means he bridles the fever and governs it at pleafure, infomuch that his patients never lofe either their appetite or fleep. It muft not be imagined, that mercurials aa as an an- tidote to the variolous poifon, any further than as, by re- moving vifcid mucus, bile, worms, and acrid fordes, from the inteftines it becomes a febrifuge. Is it not from hence, and from all our obfervations on the procefs of inoculation, palpably evident, that the fomes of fever is in the alimentary canal? If, in the progrefs of the inoculated fmall pox, there fhould appear fymptoms of great debility, recourfe is had to wine, to animal food in moderate quantity, or even to more active ftimuli. SECTION V. Of the Treatment in the Natural Small Pox. From obfervations, which I have had an opportunity of making in different parts of Europe, for more than thirty years, I am convinced, that the treatment above defcribed is equally applicable to the inoculated as to the natural fmall pox ; and I have the fatisfaaion to find, ERUPTIVE FEVERS. 221 that praaitioners of diftinguifhed abilities are of the fame opinion. The firft attention, therefore, in the natural fmall pox, muft be to regulate the eruptive fever ) and,luppoling this to be a Synocha, with fymptoms of ftrong vafcular excitement, it muft be moderated. This may be accomplifhed. i. By removing acrid ftimuli from the inteftines ; becaufe, as I have ftated, thefe, by confent of parts, increafe the irritability of the heart. i * For this purpofe we ufe emetics and cathartics. Of emetics I can fay with Sydenham, " Saepe miratus fum, dum forte materiam vomitu rejeaam aliquando cu- riose contemplabar, eamque neque mole valde fpeaabi- lem, nee pravis qualitatibus infignem ; qui faaum fuerit ut aegri tantum levaminis exinde fenferint; nempe vomitu peraao, fseva ilia fymptomata, naufea, anxietas, jaaa- tiones, fufpiria luauofa, linguae nigredo, &c. que et ip- fos excruciarant & adftantes perterrefecerant, mitigari folent ac folvi, quodque morbi reliquum eft vSvptK tole- rari." Cathartics have a twofold operation, for they not on- ly cleanfe the bowels, but, as evacuants, they diminifh the aaivity of the fanguiferous fyftem, and obviate its inflammatory ftate. Of thefe calomel deferves the pref- erence, and may be given daily during the eruptive fe- ver. i. By the antiphlogiftic regimen. For this purpofe the patient muft be expofed to the aaion of a cool and refrefhing air ; he muft avoid ani- mal food with fermented liquors ; he muft have acids ; he muft bathe his legs in tepid water, and if, notwith- ftanding thefe precautions, the eruptive fever fhould run high, with a full, ftrong, hard, and frequent pulfe, blood muft be taken from a vein ; after which either the anti- monial powder or tartarized antimony muft be given in nauic.uing doles, which will both cleanfe the firft paffa- ges and keep up a perfpiration on the fkin. But fuppoiing, that inftead of Synocha, with fymp- torcj of ftrong vafcular excitement, the eruptive fever () fhould 1 122 ERUPTIVE FEVERS. fhould incline to Typhus, with a frequent and contracted pulfe, proftration of ftrength, delirium, or other fymp- toms of diforder in the nervous fyftem, in this cafe the ""indication wuTtte, to fupport the powers of life. This purpofe, as already ftated in Typhus and paflive inflammation, may be anfwered by cordial ftimulants, with tonics and aftringents, fuch as, aromatics, bitters, wine, brandy, opium, and the Peruvian bark, with this precau- tion, that the ftomach muft firft be cleared by an emetic. In addition to thefe general remarks, it is proper to remind the ftudent, that he muft obviate any tendency to putrefaaion, not merely by the means already fpeci- fied, but by acids, and more efpecially by emptying, as far as the ftrength of the patient will admit and occafion may require, either by cathartics, or by laxative clyf- ters, that grand ftorehoufe of putrefaaive matter, the al- imentary canal. When the eruption has appeared, a watchful atten- tion is required, as well to its progrefs, as to the ftate of the pulfe, and to the ftrength and fpirits of the patient. Should the puftules flatten, and the powers of nature be infufficient to bring forward the eruption; fhould fainting, coldnefs, tremor, with other nervous fymptoms, fupervene; thefe, with the pulfe and fpirits of the patient, will plead for cordial ftimulants, fuch as aromatics, wine, bitters, volatile alkali, opium, the Peruvian bark, and blifters. In fuch circumftances, Dr. Whytt, after bathing the legs in warm water, was accuftomed to prefcribe the following; ]J> Aq. Cinnamom. un. 8. Cinchon. un. i. Syr. Limon. dr. 3. M. c. un. it o. 4. h. vel p. r. n. That is, Take cinnamon water eight ounces, bark one ounce, and fyrup of lemon three drams. The dofe may be an ounce and an half every four hours, or more frequently if needful. To this, in cafe of Petechiae, he added elixir of vitri- ol, from ten to twenty drops for every dofe. When ERUPTIVE FEVERf. 123 When vifcid mucus accumulates in the throat, deter- gent gargles muft be reforted to, and vinegar of fquills, in the dofe two drams united wirh twice the quantity of cinnamon water may be given two or three times a day. A fuppreffion of urine is fometimes removed by ex- pofing the patient to cold air; and in cafe of bloody u- rine, tinaure of rofes and,, lirit of vitriol muft be mixed with every thing he drinks. Should delirium occur, the ftudent muft confult what has been delivered on that fubjea under Synocha and Typhus. In cafe of reftleffnefs and want of fleep, if there fhould be fymptoms of debility, give opiates; but fhould the fymptoms be thofe of vafcular excitement, you muft have recourfe to evacuants, cool air, and acidulated drinks. In the decline of the eruption, when the fecondary fe- ver follows, the attention of the praaitioner muft be per- feaiy awake. Should this fever difcover fymptoms of vafcular ex- citement, he muft condua himfelf as in the fimilar erup- tive fever, with this caution, that he muft not be too hafty with his lancet, left he fhould be overtaken by a Typhus. Cool air, acids, and cathartics of the refrigerant order, will in moft cafes fuperfede the neceflityof bleedirg. Should the fecondary fever be a Typhus, the direc- tions already given on that fubjea will be fufficient. To them, therefore, I muft refer the ftudent, however, with this fhort memento, that, after he has given an emetic, his chief dependance muft be on wine and the Peruvian bark. Let the ftudent be more efpecially attentive to fupport the powers of life on the eleventh, fourteenth, and fev- enteenth days of the difeafe. With refped to nutriment, the beft and moft agreea- ble, from the time of the eruption till the puftules mat- urate, is milk porridge. It is thus made: Take oatmeal two ounces, foft water three quarts: boil this, fre- quently ftirring it, till it is reduced to two quarts; ftrain it, and let it cool; then pour off the clear liquor, and add one quart of milk, with a fmall quantity of fugar or of fait, whichever is moft agreeable. * Genu? T24 ERUPTIVE FEVERS. Genus XXIII. Varicella. The Chicken Pox. The fymptoms are, moderate Synocha; pimples bearing fome refemblance to Variola, quickly forming puftules about the fize of millet feed, which contain a fluid matter, and after three or four days, from their firft appearance, defquamate, leaving no cicatrix. This difeafe may be fafely left to nature. Genus XXIV. Rubeola. The Meafles. The fymptoms are, Synocha ; hoarfenefs; dry cough; fneezing; drowfinefs ; about the fourth day eruptions of fmall red points, difcernible by the touch, which, after three days, end nearly in defquamation. The blood, after venefeaion, exhibits inflammatory cruft. In addition to the fymptoms already related, we may remark, that the eyes and eyelids always fhew the pres- ence of this difeafe, being fomewhat inflamed and fuffu- fed with tears. The Synocha ufually continues during the whole prog- refs of the difeafe. S E C T I ON I. Method of Cure in the Meafles. For the treatment, it might be here fufficient to refer the ftudent ,to what has been delivered generally in the Introduaion to this order on eruptive fevers; but in ad- dition to this, a few hints may be ufefully given. Dr. Cullen, apprehending inflammation of the lungs, ftrongly urges us to have recourfe to copious bleeding ; but from all the obfervations I have had an op- portunity of making, I am inclined to think, that fuch a praaice can be feldom beneficial, and not only may be, but is frequently injurious. I had occafion to remark, when I was lately at Southampton, that the buff coat, or inflammatory cruft, appeared upon the blood, even alter the eruptive fevers. 125 the tenth or twelfth bleeding, when the j>atients funk and died under the lancet. The ftudent, therefore, muft be careful not to place too much dependance on this fallacious, teft of inflamma- tion, which not only depends upon various circumftan- ces at the time and in the aa of venefeaion, but is equal- ly obferved in dropfy, the putrid fore throat, and the laft ftage of a confumption. It fhould be remembered, that aaive inflammation can fubfift only with the fthenic diathefis, whereas at the end of meafles, when the inflammatory affeaion of the lungs is moft apprehended, it is not the fthenic, but the afthenic diathefis which prevails, with fymptoms not of ftrength but of debility. In the meafles, it is undoubtedly proper to abftain from animal food and from fermented liquors, and to breathe cool air. Yet we fhould.confine the patient to his bed, and keep his body open with cathartics of the refrigerant order. SECTION II. Treatment of Cough after Meafles. In the fubfequent cough, let the ftudent confult. what I have faid on Tuffis ftomachalis, and fatisfy his mind, whether this fymptom arifes by confent of parts from an affeaion of the ftomach, or whether it is induced by aclive inflammation. If the pulfe is ftrong, full, hard, and frequent, you muft bleed, and continue to obferve the antiphlogiftic regimen ; but if the pulfe is fmall or feeble, although quick, you muft avoid that operation. If you obferve dyfpeptic fymptoms, or fufpea that the cough is fympathetic, give an emetic, and follow this by tonics. In fuch circumftances, balfam of copaiva has an ex- cellent effea. Ten drops may be given, morning and evening, on a lump of fugar, # This, with the other balfams, fimilar to it in virtue, digefted in fpirits of lavender, is Fuller*s fyUfomic Tinc- ture, 126 ERUPTIVE FEVERS. ture, which was formerly in great requeft for cough and confumption ; and this balfamic tinaure, with an extraa of opium, is the famous Balfam of Honey recommended by the late Dr. Hill in thefe complaints. Genus XXV. Miliaria. The Miliary Fever. The fymptoms are, cold ftage confiderable ; hot ftage attended with anxiety, and frequent fighing ; fweat of a ftrong peculiar fmell; eruption, preceded by a fenfe of pricking, firft on the neck and breaft, of fmall red pim- ples, which in two days become white puftules, defqua- mate, and are fucceeded by frefh eruptions in the courfe of the fame fever. INTRODUCTION. This difeafe does not correfpond with the defcription of the order, for it does not appear to be contagious. Yet we can no where place it better than with fevers followed by eruption. Among the fymptoms enumerated by Dr. Cullen, is Synochus; but I can acknowledge no fuch diftinaion, becaufe I am perfuaded, that every Synocha, by bad management, that is by fuffering the fever to run high and to exhauft the vital energy, by a free ufe of the lan- cet, by violent evacuations, or by negleaing properly to cleanfe the firft paffages, may end in Typhus. SECTION I. Hiftory of Cafes. It never has occurred to me, to fee the miliary fever as an original difeafe. I have obferved it often in the cafe of lying in women, and in patients who have been confined to warm rooms, taking at the fame time the moft cordial ftimulants. I remember my own brother, fome thirty years ago, conceiting that he was ill, fent for Dr. A-------, who, after a variety of quef- tions, alked him, if he had never had any eruption on his (kin. When ERUPTIVE FEVERS. 127 When the good old man had received an anfwer in the negative, he urged his patient to recolleft again. On recollection, my brother told him, that many years before he had an eruption, accompanied by a fweat of a ftrong and peculiar fmell. The Doctor immediately repli- ed, uia impenfiores fpafmos, eruptionis auciores, excipere folet debilitas ; et relaxatio, ad flagnationem novam adeoque inducendum denuo fpafmum pnftea HEMORRHAGES. I4t foftea anfam prabens, haec utique non melius poteft praefcin- di, quam robor ando partes atonid affeclas, quod per ejufmo- di volatilia oleofa perficiter commodifftmh" Vol. II. p. 207. Here he affumes debility, as the predifpofing caufe, and to remove it he approves of tonics. Should, however, haemoptyfis be attended by a phlo- giftic diathefis, with fymptoms1 of ftrong vafcular excite- ment, the pulfe being full, frequent, hard, and the heat much increafed ; in thefe circumftances bleeding may be proper, with cooling laxatives, acidulated drinks, abfo- lute reft, and a vegetable diet. In fuch circumftances, tonics and aftringents.can have no place; they muft be deferred till the diathefis fhall be changed. Yet thefe are circumftances which do not frequently occur. For this reafon, the treatment of haemoptyfis rec- ommended by the late Dr. Marryot, who was diftin- guifhed as a fuccefsful praaitioner at Briftol, is not un- worthy of attention. He fays, never bleed, but give for a dry vomit two grains of tartarized antimony, and, when naufea begins, expedite the operation by a folution of vitriolated cop- per, two grains in water. After the operation, he al- ways ordered half a glafs of brandy. In chronic cafes, he gave balfam of copaiva, twenty drops morning and evening, with the following* eleaua- ry, to be continued many weeks. IJ, Cinchon. dr. 6. Flor. Sulph. dr. 3. Nitr. dr. 1. Sulph. Antimon. precip. fcr. 1. Mucil. Gum. Arab. q. s. f. Elec c. c' M. N. M. ter in die. That is, Take Peruvian bark fix drams, flowers of fulphur three drams, nitre one dram, precipitated fulphur of antimony one fcruple, mucil- lage of gum Arabic a fufficient quantity. Take of this ele&uary the fize of a nutmeg three times a, day. In cafes of neceffity, he gave a fcuple of alum, to be repeated as occafion might require. Dr. Rush, of Philadelphia, recommends dry fea fait to be taken in great quantities, but on what principle I am at a lofs to fay. Genus 142 HEMORRHAGES. Genus XXXI. Phthisis. Confumption. The fymptoms are, emaciation, debility, cough, hec- tic, purulent expe&oration, haemoptyfis, diarrhoea. INTRODUCTION. To diftinguifh this difeafe from others, to which it bears a ftriking refemblance, requires much accuracy of difcernment, and the moft minute attention, becaufe all the fymptoms are equivocal. Emaciation is common to tabes, to atrophy, to fevers of every fpecies,and to a variety of chronic complaints. Of debility we may fay the fame. Cough is a verry common fymptom, neither confined to this difeafe nor to catarrh, but to be obferved in ma- ny others, arifing from confent between various parts of the fyftem and the lungs. Such is the fympathy between the organs of refpiration and the alimentary canal in its whole extent, that we have frequently a cough produced by the ftimulus of acrid matters, whether acidities, bile, worms, or vifcid mucus, colleaed either in the ftomach or fmall intef- tines, and fometimes by afcarides, or even by the ufual irritation of faeces in the reaum. Heaic is regarded by Dr. Cullen as an evidence of ulceration in the lungs; but it will not be difficult to prove, that heaic is often prefent where there is no ul- ceration, and therefore no pus to be abforbed. In confirmation of this we have a curious cafe oinof- talgia related by Dr. Hamilton, of Ipfwich, to be here- after particularly mentioned in its place. And in cafes of heaic following nervous atrophy, as ftated by Dr. Whytt in his obfervations on nervous dif- eafes, there is no abforption of pus. Sir Clifton Wintringham judicioufly refers heclic fe- ver, in the firft place, to circumftances obftruaing the paffage of blood through the lungs; fecondly, to acrimo- ny ; thirdly, to inanition. Dr. hemorrhages. 143 Dr. Home in his Principia Medicinae inquires, " Is there any heaic as a primary difeafe ?" and he replies, 6< I have feen many, where no vifcus was more difeafed than another : Multas mihi certe contigit vidiffe, ubi nul- lum vifcus prce aliis, per totum morbi decurfum laborabat. Neque fidem huk opinioni derogant vifcerum obftrucliones9 quafemper in cadaveribus inveniuntur, Eff'eclus enim ague ac caufae funt febrium heclicarum," " Even in cafes, in which there is pus to be abforbed, John Hunter has clearly demonftrated, that heaic is not produced. Dr. Darwin, in a letter to Dr. Beddoes, fays, that large abfceffes, as long as they are excluded from any accefs of air, occafion no heclicfever ; but, on their fur- faces being expofed to the contaa of the external air, by burfting, heaic fever is occafioned in a very few hours. And Mr. Bell, an eminent furgeon of Edinburgh, indebted for his information to Dr. Monro, has delivered his fentiments in fimilar expreffions, as appears in the fifth volume of the Medical Commentaries. To this eminent profeffor we have been equally in- debted for teaching furgeons to exclude the air from re- cent wounds. Yet even here it may be obferved, that it is not the air itfelf which produces heaic, but, as John Hunter has fagacioufly remarked, in his Treatife on Inflammation, heaic then commences when abfceffes are put into that ftate, in which the conftitution is to make its efforts to- wards a cure, which it is not able to accomplifh ; for if the parts are well difpofed to heal, no heaic is pro- duced. The appearance of purulent expectoration is Iikewife equivocal ; becaufe, even affifted by the obfervations of Dr. Cullen, and the experiments of Mr. Charles Dar- win, it is fometimes difficult, if not impoffible, precifely to diftinguifh the nature of the expeaoration. And Dr. Cullen himfelf, after all his obfervations and reafonings on the fubjea, terminates at laft, by taking for granted, what he fhould have proved, that heaic fever always arifes from abforbed pus ; and then haftiiy concludes, that *44 HEMORRHAGES. that the prefence of heaic is fufficient to demonftrate the attendant expeaoration to be purulent. Were this indeed fufficient, he might have fpared himfelf the trouble of referring to the experiments of Mr. Darwin. But even fuppofing the expeaoration to be fuch, as in catarrh is frequently, towards the clofe, difcharged by the mucous glands of the noftrils ; yet this will by no means prove that the lungs are ulcerated. Hcemoptyfis has already been confidered as a genus, and cannot, therefore, be a fufficient evidence of phthifis. Diarrhoea is the laft and concluding fymptom. When this appears, it will be too late to fettle our di- agnofis. Since then all the fymptoms, feparately confidered, are equivocal, and even when united have deceived the moft eminent profeffors, we muft be careful in the ex- treme not to make miftakes. SECTION I. Phthifis may be Sympto?natic. Independent of the preceding obfervations, I am inclined to think, that phthifis itfelf is fometimes fymp- tomatic, and therefore to be cured by attention to the primary difeafe : for inftance, protraaed catarrh, the heclica verminofa, tuffis ftomach alls, afthma, and amenor- rhea, have been known to terminate in phthifis, and be- ing cured, have left the patient free from all complaint. What I have therefore faid upon thefe particular difeaf- es, fhould be confulted by the ftudent. It is well known, that violent, long continued, and frequently repeated, agitations of the lungs in coughing, whether that cough be idiopathic or fympathefic, will produce a ftrong determination"to the cheft, with difeaf- ed glands, haemoptyfis, and phthifis. Hence it has frequently happened, thixfpafmodic afth- mab tuffis exanthematica, tuffis verminofa, and particularly tuffis ftomachalis, improperly treated, have produced the very HEMORRHAGES. *45 very difeafe which the medical advifer was anxious to avoid. I could give inftances of eminent phyficians, who, in thefe difeafes, have loft their patients by a hafty and mif- taken diagnofis; and of others, who, whilft they were curing tuffis ftomachalis, imagined they were treating a genuine phthifis, arifing from tubercles and ulcers in the lungs. Eyery praaitioner muft have obferved phthifis arifing from amenorrhcea, as the primary difeafe, and effeaually relieved when the monthly evacuation has returned. In addition to what I have already faid on this fub- jea, I muft obferve, that Dr. S. Chapman, in his trea- tife on remittent fever, which affumes the form ofpulmo- nary heclic, or confumption, gives us many curious and moft interefting clafes, in which the fymptoms of heaic and phthifis were removed by curing the remittent fever. This he effeaed by the Peruvian bark. Scabies, fyphilis, and fcrophula, negleaed or ill treat- ed, may likewife terminate in phthifis, which, unlefs it has gone too far, may be relieved by attention to the pri-, mary difeafe. I muft here alfo refer to the fymptomatic phthifis which follows atrophia laclantiwn, when either the fond mother fuckles her child too long, or when the nurfe, ftruggling with poverty, has two children hanging at her breafts, although fhe has fcarcely ftrength enough to fuckle one. With refpeato the cafes recorded by Dr. Walker, of more than 200 patients at Leeds, who came to him within two years, and in whom he attributes this difeafe to the ufe, or rather to the abufe, of tea; the caufe af- figned does not appear to me to have been adequate to the effea produced. For, fince the unfortunate Ameri- can war, and the heavy duties impofed upon the poor to ' defray the expences of that war, the lower claffes in this diftria, the Vale of Pewfey, more efpecially the women, and confequently they who are giving fuck, live chiefly upon tea, taking it four times a day ; yet no fuch atro- phy nor fvmptomatic phthifis has appeared. T As, i4<5 hemorrhages. As, therefore, in fimilar circumftances, I can fay nothing from experience, I fhall be filent on this fubjea, and refer the ftudent to the cafes as they are related by ■»-—Dr. J)1 J^yja- jn. his valuable commentaries, Decad 2. Vol. VT* SECTION II. Of the Species of Phthifis. Dr. Cullen has diftinguifhed two fpecies of phthifis. The firft he calls incipiens, without expeaoration of pus; the fecond confirmata, attended by expeaoration of pus. But, with humble fubmiffion to his fuperior judgment, I may venture to fuggeft, that thefe diftinaions ought not to be received as charaaeriftic of different fpecies, be- caufe they are merely defcriptive of the ftages in the fame difeafe. Dr. Foart Simmons, with the utmoft propriety, af- figns for the caufe of genuine phthifis, either tubercles or a difpofition to hcemoptyfis, and thefe certainly lay a good foundation for two fpecies, which may be denominated phthifis tuberculofa, and phthifis hcemoptoica. SECTION IIL Of Tubercles, and the Predifpofition to Hcemoptyfis. For the knowledge we have of tubercles, we are in- debted to the late Dr. Stark, whofe accurate inveftiga- tions have thrown full light upon this part of the patholo- gy, and from his ineftimable work I have derived my in- formation. Tubercles, whilft fmall, are always folid ; when large, they are fometimes fo. They approach to the hardnefs of cartilage, and when cut through, appear fmooth, mi- ning, uniform. No veffels are to be feen in them, even when, after in- jeaing the pulmonary artery and vein, they are examin- ed with a microfcope. They are always in the cellular fubftances, never in' the hemorrhages. 147 the air veffels, in which the extremities of the bronchial ramifications terminate. They are at firft extremely fmall, numerous, in cluf- ters; but never in the leaft inflamed. When they become vomicae, it is always in the fuperi- or and pofterior part of the lungs, where they form ftrong adhefions to the pleura. 0 Vomicae, whofe cavity is lefs than half an inch, are quite fhut up ; but thofe, which are larger, have one or more ramifications of the bronchia opening into them through which the matter fometimes makes its way into the trachea, and is then evacuated without rupture of the vomicae. The perfons liable to tubercles are generally of a fair complexion, foft fkin, and irritable habit, defcended from fcrophulous parents, and difpofed to fuffer by lymphatic tumours. From Hyppocrates downwards it has been conftantly remarked, that thofe moft fubjea to haemoptyfis, one of the prolific parents of phthifis, have a delicate complex- ion and fanguine temperament, with florid cheeks, a flender form, long neck, contraaed cheft, and prominent fhoulders. Profeffor Camper has obferved likewife, that they have found teeth, which, as the difeafe advances, ufually become of a milky white, and more or lefs tranfparent. SECTION IV. Of the Treatment in Phthifis. ^ Let the ftudent carefully examine the conftitution of his patient, and the nature of thofe difeafes to which ei- ther he, or his parents, have been moft fubjea, whether 1. to thofe which indicate a weaknefs and relaxation of the ftomach and alimentary canal; 2. to thofe which arife from a difpofition to haemoptyfis, and a determination to the lungs; 3. to thofe which originate, as fcrophula, in debilitated fibres, and a peculiar affeaion of the glands. Let him next proceed to inveftigate with minute atten- tion the origin and progrefs of the difeafe in queftion. If 148 HEMORRHAGES. If it began as a catarrh, although it be now to his ap< prehenfion a confirmed phthifis, let him treat it as a ca- tarrh ; with a milk diet, cool air, exercife on horfeback, and the mixture of fulphur, elecampane, and liquorice, mixed with honey, as he will find thefe ordered in No. 50 of my Compendium. Of this treatment I can fay what Hoffman has advan- ced of milk alone ; " <%ud perplures phthificos in cymbd charontis quafi haerentes,fanatos priftinaeque redditos vale- tudini novi ;" for by it the moft alarming fymptoms have been fpeedily relieved, and the patient has been foon re- ftored to perfea health. If the difeafe began with fymptoms of dyfpepfia and nervous affeaion ; if there is reafon to fufpea, that the cough may be induced and fupported by irritation in the ftomach or in the fmall inteftines ; if the complaint is conneaed with either hetticaverminofa or tujfisft omachalis, already treated of; in thefe cafes, the principal indica- tionsmuft be taken from the primary difeafe. If it is attendant on amenorrhea, what fhall be faid on that affeaion of the uterus muft be confulted : if on fyphifo or fcrophula, reference muft be had to thefe dif- eafes : if it is derived frompfora or from cutaneous erup- tions, which have been repelled ; from uicers dried up, or from fweating of the feet repreffed ; the ftudent muft recollea what has been delivered on tujfis exanthematica, and muft prefcribe accordingly. When the indications of cure cannot be derived from thefe fources, the ftudent muft be contented to be wholly directed by the experience of others, and muft choofe ■for himfelf among the various plans which have been fubmitted by praaitioners to the confideration of the public. I. The firft plan to be confidered is that, which has been moft univerfally adopted, by bleeding and the an- tiphlogiftic regimen ; but this has been fo univerfally/^- ta/,that little expeaation of relief can be derived from it. If the difeafe has flain its thoufands, phyficians, by this mode of treatment, have flain their ten thoufands. Dr. Percival has judicioufly remarked, that the heaic HEMORRHAGES. 149 heaic heat is fometimes increafed by bleeding, and the ufe of nitre, which may indeed fink the pulfe from 110 to 90, but in one quarter of an hour raifes it to 130, whilft at the fame timethe ftrength is much impaired ; where- as in fuch cafes tonics fink the pulfe. I have been witnefs to inftances, where patients, fink- ing under the antiphlogiftic regimen, have revived, and every diftreffing fymptom has been mitigated, by a more generous diet. v The following cafe related by Dr. Gregory, of Ed- inburgh, to his pupils, will elucidate and confirm this obfervation. The Doaor fays, " Some time ago I was called to a patient, who, to all appear- ance, laboured under a confirmed phthifis. I thought I could be cer- tain of its being of the fcrophulous kind, both from my own knowl- edge of the patient's conftitution, and from the progrefs of the difeafe, for there had been no fpitting of blood, and indeed fcarce any fpitting at all, at leaft not fo much as we fhould have expected from the mu- cous follicles of the trachea itfelf, or the bronchiae, in confequence of the fevere irritation of the cough. • There was nothing, to all appearance, expectorated but a little mil- eus. The fymptoms were, a frequent dry cough, of the peculiar hollow found that fo ftrongly characterizes the phthifical cough ; great pain in the bread, with much difficulty of breathing ; great hectic fever ; the pulfe never under 100, and during the exacerbations fometimes a- bove 130 ; the flefh much wafted ; the features fharp ; the cheeks hol- low, and often flufhed with a circumfcribed fpot of red ; the ftrength fo much exhaufted, that my patient could not fit upright for a quarter of an hour, nor walk acrofs a room without fupport. The fleep was broken, or prevented by the cough and fever, and there were profufe fweats every morning ; but the expected diarrhcea had not yet appeared. In the opinion of one of the moft experienced practitioners in this country, as well as mine, the cafe was defperate ; nor did we think our patient could live above three or four weeks at the utmoft, appre- hending the colliquative diarrhoea would foon come on, and prove fatal; or, that the fudden rupture of the fuppofed vomicae in the lunga would occafion immediate fuffocation. Few remedies were ordered, and thefe merely palliatives ; laudanumto procure fleep, and elixir of vitriol to check the fweats, &c. The Pe- ruvian bark, at the defire of the patient's relation, was tried, but in fmall quantities and for a fhort time. There wa> no appearance of its having done either good or harm. 150 HEMORRHAGES. The ufual regimen, ordered before I faw the patient, was continued afterwards, and with the ufual fuccefs in fuch circumftances ; the pa- tient growing weaker, and the fymptoms, efpecially the hectic fever and fweat likewife, increafing daily till the elixir of vitriol was ufed. No change in the regimen was intended by us ; but a natural era. ▼ing for fome kind of folid animal food was gratified, from a conviction that the indulgence, as the cafe was defperate, could do no harm : yet no idea was entertained, that it could be in the leaft beneficial to the patient. Oyfters were the firft kind of animal food longed for and tried ; then crabs ; then a bit of fowl ; and, in about three weeks, plain butcher's meat, and at the fame time a fmall quantity of port wine. With this new regimen the patient grew better apace, recovered flefh and ftrength, and in a few weeks was able to take exercife, firft in a carriage, and afterwards on horfeback. The hectic fever was foon moderated, and at laft removed, as was in- deed every fymptom of phthifis. The patient, after experiencing repeated viciflltudes of feafons, and fome of them very inclement ones, is now alive and well, though I ap- prehend not yet free from the danger of future phthifis, being fubjeft ftill to cough, and other catarrhal complaints, on expofure to cold and moifture. Thefe, however, are commonly removed with little difficulty, by the fimple remedy of riding, which my patient has continued to employ." II. The fecond plan of cure is that of Dr. Mofes Grif- fith, who before his death, when, as I imagine, he was about fourfcore years of age, gave an account of a pecu- liar praaice, then warranted by long experience, in what he confidered as true pulmonary phthifis with ulcers in the lungs. In heaic fevers, not attended with any great decree of heat and thirft, he gave the following : }}j Myrrh, dr. 1. folve terendo in mortario c. Kali, dr. -£. Aq. Alexiter. un. 6-|. Spirit cujuflibct dr. 6. Dein adde ferri vitrio- lat. gr. 12. Syr. fimp. dr. 2. M. f. H. 4. c. c. H. 1. ter in die, augendo dofin fi moderati fuerint calor and litis. That is, Take Myrrh one dram, grind it in a mortar with fait of worm- wood half a dram ; alexiterial water fix ounces-and an half, any kind of fpirit fix drams. To thefe muft be added twelve grains of fait of fteel, fyrup of fugar two drams ; to be divided into four portions of which one is to be taken three times a day, increafing the dofe if the heat and thirft ftill continue to be mod- ••ate. HEMORRHAGES. J5i In heaic fevers, when the heat and thirft are great, with a dry fkin, hard pulfe, cough with difficulty of ex- peaoration, and flufhings in the face ; after bleeding and cleanfing the firft paffages he gave the following : 1$, Myrrh, dr. i. folve terendo in mortario cum Aq. Alex. un. 6\. Nitri, gr. 32 ad 40. Sal. Mart. gr. 12. Syr. fimp. dr. 2. M. f. H. 4. c. c. H. j. ter in die. That is, Take Myrrh one dram, grind it io a mortar with alexiterial water fix ounces and an half, any kind of fpirit one ounce, nitre from thirty two to forty grains, fait of fteel twelve grains, fyrup of fugar two drams ; to be divided into four portions, of which one is to be taken three times a day. This praaice has been adopted by many eminent phyficians, and been attended fometimes with fuccefs. III. The next method of cure, firft recommended, as I apprehend, by Dr. Marryot of Briftol, was, to give daily an emetic in the unorning, and balfam of capaiva twenty drops morning and evening. For his emetic he took, tartarized antimony one grain, ipecacuanha three grains; but, in cafe of diarrhoea, in the place of this, he judicioufly fubftituted blue vitriol one grain, with ipecacuanhaHfour grains. And, agreeable to the praaice firft recommended by Dr. Mofes Griffith, he gave fteel, as may be feen in the fubfequent prescription, where it is combined with bark. IJ> Cinchon. dr. 6. Extr. Glycyr. dr. 2. Ol. Anifi, gtt. 40. Limat. ferri, fcr. 2. Mucil. Gum Arab. q. s. f. E. c. c. M. N. M. bis,die. That is, . Take the Peruvian bark fix drams ; extract of liquorice two drams ; oil of anifeed forty drops ; filings of iron two fcruples ; mucilage of gum arabic a fufficient quantity to make an electuary, of which the fize of a nutmeg is to be taken twice a day. When the heaic fever was ftrong, he fubftituted two fcruples of nitre for the iron filings, to be taken twice a day. This praaice is in fome meafure conformable to that of Dr. Foart Simmons, who has written moft judiciouf- ly on the treatment of confumptions, and recommends the *52 HEMORRHAGES. the emetic of blue vitriol, in dofes of from two grains to ten, after having previoufly drank half a pint of water. He likewife adminifters the balfam of copaiva, in dofes of one dram, on fugar, in the fuppurative ftage. Part of this praaice, with its beneficial confequences, I have had an opportunity of witneffing in the praaice of Dr. Roberts, of Southampton, particularly in the cafe of a young lady aged twelve, who, with a violent cough difturbing her reft, and attended by a heaic moft diftinaiy marked by the evening exacerbation and the morning fweats, had the circumfcribed red fpot in the cheeks, and expeaorated a quantity of mucus mixed with pus which funk in water* To this young lady he gave the emetic of blue vitriol, in the fmalleft dofes, every morning. This brought up daily a confiderable quantity of phlegm, and in ten days effected a perfea cure. IV. A fourth method of cure, praaifed by the ingeni- ous and learned Dr. Beddoes at the Hotwells, is, to make the patient breathe hydrogene, or azotic gas, and fometimes carbonic acid gas. Of his views upon this fubjea, Dr. Beddoes has in- dulged us with a fhort account in his late publication called, " Obfervations on Calculus, Sea Scurvy, Con- fumption, Catarrh, and Fever." This gentleman attributes fcurvy to the deficiency of oxygenation, and phthifis to its excefs. It is now pretty univerfally underftood, that our at- mofphere contains, as already ftated, two kinds of air, vital and azotic, of which the former is compofed of oxygen and caloric. It is now likewife underftood, that the office of the lungs in animals is to abforb the oxygen air, by which a ftimulating power is communicated to the blood irrita- bility to the folids, and heat to both. * Hence in proportion, to the quantity of oxygen air, de- rived by refpiration from the air, the pulfe is quickened, whilft by its defea the pulfe is rendered flow and weak. To thefe obfervations it muft be added, as a well ef- tablifhed and acknowledged faa, that in phthifis the blood is HEMORRHAGES. I53 is of a florid colour, the pulfe is quick and hard ; whilft in fcurvy, meaning always the fea fcurvy, the blood is thin and fizy, the craffamentum is diflblved, and the pulfe is very feeble. From thefe faas it is induced, that in phthifis there is an excefs of oxygenation, and in fcurvy a deficiency. In confirmation of this induaion it may be remarked that, after a moft careful inveftigation, it is obferved that fcurvy is occafioned by vitiated air, and relieved by ox- ygen. ^ But what is moft to the purpofe is, that phthifical pa- tients, breathing oxygen air, have the fever greatly in- creafed ; but, by breathing common air mixed with hy- drogene, azotic, or carbonic acid, air, the heaic fever is abated, and the expeaoration becomes lefs offenfive. Should the hypothefis of Dr. Beddoes be confirmed; and fhould he be able to effea a cure in phthifis by in- ducing fcurvy, a difeafe which may be eafily removed, he will deferve a ftatue of gold to be ereaed to his memory ! I am inclined to hope that in phthifis haemoptoica this pradice will be ufeful, but in phthifis tuberculofa I fear little advantage can be expeaed from it. When no expeftation of relief from medical affiftance has been left, change of climate has frequently produced a cure. But this implies change of air, change of diet, change of fcene, reviving hope, and above all much ex- ercife, which, if on horfeback, has alone effeaed won- ders. Of rjuing, our immortal Sydenham remarks, Neque magis hypochondriafis prodeft hoc exercitii genus, quam tabidis phthificifque, quorum nonnulli mihi fan- guine junfti multum terrarum equo veaore peragrantes, ex meo confilio, fanitati funt reftkuti; cum certo iciam me vel medicamentis quantivis pretii, aur alia methodo, qiuTcunque demum ea fuerit, nihil magis iifdem proficere potuiffe, quam li multis verbis hortatus fueram ut recl:e valerent. N.que in brevioribus tantum malis, crebra tuffi & maae flipatis, id remedium obtinuit, fet ed in iabe tantum non deplorata, ubi noaurnis fudoribus jam etiam aoaffrrat diarrhoea, quae phthifi confeais mortis praenuntia folet effc. " Genus 154 HAEMORRHAGES. Genus XXXII. H^morrhois. The Piles. The fymptoms are, flux of blood from the anus ; pain there, and hemorrhoidal fwellings j vertigo ; pain in the loins, and headach. SECTION I. Hemorrhoidal Flux diftinguifhed into Aclive and Pajfive. The hemorrhoidal flux, like other haemorrhages, may be either aaive or paflive; the former falutary when moderate and critical, but not fo when untimely or ex- ceflive ; the latter - ufelefs at beft, and frequently injuri- ous. It muft be confidered as exceffive and injurious, when it deftroys the appetite, weakens the digeftion, prevents nutrition, or brings on fpafmodic afteaions, with other fymptoms of debility. In fuch circumftances it terminates in either heaic or in dropfy. ^ The aaive hemorrhoidal flux is ufually preceded and attended by vertigo and headach ; weight and pain in the back and loins; fometimes by numbnefs in the thighs ; conftriaion and fenfe of coldnefs in the extrem- ities ; flatulence in the lower belly ; hard pulfe ; drynefs of the fauces; pale and deficient urine, with frequent inclination to make water. The blood at firft is black and clotted, but afterwards red, then fometimes ferous, with fome refemblance to the white of an egg. This difcharge may be internal or external, periodical or accidental, either direaiy from the arteries, or it may firft ftagnate in the cellular texture, and form internal or external tumor. The perfons moft fubjea to aaive and periodical dif- charge of blood by the hemorrhoidal veffels are, fuch as are of a florid complexion, with a lax fibre, who indulge freely at a plentiful table with wine and fpices, eating heartily and taking little exercife. Feniaks hemorrhages. 155 Females of this defcription, during pregnancy, or with obftruaed catamenia, are liable to this complaint. It is fometimes a falutary and critical difchage in mania, Tnelancholia, epilepfia, afthma ; and, being unfeafonably checked, it may induce any one of thefe difeafes, or even phthifis, hydrops, fchirrus, nephritis, apoplexia, and paralyfis. SECTION II. Indications of Cure in the Aclive Hemorrhoidal Flux. During the flux little can be done, but to keep the body cool and perfeaiy at reft, whilft moderate aftrin- gents, fuch as conferve of rofes with elixir of vitriol, may be internally exhibited. To prevent a return, recourfe muft be had to temper- ance and exercife. ^ Spices and fpirituous liquors muft be forbidden ; and violent exertions, mental or mufcular, muft be carefully avoided. Lemonade, or cold water acidulated with either elixir of vitriol, or with vinegar, may be the ordinary drink. The body fhould be kept open with tamarinds and rhubarb, with lenitive ekauary, or with fulphur and crearn of tartar ; to which powder of elecampane and liquorice may be added, to promote a determination to the fkin. 3£> EledT:. e Senna, gifs. Lac Sulph. 5ij' Cryftal. Tart. 3fs. Syr. Rof. folut. q. s. M. f. Eleft. c. c. M. N. M. bis die. That is, Lenitive electuary an ounce and half ; lac fulphuris two drams; cryftals of tartar half a dram ; fyrup of rofes fufficient to make an eleftuary, of which take the fize of a nutmeg morning and evening. Sir John Pringle was fond of this prefcription. Moderate aftringents, fuch as conferve of rofes, chalyb- eate waters, or the Peruvian bark in fmall dofes, have an excellent^ effea ; but the more powerful aftringents muft be avoided. The 156 hemorrhages. The learned Profeffer of Hall, on this fubjea, moft judicioufly obferves, " nihil magis adperniciem ducit quam valde debilitatis corporibus, ftyptica, aftringentia, opiata, velalia fortiora remedia exhiberc." Vol. I. p. 344. SECTION III. Indications of Cure in Pajfive Hemorrhoidal Flux. This admits of more powerful tonics and aftringents, to brace the relaxed veffels. With this intention, a gen- erous diet, cool air, and exercife, are to be ftrongly rec- ommended. ^ But as this fpecies moft frequently is induced by cof- tivenefs, the bowels muft be preferved fluxile by means of fulphur and cream of tartar, made into an ekauary with pulp of tamarinds, of caffia, or of prunes, or the laft prefc rip lion may be ufed. Should the tumor be external, leeches may be appli- ed ; or fhould the pain be exceedingly diftreffing; a lini- ment may be compofed of the unguentum album and camphor equal parts, with fpirits of wine a fufficient quantity, to which a few drops of liquid laudanum may be occafionally added. In fuch circumftances three preparations have been much recommended : §, Cap. papav. alb. unc. 4. Coque ex Aq. font. ft. 4. ad fk 2 Aceti unc. 2. M. f. Fotus Anodynus. & Sperm. Ceti, dr. 3. 01. hyofcyam. dr. 1. Camph. gr. 6. Croci, gr. 10. M. f. Liniment, quo calide inungentur tumores. The laft is an epithem compofed of lime water, rofe water, elder flower water, camphorated fpirit, with a fmall quantity of fugar of lead, to be applied warm on linen to the part. Sir John Pringle injeaed twice a day lime water one ounce and half, with arquebufade half an ounce. In Spain they have an excellent ointment, which they call ung. malorum infanorurn, which gives eafe with fafety. SECTION + haemorrhages. '57 SECTION IV. Remedy for Fiftula. When the haemorrhoidal tumors have been fuffered to inflame to a confiderable degree, and by intemperance or ill treatment have been hurried on to fuppuration ; fiftulous ulcers may be formed, and thefe, when they be- come inveterate, require the afliftance of the knife. But, previous to this, it may be expedient to try what can be done by the pafte formerly in great requeft, when admin- iftered by Dr. Ward. It is thus prepared : Take elecampane and black pepper, of each one pound ; fennel feed three pounds ; powdered and lifted through a fine fieve. Thep take honey and fugar, of each two pounds ; melt thefe together over a gentle fire, fcumming them till they become bright as am- ber. When cool, mix and knead this mixture and the powders well together. Of this, a bit as big as a nutmeg may be taken twice a day. From this preparation the celebrated Dr. Marryot de- rived the ingredients of his medicine, only varying the proportions, and combining with them fulphur and bal- fam of copaiva. SECTION V. Of Reft or ing the Hemorrhoidal Flux. When habitual haemorrhoidal flux, being unfeafon- ably flopped by ftyptics and powerful aftringents, has been fucceeded by fome more troublefome or dangerous difeafe, it may be expedient to reftore this falutary and critical difcharge. For this purpofe it has been recommended to bleed in the foot ; but this alone will be infufficient for the purpofe. It will be needful, therefore, to give fmall do- fes of aloes, to be repeated till the effea defired is pro- duced. §> Limat ferri recent. Aloe Soc. Ta. 5fs« Gum Ammon. 5j« Syrup, q. s. ut f. pill. 30. Cap. pill. iij. m. & v. Genus 4 »J8 hemorrhages. Genus XXXIII. Menorrhagia. Flooding. The proper fymptom is immoderate flow of the men- fes or lochia. SECTION I. Of Menorrhagia as diftinguifhed into Aclive and Pajfive. Aclive Menorrhagia is preceded by headach, vertigo, difficulty of breathing, chillnefs, then flufhing heat, fre- quent pulfe, coftivenefs and thirft, with more than com- mon pain in the back and loins. The proximate caufe is morbid increafe of the hemor- rhagic effort in the uterine veffels. Pajfive menorrhagia has the ufual fymptoms of debil- ity, lofs of appetite, indigeftion, liftkffnefs, a weak and frequent pulfe, palpitation of the heart, want of breath, a pallid countenance, coldnefs of the extremities, with cedematous fwelling of the feet, fainting and low fpirits, with difturbed and unrefrefhing fleep. This fpecies is frequently preceded and followed by leacorrhcea. The proximate caufe is a preternatural laxity in the extremities of the uterine veffels. The remoter caufes are, fuch as increafe the determin- ation of blood to the uterus ; fuch as irritate or over- ftrain its veffels; and fuch as induce general debility and, relaxation of the fyftem. SECTION II. Indications of Cure in Aclive Menorrhagia. The indications derived from the caufes remote and proximate are, To avoid fpices, fpirits, and high feeding ; heat; vio- lent exertions, either mental or mufcular ; and whatever naturally ftimulates the veffels of the uterus. To live principally on milk and vegetables ; to drink cold water ; to keep the body open by rhubarb, fulphur, and foluble tartar ; HAEMORRHAGES. x59 tartar; or, if it fhould be needful, to clear the ftomach by emetics, and, when the pulfe admits of it, to ufe the lancet. SECTION III. Indications of Cure in Pajfive Menorrhagia. These are, i. To avoid all occafional caufes of debility. 2. To invigorate the fyftem by aftringents and by tonics^ The medicines I have always given in common cafes are the following: jj> Cinchon. un. I. Alum. dr. 2. Conferv. Rofar. dr. 4. , Syr. Rof. q. s. f. Eleft. c. M. N. M. ter in die. That is, Take Peruvian bark one ounce ; alum two drams ; conferve of ro- fes half an ounce ; fyrup of rofes a fufficient quantity to form an eleftuary. $> Cinchon. un. I. Ter. Japon. Limat. ferri, aa. dr. i|. Syr. Zinzib. q. s. f. Elect. c. M. N- M. ter in die. That is, Take Peruvian bark one ounce ; Japan earth and filings of iron, each one dram and an half; fyrup of ginger a fufficient quantity to form an electuary. » ^ Cinchon. un. 1. Rubig. Ferri, dr. 4. Conf. Cort. Aurant. un. 2. Pulv. Arom. dr. 2. Syr. Cort. Aurant. q. s. f. Elect. c. M. N. M. ter in die. That is, • Take Peruvian bark one ounce; ruft of iron half an ounce ; conferve of orange peel two ounces * aromatic powder two drams ; fyrup of oranges a fufficient quantity to form an electuary. Of cither of thefe, the fize of a nutmeg is to be taken three or four times a day. Thefe medicines have feldom difappointed my expec- tations, either in menorrhagia rubra, or in the menorrha- gia alba'. Other praaitioners have given tonics and aftringents in a different form. Thus, for inftance, Profeffer Hoffman, from his own experience, 1&o hemorrhages. experience, recommends the powder ofHeurmius, of which the following is the form: R, Sem. hyofcyam. Sem. Papav. Alb. aa. dr. i. Hsematit. Coral. rub. aa. dr. ■§. Camp. fcr. \. M. c. dr. •§, m. & v. That is, Take the feeds of hyofcyamus and of white poppies, of each one dram ; hasmatite and red coral, of each half a dram ; camphor half a fcruple. Mix. The dofe is half a dram morning and evening. Other praaitioners advife opium one grain, with five or fix grains of rhubarb every night. The fame caution will be ufeful here, as in the pre- ceding genus, to avoid the moft powerful aftringents, when the vital energy has been much reduced, left the haemorrhage fhould be thereby increafed. In cafes of uterine haemorrhages, after parturition or abortion, when the patient is exhaufted by a lofs of blood, it has been common to give cordials ; but thefe, whether aromatic or fpirituous, fhould at firft be cau- tioufly avoided, becaufe they excite the circulation, and increafe the haemorrhage. The beft praaice, in fuch cafes, has been found to be the application of cold injeaions and mechanical ftimu- lus locally applied, to excite contraaion, both in the fi- bres of the uterus and in the extreme arteries. At the fame time the patient muft be expofed to the aaion of cool air, aryi muft be perfeaiy at reft. A clyfter with fifty drops of laudanum, may be thrown into the reaum. S E C TI O N IV. Particular Direclions in Cafes of Menorrhagia Alba. This flux, known alfo by the name of fluor albus, or the whites, muft be, in recent cafes, carefully diftinguifh- ed by its proper fymptoms, fuch as general debility, lofs of appetite, indigeftion, faintnefs, palpitation of the heart, pain in the loins, and irregularity in the menftrual peri- ods ;' or by its preceding and following this difcharge. But HAEMORRHAGES. 161 But if, inftead of thefe fymptbms, heat of urine with itching are obferved to precede, and frequent defire to make water accompanies, this flux, efpecially if the dif- charge fhould be green or yellow, the injured female may be certain that her's is not a fluor albus. Should it, however, prove to be of the two, that from which leaft is to be apprehended, the fame medicines nearly will be needful, as have been recommended for the paflive menorrhagia, with the addition of oxygen air; and thefe I have feen attended with fuccefs. Dr. Whytt fometimes in obftinate cafes, ordered alum whey, to be made by putting one dram of the alum to a pint of boiling milk. Of this he gave three ounces fweetened with fugar four times a day. R, Lact. recent, bullient. ftj. Alum rup. dr. i. M. ut fiat coagulum & fero colato adde Sach. alb. un. I. Capiat un. 3. quater in die. Dr. Nankivell orders, R, Pulv. tenuiff. Alum. rup. Ferri vitriolati, a. gr. 24. Sang. Dracon. Extr. Cort. Peruv. a. 5ifs. Extr. Cathart. gr. 12. ----Opii. gr. 2. Syr. f. q. f. f. Pill. N048. q. c. 4. mane, paulo poll jentaculum, Ii. la ante prandium, & 7a vefp. fuperbibens cyathum infuf. fort. Flor. Chamaemel. vel Cardui benedict. Hoffman placed his chief dependance on rhubarb with foluble tartar, in fmall dofes ufed daily, and on fteel with bitters. Many have been relieved by afTe's milk, with conferve of rofes, and gum arabic, taken every morning. Sea bathing is excellent in this complaint. In Dr. Cullen's Nofology The fifth and laft order of the clafs PYREXIA is Profluvia ; of which the charaaer is, Pyrexia, with in- creafed excretions. It contains two genera, Catarrhus and Dyfenteria j of which I have referred the former to PhjlegmasIjE, and the latter to Spasmi. W Clafs 162 NERVOUS DISEASES. Clafs II. NEUROSES. Nervous Difeafes. J_ HE diftinaive charaaer of this clafs, as we have already mentioned in the firft page, is, Affeaions of fenfe and motion difturbed ; without either idiopathic Pyrexia or topical difeafe. The orders of this clafs are four: 1. Comata. 2. Adynamie. 3. Spafmi. 4. Vefanie. Of which the pathognomic fymptoms are the fol- lowing : 1. Comata. A diminution of the power of voluntary motion, with fleep, or with the fenfes impaired. 2. Adynamia?. A diminution of the involuntary motions of either vital or natural funaions. 3. Spafmi. A morbid contraaion or motion of mufcular fibres. 4. Vefaniae. The judgment impaired, without either Coma or Pyrexia. Of the order Comata we have two genera. 1. Apoplexia. 2. Paralyfis. But we may confider them as four : 1. Apoplexia. 3. Cataphora. 2. Hydrocephalus interims, j 4. Paralyfis. Clafs II. NEUROSES. Order I. Comata, Genus XXXIV. Apoplexia. Apoplexy. The fymptoms are, abolition of the powers of fenfe and motion, with fleep and fometimes fnoring ; the refpiration and motion of the heart remaining. Thefe NERVOUS DISEASES. 163 Thefe are the fymptoms during the paroxyfm.; others precede, to warn us of its approach. Such are, fulnefs of the head ; epiftaxis ; giddinefs ; lofs of memory, and confufion of thought ; fomnokn- cy ; deep fleep ; diftreffing incubus ; imperfea articu- lation ; flow fpeech ; virion difturbed by corrufcations of light or by tranfient darknefs ; ringing in the ears or deafnefs ; tremors, numbnefs, and a fenfe of creeping on the limbs. SECTION I. Of the Proximate Caufe of Apoplexy, and Diftinclion into Species. The proximate caufe of apoplexy is undoubtedly preffure on the brain, either by external violence or by tumours, but ufually, and as conftituting the difeafe, of which I am about to treat, either by diftenfion of blood veffels or by effufion of fluids, which may be either of blood from ruptured veffels, or of ferum paffmg by exhalants. This lays the foundation for diftinguifhing apoplexy into fanguine and ferous. Befides thefe fpecies, Hoffman has taken notice of a third, called by him fpafmodic, which, although ftriaiy fpeaking, fanguine, yet requires a feparate difcuffion. Coma is the flighteft kind of apoplexy, being nothing- more than deep, yet morbid, fleep. SECTION II. Of the Degrees of Apoplexy. We are not fufficiently acquainted with the nature and funaions of the brain to determine what degree of preffure, and where applied, produces lofs of voluntary motion, whether general or partial ; or this combined with lofs of any, or of all, the fenfes. Much lefs are we able to point out, what degree or what extent of preffure, and where applied, is neceffary, by 164 NERVOUS DISEASES. by the fufpenfion of the vital funaions, to deprive the animal of life. Yet fhould we even renounce the notion, of different fets of nerves defigned by nature for the feveral purpofes of fenfation, of voluntary and of vital motion ; we can readily conceive one reafon, why the aaion of the lungs, of the heart, and of the inteftines, fhould continue, when the fenfes fail and when volition ceafes. This may arife from their irritability, which, although diminifhed, is not inftantly deftroyed by preffure on the brain, and from the ftimulus of blood, of air, of food, which without the leaft diminution, continue to excite thofe organs. SECTION III. Of the Sanguine Apoplexy, and of Carus. The fpecific fymptoms are, a florid colour, with flufh- ings of the countenance ; the veins of the head and neck are turgid ; the face is bloated ; the eyes protu- berant, and fuffufed with tears ; the heart beats ftrongly ; the pulfe is full ; and the animal heat is high. The age moft fubjea to fanguine apoplexy is from forty to threefcore. It feldom attacks young people, al- though in them confeffedly the determination is to the head, becaufe in youth epiftaxis, and as we advance to manhood, hemoptyfis, prevents congeftion in the veffels of the brain. Perfons of a fanguine temperament and of a relaxed fibre, the indolent, the corpulent, the plethoric, and fuch as are debilitated by age, by intemperance, by ex- ceffive evacuations, or by difeafe, with thofe who have omitted their accuftomed bleedings, or in whom epiftax- is, hasmoptyfis, the lochia, catamenia, or the hasmor- rhoidal flux, have been fuppreffed, are the perfons moft expofed to fanguine apoplexy. The predifpofing caufe, therefore, is, fulnefs of veffels, with a relaxed fibre ) or it may be, either plethora or debility alone. The NERVOUS diseases. 165 The occafional caufes are obferved to be, i. Mental ftimuli, or violent paflions of the mind, fuch as anger and terror ; anger, which quickens the refpiration and the pulfe, augments the animal heat, and determines the blood with increafed impetus to the vef- fels of the head : or terror, which, inducing fpafmodic ftriaure on the furface of the body, drives the blood in too great abundance from the circumference to the cen- tre, to the heart, and to the brain ; whilft fear only finks or retards the pulfe, flowly diminifhes the heat, and qui- etly extinguifhes the vital flame. Sydenham and Hoffman have remarked, that when terror fucceeds to copious haemorrhage of any kind, or to the pains of parturition, the aimoft inevitable confe- quence has been a fatal apoplexy. 2. Material ftimuli, fuch as wine, brandy, opium, in confiderable quantity, with the ftimulus of food in tod great abundance ; warm rooms, hot bathing, and a fcorching fun. 3. Mufcular exertion, if fudden and violent, by dri- ving the blood into the veflels of the brain; or tight liga- ments about the neck, by preventing its return. 4. Spafmodic ftriaure in any part of the arterial fyftem. This, it is evident, may induce the determination to the brain already mentioned. For the arteries do not aa merely as elaftic tubes, but have their mufcular coats; by which their dimenfions may be much contraaed. The larger arteries indeed have little mufcular power, but as they recede from the heart, the mufcular power is gradually increafed, and the elaftic power is diminifhed, till in the extremities the aaion of an artery is probably aimoft wholly mufcular. We have noticed above, the operation of anger and of terror, and have only here to add, that the tremor, de- bility, and fudden convulfions, which attend thefe paf- fions, fufficiently denote affeaions of the brain. In thefe paflions, the refpiration labours, and the re- turn of blood from the veffels of the head is checked, at the 166 NERVOUS DISEASES. the fame time that the fpafmodie conftriaion of the arte- ries increafes the determination to the brain. In cafes of fpafmodic ftriaure, the face is red ; the pulfe is full and frequent ; a warm and copious fweat breaks out, and frequently the apoplexy ceafes. The perfons fubjea to this more favourable form of the difeafe in queftion are, the young, the fanguine, and thofe who have an irritable fibre ; more efpecially hyf- terical and epileptic patients. In them it is the leaft fatal, and feldom terminates in palfy. Yet a mortal epikpfy ends univerfally in the apopkaic ftroke. I am inclined to think that there is fome kind of fpaf- modic ftriaure, when, as frequently happens, apoplexy is confequent on the fweating of the feet imprudently re- preffed, or any herpetic eruption checked ; or from the irritation of worms in the alimentary canal, as in the apoplexia verminofa of Sauvage. The fame obfervations may apply to apoplexy, when it arifes from affeaions of the ftomach. Dr. Fothergill gives fome countenance to this opinion ; for, as it appears by the London Medical Journal, he at- tributes the apopkaic ftroke, in fome cafes, to a dif- tended ftomach and to overloaded bowels : and Van Swieten, in his Commentaries, § 1017, not only de- livers the fame doarine, but gives an inftance of a friend who was cured by a copious and fpontaneous vomiting. In confirmation of this idea it may be obferved, that many are feized with apoplexy after having fed vora- cioufly at a venifon or a turtle feaft. The injury, in my opinion, does not arife fo much from diftention of the ftomach creating a preffure on the aorta, as from the ftimulus of food, and fympathy ; be- caufe it happens not merely during fleep, when the glut- ton is lying on his back, but whilft the body is erea, and before the gorged morfels can ferment. Carus may derive its origin from the fame caufe with fpafmodic apoplexy. Of this, combined with lethargy, we have a curious cak in Hoffman. A J. 1 NERVOUS DISEASES. 167 A man aged 66, thin, yet plethoric, and accuftomed to bleed twice a year, had omitted this evacuation for twelve months, when, from ter- ror, he was feized with coldnefs in his extremities, oppreffion and diffi- cult refpiration, yet his face continued bloated and red. Soon after this attack he had pain in his head, heavinefs, vertigo, lethargy. In this condition he undertook a journey, but he was unable to pro- ceed, being prevented by fo profound a fleep, that for four days he could neither {land nor open his eyes. At length being roufed, he found great languor, proftration of ftrength, and perpetual defire of fleep. He breathed freely, but his pulfe was oppreffed. He had no appetite, was coftive, and made little water. The Profeffor, in thefe circumftances, bled him largely in the foot ; gave him a laxative antifpafmodic clyfter ; recommended the warm pediluvium'at night ; applied fpirit of hartfliorn to his noftrils ; and ordered him to take fal volatile with a tincture of antimony ; by which treatment he was foon reftored to health. In other cafes the Profeffor removed fimilar affeaions by antimonial emetics. That in fanguine apoplexy there is really diftention of the veffels, producing rupture, extravafation, and preffure on the brain, is clearly proved by the flux of blood and ferum from the noftrils after death, as well as by multipli- ed diffeaions. Dr. George Fordyce is of opinion, after having examined the brains of ninety eight apopkaic and paralytic patients, in all of which he difcovered ex- travafated blood, that this is the moft common caufe of thefe difeafes, and John Hunter perfeaiy agrees in this opinion. From the operation of remote caufes, as already fta- ted, the exiftence of fuch a congeftion can be readily conceived, when we confider, that one tenth nearly of the blood circulates with great velocity in the veffels of the brain, and that thefe are tortoufe, minute, and not, as in other parts, defended by ftrong membranes. Indeed rupture and diftention would more often hap- pen, were it not for a moft provident contrivance well known to the anatomift, by which the blood is checked and retarded as it approaches to the brain. Carus, as a {lighter fanguine apoplexy, is attendant upon fevers*chief!v of the intermittent fpecies; or it may be induced by paflions of the mind. In i6S NERVOUS DISEASES. In this there is fome perception, but not of long con- tinuance ; fome fenfation, yet fmall. The patient feldom awakes fpontaneoufly, and, when with difficulty roufed, foon fleeps again. The epidemical Synocha pf 1673, defcribed by Syden- ham, was attended in younger fubjeas, by delirium ; in adults by carus, during which the patient flept for fome weeks, or, as it appears, from 28 to 30 days, and fo profoundly that they could fcarcely be roufed to take their ufual drink or medicines. This fymptom was frequently induced by warm fudo- rifics, and relieved or rendered fafe by bleeding and re- frigerant clyfters. Carus may be brought on by extreme intoxication. Van Swieten tells us of a man, who in a drunken fit flept four days, and awoke only as two furgeons, having fhaved his head, were preparing to trepan him. SECTION IV. Indications of Cure in Sanguine Apoplexy and in Carus. These are, 1. To diminifh the preffure on the brain. 2. To reftore tone to the debilitated veffels of the brain and to the fyftem in general. The firft intention may be anfwered, 1. By copius bleeding from the jugular veins, from the arm, and from the temples. The relief received, together with the fulnefs, hard- nefs, and frequency, of the pulfe, muft determine the practitioner as to the propriety of repeating the bleed- ing. 2. By carminative clyfters and moderate cathartics, fuch as fenna, rhubarb, nitre, or foluble tartar, with tamarinds and fome kind of aromatic water. §> Decoft. Avenge tenuif. ft j. Flor. Chamasmel. m. 1. Sem. Cumin, un. \. Cuque & colatune adde Olei Olivar. un. 1. Sacch. dr. 3. M. f. Clyfma. That NERVOUS DISEASES. 169 That is, Take thin oatmeal gruel one pint, chamomile flowers a handful, cumin feeds half an ounce ; boil and" ftrain. Then add olive oil one ounce, fugar three drams. Mix for a defter. §> Tamarind, un. I. Coquein Aq. font. ffcj. et colaturae adde Rhei ; Kali tartarifat. aa dr. 2. Aq. Cinnamom. un. 1. M. C. un. j.'alternis diebus mane. That is, Take tamarinds one ounce ; fpring water a pint; rhubarb and folu- ble tartar, of each two drams ; cinnamon water one ounce. Mix. Three ounces to be taken every other day, in the morning. & Rhei; Kali tartarifat. aa fcr. 1. Pulpas Tamarind, q. f. f. Bol. That-is-, Take rhubarb and folnble tartar, of each one fcruple ; the pulp of tamarinds fufficient to make a bolus. It muft be here remarked,that during the paroxyfm,to prevent the accumulation of blood in the veffels of thefe brain, the patient muft be fupported in a chair, and his apart ment muft be preferved cool. The fecond intention is chiefly prophylaaic. This may be anfwered by temperance, cool air, and conftant exercife, with^gentle tonics and aftringents; but more efpecially by avoiding whatever has a tendency to induce debility, and paying particular attention to pre- ferve the feet from cold. Spafmodic apoplexy being merely a variety of the fan- guine, the indications of both will coincide ; but the meth- od of anfwering thofe intentions will not be perfeaiy the fame. The fpafmodic certainly does not admit of bkedincr to the fame extent as the purely fanguine, for which reZ fon the young praaitioner muft pay particular attention to the pulfe, the countenance, and the refpiration, whilft the blood is flowing ; and, if the fymptoms are not aggra- vated, he may proceed with confidence. In this form of the difeafe, to diminifh the preffure on the brain, it will be needful to refolve the fpafm which caufes the determination to that vital ors;an. This intention may be anfwered, after bleeding, by re- X moving 170 NERVOUS DISEASES. moving the occafional caufe of fpafm. If the fpafm is oc- cafioned by vifcid mucus, bile, or indigefted fordes in the ftomach ; an emetic may be given. If the caufe is in the bowels, they may be fafely evac- uated by the carminative clyfter already mentioned, to be repeated foon if needful, or at the diftance of fome * hours. If it be worms, anthelmintics will deftroy them. In this form of apoplexy, the legs fhould be plunged into warm water, which will both relieve the fpafm and make a derivation from the head. SECTION V. Of Serous Apoplexy, and of Lethargy. The fpecific fymptoms are, a pale and bloated coun- tenance ; a weak and languid pulfe ; fleepinefs and tor- por ; coldnefs in the extremities ; lofs of memory, and decay of faculties ; flow fpeech ; fhortnefs of breath du- ring motion ; fwolkn and watery eyes ; fcarcity of urine, and univerfal tendency to dropfy ; with other fymptoms marking its gradual approach more certainly than that of the fanguineous. The perfons moft liable to the attack of ferous apo- plexy are, fuch as are of a relaxed habit; dram drink- ers ; the aged and infirm ; the indolent and fedentary ; the ftudious, who grow pale over their books ; and fuch as have been worn out by greif, more efpecially if con- fined to damp and gloomy habitations. As to the occafional caufes, they are in fome meafure the fame with thofe already mentioned in fanguine apo- plexy. Yet here it may be remarked, that the fanguine may produce the ferous, as the natural confequence of a pre- ternatural afflux and congeftion of blood in the veffels of the brain. ^ And moreover it has been frequently obferved, that either ifchuria or the untimely fuppreflion of copious e- vacuations from the falivary glands, or even the fudden drying up of ulcers, have produced the fame effea. It NERVOUS DISEASES. 171 It is fometimes relieved by fever; at other times by fpontaneous purging of watery humours j but it moft frequently terminates in palfy. That, in fuch cafes, there is really an effufion of fe- rum in the ventricles and finufes of the brain, has been evinced by numerous diffeaions. Lethargy is a {lighter kind of ferous apoplexy. In this the patient fleeps aimoft inceffantly, for although he may awake fpontaneoufly and eafily be roufed, yet he foon forgets what has been faid, appears void of anima- tion, and numbers inftantly again. It fometimes fucceeds phrenitis, and ufually termin- ates in apoplexy. SECTION VI. Indications of Cure in Serous Apoplexy, and in Lethargy. These are, 1. To remove the preffure on the brain, as the proximate caufe. 2. To obviate debility, as the predipofing caufe. 3. To avoid the occafional caufes of the difeafe. To anfwer the firft intention we have recourfe, 1. To blifters on the head, and to antimonial emetics. §> Antimon. tartarifat. Mercur. vitriolat. IS. gr. 5. M. pro Emetico. 2. To clyfters, and to powerful cathartics, fuch as aloes, jalap, fcammony, colocynth, and calomel. §> Decoft. avenae, }b.j. 01. Oliv. gj. Salis Marin. 3ij. M. f. Enem. p. r. n. ini. That is, Take oatmeal gruel one pint, olive oil an ounce, common fait two drams, for a clyfter. §, Aloe foe. Colocynth. Scammon. aa. gr. 10. Jalap, Calomel, aa. gr. 30. Syr. Simp. q. s. f. Pil. N° 40. c. 2. alternis diebus mane. That is, Take fuccotrine aloes, colocynth, and fcammony, of each ten grains: jalap and calomel, of each thirty grains ; fyrup of fugar a fuffici- ent quantity. Make forty pills, of which take two every other day, in the morning. !£> Calomel. 172 NERVOUS DISEASES. §> Calomel, gr. 10. Jalap, gr. 15. Zinzib. fcr. 1. M. mane fumend. That is, Take calomel ten grains, jalap fifteen grains, ginger one fcruple. Mix, and take it in the morning. Sir John Pringle was accuftomed to prefcribe thefe medicines, but in a more elaborate form. §> Refin Jalap. Amygd. dul.aa.gr. 12. terantur fimul, paula- tim affundendo Aq. font. unc. j. fiat Emulfio ; Colaturae, adde Gum Tragacanth. gr. 5. Calomel gr. 8. Sacch. alb. dr. \. M. fiat hauft. ftatim fumend. 3. To diaphoretics, and more efpecially to diuretics of the flimulant order, fuch as the balfams and tereb in- thinates, or rather ammonia combined with aether, in e- qual parts, to the amount of from a dram to four fcru- ples three times a day. Setons in the neck are ufeful. To anfwer the fecond intention tonics and afiringents muft be reforted to, fuch as bitters and the Peruvian bark, but efpecially combined with fteel. ]$, Quaffiae, dr. 1. Caffias Lig. dr. \. Aq. bul. un. 8. M. f. Infuf. - Colaturas un. 3, adde Cinchon. fcr. 1. M. c. o. 8a. hora. That is, Take quaflia one dram ; caffia lignia half a dram ; boiling water eight ounces. Make an infufion. Strain it ; and to three oun- ces of the infufion, add one fcruple of Peruvian bark for a dofe, to be repeated every eight hours. 1£> Cinchon. un. 2. Limat. ferri, dr. 3. Valerian, dr. 4. Syr. Zinzib. q. s. f. EIe£t. v c. M. N. M. ter in die. That is, Take Peruvian bark two ounces ; fteel filings three drams ; valerian half an ounce ; fyrup of ginger fufficient to make an electuary. Take the fize of a nutmeg three times a day. All the aftringents formulae from 76 to 83 in my Compendium will be ufeful. During the paroxyfm, I would wifh to recommend the infpiration of oxygen air. Dr. NERVOUS DISEASES. I 73 Dr. Woodford, of Briftol, has communicated a cafe of ferous apoplexy, in which his judicious preceptor Dr. Gregory difcovered that acutenefs of difcernment for which he is juftly diftinguifhed as a medical praaitioner. C. D. labourer in Edinburg, aged 51, addicted to the drinking of fpirit8,'was admitted into the Royal Infirmary with anafarca and af- citcs. A few days after admiffion, the anafarca in the inferior extremities fuddenly receded, and prefently after, the face having fwelled, fymp- toms of Coma appeared, which gradually increafed to a perfect apo- plexy. Dr. Gregory directed the head to be (haved, a blifter to be applied, and two or three dofes of a ftrong cathartic, compofed of jalap and calomel, to be adminiftered ; by which the patient was fpeedily reliev- ed and foon difmiffed. Genus XXXV. Hydrocephalus Internus. The pathognomonic fymptoms are, in children,laffitude, a flight Pyrexia, pain in the head, a fluggifh pulfe, drow- finefs, and dilated pupils. SECTION I. Of the Progreffive Symptoms and Termination of Hydro- cephalus. In infancy, the futures of the cranium open. M. Petite, in the Memoirs of the Academy of Scien- ces at Paris, has remarked other fymptoms at the com- mencement of this difeafe, which are worthy of attention. Thefe are, convulfive motions of the lips and eyelids; biting the lips ; picking the nofe ; grinding the teeth ; coftivenefs or purging ; languor of the eyes; palenefs ; debility ; heavinefs, and depreffion of fpirits ; fleepinefs, with perpetual moaning, and fometimes inability to fup- port the head upright. He obferves, that the difeafe comes on after worms, painful dentition, and violent con- vulfions. To thefe fymptoms Dr. Fothergill adds, naufea, Jh^rt and '74 NERVOUS DISEASES. and difturbed fleep ; and, towards the clofe of the dif- eafe, urine and ftool coming infenfibly away ; the iris immoveable ; the heat great; breathing fufpirious ; the pulfe trembling, and quick beyond the poffibility of count- ing ; after which a fpafm finifhes the whole. The patients of M. Petite, died convulfed, and he % found water in the brain. SECTION II. Of the Clafs of Hydrocephalus. Dr. Cullen could with difficulty fatisfy his mind, where he fhould place this difeafe. Boerhaave and Sauvage had arranged it under dropfy; but he, diffatisfied, conneaed it with apoplexy : yet more modern praaitioners feem inclined to confider it as be- longing rather to the Phlegmafie. I have left it where I found it. Time, and more ex- tenfive experience, muft determine the refpeaive merit of thefe nofologifts. Dr. Percival obferves, that hydrocephalus derives its origin femetimes from inflammation, but moft frequently from ftruma and laxity of fibre, inducing plethora, glandular obftruaion, and feeble aaion of the lym- phatic fyftem, all which difpofe to an effufion of water in the brain. He remarks, that in fuch fubjeas, the veffels of the brain quickly lofe their tone by diftentioni in confe- quence of which, torpor and debility of the whole fyftem, follow. SECTION III. Of the Treatment of Hydrocephalus. Many phyficians of great eminence profefs to have cured this difeafe by falivation, and their teftimony fhould not haftily be called in queftion. Yet we muft have leave to hefitate, when fo refpeaabk a praaitioner as Dr. Warren, of Taunton, informs us, that in ten cafes, which NERVOUS DISEASES. 175 which on diffeaion had proved to be hydrocephalus, he had tried mercury in vain ; and that neither by calo- mel, nor by mercurial ointment, could he procure a fali- vation. The matter is rendered more dubious, when we con- * fider, that many, who we cured by calomel, voided worms ; and that many patients, as appears by the tcf- timony of Dr. Foart Simmons, phyfician of St. Luke's, who, on diffeaion, appeared to have water both between the pia mater and the brain and its ventricles, had yet, when living, no fymptoms of hydrocephalus. And fur- ther, that one child, under the care of Dr. Warren, who had all the fymptoms of this difeafe, had no water in the brain, nor any thing remarkable, except much vifcid phlegm in the inteftines. The mode of application commonly adopted to in- duce a falivation has been, to rub in the weak mercurial ointment twice a day and to take calomel at night. In this way Drs. Mackie, of Southampton, and Perci- val, of Manchefter, fucceeded in the cure of what ap- peared to be hydrocephalus ; after which they ad- miniftered rhubarb and Peruvian bark, to reftore the ftrength. Genus XXXVI. Cataphora. Catalepfy. The fymptoms are, fudden lofs of fenfation and voli- tion ; the body and the limbs conftantly retaining the pofition which they had when feized, or which is given to them during the continuance of the fit. Yet all thefe fymptoms are fubjea to degrees of in- tenfity. The eyes are commonly open and fixed ; the pulfe is natural ; the refpiration eafy ; the colour remains un- changed. Women are more frequently attacked by it than men. I had placed cataphora with Dr. Cullen under apo- plexy ; but from the moft accurate defcription of this affeaion. 176 NERVOUS DISEASES. affeaion, it does not appear to arife from preffure on the brain. Hollerius, as quoted by Van Swieten, tells us, that he faw a man, who had alternate coma, epikpfy, convul- fions, and catakpfy. And Hoffman faw the three laft in a young woman. Here, therefore, it feems to be allied to fpafm. It was brought upon a young woman eight days after fhe was married againft her will, and attacked her as of- ten as fhe faw, or even thought upon, her hufband. Terror has been known to induce it fuddenly. Hence the beauty of the poetic image : " Obflupuit,Jletcruntque coma, et vox faucibus hafit." Grief and difappointment, and even pious affeaions? have had the fame effea 5 and joy has both produced and cured it. Profound meditation has been accufed by Boerhaave, perhaps with reafon, as one occafional caufe of catakpfy j and, by his commentator, intenfenefs of thought is con- fidered as nearly related to it: but although men thus engaged can neither fee nor hear, like Archimedes at the fiege of Syracufe, nor yet move from the fpot on which they ftand, yet thefe fymptoms alone do not con- ftitute the difeafe in queftion. He therefore quotes a remarkable cafe mentioned by Galen of a fellow ftudent, who from deep refkaion be- came fuddenly fo immoveable that, as he fat holding his pen, with his eyes fixed on his book, he feemed only to be abforbed in thought, till, by fhaking and calling, they perceived that he had loft all fenfe and power of motion. Stoppage of the catamenia has produced this wonder- ful difeafe. Lambecius, attending the Emperor Leopr Id in one of his excurfions, faw in the Ferol a young woman aged 25, who conftantly twice a week, and at intervals every day, loft all fenfatiori, even when needles were thruft into her flefh ; and wherever fhe was taken, remained immoveable like a marble ftatue, as if fhe had fuddenly beheld Me- dufa's head. Van NERVOUS DISEASES. 177 Van Swieten relates a moft interefting cafe, of which he himfelf was witnefs. A good woman aged about 40, of a rigid fibre, was toafting chef- nuts in a frying pan ; when, deprived of fenfation, (he became fud- denly immoveable, till, in his prefence, (he threw up two living worms (terete*) after which fhe fuddenly recovered, and continued loading her chefnuts, without the leaft confcioufnefs that any thing had happened. She had no relapfe, but for years retained her perfect health. Aetius makes mention of catakpfy relieved by a co- pious bleeding at the nofe. Hoffman conceives, that freezing firft produces cata- kpfy, and then death. And that rapture or ecftafy is to be confidered as allied to this affeaion. SECTION II. * Indications of Cure in Catalepfy. As to the indications of cure little can be faid, becaufe we know nothing of the proximate caufe, and muft, therefore, confine ourfelves to this one point in every cafe, to inveftigate and to remove the occafional caufe of this affeaion, whether it may beobftruaed catamenia, worms, or both united, as in a cafe relieved by Hoffman. This learned profeffor fays, that he has feen the moft ob- ftinate catalepfy cured merely by a change to wholefome air, and, with the utmoft propriety, he adds, accounting for this effea, " that one of its component parts uniting with the blood, communicates fenfibility and motion to the folids.** Vol. III. p. 49. Let the ftudent in this difeafe tread in the fteps of Sydenham, who, when he met with a kind of fever which was new to him, remarked, " Nihil mihi itaque aliud jam reftabat, nifi ut in hunc morbum nudum & ab aliis fepofitum accuratiffimo examine inquirerem, atque oculo adjuviiitia & Isedentia quam diligentef maxime potui, kmper intento, viam pro virili, exploratoris inftar, prastentarem." Y Genus I78 NERVOUS DISEASES. Genus XXXVII. Paralysis. Palfy. The pathognomonic fymptom is, a lofs of the power of voluntary motion affeaing certain parts. SECTION I. Diftinclion of Species, with General Obfervations. Professor Hoffman diftinguifhed palfy into, 1. Hemiplegia, affeaing one fide. 2. Particulars, affeaing fome mufcles only. He made another diftinaion of little importance to the praaitioner, dividing palfy into vera and fpuria ; the former attended by lofs of fenfe and motion, the latter by lofs of motion only. Atrophy, and diminution of vital heat in the limb af- feaed, are alfo fometimes attendant fymptoms. Senac, as quoted by Van Swieten, makes mention of a man, who had loft all power of motion in one arm, whilft the moft exquifite fenfibility remained in it ; and was at the fame time deprived of all fenfation in the other, whilft the power of moving it was unimpaired. ' In hemiplegia, the lofs of fenfe and motion in one fide is often attended by fpafm and convulfive motion in the other ; and, as the difeafe advances, the mental faculties, more efpecially the memory, are much impaired. Hemiplegia and apoplexy have an intimate conneaion. The latter commonly precedes ; and when the former terminates in death, it is univerfally by the apopkaic ftroke. The near approach of hemiplegia, when it is not the confequence of apoplexy, is commonly announced by vertigo and coldnefs of the fide. In a partial palfy, it is ufual for a fenfe of weight and numbnefs to precede the ftroke, and the part affeaed becomes flaccid, cold to the touch, and fometimes, as before obferved, atrophic. When i nervous diseases. 179 When the lower extremities are rendered paralytic, it is not uncommon for the bowels to be torpid. Palfy of the hands and arms is frequently a fymptom of the Colica Piaonum, that is, Colic of Poitou, or Ra- chialgiajMetallica of Sauvage. a SECTION II. Of the Caufes, Remote and Proximate, of Palfy, The proximate caufe of palfy is, interruption of the nervous influence, which may be either by folution of continuity in the nerve of the part affeaed, or by com- preffion either on the nerve or on the brain ; and it is fuggefted by Profeffor Hoffman, that in the paralyfis fpuria the interruption is partial, but that in the vera it is total. When treating of apoplexy, we took notice of two fpecies, the fanguine and the ferous. The fame diftinc- tion will be needful in cafes of palfy; becaufe, the hemi- plegia fanguinea and hemiplegia ferofa have the remote caufes different, and require different indications to effea a cure. Hemiplegia fanguinea acknowledges the fame caufes, predifpofing and occafional, as the apoplexia fanguinea, to which I muft refer the ftudent. The perfons moft fubjea to this are, fuch as are of a fanguine temperament with a relaxed and irritable fibre. The predifpofing caufe is debility, and the occafional may be ftrong ftimuli and fpafmodic affeaions, caufing a determination of blood, as in apoplexy, to the veffels of the brain. Hemiplegia ferofa attacks thofe chiefly who have a re- laxed fibre and abound with ferum, which is, therefore, eafily feparated from the blood; and thofe alfo in whom ferous evacuations have been unfeafonably flopped, or a falivation checked. In fuch patients the pulfe is weak and languid, the face i8o nervous diseases. face is pale, and drowfinefs with torpor mark its near approach. It is moft frequent in autumn and winter. A partial palfy may arife from an affeaion of the fpinal marrow, from fraaure or luxation of the fpine, or from any mechanical compreflion. Of this, paraplegia, or the palfy of the lower extremi- ties, may ftand as an example. Palfy is fometimes relieved fpontoneoufly by fever or by diarrhoea. SECTION III. Indications of Cure in Palfy. The indications of cure muft be taken generally from apoplexy, whether fanguine or ferous, with this referve, that even in the fanguine hemiplegia bleeding, if not adopted early, muft be omitted, for this reafon, that the fanguine from diftention without rupture becomes ferous. In all cafes of inveterate palfy the powerful evacuants muft be avoided, and gentle tonics with aftringents muft be given in their ftead. The bowels, however^ muft be kept foluble by mild and moderate cathartics, or by carminative clyfters, as in the fanguine apoplexy. The following medicines have been ufeful: 5, Teft. Ofteror ppt. Antimon. Calcinat. Cort. Eleuther. aa dr. 2. 01. Cinnam. gtt. 8. M. f. Pulv. c. dr. \ alternis diebus. h. s. That is, Take teftaceous powder, calx of antimony, and cafcarilla bark, of each two drams 5 oil of cinnamon eight drops. Mix j and take half a dram every other night going to reft. ^ Tinct. Lavend. un. 4. Ol. effent. Lavend. ---------Nucis Mofchat, aa dr. 2. Axung. porcin. un. 2. Aq. Ammon. un \ M. f. Ung. quo inungantur fpina dovfi & pedis planta. That NERVOUS diseases. 1*1 That is, Take compound fpirit1 of lavender fouf ounces ; effential oils of lav- ender and nutmeg, of each two drams ; hogB lard two ounces ; fpirit of hartmorn half an ounce. Make an ointment for the back bone and fole of the foot affected.' - It has been ufual in palfy to try every kind of ftimu- lus, externally and internally applied, fuch as canthari- des, horfe radifh, muftard, garlic, fpirit of hartfhorn, guaiacum, aromatics, friaions, cold bathing, and hot bathing. One ftimulating power has, however, indubitable evi- dence in its favour, and comes to us recommended by the moft eminent praaitioners. That is, Eleclricity moderately applied, and long perfifted in. Dr. Ferriar fays, that in ekarifying patients for the palfy, he often remarked they received no benfit till red fiery eruptions were produced on thofe parts of the limb which were furrounded by the chain. Let the ftudent before he has recourfe to it infcribe feftina lente on his machine ; for fmall fhocks invigorate, while ftrong ones exhauft the vital energy, and debilitate the fyftem. Emetics, and alfo cathartics, fuch as fencka, aloe;, fcammony, calomel, and jalap, have been likewife recom- mended ; and thefe, in certain fpecies of palfy, fuch as the rachialgia, biliofa, 2nd ferofa, of Sauvage, may have been attended with fuccefs ; but in this praaice, the fa- gacious phyfician will be guided by his own obfervations on the cafe before him. Of late, the arnica montanahas acquired much repu- tation in the cure of palfies, and from its fenfible quali- ties, from its penetrating, bitter, aromatic tafte, with fome degree of aftringency, it promifes to be a ufeful medi- cine. Since the year 1773, -^rs* Stoll and Collins, of Vi- enna, have had repeated trials of its tonic power ; and the latter is faid to have cured twenty eight cafes of pal- fy, by giving either one dram of the extraa, or from two dratis to half an ounce of the flower.?, infufed in boiling water, every day. 182 NERVOUS DISEASES. In the fouth of Spain I found it highly fpoken of by the moft fuccefsful practitioners. The praaice of Dr. Marryot was in fome meafure pe- culiar to himfelf, yet he was remarkable for curing, al- though not fkilful in defcribing, the feveral fpecies of difeafe fubmitted to his care. He gave in all cafes of palfy dry vomits, of blue vitri- ol and tatarized antimony ; and after thefe, cathartics of calomel with ginger. He ordered blifters, and gave internally a teafpoonful of tinaure of cantharides, with twenty drops of the tinc- ture of muriated iron, twice a day ; or fometimes fteel filings five grains, with either the fame quantity of aloes, or a fcruple of Peruvian bark, twice a day : and he rec- ommended his patients to go into the cold bath every morning. He caufed the fpine to be well rubbed with oil of am- ber twice a day. The firft part of this praaice was certainly proper in paralyfis ferofa ; but the cold bath, unlefs rendered tem- perate, could be proper only for convalefcents. In fuch cafes, therefore, the praaice of Dr. Vaughan, of Leicefter, is much more judicious. He orders, & Sal. Vol. fcr. 2. Elea. Cardiac, fcr. 1. Cantharid. gr. 2. M. f. Bol. > oroni 3 hora fumend. fuperbibendo Infuf. Raph. Ruft. Sinapi. Valerian, & Canel. Alb. That is, Take fal volatile two fcruples; cardiac ek£tuary one fcruple; can- tharides two g>ains. Mske a bolus, to be fwallowed every three hours, with fome infufions of horfe radifh, muftard, valerian, and canella. He applies blifters to the head and the facrum ; and he anoints the fpine with a liniment of fpirit af ammoni- ac and quick lime. After thefe medicines, to convalefcents, he orders aro- matics, bark and fteel, with cold bathing. In all cafes of palfy, continued reft of the affeaed mufcles muft be carefully avoided, becaufe when brought into aaion* they will acquire ftrength by exercife. ' ° This NERVOUS DISEASES. 183 This fhould be moderate, regular, and long contin- ued. Should the patient be obliged to fit, he may yet eafily contrive to exercife both his hands and* feet. For this purpofe, he will require only two pullies faf- tened in the ceiling of his room, at the diftance of fif- teen inches from each other, with a rope, paffing over them, long enough to reach two treadles on the floor, and two bell handles, fattened to a proper height, on the depending ropes. By means of this machine, even a paralytic may, in the moft diftreffing circumftances, contrive to exercife both hands and feet. SECTION IV. Cafes of Palfy. In my Compendium of Nofology, I have introduced a fpecies hitherto unnoticed by nofologifts, and have call- ed it Verminofa. I met with it fome years fince in a lady refident at Bath, who had confulted many of the faculty without the leaft relief. She was at that time under the care of Dr. Marryot, with whom I correfponded on this fubject. « Not fatisficd with knowing merely the nature of the affection, I was anxious to afcertain what had been the occafional caufe; and af- ter a vaft variety of queftions, to all of which fhe anfwered in thenega- tive, obferving the upper lip much fvvelled, I afked her if fhe had any itching in her nofe ? if fhe ftarted in her fleep ? whether fhe was apt to grind her teeth ? whether fhe had noifes in her head, a gnawing pain in her ftomach, with a fickly appetite, coftivenefs, and more efpe- cially a foul breath in the morning. To all thefe queftions (he anfwer- ed in the affirmative. Having thus difcovered that fhe had worms, and obferving that fh= was of an irritable habit, I had little doubt remaining as to the caufe ofthii difeafe. I ordered anthelmintics, fuch as calomel and rhubarb, which wrought from her a great number of worms, man) of which were more than fix inches long. And in the courfe of a few weeks every para- lytic fymptom vamfhed. It 184 NERVOUS DISEASES. It is a fatisfaftion to find that other practitioners have had fimilar experience. And I am pleafed to fee, in the Medical Communica- tions of Dr. Duncan, that a Dr. Allix, of Frankfort, had, in a cafe of the fame nature, cured the palfy by the ufe of anthelmintics. I have already referred the ftudent to Sauvage for a- poplexia verminofa, and he is fufficiently aware that apo- plexy produces palfy. Hoffman, in his ineftimable works, has left us many cafes of paralytic affection fubmitted to his care, and cur- ed by him. Among thefe the moft remarkable are, I—A man aged 40, with a red and bloated countenance, whofe pulfe was both full and frequent, even after many copious bleedings, and plentiful evacuations by carminatives, clyfters, and cathartics of manna and nitre. This patient was foon cured of hemiplegia by thefe evacuations, fol- lowed by Seltzer water, aether, nitre, tepid pediluvian, and ftrict tem- perance. II.—A man aged 60, of a fanguine temperament, fedentary and plethoric, after having had a flight apoplexy, which was cured by bleeding, and by fpirit of hartfhorn with antimony and caftor; this man had a palfy which was immediately and effectually relieved by bleeding only. -111.—A man aged 47, of a fanguine temperament, but of a relax- ed fibre and debilitated habit, being, from ftoppage of habitual perfpi- ration, feized with a perfect hemiplegia, affecting the eye, the ear, half his tongue, and all the mufcles, and even the pulfe, of the right fide, was cured by warm bath with antifpafmodics which reftored the per- fpiration. IV.— A. woman aged 30, of a fanguine temperament fubject to hremaptyfis and hyfferia, and frequently attacked by apoplexy after either frights or fits of anger, having her menfes flopped by tenor. was feized with hemiplegia of the right iide. She was cured after venefection, by bathing in a chalybeate fpriiv, which ftrcngthened her pulfe, increafed the vital heat, and promoted perfpiration. V.—A woman aged 50 and plethoric, after a ftoppage of the hemorrhoidal flux, being feized with palfy, was cured by warm pedi- luvium, bleeding in the foot, and moderate cathartics of rhubarb, nitre, and fait of tartar, exhibited three times a week. VI.—A man a-vl 30 had palfy, induced by the colic of Poitou and attended by coftivenefs. He NERVOUS DISEASES. 185 He was cured by oily fomentations, oil of almonds with cordial ftimulants taken internally, and oily clyfters. The Profeffor mentions two cafes which proved fatal. The firft was of a young man in high health and vig- our, who, from the fudden influence of terror, was feiz- ed inftantly with paraplegia, which, at the end of two years, proved mortal. The other was of a man aged 58, of a fanguineo-mel- ancholic temperament, coftive, irrafcible, and thence fub- ject to jaundice ; who, by a violent fit of coughing, after a crumb of bread had paffed into the afpera arteria, was feized with hemiplegia of the left fide, attended by vom- iting and convulfions of the right arm. Lethargy fupervened, and in one week he died. Clafs II. NEUROSES. Order II. Adynamic. A diminution of involuntary motion in either the vital or natural functions. In this order we have three genera : Syncope, Dyfpepfia, Hypochondriafis. Genus XXXVIII. Syncope. Fainting. The fymptoms are, the refpiration and a&ion of the heart, either ceafe or become much weaker than ufual, with palenefs of the countenance, coldnefs of the extrem- ities, and a cold fweat ufually about the temples. SECTION I. Of the Proximate and Remote Caufes of Syncope. The proximate caufe of fyncope is evidently, extreme weaknefs, or total ceffation of a&ion in the heart. Z The 186 NERVOUS DISEASES. The predifpofing caufe is, generally fpeaking, debility and morbid irritability ; for perfons of an irritable fibre are moft liable to fyncope, and irritability we know is increafed by debility. The occafional caufes are numerous, and require a particular arrangement, that the feveral fpecies may be properly diftinguifhed. SECTION II. Of the Difiinclion of Species in Syncope. The fpecies may be-called, i. Cardiaca. 2. Cerebralis. 3. Pulmonea. 1. Syncope cardiaca, arifing from organic affection of the heart. It returns without any manifeft caufe, attended at in- tervals by violent palpitation of the heart. It is incurable. Of this Dr. Monfey, Dr. Wathen, and Mr. John Hunter, died. 2. Syncope cerebralis, arifing from diminifhed energy in the fenforium induced by, a. Paflions of the mind, fuch as horror, anger, joy, terror. b. Deficiency of blood in the veflels of the brain, as in haemorrhage ; and after tapping, or long ftanding. c. Flatulence in the ftomach, worms, the ftimulus of the gaftric juice when the ftomach is void of food, or perhaps inanition itfelf, and poifons. d. Extreme pain, either exhaufting the powers of life, or rendering the heart and arteries irritable by the aimoft infinitely weaker ftimulus of the blood. I have already ftated that the mufcles of a frog, immediately after de- collation, are not fufceptible of irritation ; but in ten minutes after this, on pricking the toes, the legs, and thighs, and whole body, are violently moved. e. Sudden ceffation of violent pains, as after parturi- tion, or the reduction of a painful diflocation. /. An effort of nature to produce eruptions, or the menftrual flux. g. Exceffive NERVOUS DISEASES. 187 g. Exceflive evacuations, fatigue after hard labour or protracted watchfulnefs, and fevers attended by debility. h. Heat. i. Offenfive fmells. 3. Syncope pulmonea or afphyxia, arifing from deficien- cy of action in the lungs, which is induced by, a. Drowning. b. Strangling. c. Suffocation. This fpecies of fyncope was confidered by Dr. Cullen as an apoplexy ; but the fymptoms and the proximate caufe of this affection reftore it to its proper place. Dr. Goodwyn very properly calls it melanaema, and defines it " impedita fanguinis venofi in arteriofum con- verfio, cuius figna, fyncope, & livor corporis." Here the proximate caufe of deficiency of action in the lungs is the exclufion of vital air, for as Dr. Fother- gill has beautifully expreffed himfelf, no fooner is the vital air excluded, than refpiration is fufpended ; refpi- ration being fufpended, the paffage of the blood through the lungs is intercepted, and of courfe through the whole fyftem. The action of the heart being impeded by the fame caufe, the circulation is fuppreffed. The brain, unfupported by the circulation, being unable to exert its influence, the mental and corporeal actions ceafe; the mind is no longer confcious of the ftate of the body ; and the blood being deprived of its power of generadng heat, coldnefs is diffufed over the whole fyftem.—Fother- gill on the Sufpenfion of Vital Action. SECTION III. Of the Treatment of Syncope Cerebralis. In the fainting fit little need be done to excite the mo- don of the heart; becaufe, 1. Reft or ceffation of action has a natural tendency to accumulate irritability. 2. The chyle and lymph, by the periftaltic motion of the bowels, continue to flo^nto the fubclavian vein and cava, i88 NERVOUS DISEASES. cavas, whilft the venOus blood, by the contraction of the arteries, is tranfmitted inceffantly through the venae ca- vse to the right auricle and ventricle of the heart, which it ftimulates to action. Hence it is obferved, that the right auricle and ventri- cle contract and dilate alternately for near half an hour after refpiration ceafes, and thofe of the left for more than twice as long. 3. The ftimulus of blood in the right ventricle of the heart excites, by confent of parts, the expanfion of the lungs. To haften the recovery it is expedient to admit, not a blaft of wind, which might be injurious, but merely frefh air, which of itfelf is ufually fufficient for the purpofe. This, however, will be rendered more efficacious by blending with it oxygen air, by fprinkling vinegar on the face, and by fmall electric fhocks paffed through the cheft, to excite the action of the heart. In cafe of fyncope from lofs of blood, no ftimulants fhould be applied ; becaufe fyncope is itfelf the moft ef- fectual remedy for haemorrhage, and ftimulants will, by exciting equally the nervous and arterial fyftems, in- creafe the haemorrhage. Hyfterical patients, who faint frequently even at the fmell of the fweeteft flower, require only to be left quiet till they recover of themfelves; for we muft always re- member, " quo levioribus caufis £ff morbis, animi deliquia fuccedunt, eo minus alunt periculi** Some practitioners have abfurdly ufed the lancet, even in cafes of debility, in which the vital energy has been exhaufted by fatigue. When our foldiers in America, after having been ex- pofed during a march to fervent heat, were fainting, ma- ny were bled and died. For immediate lelief after the fit, if the fyncope arofe from paflions of the mind, give wine or Hoffman's ano- dyne with fome aromatic, fuch as a few drops of efien- tial oil, either of mace or cinnamon. Suppofing it to have been induced by any acrimony in the alimentary canal, demulcents, anodynes, and cor- rectors NERVOUS DISEASES. iSg rectors of the peculiar acrimony, muft be combined to- gether. To prevent a relapfe, attention fhould be had to the predifpofing and to the occafional caufes of this affec- tion. The latter muft be avoided, and to obviate the form- er we muft have recourfe to tonics and aftringents, to ftrengthen the habit and to brace the fibre. One cafe of fyncope, calling for fpeedy and powerful exertions, has hitherto efcaped unnoticed, and proved fatal to many recovering from Small Pox and Typhus. When the danger from fever has been over, and the patient has been raifed in bed, or has rifen before his ftrength has been fufficiently*reftored, the blood has fud- denly deferted the fuperior regions of the body, and the miferable object has unexpectedly expired. The fame event from the fame caufe has been obferved in confumptive patients. In fuch cafes brandy fhould be conveyed into the ftomach, and, without lofs of time, the lungs fhould be inflated with vital air. The fame conduct fhould be purfued when parturient women, and when hydropic patients on being tapped, have fuddenly expired. It is very remarkable, that even hydrocele, if confid- erable, when evacuated, has produced faintnefs. fyncope, and death ; as it is reported to have happened in the cafe of Mr. Gibbon the hiftorian. SECTION IV. Of the Treatment of Syncope Pulmonea. Whilst the foetus continues in the womb, the mother decompofes the oxygen air in the blood by means of the placenta, and fupplies the vital heat. But no fooner is the little infant introduced into the world, than new ar- rangements are required ; the foramen ovale clofes'; the lungs expand, and, attracting the vital air, fupply at once the needful oxygen and heat, to ftimulate the heart and to maintain the circulation of the blood. But I GO NERVOUS DISEASES. But when, by either drowning, ftrangling, or by fuf- focation, this ftimulus is wanting, a total ceffation of ac- tion in the heart enfues, producing fyncope, which, unlefs relieved, will terminate in death. In this our firft attention muft be, to inflate the lungs and to oxygenate the blood. Rabbits, mice, and Guinea pigs, have been confined alternately in azotic air and vital air. In the former, refpiration has been fufpended, and the animals have been to all appearance dead ; but no fooner have they been expofed to the action of vital air, than they have difcovered figns of life. The inflation of the lungs may be eafily effected, in the cafe of ftill born infants, by blowing the breath for- cibly into the mouth, whilft their noftrils are clofed ; and, in all cafes above fpecified, with an inftrument con- trived by Dr. Curry, a young phyfician of diftinguifhed merit, or, for want of this, the nozzle of a common bel- lows muft be paffed up one noftril, the mouth with the other noftril being clofed, and the tongue previoufly pulled forward or preffed down to open the epiglottis. Should this practice fail, bronchotomy muft be per- formed ; and, by dividing the two arytenoid cartilages, a paffage muft be made for the air into the lungs. When fuper oxygenated air, or, in defect of this, when atmofpheric air, has been received into the lungs, every means fhould be attempted to ftir up the vital embers. The arterial fyftem fhould be roufed to action by elec- tricity, paffing gentle fhocks through the cheft in the di- rection of the heart, whilft the lungs are inflated, and before they have collapfed again. At the fame time moderate heat fhould be applied to the furface of the body. I fay moderate heat, becaufe ftrong heat would fudden- ly exhauft the powers of life. A dormoufe at the approach of winter fleeps. But if, in the fpring, he be fuddenly expofed to the fame de- gree of temperature, as that which induced torpor in the autumn, animation is deftroyed. Thus precifely is it with the vegetable tribes, for they fleep NERVOUS DISEASES. 191 fleep in winter, and are awakened by the vernal fun ; but die if too powerful heat be fuddenly applied. On this principle we may account for the deftruction of plants by blight in fummer ; for unlefs there be fr-oft at night there is no blight; and it may be remarked, that the blight does not take place during the action of the froft, but at the rifing of a cloudlefs fun. Hence it is that our garden crops, fuch as French beans and peas, which ufually fuffer moft by blight after a frofty night in fummer, fuffer no injury if they are wa- tered immediately before the rifing of the fun, becaufe the evaporation carries off the heat. When the heart has once been made to receive the florid blood, it will be ftimulated to new action, and the vital functions with the vital heat will be reftored. It will not, however, be fufficient to ftimulate the heart and lungs, we muft at the fame time ftimulate the ftomach. This may be effected by wine conveyed through Dr. Monro*s flexible tube into that vital organ. Clearly to comprehend the purpofe of thefe operations, the ftudent fhould be well acquainted with the difceveries of the modern chemifts. I have faid that wine muft be conveyed into the ftom- ach ; but he fhould not be fatisfied with being guided merely by the hand, without underftanding the reafon why fuch an application is attended with fuccefs. In the ufe of medicines he muft endeavour to afcertain their mode of operation ; for while the rafh empyric wanders m the dark, the cautious and rational practi- tioner will be anxious to inveftigate the path of nature, and to account for her proceedings before he ventures to prefcribe. I fhall attempt therefore to throw fome light upon a fubject. which is new, and therefore little underftood. It is well known that in nature's elaboratory, the vine, zvine is compofed of three ingredients, alcohol, water, and carbone ; and that on the proportion of the former depends the ftrength or weaknefs of the wine. Alcohol being highly combuftiblc, it will be proper to obferve, I92 NERVOUS DISEASES. obferve, that in this, combuftion is nothing but the com- bination, or chemical union, of hydrogen with oxygen, from which refults a third fubftance, water ; whilft the heat, which was in combination with the oxygen, efcapes. Alcohol itfelf contains fome oxygen, but, by com- buftion, it takes ftill more from the atmofpheric air: and thus by experience it is found, that fixteen ounces of alcohol, by combuftion, produce eighteen ounces of water. Pilatre de Rozier has frequently amufed his friends by inhaling a large quantity of hydrogen air, which may be taken into the lungs without fear of inju- ry, and then, applying his mouth to a tube, he blew out the air unmixed with atmofpheric air, and fired it at the end of a tube, fo that he appeared to breathe flame. By this operation water was produced, which afcend- ed in the form of vapour. This hydrogen air he obtained from fleam and heated iron. In order to give a diftinct idea of the quantity of heat arifing from the combination of hydrogen air, I fhall only mention, that one pound of this melted 295 pounds of ice, whereas in fimilar circumftances a wax taper, weigh- ing one pound, melted 133. Thefe obfervations I have prefented to the ftudent, in order to give him a clear and diftinct idea of the fub- ftances which I have had occafion to mention ; and by which he will fee the ftrong affinity and chemical attrac- tion between hydrogen and oxygen, the latter of which, as I have ftated, is by the lungs derived from the atmof- phere, whilft the former is conveyed into the fyftem by the affiftance of the ftomach, and is moft readily obtained from alcohol and wine. So much for what has been difcovered by the chemift with his retorts. But it is time that we fhould return to the living retort, and confider by what laws the proportions are eftablifhed between the oxygen,' to be derived by infpira- tion NERVOUS DISEASES. ^93 tion from the atmofphere, and the hydrogen, to be conveyed into the fyftem by the action of the ftom- ach. In the Cafe of Bilious Autumnal Fever the ftudent may remember having met with this remark, " The at- tentive obferver will take notice, that there is a certain proportion between the vital air received into the lungs and the quantity of food which can be digefted in the ftomach.** When I made that obfervation, I was not aware that the fame had occurred to any one before me. But I have now the pleafure to fee, that the fame had occurred to Dr. Thornton, as appears in his Thefis, and to Dr. Beddoes, as is feen in his letter to Dr. Darwin. He had been breathing air of a much higher tempera- ture than the ordinary ftandard, fuch as contained aimoft equal parts of oxygen, and azotic, air. " His spirits were elated ; his appetite was GOOD ; AND HE EAT ONE THIRD OR ONE FOURTH MORE THAN BEFORE, WITHOUT FEELING HIS STOMACH LOADED." It appears, however, that he pufhed his experiment too far, and that he induced, by this quantity of oxygen air, fymptoms of a fever. Yet by the afliftance of a diet, in which fweet pil, but- ter, and cream, bore a large proportion to the other arti- cles, he foon recovered health. The ftudent muft remember in the firft place, that oil and butter contain no other fubftances than carbone and hydrogen, fubftances which have a ftrong affinity and chemical attraction to oxygen ; and in the fecond place, from what, in the former part of this work, I have fug- gefted on refpiration and digeftion, that in proportion to the quantity of food received into the ftomach, if it a- bounds with hydrogen, the fyftem covets oxygen, taking up a greater quantity of it by refpiration from the atmof- pheric air, and ultimately expels them both combined in the form of vapour, when they have ferved the purpofe, for which they had been received. A a This 194 NERVOUS DISEASES. This balance is alfo beautifully illuftrated by the ex- perience of my friend Dr. [Thornton. Mr.----—, Member for------, laboured under fuch irritability of ftomach, that upon eating, he was aimoft conftantly feized with vomiting, and latterly it became fo frequent, that ifothing would ftay on his ftomach. In this diftreffing moment, Dr. Thornton was fent for. The ox- ygen gas, with a certain portion of atmofpheric air, was inhaled* and the balance being made on the fide of oxygen, Dr. Thornton re- quefted his patient to take fome fuftenance, which he had not done for many hours. Mr.-------refufed it at firft, "as he was certain it would bring on him a renewal of his diftrefs. But being perfuaded by Dr. Thornton and his apothecary, Mr. Wood, to make the trial, he was pleafantly furprifed on fuddenly experiencing the power of vital air, and he declared himfelf convinced, from the experience he had of dif- ferent medicines, that no other means could have produced the fame effect. He continued free from ficknefs as often as the air in a dilu- ted form was adminiftered. From thefe premifes I truft it will be clear, why, in cafes of afphyxia, we muft not be contented merely with conveying vital air into the lungs, but at the fame time hydrogen into the ftomach, which powerfully attracts this fubftance fo effential to vitality. Bleeding has been recommended, but as the congef- tion is in the right auricle and ventricle of the heart, till the refpiration is reftored, venefection can give no relief. Befides tenfion and tone being intimately connected, a diminution of the former would induce a fimilar dimi- nution of the latter. As therefore the ftimulus bears proportion to the dif- tention of the veffels, it would not be advifable to leffen the quantity of blood at the time when we wifh to in- creafe the excitement of the heat. Frictions, as a powerful ftimulus, may be advantage- oufly employed when the circulation begins to be re- ftored. For this purpofe a hare's fkin is beft ; but if only flannel is at hand, fome kind of oil, well mixed, with half the quantity of camphor, will be proper, to promote the NERVOUS DISEASES. 195 the general intention, and to prevent the abrafion of the fkin. Genus XXXIX. Dyspepsia. Indigeftion. The fymptoms are, want of appetite; naufea ; vom- iting ; flatulence j heart burn j pain in the ftomach ; coftivenefs. Thefe are the common fymptoms, of which the moft remarkable, as being always prefent, is a difpofition to flatulence. But as to want of appetite, it is fo far from being prefent in all cafes, that I have known many dyf- peptic patients, who, perhaps from the diftention of their ftomach and the ftimulus of acefcent fordes, have had a voracious appetite, and have indulged it without re- ftraint. SECTION I. Of the Caufes Proximate and_ Remote of Dyfpepfia. The proximate caufe of this difeafe is certainly, re- laxation in the mufcular fibres of the ftomach, in confe- quence of which vifcid mucus is collected, and tha quantity of gaftric juice is diminifhed. As to the predifpofing caufe, it is evidently a debilita- ted fibre, for perfons of that defcription are moft fubject to dyfpepfia. The occafional caufes of this difeafe are, indolence, in- temperance in every fhape, paflions of the mind, intenfe application, unfeafonable hours of repofe, vitiated air and heat in crowded affemblies, haemorrhage and excef- five evacuations, the abufe of tea, and, as the moft com- mon fource of this complaint, expofure to cold fogs. This may be evidently feen in Holland, and in the fenny parts of England, I have obferved the fame difeafe prevailing in the north- ern parts of Spain, which are expofed to cold and damp; but I never faw it in the fouth. All ig6 NERVOUS DISEASES. All thefe caufes tend to create and to increafe de- bility. SECTION II. Of the Indications of Cure in Dyfpepfia. From what has been faid, the indications of cure will readily prefent themfelves. Thefe are, in the firft place, to cleanfe the ftomach and the alimentary canal from vifcid mucus, that you may act upon the living fibre. The fecond is, to give tonics and aftringents, fuch as the bark and fteel. Thefe intentions may be carried on together. & Pil. ex aloe c. Myrrh, fcr. 4. Kermes Mineral, dr. \. Limat. ferri, dr. 1. Syr. f. q. s. f. Pill. 32. c. c. 2 bis die. That is, Take Rufus's Pill four , fcruples ; Kermes Mineral half a dram ; filings of iron one dram ; fyrup a fufficient quantity to make 32 pills, of which take two twice a dav. Yet all the medicines that can be adminiftered, will be unequal to the cure, unlefs the mind be tranquil, and 'kmlefs attention be given to avoid all the occafional caufes of debility. The dyfpeptic patient muft rife early, muft be for ever in the open air, muft ufe cold bathing, and muft fhun the crowd. ^ He muft be purfuaded that a horfe is the beft phyfi- cian, and that temperance of every kind, with reafonable diffipation and exercife in a dry healthy air, will do more for him than all the medicines in the world. I remember, about thirty years ago, I had a friend, who was a. hard ftudent, buried -among his books in a room of fmall dimenfions for fourteen hours in the day. This was fufficient to create difeafe ; but, in addition to this, he had an haemorrhage, and loft many pounds of blood within the fpace of four and twenty hours. Dyfpepfia, NERVOUS DISEASES. I97 Dyfpepfia followed, fuch as I never witneffed in any patient, either before or fince. His flatulence was fo great for three hours every day, after he had eat his dinner, that by this circumftance, in- dependent of natural inclination and contracted habit, he was compelled to live alone. From this difpofition to flatulence, he was obliged to give up wine and all fermented liquors, with fat and but- ter, to abftain from vegetables, from tea, from fugar, and aimoft from bread. He lived entirely on meats roafted aimoft to a chip, and toafted bread ; whilft for liquids he was confined to brandy and water only. Notwithftanding this degree of abftinence, the diftreff- ing flatulence continued, as long as he confined himfelf to his books and to his ftudy, which was for two years complete. He applied to many phyficians, but in vain, till Dr. Whytt advifed him to take three grains of James's Pow- der every night, five grains of rhubarb every morning, and tonics with aftringents in the middle of the day. ~9f> Cinchonae, un. 4. Gentian, Cort. Auiant, aa dr. 12. Sp. Vin. Gal. ft, 4. digere per 6 dies. Capt. dr. 4 ad dr. 6 meridie. That is, Take Peruvian bark four ounces ; gentian and orange peel, one ounce and an half; brandy two quarts ; digeft fix days in a fand bath, and take half an ounce or fix drams in the middle of the day. It happened at the fame time, that this gentleman had a favourite fpaniel, who was always at his fide. This faithful animal, who fhould have been ranging in the woods, being thus confined, was afflicted with a more de- plorable difeafe, being troubled exceedingly with flatu- lence and borborygmi, from wind always in motion and grumbling through the colon. With thefe fymptoms of dyfpepfia, Pil. ex. Aloe, cum Myrrha, gr. 15. ad. fcr. 1. h. f. f. R, Pulv. Aloet. c. guaiac. gr. 15. ad fcr. 1. h. f. f. In cafes where the bowels have been more than com- monly torpid, I have given to advantage from three to eight grains of calomel at night, to be carried off in the morning by the following : Jjo Infuf. Sennae tartarifat. un. 2. Kali tartarifat. gr. 12. ' Rhei, gr. 8. M. Mane fumend. That is, Take infufion of fenna two ounces, with foluble tartar twelve grains, and rhubarb eight grains. Mix. II. The fecond intention may be anfwered by aftrin- gents, more efpecially fteel filings, which are certainly preferable to Peruvian bark alone in torpid habits. The myrrh and fteel are recommended by Dr. Grif- fith ; and, as already particularly mentioned in phthifis, may be given to advantage. Or, R, Cort. Anguftur. un. 1. Ferri tartarifat. dr. 2. Pulv. Myrrh, compof. dr. 6. Zinzib. dr. 4. Syr. Cort. Aurant. q. s. f. Elect. M. N. M. bis die fumend. That is, Take anguftura bark one ounce ; tartarifed iron two drams; com- pound powder of myrrh fix drams ; ginger half an ounce ; fyrup of orange peel fufficient to make an electuary. Take of this the fize of a nutmeg twice a day. Or any of the formulae yy, 78. 80. 82, 83. of my Compendium may be ufed. Dr. Marryot was accuftomed to combine the tonics and cathartics with fome antifpafmodic in the fame pre- scription ; and I have found this, after having once cleanf- ed the alimentary canal, to anfwer both intentions. R, Afie fetid, dr. 1. Aloe foe. Limat. ferri, aa fcr. 2. Syr. Zinzib. q. s. f. Pil. 24. Capt. Pil. 2. mane & vefpere. That 206 NERVOUS DISEASES. That is, Take afafcetida one dram ; focotrine aloes and fteel filings, each two fcruples ; fyrup of ginger fufficient to make twenty four pills, of which take two morning and evening. The warm pediluvium is of fervice. Regular exercife, change of fcene, cheerful fociety, amufements, and conftant yet agreeable occupation of the mind, are indifpenfable in the cure of this complaint. All the occafional caufes muft be carefully avoided, but more efpecially folicitude, which can be effectually banifhed from the mind only by that confidence which Chriftianity infpires. Clafs II. NEUROSES. Order III. Spasmi. A morbid motion or contraction of mufcular fibres. SECTION I. Of Irritability. Motion, as far as we are acquainted with the laws^of the creation, appears to be produced by four feveral caufes, attraction, repulfion, irritation, and volition. Lifelefs, inorganized matter is governed in all its mo- tions by the laws of attraction or repulfion. Vegetables are fubject chiefly to the laws of irritation. Animals are equally with vegetables fubject to the laws of irritation ; but, rifing above the vegetable tribes, we fee them endued with a fuperior power, that of vol- untary motion. It is of motion, as caufed by irritation, I am now to treat; and in the profecution of this fubject, let us begin with the motion of the fap in plants. If the ftudent will confult that incomparable work, the Vegetable Statics of the Rev. Doctor Stephen Hales, chap. iii. he will be convinced, that the rifing of the fap in plants is not produced either by rarefaction of NERVOUS DISEASES. 207 of the external air, or by capillary attraction, as was formerly imagined, but by irritation from the ftimulus of light and heat, increafed perhaps by the motion of the fap itfelf as it afcends. The Doctor tried his experiments chiefly on the vine, by cementing to its mutilated flump glafs tubes, each feven feet long and a quarter of an inch diameter, with brafs caps, by which they were fcrewed on one above another, till they rofe to the height of fix and thirty feet. At other times he ufed. inflected tubes, each with columns of mercury to be put in motion by the amend- ing fap. In the former, the fap ran over : in the latter, the mercurial gage ftood at 38 inches, which he reckoned equal to the preffure of more than 43, feet of water. To one thriving branch, in a prime bleeding feafon, he fixed tubes to the height of 25 feet, and in, two hours the fap flowed over. By thefe gages it appeared ift, that the fap began vifi- bly to rife March 10, when the thermometer by day ftood only at three degrees above the freezing point ; 2dly, that April 18 it was at its height and vigour ; 3dly, that from that time to May 5, the force gradually de- creafed ; 4thly, that it conftantly rofe fafteft from fun- rife to about 9 or 10 in the morning, and then, unlefs the day was cloudy, gradually fubfided till about 5 or 6 o'clock in the afternoon, after which it flowly rofe again: but on a cool and cloudy day it fubfided only from about 12 o'clock to 2 in the afternoon. If in the morning, while the fap was rifing, and a cold wind blew, the fun was clouded, the fap would immedi- ately begin to fink at the rate of an inch per minute, but when the fun fhone out, it rofe again. Moifture and warmth made the fap moft vigorous, more efpecially af- ter cold weather, caufing it to rife all day, although flow- eft about noon. It rofe likewife fooner in the morning after cool weather, than after hot days. In the beginning or middle of the feafon, if warm weather 208 NERVOUS DISEASES. weather had made the fap flow vigorously, that vigour would be immediately much abated by cold eafterly winds. When the tube was fixed to a very fhort flump of a vine, without any lateral branches, and at only feven inches from the ground ; the fap flowed inceffantly and fafteft of all in the greateft heat of the day, finking only after fun fet. The further the tubes were fixed from the root, for inftance on the_ extremity of a branch, at the diftance of 44 feet 3 inches, the higher the fap was raifed and the longer it continued to flow, perfectly agreeable to a com- mon obfervation, that in wall trees the moft diftant branches draw hardeft and receive moft nourifhment. The oldeft branches were fooneft affected by a change of temperature, and in them the fap firft began to fink. July 4, whilft in one vine, which was planted in a pot, fap was rifing, and a confiderable quantity was daily preffing through the ftem, to fupply the evaporation from its leaves, which amounted to many ounces in the day ; another vine, being cut off within three inches of the ground, was fo far from emitting fap, that it imbibed water from the tube at the rate of one foot per hour ; thereby demonftrating, that the fap in the former vine rofe by the ftimulus of light and heat, and not by trufion from the root. When the fap was flowing with the greateft vigour, the Items did not dilate, as they evidently do by rain, which enters by the perfpiring pores. This makes it clear, that the fap paffes through its proper veffels, and that it is confined by thefe. From all thefe obfervations and experiments is it not clear ? 1. That the ftimulaiing powers are light and heat. 2. That the irritability of plants is greateft in thefpring and leaft in autumn ; and that being accumulated during the night, it is exhaufted, in fome meafure, before the middle of the day. By various experiments of Dr. Hale's, compared with thofe of Dr. Ingenhoufz, it is evident, that vegetables in fummer, NERVOUS DISEASES. 209 fummejr, whilft they enjoy the fun, are inceffantly decom- posing'water, and emitting from their leaves its oxygen, combined with caloric, in the form of vital air. And it is clear, that as long as water is fupplied abundantly, they not only preferve their vigour, even at midday with the moft fervent heat, as in the fouth of Spain, but make a rapid progress in their growth, and emit a proportiona- ble quantity of vital air. May we not infer from thence, that their irritability depends on oxygen and heat, and their vital energy on a plentiful fupply of* thefe reviving elements, whilft the hydrogen of the water not only fup- plies the combuftible part of vegetables, but, by depofit- ing its caloric, maintains the vital heat ? That the motion of the fap depends on irritation will be ftill more evident, if we confider the effect produced by infects ; for wherever they have depofited their eggs, the part begins to fwell. This I have particularly remarked at Alicant, in the quercus coccifera. It was evident likewife fome years fince in Cornwall to a great extent in the barley, and to an alarming degree in America, where the wheat, in fome difiWls of the middle provinces, was totally de- ftroyed fm feveral years, by having the eggs of infects lodged in the Items. This effect may be particularly noticed in the gall nuts, growing on the oak j and at the prefent moment I have a ftriking example of it in my garden, where feveral branches of fweet briar have bunches, of from one to three inches in diameter, folid within, excepting the fmall chambers, in each of which is a little maggot, but ex- ternally covered, as it were, by mofs. That infects irritate the plant, on which they fix, is clear ; becaufe in a green houfe, when the lice, as they vare called, are numerous on the leaves, the irritability is foon exhaufted, and the plant quickly dies. In fuch circumftances, when I have wafhed my greens with a ftrong infufion of bear's foot ('Helleborusfceridus) the lice have been deftroyed, and the plants have fpeedi- ly recovered. Vegetables have various motions, which evidently de- C c pend 2IO NERVOUS DISEASES. pend on their irritability, and the ftimulus of light and heat. To this muft be attributed the motion, i. Of the branches, when they ftretch toward the light., 2. Of the whole flower, when it follows the motion of the fun. 3. Of the petals, when they clofe, either, as the hibif- cus, at midday, or as others before the fetting of the fun. 4. Of the lejaves, when like the hedyfarum gyrans, they turn their upper furface to the fun. Someiparts of the flowers have peculiar motions, de- figned tojDropagate the fpecies, when either the ftigma inclinesjbwards the flamina, or the ftamina embrace the ftigma,-which is more fully explained in Dr. Darwin's Loves of the Plants, and in Dr. Thornton's magnifi- cent explanation of the Sexual Syftem of Linneus. This operation once performed, the ftamina, exhauft- ed of irritability, immediately begin to droop and die, precifely as the male locuft, and indeed the males of moft infects die the inftant they have impregnated the female. Many plants are faid to move their ftamina, on their being punctured with a pin, even when they are fepara- ted from the flower. Other motions, evidently caufed by ftimuli, prove the irritability of plants in which thofe motions are ob- ferved. Such every one has noticed in the feveral fpecies of mimofa or fenfitive plants, in the averrhoa carambola, the onoclea fenfibilis, and the oxalis fenfitiva, but more efpe- cially in the dionea mufcipula, or venus fly trap. Should Drs. Girtanner, Gahagen, and Thornton, pur- fue the experiments they have fuccefsfully begun, or fhould other philofophers, with the fame ardour of in-' quiry, take up this fubject ; we fhall then be able to af- certain a fact, aflerted by the former, that \he plants call- ed fenfitive, may be deprived of their fenfibility by opi- um and alcohol, whilft vinegar and the oxyds of arfenic .'% or NERVOUS DISEASES. 211 ©r mercury, communicate irritability to plants, which did not poflefs it before. Were this fact well afcertained, it would throw great light upon the operation of thefe medicines in the hu- man frame, and contribute to eftablifh the fyftem, now received by many, refpecting irritability, as induced by oxygen. *# The irritability of the animal fibre is obferved particu- larly in the heart and arteries ; in the lungs, in* the ftomach and inteftines, in the abforbents, and in the fe-"f cretory glands. Thefe perform the functions moft effential to vitality, which being therefore inceffantly needful, whether we fleep or wake, are produced, not by fenfarion^1 and vou> tion, but, for the beft reafons, by irritatfpn only.y Some fibres, as for inftance thofe of the fphincter mufcles, are ufually under the dominion of the will; yet when ftrongly irritated, thefe likewife affert their inde- pendence, n It has been well remarked by Dr. Brown and his difciples, that the irritability of the fibre may be in a ftate of tone, in^i ftate of accumulation, or in a ftate of ex- hauftion, and all our obfervations feem to confirm this part of their fyftem. The abfence of flimulating powers, produces accumu- lation of irritability ; whilft the frequent and too power- ful operation of ftimuli tends to exhauft it. Boerhaave, in his lectures, makes mention of a prif- oner, who being confined in a fubterranean dungeon, which was wholly deftitute of light, had the fenfibility of his retina increafed to fuch a degree, that he not only dif- cerned the walls of his prifon, but was in time able to amufe himfelf by reading j and many, being fuddenly expofed to a ftrong light, have been deprived of fight. Tone is the proper medium between accumulation and exhauftion. When a mufcle is ftimulated, it does not commonly remain in a contracted ftate, although the ftimulus con- tinue ; but, unlefs in cafe of fpafm, is alternately con- tracted and releafed j or, as Dr. Cullen was j|cuftomed 212 . NERVOUS DISEASE?. to exprefs himfelf, is alternately in a ftate of excitement and of collapfe ; becaufe the vital energy, even when ftrongeft in the animated fibre, is fpeedily exhaufted by exertion, and requires a given time for the arrival of a frefh fupply. Hence tremor is moft obfervable in cafes of debility. £- Violent exertion is found to quicken the refpiration ^ and the pulfe. TJhefe circumftances, when combined with others, tend in fome meafure to confirm the opinion of Dr. Girtan- ner, that oxygen is the principle of irritability, as irrita- bility is the principle of life. Certaia.it is, as Dr. Fowler, after having carefully and repeatedly ^examined the effects produced by tying the crural artery, :and dividing the fciatic nerve, has ju- dicioufly obierved, that the fanguiferous fyftem contrib- utes more immediately than the brain to the fupport of that condition of mufcles and of nerves, on which depend all the phasnomena of contraction in the anima- ted fibre. Did the fupply of vital energy, after violent exertion, depend merely on the nerves, it would not require time for its arrival, becaufe the nervous influence moves as > quick as thought. There was long fince a difpute between Dr. Whytt and Baron Haller, refpecting irritability, and that difpute is not yet completely fettled. The former attributed this power wholly to the nerves ; the latter to'lhe mufcular fibre, independent of the nerves. This difcordance of opinion muft, I fear, remain till fome one is able with the point of the fineft needle, to touch a mufcular fibre, without wounding at the fame time a nerve. But were we permitted in this cafe to reafon by analo- gy, we might fufpect, if not conclude, that fince plants by irritability alone, without brain or nerves, exercife the vital functions ; thefe likewife may in animals depend on the irritability of the mufcular fibre, whilft fenfation> • thought, NERVOUS DISEASES. *V1I3 thought, and voluntary motion undoubtedly refult from the prefence of a brain. What has been remarked refpecting the action of a finglemufcle, is applicable to feparate parts of the fyf- tem and to the whole. Thus during the operation of an emetic, the ftomach is alternately in a ftate of excitement and repofe. And >r thus the moft violent pains and labour of a parturient woman, if not effectual for the expulfion of the offspring, >■ ceafe for a time and are then Jftiewed. Thus likewife all the appentesare liable to fits, re- turning however after ceffation at llated periodsi;"if it be hunger, at the diftance of fome hours ; if it bej^an appe- tite, not defigned for felf prefervation, it mtfy r^ftirn eL ther at the returning feafon of the year, or at ajefs diftant period, according to the nature of the animal, and the irritability either naturally accumulated and excited, or morbidly induced. gfc The neceffity of fleep arifes from exhauftion, and is defigned in the abfence of all fuperfluous ftimuli to re- new the vital energy for the various purpofes of life. It is remarkable, that during fleep, not only the breath- ing and the pulfe are flow and full, but the feeling is ren- dered dull : murmurs make no impreffion on the ear ; gentle cathartic* remain all night inactive in the bowels, and coughing is allayed. From what has been faid it will appear, that the irri- v'tability of the fyftem is never in a permanent condition, but inceffantly ebbing and flowj^ like the tide ; con- ftantly in motion, like the pendulum in its vibrations, or rather bearing refemblance to the Ley den phial, when it is alternately charging, difcharging, and difcharged. Exhauftion prepares the fyftem for frefh accumulation, and this again, giving force to the moft feeble ftimuli, leads back to the exhaufted ftate, as in the cold and hot ftages of intermittent fevers, or as in melancholia alter- nating with mania. I have ventured to fuggeft a poffibility that jmtabili- ty may refide in the fimple fibre, as in the vegetaftt tribes, % , but 2I4 NERVOUS DISEASES. but I am perfectly fatisfied, that without nervous com- munication there can be no confent of parts. This fubject is exceedingly abftrufe, and the ideas of the belt phyfiologifts are not fo clear and diftinct, fo complete and comprehenfive, as we could wifh : but as Dr. Beddoes has judicioufly obferved, " we fhould fet a proper value on our prefent knowledge, although it be im- perfecl, and reftrain thofe rude hands, that are ever ready to pluck up the tender plants offcience, becaufe they do not bear ripe fruit at a feafon, when they can be only putting forth their bloffoms.** SECTION II. Of Stimuli. i. Whatever has a tendency to preferve or to de- ftroy the animal economy is flimulant. Thus hunger, thirft, and nutriment equally ftimulate the fyftem. And to this head muft be referred, pleafur- *: able or painful fenfations, defire and averfion ; hope and fear. 2. Whatever has a tendency, either fimply to deftroy . the ftructure of the irritable fibre, to diffipate that which is effential to its action, or to form a feparate combination with any of its elements, is flimulant. Thus attrition, preffure, puncture, diftention, cold, heat, the concentrated acids, cauftic alkali, and electrici- ty, ftimulate the fyftem in general, and more efpecially *• the part to which they are immediately applied. 3. Even deficiency and redundance, as John Hunt- er obferves, are flimulant, and excite the abforbent fyf- tem to new action. 4. Subftances which are flimulant to one organ may be indifferent to another. ^ Light ftimulates the eye, but not the ear. Sound ftimulates the ear, but not the eye. A fingle drop of water irritates the trachea and excites convulfive motions, but, unlefs in hydrophobia, paffes quietly by the cefopha- «^gUS. ,: From what has been delivered in this work we may underftand, NERVOUS diseases. 2I5 underftand, why alcohol, mufk, volatile alkali, asther, and opium (the diffufible ftimuli of Dr. Brown) act as fuch, yet very differently, according to the quantity in which they are exhibited. But to comprehend their firft operation we mufl ob- ferve, that the gaftric juice, although it cannot* diffolve, yet certainly it ftimulates the living fibre, rapidly induces debility, and excites both vomiting and purging. When, by vomiting, it is rejected from the ftomach, thefe fymp- toms ceafe. This fluid operates on all the diffufible ftimuli above mentioned, but not with the fame rapidity, for thofe which have moft hydrogen, fuch as aether, alcohol, and volatile alkali, as being moft expeditious in reftoring the vital energy, feem to be firft acted on. A Lady of an irritable fibre, fome fhort time after vomiting, fwal- lowed about half an ounce of lemonade, and was inftantly feized with excruciating paiA and fpafmodic contractions of the ftomach ; but thefe fymptoms were as inftantly removed by lefs than half an ounce of brandy. When fmall quantities of opium, alcohol, or of other fubftances containing hydrogen, are received into the ftomach. their firft operation is, to neutralize the gaftric juice, and thereby to remove the irritation which it cauf- ed, in the fame manner as an alkali would have neutral- ized an acid, or an acid would have removed the ftimu- lus of a cauftic alkali. Befides combining with the gaftric juice, the carbone and hydrogen of the fubftances iqfqueftion attract oxy- gen, which they neutralize, and form with it carbonic acid and water. #But, when fuperabundant and not neutralized, they ftimulate the ftomach and bowels to reject, to dilate, or to expel them, as injurious to the fyftem, which requires a due proportion of its elements. Agreeable to this obfervation we may remark of ftim- uli in general, that, when gentle and regular, they excite the containing veffels to their accuftomed action for the purpofe of nutrition. But, if they are violent, they .*. either excite fpafmodic action of the veffel, to exclude or to flop the progrefs of the offending matter ; or they iu- cluce *$■ *f ••* .* 2l6 NERVOUS DISEASES. duce inverted motion, to expel the enemy, and that by the fhorteft paffage, as in the act of vomiting. SECTION m. Of the Predifponent Caufe of Spafm, Physicians have an axiom, which Dr. Cullen fre- quently repeated to his pupils : " debilitas gignit spasmum." This axiom, although not accura tely true, is ineftima- ble in the hands of the rational practitioner. Debility is indeed the predifpofing, but not the proxi- mate, caufe of fpafm ; and it is allowed, that the predif- pofition is not fufficient, without an occafional caufe, to produce difeafe. Nay, debility is only the predifpofing caufe of fpafm as increafing irritability, and difpofition t<$ act without power to act with. The connexion between the caufe and its effect will be evident, if we either compare the debility and irrita- bility of infancy with the vigour and diminifhed irrita- bility of the adult; or contrail the lax fibre and irritable difpofition of the female with the tenfe fibre, robuft hab- it, and more tardy difpofition to excitement in the male. In our infancy how readily do we pafs to oppofite ex- tremes of hope and fear, how eafily are we pleafed, how foon difpleafed, and what a thin partition feparates between laughter fhaking both his fides, and grief over- whelmed with tears. This irritability is not difcovered merely in the mind • it affects the whole fyftem, as muft be evident to every one,who has had an opportunity of making obfervations upon children, or has even felt their pulfe. Thefe obfervations have no claim to novelty ; but I do not recollect, that on this fubject it has been noticed, in pointing out the connexion between debility and irri- tability, that no fooner is a Synocha converted into Ty- phus, a difeafe of extreme debility, than irritability fuc- ceeds ; the moft patient become impatient of the leaft contradiction NERVOUS DISEASES. 217 contradiaion or delay; and, from the flighteft caufes, are with equal readinefs excited, either to laugh or cry. In this fituation, when the afthenic diathefis has fuc- ceeded to the fthenic, the heart and arteries, as we have obferved already, when treating of Typhus, have their irritability increafed, which appears by counting the pul- fations, now more numerous, whilft their debility is evi- dent to the touch, and at the fame time the alimentary canal becomes more irritable to the operation of cathar- tics. But that we may have more clear and diftinct ideas upon this fubject, let us take a view of tht fanguine tem- perament, contrafled with the melancholic already given j both which are well defcribed by Dr. Cullen in his Ma- teria Medica. ^ The fanguine temperament has, hair foft, weak, and light coloured, verging towards red ; fkin fmooth and white ; complexion ruddy ; eyes blue ; habit foft, plump, inclined to fat, and difpofed to fweat on exercife ; ftrength moderate; the mind fenfible, cheerful, unfteady ; fimple folids lax; red globules great in proportion to the ferum; heart active and ftrong ; blood in the arteries copious with refpeft to that of the veins ; fluids abundant ; ner- vous fyftem fenfible, irritable, changeable ; the fibre dif- pofed to fpafm and to involuntary action, by confent and fympathy with diftant fibres. Perfons of this conftitution are more particularly liable to haemorrhage, to inflammation, and to hyfteria. In this temperament, we fhould be at firft difpofed to think, that the veffels being diftended mechanically by blood, this fhould ftimulate the fibres to contract with vital energy, that the action and reason would be great, the contraction ftrong, and that, fo far from being liable to fpafm, which is a fymptom of debility, all would be activity and vigour. This, however, is not fo in fact, for it is univerfally obferved of this conftitution, oppofed to the leucophleg- matic, where torpor is a prevailing fymptom, that in pro- portion to the laxity of the fimple folids, debility, irrita- bility, and difpofition to fpafm, prevail. Dd In 2l8 NERVOUS DISEASES. In this conftitution the relaxed fibre readily receives and quickly parts with vital energy, precifely as azote and hydrogen loofely, yet readily, combine with oxygen. Whereas the rigid fibre, more tenacious of its power, in this circumftance bears fome refemblance to the bafe of muriatic acid, which adheres fo ftrongly to its oxygen, unlefs in its fuperfaturated ftate, that no procefs has been yet difcovered to make the feparation. The robuft and elaftic fibre comes between them both, and, like carbone, feems to be covetous of oxygen, and to combine with it firmly, but not with obftinate tenacity. The particular temperament will through life, in a de- gree, retain its influence. Yet, by advancing years, the fanguine tends inceffantly towards the melancholic. By poverty of living, by lofs of blood, by exhaufting difeafes, by frequent ufe of the warm bath, and more ef- pecially by indolence and protracted fleep, this progrefs towards rigidity of fibre will not only be retarded, but the fimple folids and the whole fyftem will become mor- bidly relaxed. A generous diet, with the affiftance of bark, chaly- beates, cold bathing, and cool air, will gradually reftore the tone ; but it is exercife which muft diftribute, impact, condenfe, accumulate, this energy in every part ; for it is this alone which can effectually brace up the animated fibre and make it tenacious of vitality. Every mufcle by neglect of exercife grows flaccid, ten- der, and liable to be foon fatigued ; but by conftant ex- ertion it is increafed in fize, its fibres are rendered every day more elaftic and robuft, and, in procefs of time, the weak may become patient of labour without the leaft fatigue. It is not from the fleek and ruddy countenance, not from the plump habit, as indicating diftended veffelsr that we are to form our judgment of the ftrength, for Hip- pocrates has well obferved, " Otium humectat, & corpus reddit debile; labor ficcat & corpus robuftum efficit." To fee, therefore, vigour in perfection, we muft look at the hardy and laborious ruftic, whofe turgid mufcles, as NERVOUS DISEASES. 219 at in the flatue of the Farnefian Hercules, can be readi- ly diftinguifhed through the fkin. In fatting poultry, we feed them to the full, but we endeavour to keep them perfectly at reft. In confe- quence of this treatment the veffels are diftended, but the fibres are relaxed, tender, and weak in their cohe- fion. To fatten our ducks, we not only confine them in a place of fmall dimenfions, but keep them from the water, becaufe we obferve that their cold bath and exer- cife render the fkin and all their fibres tough. It may be received as an axiom, that the living power cr energy of an organ is in proportion to the quantity of ar- terial blood that circulates through it. For it is not merely the quantity of fluids feebly creeping through the veflels, nor fat flagnant in every part of the fyftem, but the quick fucceflion and ftrong impulfe of well ox- ygenated blood that produces tenfion, tone, and vigour. This may be ftill more clearly comprehended, if we attend to the manner in which horfes are fed and work- ed upon the road. When firft taken up from grafs they abound with fat, but are not fit for labour, becaufe, on moderate exertion, they are bathed in fweat, and foon ex- haufted by fatigue. If, when taken into work, they are flinted to five bufhels of oats per month, which was for- merly their allowance on the road ; little work can be obtained from them. But, with fixteen bufhels of oats, befides beans, per month, and a fmall quantity of hay, if worked in proportion to their food, they know not what it is to feel fatigue. Their veflels, diftended with well oxygenated food, contract with vital energy, the action and reaction are great, all is activity, all is vigour. Such are the p©ft horfes. But where ftrength, rather than activity, is wanted, as for the carriers' waggon horfes, the proportion of beans is much increafed, and that of hay is fourfold ; for it is here that the maxim will hold good, pondus addit robur. Their motion is flow, but it is long continued. From all that has been delivered the ftudent xd\\ be, I truft, prepared to diftinguifh between debility as con- nected with irritability, and the debility of torpor. Al! 220 NERVOUS DISEASES. All ftimuli, either violent or long continued, tend, as we have feen, to exhauft the vital energy, and to induce morbid irritability, as in Typhus and Hyfteria. Hence it is that violent inflammation terminates in gan- grene ; and long life in decrepitude, which may be ren- dered premature by the reiterated abufe of ftimuli. We may obferve two fpecies of torpor ; torpor with relaxation, and torpor with rigidity; the one relieved by tonics and mineral aftringents, the other not admitting of relief. In the leucophlegmatic, in chlorofis, and in dropfy, we have the debility of torpor ; not attended by rigidity but by relaxation. The veffels of the lymphatic, not of the arterial, fyftem are diftended, and that not from vital energy but its defect, and the confequent relaxation of the tenfile fibre. In hypochondriafis, although not to the fame degree, we obferve the debility of torpor, not induced by the excefs of ftimuli, nor attended either by rigidity of fibre or by any remarkable relaxation of the lymphatics ; but arifing from the caufe already mentioned, when I was treating of that difeafe. In all thefe affections we diftinguifh a languid circula- tion and deficiency of heat. It were needlefs to remind the ftudent, that the debili- ty, which is the predifponent caufe of fpafm, is not the debility of torpor, but debility as connected with irrita- bility. This then is the predifponent caufe ; but this alone will not produce difeafe. It is acknowledged, that the retina is aimoft infinitely irritable ; yet this irritability will never produce contrac- tion of the iris without the ftimulus of light, nor will the higheft degree of irritability produce fpafm without fome irritating caufe. The firft time I vifited the New Foreft in Hampfhire, I thought my horfe was frantic ; he foamed, he fretted, he lafhed himfelf with his tail, every mufcle was convulf- ed, and he was bathed in fweat. The fervant of my friend, who was prefent, watched his opportunity to re- move NERVOUS DISEASES. 221 move one little fly, and all was calm ; tranquillity was in- ftantly reftored. Thus precifely is it in the human frame. In fpafmod- ic affection arifing from extreme debility, with its cor- refponding irritability as the predifponent caufe, you re- move the little fly and the fpafm ceafes. Should the ftudent meet with fpafm in the fthenic dia- thefis, as I have ftated in the Cafe of the Bilious Autumnal Fever, he may be certain that it is not a little fly to be removed, but a wafp, a hornet, becaufe in this conftitu- tion the irritating caufe muft be much ftronger to pro- duce even a flight fpafmodic affection, than would be fufficient for the moft violent, where irritability in the ex- treme prevails. In the cafe, to which I have referred, we faw gaftrody- nia flatulenta, which was removed when the firft paffages were cleanfed ; and violent fpafmodic ftricture, in either the csecum or in a flexure of the colon, which ceafed as foon as thofe vifcera were cleanfed of accumulated fcy- bala by repeated clyfters. Spasmodic affections are occafioned by, i. Local irritation. 2. Confent of parts. The firft is wholly independent of the brain and fpinal marrow ; but the latter ceafes when the communication with the origin of the nerves is interrupted. i. As an inftance of fpafm induced by local irritation, without coVifent of parts, we may mention colic, In which fcybala ftimulate a portion of the colon precifely, and with the fame effect, as when calculi in the ureters, or fliarp fand in the eye, ftimulate the part with which they are in contact. 2. The confent of parts may be confidered as either univerfal or particular. When cold is fuddenly applied to the furface of the body, all the irritable fibres appear to have one general confent. The alarm is univerfal j we feel a contraction of the fkin, and the rapidly increafed fecretion of limpid urine proves, that the irritation and conftriftion reach to the kidneys ; every part of the alimentary canal is in- ftantly 222 NERVOUS DISEASES. ftantly affected ; the arterial fyftem feels the momentary influence ; the exhalants on the furface are drawn into confent; the abforbents are excited ; and the greater the extent of furface expofed to the action of cold air or wa- ter, the more evident are thefe effects. On this principle it is that partial application of cold flops the epiftaxis or bleeding at the nofe. Mental ftimuli are equally univerfal in their effect. In a ftate of health every paflion of the mind is connected with fome correfpondent motions in the body, and exerts its influence, not merely on the heart, but on the whole arterial fyftem, even on the moft minute ramifications and the fmalleft veffels, to which the direct force of the heart does not extend. Hence fhame is manifefted by rednefs of the face ; fear by palenefs ; anger alternately by both. But the influence of the mind, when fuffering by paf- fion, is extended equally to the brain and to the nerves ; hence it is that anger and fear produce univerfal tremor ; and hence it is that various affections, paflions, and ap- prehenfions of the mind, produce difeafe and fpafm ; as we fhall clearly fee when we come to treat of the various genera included in this order. From this univerfal confent it is, that opium applied to the extremities of the nerves, not only deftroys irrita- bility in the mufcles to which it is immediately applied, but exerts its influence by fympathy on the origin of the nerves, deftroying the vital energy of the braki, and ren- dering every animated fibre irritable even by the ftrong- eft ftimuli. Befides this general confent, we obferve a fpecial con- fent and fympathy between diftant parts which are fub- fervient to each other. i. Between the lungs and all the mufcles which aflift in refpiration. 2. Between thefe and the right ventricle of the heart, when it is ftimulated by the returning blood. 3. Between the rectum and the uterus, and all the mufcles which aflift in the involuntary expulfion of either the faxes or the foetus. 4. Between NERVOUS DISEASES. 223 4. Between the ftomach and all the mufcles which aflift in the convulfive aft of vomiting. 5. Between the noftrils and the lungs, as well as all the mufcles which affift in refpiration. For when ftimuli irritate the noftrils, the lungs are inftantly inflated to their full extent, and a ftrong involuntary blaft is direct- ed through the contracted paffages to drive off the of- fending matter. 6. Between the ftomach and the gall bladder, when charged with gall ftones, which excites ftrong vomiting, to fhake the cyft and to difcharge the ftones. 7. Between the ftomach and the heart. See Zoono- mia, II. 728. 489. 8. Between the ftomach and the lungs, as I have already had frequent occafions to obferve, particularly in fpeak- ing of digeftion and of tuffis ftomachalis. The fame will be noticed when I proceed to treat of afthma and of hooping cough. 9. Between the ftomach and the brain. 10. Between the pregnant womb and the breafts, to prepare nutriment for the new born infant. Some kinds of confent arife from vicinity, as when tenefmus and ftrangury excite each other. Some are founded only in continuity, as when tenef- mus produces vomiting. Hence it is that tenefmus, in irritable habits, may be inftantly relieved by fpices, wine, and brandy, or even by food received into the ftomach. The confent of parts, which are fubfervient to each other, being founded in utility, may be termed fahitary and well directed in oppofition to other kinds of confent, which, being either ufelefs or deleterious, might with propriety be denominated frantic or capricious. In thefe we can difcover no appearance of defign, and can fcatcely therefore confider them as the efforts of na- ture to relieve herfelf. The common fenforium feems to be fo difordered, that none but the wildeft efforts are produced, in which commonly the weakeft and moft ir- ritable part of the fyftem is the firft to fuffer. Thefe wild efforts very commonly arife from affec- tions 224 NERVOUS DISEASES. tions of the ftomach, as in cafes of worms, or as in that beautiful cafe reported by Hildanus, and quoted by Hoff- man. A young woman having fwallowed a large needle, fhe foon felt fuch intolerable pain in her ftomach as de- prived her of reft. On the fixth day after this accident fhe had a fever, became phrenitic, and neither eat nor drank. She was feized with horrid convulfions of the neck, of the arms, of the lower extremities, and fo vio- lent, that three ftrong men could fcarcely hold her. After fuch exertions fhe lay for a time exhaufted, then fuddenly was feized with frefh convulfions. She was however preferved by oleaginous medicines, and by broth, and having paffed the needle, was reftored to perfect health. Hoffmanni Op. Tom. I. p. 312, Hilda- nus, Cent. I. Obf. 34. SECTION IV. Of the Occafional Caufe of Spafm. When we are feeking for the irritating caufe, nature fometimes points by her efforts to the fource of all her fufferings. and then we can fcarcely fail to underftand her meaning. In all difeafes, but more particularly in the fpafmodic, our attention fhould be turned towards what are called the fix nonnaturals. 1. Air. 2. Food. 3. Motion. 4. Sleep. 5. Paflions. 6. Things retained or difcharged, for among thefe wc fhall find the occafional caufe of the difeafe. 1. Air. I know not that any condition of the air, as fuch, will immediately produce a fpafm ; but certain it is, that impure air, fuch as we breathe in crowded affem- blies, increafes debility, and then, as Dr. Brown, and before him Dr. Whytt, judicioufly remarked, when the body is debilitated, the ordinary ftimuli, that in its healthy ftate invigorate it, produce irregular motions. Among thefe we may reckon the heat of the furrounding atmof- phere, which, if fuddenly increafed, more efpecially fup- pofing irritability to have been previoufly accumulated by NERVOUS DISEASES,. 225 by its abfence, that is by cold, proves a moft powerful ftimulus. In warm climates, obftinate fpafmodic affeaions are frequent ; but thefe arife from debility, as the predifpo- fing caufe, induced by heat ; and the occafional caufe muft commonly be fought for in fome other flimulating power. 2. Food, if fuperabundant, morbidly affeas the nerves of the ftomach, which is itfelf the moft irritable organ, and with which every other part of the fyftem fympa- thizes. But, independent of the quantity, the quality of the food may prove a flimulant inducing fpafm. 3. Of motion and reft I have already fpoken ; of reft as leading to debility, and of exercife as increafing ftrength. But here it is proper to obferve, that violent mufcular exertion is a powerful ftimulus, fuch as debilitated fub- jeas cannot bear without inducing fpafmodic affeaions. 4. Wakefulnefs tends to exhauft the vital energy, and to induce debility ; but in fleep, when no animal motion diminifhes the rapidly increafing energy, accumulation muft be the confequence. Yet even during fleep fpaf- modic affeaions are apt to intervene. The reafons feems to be, that, although fenfibility is blunted during fleep, irritability in fome funaions appears to be increafed, as in the aaion of the abforbents, and the convulfive fpafms arifing from the ftimulus of worms. 5. The paffions have an amazing influence, as I have already ftated, in the produaion of fpafmodic affeaions. Were I to attempt a new and univerfal arrangement of the difeafes incident to man, I fhould feel myfelf in- clined to unite in one fyftem the mental and corporeal% between which there is a manifeft conneaion. As a clergyman I meet with moral difeafes, which re- quire the aid of a phyfician ; and, in the praaice of medicine, I have frequently obferved difeafes of the body induced by morbid affeaions of the mind, in which tfiere- fore moral arguments combined with medicine are the moft effeaual remedies. 6. Things retained afford abundant caufe for fpafm. a. In the alimentary canal. E e Thefe 226 NERVOUS DISEASES. Thefe may be, indigefted fordes, vifcid mucus, worms, the gaftric juice, bile, or, as in the cafe quoted from Hildanus, fome extraileous body. Profeffor Macbride, of Dublin, judicioufly obferves,. that the moft common fource of difturbance in the ner- vous fyftem is acrid and offenfive matter, either in the ftomach or flexure of the duodenum, of which the fymp- toms are, in the tongue foulnefs, fordes, and thick Houghs ; in the mouth a tafte, bitter, four, rancid, pu- trid ; naufea and lofs of appetite; pain in the left orifice and upper part of the ftomach ; weight and oppreffion about the prsecondia ; fulnefs of the hypochondria; heavinefs, giddinefs, and pain in the head; fhivering and coldnefs of the extremities ; with laffitude and lofs of ftrength. Profeffor Hoffman fpeaks of acrid, bilious matter in the inteftines as the caufe of fpafm. Materia acris biliofa flatuum & fpafmorum genitrix, Tom. II. p. 199. And Dr. Whytt, in his ineftimable work on Nervous Diforders, has delivered his opinion, that tough phlegm and worms may be confidered as their efficient caufes. See Hoffman, I. 235. b. In the vafcular fyftem. Retention of any accuftomed evacuations throws the whole fyftem into confufion, and produces a great vari- ety of fpafmodic affeaions, more efpecially at the time when nature is making an effort to relieve herfelf. Hence it is, that we fo often find thofe affeaions attendant on obftruaed catamenia, and the intermiflion of any haem- orrhage which is become habitual. c. In the exhalants. Eruptions of any kind, which are either tardy in their appearance, or which have been repelled, produce the fame confufion in the fyftem. Hence it is that children and perfons of an irritable habit are apt to have convul- fions or epileptic fits at the commencement of eruptive fever, and more efpecially prior to the appearance of , fmall pox and meafles. Perfpiration checked has frequently the fame effea. d. In NERVOUS DISEASES. 227 d. In the gums. When children are teething, they are liable to convul- fions, unlefs the gum is cut as foon as it begins to fwell, to affift in the protrufion of the tooth. Dr. Whytt has left us many curious cafes of fpafmodic affeaions cured merely by fome fmall natural evacuation of blood from a part whence it had never flowed before, or by a fimilar difcharge of pus ; by the appearance of either the catamenia or the haemorrhoidal flux ; by cuta- neous eruption, and by the inflammation of the gout; and every one knows, that in children, as foon as the tooth comes forth convulfions ceafe. Things difcharged have not a tendency to produce fpafm any otherwife than by inducing debility, in cafe the difcharge, whether of blood or lymph, has been im- moderate. « SECTION V. Of the Indications of Cure in Spafmodic Ajfeclions. In fpafmodic affeaions the general indications maybe, to relieve the fpafm, if neceffity requires it, by antifpaf- modics, fuch as, peppermint water, aether, opium, cam- phor, elearicity; but thefe muft be confidered as merely palliative. The fecond is, to remove occafional caufes, which, ac- cording to circumftances, may be by emetics, cathartics, emmenagogues, anthelmintics. The thirdh, to obviate the predifpofing caufe, by tonics and aftringents either vegetable or mineral, by a gener- ous diet, by cold bathing and cool air, and more efpecial- ly by temperance and exercife. Under this order we have fixteen genera : Raphania, Epilepfia, Convulfio, Chorea, Tetanus, Pal- pitatio, Dyfpnaa, Afthma, Pertujfis, Dyfenteria, Colica, Cholera, Diarrhoea, Diabetes, Hyfteria, Hydrophobia. The five firft affea the animal funclions, the external^ . fenfes, with the judgment, memory, and will. The 228 NERVOUS DISEASES. The four following affea the vital funclkns^ the refpi- ration and the motion of the heart. The feven laft affea the natural funclions, the digeftion, with the appetites, fecretions, and excretions. Genus XLI. Raphania. The pathognomonic fymptoms are, fpafmodic contrac- tions of the joints, with convulfive motions and moft vi- olent pain, reverting periodically and continuing from ten days to three months. SECTION I. Of the Ufual Symptoms of Raphania. It begins with cold chills and laffitude, pain in the head, and anxiety about the prsecordia. Thefe fymptoms are followed by, fpafmodic twitch- ings in the tendons of the fingers and of the feet, dif- cernible to the eye, hedit, fever, ftupor, delirium, fenfe of fuffocation, aphony, and horrid convulfions of the limbs. After thefe, vomiting and diarrhoea come on, with a dif- charge of worms. About the eleventh or the twentieth day copious fweats fucceed, or purple exanthemata, or tabes, or rigidity of all the joints. SECTION II. Of the Treatment in Raphania. For the proper treatment of this difeafe I muft refer the ftudent to what I have faid on fever and on fpafm, with the moft perfea confidence, that the hiftory here taken from Sauvage will receive light from what I have delivered on thefe two orders of difeafe, and that my in- dications in them will equally apply to this. With this perfuafion I have placed it as the conneaing link between Pyrexia and Neurofes. It . NERVOUS DISEASES. 229 It muft be evident that raphania originates in the ali- mentary canal, and I have not the leaft doubt that as, ac- cording to Sauvage, it is induced by the coarfeft, the moft clogging, and the moft improper, food, fo it might be fpeedily removed by emetics, followed by a generous diet, with tonics and aftringents. Genus XLII. Epilepsia. Epilepfy. The pathognomonic fymptoms are, convulfions with fleep. SECTION I. Of the Attendant Symptoms. The ufual attendant fymptoms are, foam iffuing from the mouth ; refpiration laborious, as in the aa of ftrang- ling ; pulfe at the commencement quick and fmall, but in the progrefs of the paroxyfm languid and full. The eyes are fwollen and protuberant, conftantly in motion, and turned up, fo as to conceal the pupils; teeth grinding with fuch violence, as fometimes to fplit them ; the jugular veins turgid ; the tongue fwollen and pro- truded. The head is convulfed, and fometimes feized with tetanus, and either drawn forwards to the cheft, or back- wards to the fpine, where it continues fixed and im- moveable. The thumbs are ftrongly rivetted within the palms. All the mufcles are, either convulfed to fuch a degree that four or five men can fcarcely reftrain their motion, or the whole body becomes rigid with tetanus like a mar- ble ftatue. The wind is heard rumbling through the bowels, and fometimes efcapes by eruaation. A vomiting comes on ; the faeces are ejeaed with violence ; 230 NERVOUS DISEASES. violence; and blood is fometimes evacuated both up and down, yet without rupture of the veffels. The urine is at the fame time forcibly emitted with the contents of the adjoining veficles. It fometimes comes on fuddenly and without the leaft warning of its approach. But it is frequently preceded by fome degree of laffitude ; headach and heavinefs j ob- tenebration ; finging in the ears ; difturbed fleep ; unu- fual timidity; palpitation of heart; refpiration intercept- ed ; coldnefs of the extremities ; rumbling in the bow- els, with offenfive flatus; urine copious and limpid, a- greeable to the axiom of Hippocrates: " Epilepticis, uurine tenues & crude preter morem,fine repletione, morbi invafionem fignificat.** In fome patients the epileptic aura is perceived in the extremities, creeping, unlefs flopped by a tight ligature, towards the head, and, arriving there, it inftantly pro- duces the epileptic fit. SECTION II. Of the Intervals and Effecls Produced by Epileptic Fits. The intervals between the fits are various, either an- nual, monthly, or diurnal. The paroxyfms fometimes return more than once in the fpace of four and twenty hours, commonly at the new and full of the moon, frequently at the quarters, but nearly about the fame hour of the day. It is not, however, unufual for them to come on during the time of fleep. Epileptic fits weaken the underftanding, memory, and judgment; and, unlefs reftrained, induce fatuity. They often leave behind them mania, palfy, deafnefs, lofs of fight, and at laft terminate in the apopkaic ftroke. SECTION III. Of the Predifponent Caufe of Epilepfy. The perfons moft fubjea to epilepfy are, infants and children NERVOUS DISEASES. 23I children before the age of pu&erty,'more efpecially fe- males, and fuch as are of a relaxed and therefore of a plethoric and irritable habit, but efpecially if defcended from epileptic parents, or if the mother happened to be terrified during the time of pregnancy. The indolent, and-fuch as have been reduced by pov- erty, exhaufted by haemorrhage, or worn out by any fpecies of drain or of intemperance, and fuch as in any way offer violence to nature, are among the firft who fuffer by this formidable difeafe. The predifpofing caufe of epilepfy is, therefore, debili- ty with fenfibility and irritability, which Dr. Cullen well expreffes by one word, mobility. Yet I cannot agree with him and Dr. Home, that this wholly depends on a plethoric ftate of the fyftem and general turgefcence of the blood. SECTION IV. Of the Occafional Caufes of Epilepfy. The occafional caufes are, 1. Violent excitements of the brain. a. By the fenfations of pain or pleafure. b. By the paflions of joy, anger, furprife, and terror. Even a violent and fudden nojfe, or blaze of light, k fufficient to produce a fit; and what is very remarkable, children hanging at the breaft, when their nurfes are en- raged or terrified, are liable to be attacked by this dif- eafe. c. By mufcular exertions. 2. Irritation from a. Worms. Thefe have fometimes made their way through the inteftines into the cavity of the abdomen. Van Swieten particularly mentions a child, two years old, who appeared to be healthy till he was feized with violent convulfions of which he died. When opened, they difcovered the duodenum pierced by a lutnbricus teres, which was taken out alive, v. Hoffman I. 235. b, Indigefted fordes, Vifcid Mucus. Bile. A 232 NERVOUS DISEASES. A patient came to me, a lad of about 17 years of age, who had had two and twenty fits within the laft fourteen days. He remarked, that about a quarter of an hour before they came on, he had uneafy fenfations in his ftomach and began to yawn. He had no appetite. He had been lately eating a great quantity of floes, and had fwallowed all the ftones. One dofe of jalap flopped the fits, and he had no return. Dr. Ferriar relates the cafe of a patient, who at the firft attack of a rheumatic fever, was attacked with epi- leptic fits, to which he had never been accuftomed. Suf- peaing that they were occcafioned by the ftimulus of accumulated bile, I gave him a vomit, fays the Doaor, which brought up a great quantity of green bile, and re- lieved him intirely from the convulfions. In the courfe of the fever the convulfions returned, and were again removed by fome dofes of calomel, which always pro- duced green flools. Ferriar Med. Hift. p. 8. The meconium remaining, and acidities colleaed in the ftomach and inteftines, are the common fource of epilepfy in new born infants. c. Hunger, arifing either from acidities or from the ftimulus of the gaftric juice. Galen makes mention of a ftudent, who, whenfafting long, never failed to have an epileptic fit. d. Opium and fpirituous liquors, taken in fuch quan- tities as rapidly to expend the vital energy and produce intoxication. e. Renal calculi, exoftofis and extraneous bodies. La Motte, in his Treatife of Surgery, makes mention of two epileptic patients, in whom no occafional caufe for this difeafe could be afligned, till one of them, after a violent paroxyfm, having paffed five calculi, had no return of the diforder ; and in the other, after death, there was difcovered a ft one, weighing five drams, lodged in the pelvis of the right kidney. Dr. Whytt obferves, that epileptic fits have proceeded from a rough bone or cartilaginous fubftance irritating the nerves of the great toe or the calf of the leg. A Girl, aged twelve, having dropped a glafs ball into her ear, was feized with acute pains, which were com- municated NERVOUS DISEASES. 233 municated to the head, and produced numbnefs in the left arm, and of the whole fide, accompanied by great pain, which increafed in the night,* and in wet weather. Her courfes became irregular, and fhe was feized with epilepfy, and emaciation of the left arm. Fabricius Hil- danus, after eight years, when every other medicine had failed, extraaed the glafs ball, and all the fymptoms vanifhed. /. Tittling. Van Swieten faw a young lady, who had no claim to epilepfy, yet for many years fuffered by this difeafe, induced at firft by tittling, whilft fome of her companions pinned her down, and others amufed themfelves for a great length of time in tittling the foles of her feet. g. Hasmorrhagic effort, whether direaed towards the uterus, haemorrhoidal veffels, the nofe, or any other part, from which blood has been accuftomed to proceed. h. Exanthematic effort, more particularly in fmall pox and meafles. /'. Herpetic eruptions checked by repellents, as when the tinea or fcald head in children, a running behind their ears, the gutta rofea in hard drinkers, or any ulcer, is dried up by aftringents; or when the itch has been re- pelled by improper external applications. A Lady with a red pimpled face applied to it, as Dr. Darwin thinks, a folution of lead, and was feized with epileptic fits, which terminated in palfy, and deftroyed her. Zoonomia, II. p. 260* k. Arthritic effort; for it has been frequently obferved that the difpofition to epilepfy has been inftantly remov- ed by the firft attack of inflammatory gout, and has nev- er more returned. See Van Swieten. Sea. 1075. /. Cold fuddenly applied. According to the Brunonian doarine, this cannot be confidered as a caufe of epilepfy, any otherwife than as accwnulating irritability, and the fubfequent heat ought to have been afligned as the caufe. m. Heat, when exceffive or fucceeding to cold. Epi- lepfy has been called with great propriety morbus comiti- alis, for it has been conftantly obiciv~ j. that they who F f are 234 NERVOUS DISEASES. are difpofed to this difeafe, are moft liable to be attacked by it in crowded affemblies and in heated rooms. n. Thunder ; for Van Swieten has well remarked : " Plures epileptici inftanti tonitru corripiuntur paroxyf- mo.iy o. Odours, fuch as, from peculiarity of conftitution, difagree. p. Imitation. I remember hearing Dr. Whytt relate, that a whole ward of young women became affeaed with epileptic fits, merely by the fight of one epileptic patient; and I have more than once had occafion to obferve, that epilepfy, like yawning and many other nervous tricks, is to be acquired by imitation. q. Lively recolleaion, producing the fame effea as the original impreffion. Thus the young lady mentioned by Van Swieten fell into an epileptic fit, even when fhe faw her companions preparing to tittle others. He tells likewife of a boy, who was fo terrified by the unexpeaed attack of a great dog, that he fell down epi- leptic, both at the inftant and whenever he either faw a great dog or even heard one bark. We know what it is to fhed tears at the recolleaion of fome tender or diftreffing fcene long fince paft, and the fame degree of recolleaion will, in irritable habits, renew fpafmodic motions which had ceafed; as for in- ftance, in the aa of vomiting: and Van Swieten men- tions a young man, who was feized with naufea and purging merely at the fight of the cup, in which he had repeatedly taken a cathartic. r. Dropfy, as mentioned by De Caftro and Lieutaud. j. Habit. SECTION V. Of Habits. I have formerly remarked, when treating of intermit- tents, that nature is fond of habits. The propenfity to acquire habits and to aa from them, NERVOUS DISEASES. 235 them, when the original incentive has long fince ceafed, is peculiarly the property of animals. This general faw of the animal economy, although fometimes the fource of evil, is produaive of much good. The generous fteed, once fet in motion, no longer needs the whip and fpur, nor yet the curb, unlefs it be to make a change, and either to quicken or retard his motions. And the rider himfelf, if he has been accuf- tomed to travel on one road, may wholly occupy his mind about a thoufand fpeculations, or, with intenfity of thought, purfue one continued feries of ideas; and yet, although he may often change his direaion, never wan- der from his way. Innumerable aaions, needful to the well being of the animal, are performed by habit without the leaft atten- tion at the time. Habits have refpecl to place. All animals have their haunts and home bufh. The firft objea of purfuit is food, and with regard to this they have all their haunts. The fportfman knows where to look for the covey of partridges to day, which yefterday he moved, whilft they were feeding in the Hubble; and we have great reafon to believe, that even birds of paffage return annually to their accuftomed fpot. The next objea of purfuit to animals is fome fafe re- treat, in which they may quietly repofe, fome hiding place in which to fleep. In the choice of a fequeftered fpot, it is accident which firft determines them ; but the choice once made, they habitually return to it, unlefs fear, or fome motive, more powerful than habit, determines them to change it. When they are to pafs from their place of reft in fearch of food, the choice of a path is not a matter of indifference, but it is influenced by habit. If one of the fame fpecies has paffed before them, they follow in his fteps, and having once paffed unmolefted in this path they tenacioufly adhere to it. Hence it is, that on the open down you may diftina« ly trace the track of different tribes. Hares 236 NERVOUS DISEASES. Hares have their track, with which the poacher is well acquainted, for it is here he fixes up his fnare. Sheep and horfes have each their peculiar track ; and it is well known that men will tread where men have trod before, infomuch that if a drunken clown makes a crooked path over a new ploughed field, the next who follows will in- advertantly trace his footfteps ; and, having once paffed by a given track, men habitually refort to it again. I have frequently remarked the force of habit in large companies, who dine together at a public table, for every man, even without intending it, returns to the fame feat he occupied the day before. And in a farmer's flable, or in his fhed, his horfes and his cows pertinacioufly retain each one its peculiar place; and fhould it be occupied by fome impertinent intruder, this will be a fufficient fubjea of contention. Dogs, in a peculiar manner, feel the force of habit refpecting the J'pots they have fixed upon for their evacu- ations. In their friendfhips animals are governed by the force of habit, for any two which meet accidentally, at a time and place diftant from that in which they accidentally met before, are attached to each other, and, fuppofing them not to be reftrained by fome more powerful influ- ence, will immediately become aflbciates. If two horfes, ftrangers to each other, travel together to a fair, although they fhould have formed an acquaint- ance only for ten minutes, they will find each other out among a thoufand others, and will quickly come to- gether. Habits have refpecl to time. Whatever habits we have formed, with regard to the times of feeding, will have a powerful influence on the appetite for food. The favage, who lives by hunting, may faft many days, and then feed voracioufly, without Tuffering either by in- anition or repletion : but they who, in civilized fociety, have acquired the habit of feeding five times every day, cannot pafs one meal, nor without impatience wait five minutes beyond the ufual time of eating. NERVOUS DISEASES. 237 In both, the appetite for food and the powers of di- geftion depend on habit. In cafe of great mental excitement, men may continue many days without repofe ; but, if they have acquired the habit of fleeping at a certain hour and for a certain length of time, fleepinefs at that hour will return, and at the accuftomed hours they will awake from fleep. Both the defire for fleep and the difpofition to awake may, by habit, become as regular as the rifing and the fetting pf the fun. The fame may be faid of evacuations. I had a nurfe for my children, who was fo perfeaiy fatisfied of this, that fhe governed all their motions by the clock, and in their earlieft infancy taught them the vaft influence of habit. Every part of the fyftem is under the influence of habit, and even the mind itfelf is not exempt from it. Hence, as Mr. Locke has taught us, arife affociation of ideas, affociated aaions, and affociation between aaions and ideas. Some affociated motions are governed by the will, as in playing the violin or flute, and the arts of turning, of fpinning, and of weaving. Others are occafionally un- der the guidance of the will; yet, in cafe of violent ftim- uli, they are not to be reftrained, as happens fometimes in the expulfion of the fasces and the urine. Motions are eafily affociated if they ferve the purpofes of life ; but not if they go counter to natural combina- tions, as when the filverfmith, for the firft time, at- tempts to infpire by his noftrils whilft he is blowing through his lips. Yet by frequent repetition the habit is obtained, and the confent of parts is effeaually eftablifhed. One combination is fo perfeaiy unnatural, that no one has yet been able to defcribe at the fame time two circles in oppofite direaions, one with his foot, the ether with his hand. Some affociated motions, although at firft either vol- untary or accidental, become at laft wholly independent of volition. Thus 238 NERVOUS DISEASES. Thus it is, that by habit we acquire tricks. Other affociated motions are from the beginning inde- pendent of the will, fuch as the vital motions, and thofe which are eftablifhed by difeafe. Of fympathy and confent of parts I have already treat- ed, and have only here to add, that, agreeable to a re- mark of Dr. Cullen, Sea. 1311. in proportion as the habit is eftablifhed, a lefsj degree of ftimulus is needful to excite the fyftem, and to induce affociated efforts ; whether to exclude the enemy, to arreft, or to expel him, fuppofing him to have gained admiffion, or thofe wild efforts and confent of parts, which feem to be alto- gether either frantic or capricious.- Before I quit this fubject I muft yet obferve, that nature learns in a meafure to provide for habitual drains, and ufually feels burthened if thefe are intermitted. This obfervation extends to haemorrhages, whether artificial, natural, or morbid ; to perfpiration ; to ulcers; and to every other kind of drain, as may be particularly remarked in France, where the natives acquire the habit of inceffantly fpitting out their faliva ; in Spain, where a voluntary difcharge of mucus from the fauces is both exceffive and difgufting to the laft degree ; and in Hol- land, where fpitting is induced by fmoaking ; for none of them feem to fuffer by fuch a conftant drain. This obfervation extends likewife to the local expendi- ture of vital energy, or of that, whatever it may be, on which vital energy depends, whether this pabulum be merely oxygen derived from the arterial blood, or the nervous fluid, whatever that may be, or both, as I am in- clined to think, united. SECTION VI. Of the Proximate Caufe of Epilepfy. Boerhaave, as the proximate caufe of epilepfy, afligns vehement aaion of the brain on the motory nerves, and total defea of aaion on the fentient nerves. With this, the opinion of Hoffman fubftantially coin- cides, yet it is more methodically expreffed, for he con- fiders NERVOUS DISEASES. 239 fiders the proximate caufe to fpafmodic ftriaure of the dura mater, compreffing the fentient nerves, and cauf- ing a greater influx of the nervous fluid to the moving fibres. Epilepfy appears to be nearly conneaed with apo- plexy, more particularly with apoplexia fpafmodica of Hoffman, and feems to admit of diftinaion into fanguine and ferous. " The paroxyfm feems to originate in fpafm, but there is evidently, and perhaps induced by fpafm, a determina- tion of blood to the veffels of the head, with fome degree of preffure on the brain, which may be from diftended blood veffels ; or, the aaion of the exhalants being in- creafed, there may be effufion on the brain ; and during the ftate of coma this fuperabundant lymph may be taken up by the abforbents. In cafe of rupture of the blood veffels, apoplexy and death will clofe the fcene. Now, as the preffure on the brain is only partial, and the animal funaions are alone fufpended, the vital energy will be accumulated, and therefore aa with increafed vigour on the other funaions, as we have remarked in the enumeration of the fymptoms. This fubftantially agrees with the pathology of the fa- gacious Hoffman, and with a curious experiment of Sau- vage, when he induced epileptic fpafm by wounding the medulla oblongata, and death by punaure of the fpinai ' marrow. SECTION VII. Indications of Cure in Epilepfy. Practitioners in their treatment of this difeafe mav be' feparated into three claffes. The firft prefcribe only to the fymptoms. Thus they commonly recommend carminatives, that is cordial ftimulants, to difcharge the flatulence of the ftomach and bowels ; ether, the fcetid gums, and opium, to relieve the fpafmodic affeaions of the moving fibre ; magnefia, 240 NERVOUS DISEASES. magnefia, to abforb the acid ; or falts and manna, to re- move the coftivenefs. The fecond feem to proceed one flep farther, and pre- fcribe for the difeafe. They look into books, and being told that epilepfy is to be cured by fuch a medicine, they give it with confi- dence ; but being difappointed in their expeaations, they try fome other infallible fpecific, governed entirely by chance, without one ray of light to guide their fteps. The third prefcribe, if I may fo exprefs myfelf, nei- ther to the fymptom nor yet to the difeafe: they endeavour to find out the proximate caufe ; but neither are they con- tented with that inveftigation, for they never reft till they have made up their mind as to the predifponent and the occafional caufes of the difeafe fubmitted to their care, and on thefe they eftablifh their indications. Boerhaave concludes his judicious remarks on epi- lepfy by pointing out the inutility of fpecifics : yet moft of his cotemporaries, and too many of his followers, have had no other dependance in the cure of moft difeafes. Even Hoffman, in this refpea, deferves our cenfure. He agrees with Wiefmann and Dolseus in recommend- ing a fpecific powder, to be compofed of all the fubfe- quent ingredients, earth worms, frogs, moles, fwallows, frefh feet and embryos of hares, ivory, flag's horn, hu- man fkull, blood of a healthy man, with manatee ftones, but above all the hoof of the elk. The elk was" chofen as being himfelf fubjea to epi- leptic fits ; and the hoof, becaufe, when feized with epilepfy, he cured himfelf by putting his hoof up to his ear! Etmulier informs us, that the horn of the elk, by dif- tillation, yields a volatile alkali, which is antiepileptic ! But to render this efficacious for the human race, it was needful, that the hoof fhould be ftruck off by a hatchet whilft the animal was young and moft at rut. The manatee, or fea cow of warm climates, was fixed upon, as being friendly to the human race. See Schro- der, b. 5. d. 3. n. yy. & Rejes C. El. q. 45. n. 3. A:. NERVOUS DISEASES. 24I As to the blood of a healthy man, this feems to have been the relic of Pagan fuperflition, for we learn from • Celfus, that a common prescription for epileptic fits among the quacks, was to make their patients drink the warm blood of a gladiator flain in combat. »We may remark, however, that with thefe fpecifics, the beft inftruaed phyficians were accuftomed to combine cordial ftimulants, antifpafmodics, tonics, and the vegeta- ble aftringents, not, however, forgetting oriental pearls. Profeffor Hoffman particularly ftates, that evacuants, temperants, and alteratives, muft precede the ufe of thefe fpecifics. His learned friend, Dr. Nicolai, very properly ob- ferves, that the epilepfy of children, arifing from acidities in the firft paffages, is effeaually relieved by the tefta- ceous powder contained in this farrago ; that nothing can be more idle than to feek an univerfal remedy for fpaf- modic affeaions, and that, to cure them effectually, the medicines muft be adapted to the caufe. After which, however, he with the utmoft propriety, exclaims, " Sed quam varie funt fpafmi vel epilepfie caufe !** In epilepfy the indications muft be taken from the re- mote caufes, becaufe during the paroxyfm nothing can be done to give relief. The indications then will be, 1. To increafe the vital energy. 2. To remove the morbid ftimulants. 3. To obviate the contracled habit. I. To anfwer the firft intention, we muft recollect what has been delivered in the feaion on debility and fpafm, and in conformity to thofe ideas, we muft increafe the tone by increafing the tenfion of the folids and the circulation of the fluids. For this purpofe we muft adopt a generous diet, with cool air, exercife, and the, moft powerful aftringents, avoiding at the fame time all caufes of debility. The cold bath, gradually increafed in coldnefs, and the time of the immerfion gradually increafed from mo- mentary to five minutes continuance, will be found an efficacious tonic. G g Hippocrates 242 NERVOUS DISEASES. Hippocrates obferves of epileptics, " 5/ quart ana fupervenit, liberantur** We cannot induce a quartan, but we can fupply its • place by the fudden application of cold, to be followed immediately by glowing heat, fo as to induce a univerfal excitement of the fyftem. Dr. Brown has well remarked, that the caufe of epi- lepfy is neither plethora, nor plethora with mobility, but debility ; and therefore he prohibits venefeaion. Yet, with fubmiffion to his fuperior talents, I mufl here fug- geft, what I hope has been already proved, that debility implies, relaxation of the folids, which often induces plethora, and that this kind of plethora prevents the de- gree of circulation which is needful for the increafe of tone. If, therefore, the ftudent fhould obferve in his epileptic patient a tenfive pain in his head, with inflamed eyes, but more efpecially with oppreffion on the pulfe, let him not be afraid to ufe the lancet, yet, whilft the blood is flow- ing, let him put his finger upon fome artery, that by its feehlenefs, he may be warned to defift, or by its increaf- ing vigour he may be encouraged to proceed. At the fame time let him remember, that venefeaion, as Dr. Brown has demonftrated, increafes ultimately the evil it was intended to remove, and therefore let him not re- peat this operation, but proceed to brace up the relaxed fibre, as the beft prefervative from fuch plethora. Many eminent phyficians, in the cure of epilepfy, have placed their whole dependance on metallic oxyds, and have particularly recommended zinc. Some give either flores zinci, or the precipitate obtain- ed from vitriolated zinc by alkali, beginning with one grain twice a day, and gradually increafing the quantity to twelve grains three times a day : but others prefer the zincum vitriolatum, increafing the dofe from five to twelve grains twice a day. Dr. Cullen frequently prefcribed and ftrongly recom- mended cuprum ammoniacale, and many of his pupils have produced wonderful effeas by giving a quarter of a grain to a dofe, advancing gradually even to four grains twice a day. NERVOUS DISEASES. 243 Had they began by giving the largeft dofes, the ftom- ach would have revolted, and by the force of habit fub- fequent dofes, although reduced in quantity, would have produced the fame bad effea. But by proceeding grad- ually, the ftomach may habitually be taught to bear the largeft dofes ; the laaeals may be trained to take up thefe fubftances in great abundance ; and then, being convey- ed into the blood, they will circulate through the minu- teft veffels of the fyftem, to depofit perhaps their oxygen wherever it is panted, but certainly, in whatever way it is accompliftied, to increafe the vital energy. In my own praaice I have been much attached to fteel. This I learned from Sydenham, and having feen its wonderful effeas, as adminiftered by the late Dr. Smith, of Blackfriar's Bridge, and by Dr. Nankivell, in Can- non Street, I have conftantly adhered to it. The belt preparations are, the filings and the ruft of iron, either of which I give from five to ten grains, two or three times a day, at ftated hours, and fometimes I have united it with anguftura bark. 5o Cort. Anguftur. un. 2. Limat. ferri, dr. 4. Pulv. Arom. dr. 1. , Syr. Zinzib. q. s. f. Eleft. c. "M. N. bis vel ter in die. That is, Take anguftura bark two ounces ; filings of iron half an ounce ; aromatic powder one dram ; fyrup of ginger fufficient to make an ele&uary. The dofe may be a bit as big as a nutmeg twice or thrice a day. I have lately found the bark of the Englifh oak, combin- ed with bitters and aromatics, abundantly ufeful as a tonic and aftringent. But in epilepfy, the minerals deferve the preference. Dr. Wilfon, where tonics and aftringents failed, has cured by giving camphor gr. 5. increafing the dofe grad- ually to thirty grains. II. To anfwer the fecond intention will require the watchful attention of the patient. He muft learn to moderate his paflions and enjoyments, equally avoiding all fudden and violent excitements both of pain and pleafure. He 244 NERVOUS DISEASES. He muft be temperate as to his eating and drinking, and in proportion to thefe he muft regulate his exercife ; yet cautioufly abftaining from exceflive mufcular exer- tion. It will likewife be needful for him to fhun the ex- tremes and fudden alternations of heat with cold, and to keep at a proper diftance from thofe who are fuffering by the fame difeafe. Hoffman gives a very interefting cafe of a young girl, aged 12, of a florid complexion, plethoric habit, and in- clined to coftivenefs, who, being terrified, was feized with violent epileptic fits, but was cured by bleeding at the nofe. The cafes of epilepfy, which in the country have been fubmitted to my care, have been principally induced by terror, by indigefted fordes in the ftomach, or by worms. Of the latter, one cafe gave me much perplexity, be- caufe I thought myfelf certain of the caufe, yet by no medicines could I either cure my patient or hiring away the worms. When I difmiffed her, I fuggefted my opinion of the cafe, in which fhe acquiefced, and told me, that her filler had been for many years fubjea to the fame complaint, but that, after having tried every kind of vermifuge, recommended by phyficians, fhe had taken bear's foot (helleborus fcetidus) in a confiderable dofe. At the dif- tance of about two hours, after fhe had fwallowed this, fhe had a fit, was violently convulfed for a confiderable time, and was left for dead ; but in about half an hour fhe revived, felt an inclination to evacuate her bowels, and, at one motion, paffed feventy worms (the teretes) alive, fome of them nine inches long, and all twined to- gether in a round ball without the leaft admixture of fasces. The convulfions, I apprehend, were moft violent whilft thefe worms were paffmg the pylorus. From this time fhe never had an epileptic fit. Dr. Lncrer.houfz informs me that to a man aged 40, at Vienna, who had epileptic fits, he gave in one- day four pints of water fuperfaturated with carbonic acid air, by which NERVOUS DISEASES. 245 which he paffed a great number of dead worms both up and down, and was cured of epilepfy. A long time af- ter this he relapfed, and was cured in the fame way. The Dr. fays, that he has in a variety of cafes deftroyed worms by filling the alimentary canal with mephitic water. Vifcid mucus with indigefted fordes in the ftomach and duodenum, have been ftated as one occafional caufe of epileptic fits, and Dr. Fothergill confidered this to be their moft ufual caufe. When they originate from hence, nature fometimes makes an effort to relieve herfelf by vomiting. Van Swieten makes mention of a young man, in whom the paroxyfm ceafed whenever Ujjjj^ymptom fupervened; and, as the fits conftantly returned at the full of the moon, he availed himfelf of this circumftance to prevent them by the timely interpofition of an emetic. Hoffman relates the cafe of a young lady, the daugh- ter of an epileptic mother, who, having drank a great quantity of cold water during the operation of an emetic, which fhe had taken for a quartan ague, was feized with epilepfy, but foon relieved by drinking largely of warm water, which reftored the vomiting, and cleanfed the ftomach ; yet, after a time, the fits returned with in- creafing violence, but were again relieved chiefly by emetics and fpontaneous vomiting. The Profeffor on this cafe makes the following re- mark : ^ " This affeaion originated altogether in the primae vise, occafioned by indigefted fordes, acidity, vifcid phlegm, and bile, either in the ftomach or the duodenum. And thefe alfo produced the intermittent.'' Dr. Bondt, as we fee in the Medical Commentaries of Dr. Duncan, mentions an epileptic patient, to whom he gave the bark of the geoffraea furinamenfis in ftrong de- coction, as a powerful anthelmintic. This copioufly evacuated a denfe and vifcid mucus both up and down, and, although it brought no worms to light, effeaually cured the fits. When the difeafe is occafioned by renal calculi, by ob- ftruaed 246 NERVOUS DISEASES. ftruaed catamenia, by the haemorrhoidal flux impru- dently repelled, or by atonic gout, it muft be confidered as fymptomatic, and the attention muft be turned to- wards the primary difeafe. Dr. Ferriar has favoured us with a very curious cafe of epilepfy, brought on by the retroceflion of the itch (in confequence of fome external applications) and cured by inoculating the patient for the itch. HI. To anfwer the third intention, fuppofing epilepfy to have been induced by paflions of the mind, by tranfient fenfations, by irritation paft, by thunder, by imitation, or by affociation of ideas, and to be fupported, not by any fomes in the fyftem, but by the power of habit ; in this cafe, our plan of cure'fouft be more efpecially to give vital energy near the period of acceffion, that, by pre- venting the fit, we may difturb the habit and thus ulti- mately effea a cure. For this purpofe, the fame praaices recommended to break the habits of intermittents will here alfo frequently anfwer our intentions. As near as may be previous to the fit, bark, fteel, wine, ether, opium, muft be given with a liberal hand, fo as to fupport the vital energy, taking care, at the fame time, not by excefs of ftimulants to induce debility. To direa his caution, let the ftudent confult what has been recently delivered on ftimuli, compared with what I ftated, in the beginning of this work, whilft treating par- ticularly of opium, wine, and ether. Dr. Darwin, in a cafe of fomnambulency, and epilep- fy, which came on every morning at feven, gave one grain of opium at fix, and in half an hour fifteen drops of laudanum in wine, increafing the opium. He order- ed likewife bark with filings of iron twice a day, and in three or four days, the patient was reftored to health. Zoonomia II. § 34. When the paroxyfm returns nearly at a given hour, the attack may be prevented by a repetition of ekaric fhocks, continued, as in the cafe of intermittents, beyond the period of acceffion. In the cafe already mentioned of a lad, who had Aval- lowed NERVOUS DISEASES. 247 lowed a great quantity of floes, I ftated, that after the cathartics he had no return of his fits for fix weeks ; but fome time after the expiration of that term he came to tell me, that in the laft twenty days he had ten fits, one every other evening, and nearly at the fame hour. As he had fufficient notice of their approach, I ordered him to return before the ufual hour of attack. He did fo, and was elearified with gentle fhocks till all the fymptoms had difappeared, after which he never had another fit. This, although it is the only cafe I have recorded, is not the only one I have cured by eleclricity, when the* periods were diftinaiy marked, and the fits regular in the time of their approach. And I remember Mr. Randall, who for thirty years praaifed medical elearicity on a moft extenfive fcale in London, affured me, that in fimilar circumftances he had feldom failed to cure. We have remarked above, that thunder clouds occa- fion epilepfy, and here we fee that elearicity in fome ca- fes effeas a cure. No phifiologift has ever yet been able to afcertain precifely what office the elearic fluid commonly per- forms in the animal economy. We know that it is a flimulant exciting powerfully the aaion of the animated fibre, and we obferve that it - promotes the growth of vegetables, the evaporation of fluids, and the perfpiration of animals, that it increafes the flow of liquids from capillary tubes, and brings on fuddenly in obftruaed females their periodical difcharge. We fee clearly, that it quickens, with wonderful ra- pidity, both the acetous and the putrefaaive fermenta- tions, and that when it burfts impetuous from a cloud the vital principle is at once deftroyed. My valuable friend Dr. Fothergill, of Bath, affured me, that he faw a puppy killed by fhocks of elearicity • fent through the head, and afterwards reftored to life by gentle fliocks direaed through the region of the heart and lungs. As often as the operation was fufpended, the little an- imal 248 NERVOUS DISEASES. imal relapfed ; but perfeaiy recovered by a repetition of the fhocks. The operator was Mr. Partington, of Cavendifh fquare, who in the fame manner cures Syncope and Af- phyxia induced by lightning. I have already mentioned elearicity more than once, as an efficacious remedy, and fhall have occafion to rec- ommend it yet again in fome chronic complaints. To break the habit, by diverting the attention, and by introducing a new affociation of ideas, as well as by the attendant exercife and change of air, all medical praai- tioners have agreed in recommending a long journey, which frequently proves an effeaual remedy in this dif- eafe, when all the ufual remedies have failed. I cannot conclude this article without requefting the ftudent, to confult what has been delivered, in the pre- ceding part of this work, on apoplexy, and what has re- cently been faid on fpafm. Genus XLIII. Convulsio. Convulfions. The fymptoms are, alternate relaxations, with violent and involuntary contraaions of the moving fibres, with- out fleep. It is evident, that children, women, and other perfons of manifeft debility, are moft fubjea to this difeafe; from whence we cannot hefitate to aflign morbid irritability as the predifpofing caufe, and on this muft be eftablifhed our firft indication of cure, in the liberal ufe of tonics and aftringents. The fecond indication will be to remove the occafional caufes, which are the fame as in epilepfy. But in general it may be obferved, that convulfions are moft frequently fympathetic, and therefore to be cured by curing the primary difeafe. Let the ftudent, on this head, look back to what has been delivered on epilepfy and fpafm, and forward to chorea and tetanus. Sauvage gives a curious cafe of a young girl, who was aimoft NERVOUS DISEASES. 249 aimoft inceffantly, both night and day, convulfed in her head, eyes, tongue, neck, trunk, arms, fingers, feet, &c. yet retained her fenfes, and made efforts to anfwer when he fpoke to her. He cured her at the end of eight days by bjeeding, followed by an emetic and a cathartic. Genus XLIV. Chorea. Dance of St. Vitus. The fymptoms are, convulfive motions of the limbs or trunk, with fu^i uniformity as to reprefent the gefticula- tions fometimes ufed in dancing. SECTION I. Of the Remote Caufes of Chorea. This difeafe affeas young people, chiefly thofe of a debilitated habit. Hence we cannot hefitate to affign morbid irritabili- ty as the predifpofing caufe. » The occaflonal caufe precifely as in epilepfy, to which I muft refer the ftudent, muft be fought for in fome error of the nonnaturals ; or, as we may exprefs it, 1. In fomethin'g improper received into the fyftem. 2. In fomething improper, that has been done, offer- ing violence to nature. 3. In fomething retained, which ought to be evacuated. SECTION II. Of the Indications of Cure in Chorea. The indications of cure muft here be taken from the remote caufes occafional. and predifponent; but the mif- fortune is, that, in the cure of this difeafe, the attention has been confined chiefly to the latter. To obviate debility, and thereby to diminifh morbid irritability, praaitioners have been commonly contented with giving, either the flowers of zinc, or white vitriol, or the calx of zinc precipitated from the latter ; and oth- H h ers 250 NERVOUS DISEASES. ers have ordered the cuprum ammoniacum, given daily, beginning with one grain, and increafing gradually till the dofe came to three or even four grains twice a day. But, in my opinion, attention fhould be paid firft to the occa- fional caufe, by obviating whatever error has been com- mitted in the nonnaturals, as expreffed above, and then to the predifponent caufe. Dr. White, of York, makes mention of a lady, who, having by emetics brought up a great quantity of phlegm, was afterwards completely cured by flowers of zinc. And Dr. Whytt, of Edinburgh, tells us of a girl, aged fourteen, who was cured by a diarrhcea,*during which fhe difcharged much vifcid flime by ftool. I do not mean to fuggeft, that flime in the inteftines is the only occafional caufe to be regarded, for that would be inconfiftent with what has been recently ftated; but, that both flime and worms, with other irritating caufes, appli- ed to the alimentary canal, require particular attention, muft be obvious to every one, who knows any thing of fpafmodic affeaions. Hoffman was well aware of this, as appears by his chapter de rebus non venenatis, fed inftar veneni in corpus humanum agentibus, where fpeaking of worms, he fays, avermibus filia oao annorum ita fuit vexata ut caput, brachia & crura in continuo effent motu & caput adextro in finiftrum & contra brachia & crura furfum deorfum agitarentur. Tom. I. p. 235. Yet the attention muft not be confined wholly to ir- ritation, arifing from material caufes, for there may be mental irritation, or fuch as affeas immediately the ner- vous fyftem, to be fought for, as ftated above, in various errors refpeaing the nonnaturals. Therefore, 1. If any evil paflions have been excited they muft be reftrained. 2. If any natural evacuations have been checked, they muft be reftored. 3. If any thing improper hath been received into the fyftem, or generated there, it muft be rejeaed, either b\ emetics, by cathartics, or by both, as occafion may re- quire ; after which the following prescription may be given: ]£, Limat. NERVOUS DISEASES. Z$I 5> Limat. ferri, fcr. 2. Sulph. Antimon. praecip. fcr. 1. Aloe Socotrin, dr. 1. Syr. Simp. q. s. f. Pil. 24. Cap. ij. o. n. That is, Take filings of iron two fcruples ; precipitated fulphur of antimony one fcruple ; focotrine aloes one dram ; fyrup of fugar a fuffi- cient quantity to make four and twenty pills, of which take two every night. At the fame time the anguftura bark, with iron and aromatic fpices, as ordered for epilepfy, muft be given twice a day. Or, agreeable to the praaice and recommendation of Drs. Hart, Ganbius, White, Walker, Wright, Percival, Haygarth, and other eminent phyficians, the more pow- erful tonics, fuch as the preparations of zinc and copper, in the dofes already ftated for epilepfy, or even arfenic, as recommended in intermittents, may be ufefully pre- scribed. To thefe fhould be added fea bathing, when it can be had ; or the ufe firft of a tepid, and then gradually of the coldeft frefh water bath may fupply its place. Genus XLV. Tetanus. The fymptom is, fpafmodic rigidity of aimoft the whole body. SECTION I. The Hiftory of Tetanus. ^ This difeafe is common in warm climates, more efpe- cially in fummer, and is moft frequent, when the fcorch- ing heat of a vertical fun is followed by heavy rain or by evening dew. In the Weft Indies it may be confidered as endemic a- mong the negro flaves, who fuftain the viciffitudes of heat and cold, more efpecially when, fleeping after a hard day's work, they are expofed to heavy dews. But although it be endemic in warm climates, yet in every 252 NERVOUS DISEASES. every climate it frequently occurs after wounds, efpecial- ly if the vital energy has been previoufly exhaufted by intemperance, heat, pain, watchfulnefs, or hard labour, and this moft commonly when excitement, pain, and in- flammation ceafe. Tetanus appears either as Opifthotonos, Emprofthoto- nos, or Trifmus. In Opifthotonos the body is drawn violently backward, and all the mufcles of the neck and fpine are affeaed with rigidity. In Emprofthotonos we have fimilar fpafms and the fame rigidity, with this difference, that the body is drawn forwards, more efpecially the head. And, in addition to thefe diftreffing fymptoms in both cafes, Trifmus, that is a locked jaw, is apt to fupervene. In the firft volume of the London Medical Obferva- tions may be feen a very .particular defcription of Opift- hotonos, by Dr. L. Chalmers, of South Carolina, of which the following are the chief particulars. Stage the firft.—Stiffnefs about the back part of the neck, and general laffitude, fo that the patient cannot turn his head without turning his body. He feels a fud- den and painful traaion under" the cartilago enfiformis, which ftriking through to the back, increafes inftantly the rigidity about the neck, draws the head back, and fhuts the jaws. Swallowing then becomes painful, and occa- fions return of fpafm, which extends along the fpine to the lower extremities. Pulfe low and hard. Belly bound. Blood natural. Second ftage.—Spafm under the fternum returns eve- ry ten or fifteen minutes, followed by inftant affeaion of the fpine and jaw, continuing for a few feconds. Pulfe variable from forty to eighty, always hard. Face pale at intervals, but moft often flufhed, and marked with expreflions of diftrefs. Rigidity becomes permanent. Drinking, moving, fpeaking, bring on the fpafm. Third ftage.—Spafms more violent, returning every minute and continuing longer ; univerfal rigidity ; the body being fupported by the head and heels ; the fpine forms an arch. Pulfe between the fpafms quick, fmall, irregular. NERVOUS DISEASES. 2S3 irregular. Heat great; ftrong fweat; delirium. A gen- eral convulfion clofes the fcene. The duration is from twenty four hours to fix and thirty days. They who recover labour under fuch an atony, that for months they cannot raife themfelves in bed without affiftance. SECTION II. Of the Proximate Caufe of Tetanus. This, agreeable to Hoffman, is, violent contraaion of the membranes furrounding the fpinal marrow and the nerves proceeding from it, which caufes impetuous in- flux of the nervous fluid into the affeaed mufcles. The convulfive irritation, according to him, may be induced two ways : for either the membranes of the fpinal marrow, being direaiy irritated, are convulfed themfelves, and draw into confent (in banc convulfionem focietatem) other parts conneaed with them ; or, fome of thefe parts, being firft fpafmodically affeaed, commu- nicate ftriaure to the fpinal marrow, from which it ex- tends by confent to other parts, between which there is no evident conneaion, unlefs through the medium of the brain. Hence he would diftinguifh two fpecies of convulfive motion, idiopathic and fympathetic. SECTION III. Of the Predifponent Caufe of Tetanus. From the hiftory of this difeafe it is clear, that the predifponent caufe is morbidly increafed irritability, as the confequence of extreme debility. As for the fource of debility in warm climates, it muft be evident to every one, who has paid attention to the fubjea, that we need look for no other but excefs of heat, unlefs among the flaves who endure extreme fatigue, and among fuch of the planters as are debilitated by in- temperance and vice. Let 254 NERVOUS DISEASES. Let the ftudent however confult the preceding obferva- tions on- fpafmodic affeaion in general, and particularly thofe on epilepfy. SECTION IV. Of the Occafional Caufe of Tetanus. Hitherto we have affigned only the predifponent caufe, but have not pointed out the hornet, the wafp, nor yet the little fly, if I may be permitted to allude to the general remark, with which I introduced my obferva- tions on fpafm ; that is, we have found irritability, but not the irritating caufe. This in fome cafes, and thofe the moft common, may be difcovered in the alimentary canal. Let.the ftudent recollea what has been faid already, in the beginning of this work, of the effeas of heat al- ternating with cold ; and likewife what every praaition- er from the warm climates, either of the eafl or weft, can teach him refpeaing thofe powerful agents, in load- ing the alimentary canal with bile and vifcid mucus ; and he will not be at a lofs to find an irritating caufe. In fupport of this opinion, let the ftudent further rec- ollea what I have quoted from three eminent profeffors, Whytt, Macbride, and Hoffman. The latter, in his la- borious and moft ineftimable works, is conftantly incul- cating this doarine, that fpafm and convulfions have moft frequently their feat in the ftomach, and more efpe-- cially in the duodenum. He fays, " Non frequentiores occurrunt convulfiones, quam quae in duodeno potiffimum inteftino primarium ag- nofcunt fedem : in quo flabulantes cruditates acidje, at- que vifcidas, ob concurfum biliofi ac pancreatici fucci, promptiflime acrem ac caufticam fere indolem acqui- runt." Tom. III. p. 26. When the inteftines are relaxed and loaded with vifcid mucus, worms can form a lodgment, and, by their irri- tation, are frequently the caufe of tetanus. In the Efprit des Journeaux for Auguft, 1793, we have NERVOUS DISEASES. 255 have two cafes of tetanus defcribed and cured by Dr. Roucher, of Montpelier. The firft is of a man aged 25, who with a locked jaw had an Opifthotonos. This patient, by three grains of tartarized antimony, threw up a moft enormous quantity of vifcid mucus (une quantite enorme de matieres epaif- fes & glarufes.) The other cafe is of a girl aged eight, who was freed from the fame fymptoms by anthelmintics with cathartics. She had copious evacuations, paffed fix worms, and by the repetition of thefe medicines fhe fpeedily recovered. Sauvage has a fpecies of tetanus, which he denomin- ates convulfio Indica, obferved principally in the ifle of Bourbon. It originates in the expofure of wounds and punaures, although healed, to cold ; and appears firft as a cramp in the part, then as fpafm in the head and back, but finally terminates in trifmus, and, unlefs reliev- ed, in death. To cure it they open the wound afrefh with a red hot iron, by which many are preferved. In colder climates the moft common caufe of tetanus is, the partial laceration or even punaure of a nerve or tendon. Nay, fhould the tendon be merely touched, when deprived of its vagina, in a moment the whole fyf- tem will be convulfed, and tetanus may be induced ; yet it is remarkable, that whilft the coverings remain, the tendons may be preffed between the forceps, may be ftretched confiderably, and may be even fewed together. Boerhaave had once warned a furgeon not to touch a tendon, which, in a fuppurated wound, had loft its cover- ings ; but the furgeon, by miftake, touched it with his forceps. Inftantly the miferable patient was convulfed from head to foot, and for fome time remained rigid with tetanus. Hippocrates relates of Thrinon, the fon of Damon, that having an ulcer on his ancle, to which a cauftic drefling was applied, the irritation of the naked tendon induced an Opifthotonos, of which he died. We have already noticed the conneaion between epi- lepfy and tetanus in defcribing the attendant «\ rnatoms of the 256 NERVOUS DISEASES. the former, and it appeared, that one of thefe is fome- times tetanus. Van Swieten mentions a patient, who, during the epi- leptic paroxyfm, was feized, whilft he was prefent, with opifthotonos to fuch a degree, that he heard the vertebras of the back bone crepitate, and faw tt\e head drawn back aimoft to the pofteriors. Yet when fleep came on, this tremendous fymptom was inftantly removed. SECTION V. Of the Indications of Cure in Tetanus. The indications of cure are, 1. To obviate the morbid irritability ofthefyfiem. 2. To remove the occafional caufe, whatever that may be. To fulfil the firft intention we may purfue, either the highly flimulant plan, or we may rely on the common tonics and aftringents. Hippocrates reccommends the feeds of hyofcyamus ; but modern praaitioners of the greateft eminence, who have communicated their ideas to the world, and whofe treatment has been moft fuccefsful, are aimoft univerfally agreed in prefcribing opium, in large dofes, to be repeat- ed frequently, till the fpafm under the flernum ceafes. Some of them give the tinaure of opium, forty drops every four hours ; others give it every half hour, till they have confumed an ounce in four and twenty hours, yet without producing the leaft approach towards in- toxication. To this powerful medicine fome have added mufk and camphor, without regard to quantity, till the whole tu- mult was allayed. In a cafe of tetanus proceeding from a wound, a prac- titioner, of the higheft eminence in London, gave a dram of opium and half an ounce of mufk every four and twen- ty hours, and cured his patient. In fome cafes the warm bath appears to have been eminently ufeful. Hippocrates confidered warmth as mitigating pain, rigours, convulfions, tetanus ; and, on the NERVOUS DISEASES. 257 the other hand, he affirms, that all thefe are induced by cold. On this principle he recommends warm foment- ations, and his followers, Aretaeus and Celfus, with fome among the moderns, are of the fame opinion. Dr. Chalmers, of South Carolina, particularly advifes, that tetanic patients fhould continue in a warm bath, heated to 96 or even 102 degrees, till the pulfe becomes foft and full, before the exhibition of the opium, which is then to be followed up in large dofes every half hour, as I have before ftated, till the fpafm under the fternum ceafes. Dr. Rufh, of Philadelphia, relies on tonics and aftrin- gents. He condemns the ufe of opium, and affures us, that by giving the Peruvian bark, three ounces in three pints of wine, within the four and twenty hours, he foon relieved his patients, and cured them in a few days. Among the tonics, phyficiaris are now aimoft agreed in recommending the cold bath. In the fixth Volume of the London Medical Journal, Dr. Wright informs us, that, adopting from Dr. Lind the ufe of the cold bath in cafes of tetanus, that is by pouring two or three pails full of cold water every three or four hou~s over the body of his patient, he had never failed in a fingle inftance to effea a cure. Dr. Hutchinfon cured one patient by eleclricity ; and Dr. Colin, of Vienna, effeaually relieved another by the flowers of arnica. The fecond indication is to remove the occafional caufes, which, as ftated, may be, i. Vifcid mucus. To evacuate this, emetics are abfoluteiy neceffary, and thefe muft he followed by cathartics. For the former tartarized antimony, three grains, triturated with five grains of teftaceous powder, may be given in the morning falling ; and, at night, for the cathartic, calomel will be found of all others the moft efficacious. Two cafes are related by men of the moft refpeaable authority, in which twenty grains of calomel were given in the fpace of four hours, with vifible advantage, fuch I i indeed 258 NERVOUS DISEASES. indeed as, by the fubfequent affiftancepf wine and bark, effeaed a perfea cure. In the Nofologia Methodica of Sauvage, Clafs VII. Order IV. Genus XXI. Species II. we have gaftrodynia flatulenta, of which he gives the following defcription: " Eft vehemens dolor tenfivus fub cordis fcrobiculo,cum refpirandi difficultate, fleaendi antrorfum trunci neceffi- tate qui flatuum emiffione fublevatur; accedit pulfus im- minutio, depreflio extremorum frigus, fumma anxietas, praecordiorum anguftia. Diff'ert a gallritide, a gaftrody- nia hyfterica aliifque,quod epigaftrium preffionem a manu faaam toleret, qua alias exacerbatur dolor." That is, a violent pain and tenfion under the fcrobiculus cordis, with difficult refpiration, a neceflity of bending the trunk of the body forwards, which fymptom is reliev- ed by difcharging flatulence colleaed in the ftomach. To thefe are added, diminution and depreffion of the pulfe, coldnefs of the extremities, and ftraitnefs over the prsecordia. It differs from inflammation of the ftomach, and from the hyfterical affeaion of the fame Organ, in this partic- ular, that the hand may be preffed upon the epigaftrium without increafing pain. Is not this a fpecies of emprofthotonos ? If we compare it with the firft ftage of opifthotonos, above defcribed by Dr. Chalmers, we fhall find a re- markable coincidence of fymptoms, which naturally di- reas the mind to feek fome fimilarity, or rather identi- ty, in the occafional and predifponent caufes. Among all the praaitioners, with whom I have had occafion to converle, I never met with one who had ev- er feen, either the gaftrodynia flatulenta of Sauvage, or the emprofthotonos of authors. Yet I am intimately acquainted with a gentleman, who has been fubjea to a difeafe, of which I fhall now enumerate the fymptoms, and, as he has had it often, I can rely upon the accuracy of his defcription. The firft notice he has of its approach is a certain anxiety and dread of evil, which he is not able to exprefs. He then perceives a pain, NERVOUS DISEASES. 259 pain, which he can cover with his finger, on one fide or other of his breaft, about two inches below the nipple. This gradually increafes, with fome little difficulty of refpiration, total inability toraife his head, or to turn it either to the right hand or the left, without moving the whok- body ; the fhoulders are drawn up ; the chin drawn downwards, till it approaches the cheft, where it continues fixed. To this fymptom is fometimes added, an abfolute neceffity of bend- ing the trunk of the body forwards. If he is lying on one fide, and wifhes to relieve himfelf by turning to the other, he is obliged for that purpofe to rife up in bed, and then fall into the pofition to which he looks for eafe. He can never bring up wind from his ftomach till the difeafe is go- ing off. The pulfe is depreffed and flow ; the extremities are cold ; and he can bear any degree of preffure on the epigaftric region without in- creafing pain. Coftivenefs is always an attendant fymptom. After having repeatedly tried the effect of cordial ftimulants, un- der an idea that it might be a fymptom of atonic gout, yet without obtaining the leaft relief, he had recourfe to warm cathartics, by which, in a few days, the fymptoms were fomewhat relieved. But nothing was effectual, till he happily took firft an emetic, which foon brought up a quantity of bile, and then calomel, which difcharged bilious ftools and a great quantity of vifcid mncus. Horfe exercife, with fteel and the Peruvian bark completed the cure. 2. Worms. Thefe muft be deftroyed, not by aloetics, becaufe thefe are too heating and to irritate the fyftem, but by fanto- nicum, by fpigelia, by decoaion of Geojfrea, made with one ounce of the bark to fifteen ounces of water, of which the proper dofe is about three ounces ; or by cal- omel, followed by fteel filings, rhubarb, bark, and bitters. 3. The meconium. There is a fpecies of tetanus to which newborn infants are fubjea, attended with locked jaw and opifthotonos. It is moft frequent in warm climates, and is attributed, by the moft judicious praaitioners, to the neglea of nurf- es, in overfeeding their infants before they are cleared from the meconium. The method of cure adopted by Dr. Chalmers was, to cleanfe their bowels by rhubarb and clyfters. This fpecies is fo deftruaive in Catalonia, that no one felicitates a parent on the birth of a child till the infant is nine days old. In Madrid, where the fum- me rs are much hotter, it is totally unknown. 4. Wounds* 2tjO NERVOUS DISEASES. 4. Wounds. If the nerve or tendon is lacerated, but not divided, all fear of tetanus will be removed by completing the di- vifion. And in all cafes, where the fpafm arifes from local irritation, this may be relieved by cutting off the communication between the fpinal marrow and the part affeaed, which may be accomplifhed either by compref-. fion, by the knife, or by a cauftic. In Catalonia they bathe the foot in oil, when the apo- neurofis plantarum has been wounded. Experience jufti- fied this praaice. Dr. Rufh has favoured us with one cafe, which is highly interefting, where a nail was run into the foot without producing inflammation, and the jaw began to be affeaed. He dilated the wound, and poured in fpirit of turpen- tine, which, producing pain and inflammation, cured the patient. It is worthy of our obfervation, that a fplinter under the nail produces no convulfions, nor will tetanus enfue, if pain, inflammation, and fuppuration, have taken place. 5. Should any other occafional caufe prefent itfelf to the attention of the praaitioner, this mufl be obviated ; but fhould the occafional caufe, after his moft diligent refearches, be concealed, he muft then place his whole dependance on the medicines which anfwer the firft in- tention, that of removing the predifponent ca\ife. Genus XLVI. Palpitatio. Palpitation of the Heart. The fymptoms are, bounding of the heart to be felt againft the ribs, frequently with a fmall, weak, intermit- tent, pulfe, and followed fometimes by Syncope. SECTION I. Of the Predifponent Caufe of Palpitation. The perfons moft liable to this difeafe are, thofe of a relaxed and irritable fibre j the young, particularly fe- males ; NERVOUS DISEASES. ?.6l males ; the plethoric ; thofe in whom accuftomed evac- uations fail ; and fuch as have been reduced by copious haemorrhages or exhaufted by difeafe. Hence it is clear, that the predifponent caufe is debility and morbid irrita- bility. SECTION II. Of the Occafional Caufe of Palpitation. Palpitations may be induced by paflions of the mind, fuch as vehement defire, joy, anger, terror, and furprife ; or by mufcular exertion, as in running, leap- ing, and the like ; by long continuance in a warm bath ; by flatulence and diftention of the bowels ; by tight bandages round the waift or on the lower extremities; and by eruptions prematurely checked. Malpighius particularly remarks, that he was frequent- ly attacked by troublefome palpitations, after eating legumina ; and Hippocrates obferves, that flatulence al- ways attends this affeaion of the heart. No wonder then, that hyfterical and hypochondriacal patients fhould complain of palpitations. Foreftus, as quoted by Hoffman, relates the cafe of one, who, fleeping at noon with tight garters, was feized with palpitation, but relieved by loofening them. It has alfo been eftablifhed as a faa, that, by fuppreff- ing the fweating of the feet, by repelling herpetic erup- tions or any exanthemata, as well as by the drying up fuddenly of ill conditioned ulcers, and by the gout, when retrocedent, the fame diftrefsful fymptom has been pro- duced. I fay nothing of polypus, becaufe it may be the confe- quence of death and not the caufe of palpitation ; nor do I fpeak of organic affeaion, becaufe it is irremediable. SECTION III. Of the Proximate Caufe of Palpitation. The proximate caufe affigned by Hoffman is, fta^na- tion and congeftion of blood in the right chambers of the heart, 262 NERVOUS DISEASES. heart, inducing impetuous influx of the nervous fluid to the nerves and fibres of the heart, which excites their preternatural contraaion. In fupport of this opinion he fuggefts, that no organ is lb plentifully fupplied with nerves as this. It has no lefs than five pair. One from the par vagum, another from the fuperior intercoftal, a third from the vertebral, a fourth from the inferior intercoftal, and the fifth from the phrenic. The three firft are derived from the brain itfelf; the two latter from the fpinal marrow. He remarks, that all the fafciculi of fibres and fibrilli compofing the mufcles of the heart, are each covered \Bith the fined contexture of arteries and nerves. This wonderful organ hangs fufpended in the cheft, fo as to move freely ; and, in cafe of palpitation, to bound with violence againft the ribs, fo as even to excite the ab- forbents and to deftroy the bones. Now when the blood, after having diffufed a genial warmth and vital energy over the fyftem, and after hav- ing fupplied the fecretory glands, but more abundantly the brain, with all that is needful for the performance of their funaions, returns from the minuteft through the larger veflels to the vena cava, and from thence, with the addition of chyle and lymph, received from the thoracic dua, by the fubclavian vein, rufhes into the right cham- bers of the heart ; the fwelling torrent, by diftention, ftimulates this organ to powerful contraaions ; and as the ftream is prevented, by the tricufpid valves, from return- ing backwards to its fource, it efcapes through the pul- monary artery into the lungs, where, as already ftated, it purges itfelf, and acquires frefh oxygen and heat. From hence it returns by the pulmonary veins to the left chambers of the heart, to be again diftributed throughout the fyftem. Thus the circulation is maintained till the filver chords are loofened, and the golden bo vl is broken at the fountain. Hence it is evident, that for the natural motion of the heart there is required, 1. A NERVOUS DISEASES. 263 1. A due proportion between the quantity of fluid to be moved, and the natural power of the heart. 2. A due degree of vital energy, or moving power, in the heart, and therefore a fufficient influx both of nervous fluid and of well oxygenated blood. 3. Perfea organization and freedom from incum- brance in the heart itfelf, and in the veffels, which either bring back the blood, or receive it from the heart. But to caufe that degree of palpitation, which is re- garded as a difeafe, there is required, 1. Some obftacle to free circulation, as already ftated, with, 2. A nwre abundant influx of the nervous fluid to the ftimulated part. This violent bounding and contraaion of the heart, repeated with extreme rapidity, may be fufpended, but cannot ceafe altogether, till the enemy is expelled and the remote caufes are removed. SECTION IV. Of the Indications of Cure in Palpitations. The indications will be evidently thefe, 1. To quiet the violent commotion of the heart. 2. To promote a free circulation of the blood. 3. To remove the occafional caufes of the difeafe. To anfwer thefe intentions, Profeffor Hoffman recom- mends diaphoretic antimony with nitre and teftaceous powders, and fpeaks highly of his anodyne. In cafe of flatulence, with coftivenefs, a dry fkin, and cold extremities, he orders, with the above, friaions,the warm pediluvium, and carminative clyfters. Should thefe applications fail, and fhould the fulnefs of the veffels admit of bleeding, this may be tried. Galen, and after him the moft eminent praaitioners, affirm, that venefeaion, with medicines and aliment of the attenuating kind, are infallible in the cure of palpita- tion ; but this muft be underftood merely in cafes of plethora, or uncommon fpiffitude and richnefs of the blood. In 264 NERVOUS DISEASES. In cafes that depend on debility and irritability mor- bidly increafed, a generous diet, with tonics and aftrin- gents, muft be freely given, as recommended in epilepfy and chorea. In all cafes the body muft be preferved open, and the perfpiration free. Sauvage makes mention of fifteen fpecies of palpita- tion, of which moft are from organic affeaions. Of the reft we may remark, 11. Palpitatio Arthritica. 12. Chlorotica. 13. Hyf- terica. 14. Melancholica. 15. Febricofa. Thefe are evidently fymptomatic, and therefore to be relieved by curing the primary difeafe. Genus XLVII. Dyspnoca. Difficult refpiration, continual, and without fenfe of ftriaure ; cough frequent through the whole courfe of the difeafe. The idiopathic fpecies are reckoned by Dr. Cullen, 1. Catarrhalis, with a frequent cough, throwing up a great quantity of vifcjd mucus. 2. Sicca, with cough moftly dry. This includes Dyfpncea a tuber-culofis, D. afteatomatis,D, ab hydatidihus, and D. polypofa, of Sauvage, with his Orthopncea a lipomate, which is the fame difeafe with his D. afteatomatis. 3. A'eria, from change of temperament in the air. 4. Terrea, from earthy concretions in the lungs. 5. Aquofa, with deficiency of urine and ©edematous fwelling of the feet, but without fluauation in the cheft, or other fymptoms of hydrothorax. 6. Pinguedinofa, in fubjeas who are oppeffed with fat. 7. Thoracica, from deformity of the cheft. 8. Extrinfeca, from extrinfic caufes. This includes feven fpecies of Sauvage, to be readily diftinguifhed by the offending matter, whether duft, me- tallic fumes, poifons received into the ftomach, or com. preflion of the lungs by bronchocele. Befide NERVOUS DISEASES. 265 Befides thefe fpecies Dr. Cullen mentions twenty fev- en from Sauvage, which, like many of the former, are clearly fymptomatic. Of thefe feven are derived from dif- eafes of the heart and larger arteries ; feven from tumors and diftention of the abdomen, preventing the defcent of the diaphragm ; and thirteen from other difeafes, inclu- ding Orthopnea a verminibus, which Dr. Cullen fhould have arranged under his Extrinfeca. Of all the enumerated fpecies, Dr. Cullen has judi- cioufly remarked, that they are difeafes which either do not admit of cure, or belong to other difeafes, as merely fymptomatic, excepting only the Extrinfeca, whofe occa- fional caufes are to be carefully avoided. Genus XLVIII. Asthma. Spafmodic Afthma. The pathognomonic fymptoms are, difficult refpiration returning at intervals, with fenfe of ftriaure acrofs the breaft and in the lungs ; wheezing ; hard cough at firft, but more free towards the clofe of every paroxyfm, with a difcharge of mucus followed by remiffion. SECTION I. Of the Attendant Symptoms and Progrefs of Afthma. Aret^eus among the fymptoms of afthma has re- marked, previous to the attack, a tightnefs and ftriaure on the cheft, unufual indolence, hoarfenefs, cough, dif- tenfion of ftomach, naufea, eruaation, watchfulnefs, and deficiency of animal heat during the night. As the difeafe advances, the cheeks are red and the eyes are prominent, as in ftrangulation. The patient fnores even if awake, but more when fleep- ing. He has in general the keeneft and moft impatient defire for frefh cool air ; and for this reafon feels diftrefs, when confined within the limits of a houfe, although the apartments fhould be fpacious. FroAi the fame fenfation of diftrefs he raifes himfelf upright and breathes with his mouth open. K k Th* 266 NERVOUS DISEASES. The pulfe is quick, fmall, and commonly oppreffed. Coftivenefs, Agith vomiting of bile, and a copious dif- charge of limpid urine, are prevailing fymptoms. After dinner, and more efpecially after a full meal, there is commonly much flatulence in the ftomach, with drowfinefs and increafed dyfpncea ; but the violence of the paroxyfm is commonly from about midnight till to- wards morning, when it is relieved by fleep. In the progrefs of the difeafe, a flight fever of no cer- tain type comes on, with evening exacerbations. The face, the hands, and arms, begin to fwell; the countenance is pale and lurid ; the legs become ©edema- tous ; and afcites, anafarca, a dropfy of the cheft, or a lethargy, fupervenes. A torpor of the arms is felt, pre- ceding partial paralyfis, and the diftreffing fcene is clofed by fuffocation. SECTION II. Of the Perfons moft fubjeel to Afthma. These are chiefly of the fanguine temperament, with fmall, but numerous, veffels; the corpulent and plethor- ic ; but more particularly perfons of a contraaed cheft ; the intemperate, and fuch as have been debilitated by exceffive haemorrhage, or in whom any accuftomed evacuations, either fanguine or ferous, have been fup- preffed ; thofe alfo in whom herpetic eruptions have been unfeafonably checked, or ulcers fuddenly dried up ; but particularly thofe who are much oppreffed with flatu- lence ; and all thefe more efpecially at the vernal and autumnal equinoxes. SECTION III. Of the Caufes of Afthma Proximate and Remote. The proximate caufe is certainly, a fpafmodic con- ftriaion of the mufcular fibres of the bronchiae, commu- nicated by confent to the larynx and the diaphragm. The predifponent caufe is morbid irritability. The NERVOUS DISEASES. * 267 The occafional caufe is to be fought for in fome error of the nonnaturals, as already ftated in the preceding feaion. SECTION IV. Of the Species of Afthma. Sauvage enumerates eighteen fpecies of afthma, taken principally from the works' of Hoffman. 1. Humidum. 2. Convulfivum. 3. Hyftericum. 4. Hy- pochondriac hum. 5. Arthriticum. 6. A Polypo Cordis. 7. Pulverulentorum. 8. Stomachicum. g.AGibbo. 10. Equinum vel Emphyfematofum. 11. Exanthematicum. 12. Metallicum. 13. Cacheclicum. 14. Venereum. 15. Pleth- oricum. 16. Catarrhale. \y. Pneumodes. 18. Febri- cofum. Of thefe, fuch as are not fymptomatic are reduced by Dr. Cullen to three fpecies : 1. Spontaneum. 2. Exanthematicum. 3. Plethoricum. Species 1. Spontaneum is the fame with the flatulen- tum of both Hoffman and Floyer, and with the ftom- achicum of Baglivi and Sauvage. Among the fpecific fymptoms are, previous to the par- oxyfm, fulnefs and diftention of ftomach ; infipid eruc- tation ; tightnefs in the prsecordia ; copious difcharge at night of limpid urine ; weight, anxiety, and difficult refpiration. About two in the morning the paroxyfm commences, and, if it is fevere, induces bilious vomiting. The pulfe is firft quick and irregular, then weak and intermittent. In the progrefs of the fit the hands and feet are cold, the face becomes pale, there is fometimes heartburn with palpitation, and the whole is clofed by fleep. Baglivi, with the utmoft propriety, confiders this as an affeaion of the ftomach. Dr. Whytt has particularly noticed fympathy with the ftomach, when the nerves of this organ are affeaed by wind, phlegm, or crudities, as one caufe of fpafmodic afthma. Species 268 NERVOUS DISEASES. Species 2. Exanthematicum is the fame with the con- vulfivum of Hoffman. The fpecific fymptoms are tightnefs on the cheft, pain- ful fenfations on the fternum extending to the fcapulae, torpor of the arms which fometimes become paralytic. In this fpecies the fpafmodic ftriaure is not confined to the mufculo-tendineous membrane conneaing the an- nular cartilages of the bronchia, but is communicated to the intercoftal mufcles, preventing thereby the expanfion of the cheft, and, as thefe conftriaed regions borrow their nerves from the vertebral and dorfal, which fend branches to the arms, thefe parts muft fuffer as above defcribed. The occafional caufe may be fought for in the prema- ture retreat of eryfipelas, meafles, or any other of the exanthemata ; in the repulfion of -herpetic eruptions, fcald head, itch, &c. ; or in the drying up of inveterate ulcers. It may be induced by a fudden check of per- fpiration in general, but more efpecially by repelling that of the feet, when copious and offenfive, or, as frequently happens by retrocedent gout. Species 3. Plethoricum is the fame with the fanguineum of Hoffman. The fpecific fymptoms are, rednefs of the face, fulnefs of the veffels, with other fymptoms of plethora ; palpita- tion of the heart ; pulfe quick, unequal, fmall ; and a flight Pyrexia attending the firft paroxyfms. It is induced by indolence in conjunaion with full diet, but more particularly by the ftoppage of accuftom- ed evacuations. In whatever part of the fyftem fpafmodic ftriaure firft takes place, if it induces congeftion in the right cham- bers of the heart and in the lungs, fpafmodic contraaion of the bronchial tubes and veficles will be the confe- quence. For it may be univerfally received, that im- moderate diftention produces fpafm, and fpafm contrib- utes to congeftion. Hence it is that the lungs of thofe. who have died of this difeafe, have been difcovered full of black, extravafated, and flagnant, blood. Dr. Darwin confiders afthma as either, ift. humoral, or NERVOUS DISEASES. 2D"o, or 2d. convulfive, the former arifing from torpor of the pulmonary veffels, or deficient abforption of the lymph effufed into the air cells, and therefore conneaed with anafarca : the latter arifing, like epilepfy, from fympathy with remote parts of the fyftem, as on the retroceffion of eruptions, or the irritation of worms in the alimentary canal. Zoonomia, Vol. II. p. 339. SECTION V. Of the Indications of Cure in Afthma. These may be taken from the proximate caufe, and then ether with opium muft be given frequently in con- fiderable dofes, till the paroxyfm is relieved. 5> iEther vit. dr. i. Tinft. Opii gtt. 40. Aq. font. un. 2. M. p. r. n. s. Or, the indications may look towards the predifponent caufe, which calls for tonics, fuch as the metallic calces, principally fteel in its various preparations. But on whichfoever of thefe caufes we build our indications, we muft not be unmindful of the occafional caufes, as already ftated in the feveral fpecies. Species i. Spontaneum. Here, as I have faid, the oc- cafional caufe muft be fought for in affeaions of the ftomach, and I am confirmed in this opinion, not merely by the authority of the moft fagacious praaitioners, Bag- livi, Hoffman, and Whytt, but by a confideration of the fymptoms, and more efpecially by the effea of an emetic, for in this fpecies of afthma it never fails to give relief. §, Vin. Antimon. dr. 1. Oxymel Scill. dr. 6. M. pro. Emet. §> Ipecac, gr. 15. vefpere fumend. The former of thefe profeffors gave his emetic every morning. Dr. Thornton, having the misfortune to fee his mother, and uncle General Brathwaite, affliaed with afth- ma for more than twenty years, and his aunt fubjea to mucous expeaoration, but without afthma, was naturally excited 27® NERVOUS DISEASES. excited to pay every attention to this moft harrafling and frightful complaint. As emetics were the only remedies that gave them re- lief, but, being frequently repeated, aggravated the dif- eafe, by injuring the tone of the ftomach ; and as bitters with bark and fteel filings, though at firft of fervice, were contra indicated as locking up the accumulated mu- cus in the ftomach,'Dr. Thornton from thence con- cluded, that in fuch afthmas the emetic and tonic plan might be fuccefsfully conjoined with the inhalation of ox- ygen air ; for in afthmatic patients there is evidently a deficiency of the vital principle in the blood, as appears from their fallow countenances and cold extremities, arifing probably from ftraitened refpiration during each paroxyfm, and becaufe, when the ftomach is difeafed, the blood lofes in fome degree its attraaive power for oxygen, as was before fhewn. Nor has this ingenious phyfician been at all difappointed in his views. During the laft five years Dr. Thornton has admin- iftered the pneumatic remedies to multitudes both of rich and poor, with remarkable fuccefs. From a number of interefting cafes I fhall, however, only felea one. The Rev. Dr.----——-> an intimate friend of the celebrated oc- cuhft Mr. Wathen, had for more than two years been afflicted with ojthma. The paroxyfms were Angularly fevere, fo that he could not breathe But in a contorted pofition of his body; they recurred regu- larly each night, and lafted in general from five to feven hours. Be- ing quite exhaufted, he would at length fall afleep, but awoke with a parched tongue and very languid. He had been under the care of feveral very eminent phyficians, and latterly under, Dr. Warren, who told him, with his accuftomed liberality, that he was purfuaded, from a very extenfive experience, that aflhrna, when once fixed in the habit, was not to be removed by art, however it might be palliated, and he muft not therefore enter- tain the fallacious hope of a cure from medicine, and fly from phyfician to phyfician, but mufl patiently refign himfelf to the affliction. But daily lofing flefh and ftrength, his family began to be very apprehen- five, and Mr. Wathen having told them of the extraordinary relief and final cure, obtained by a young lady of his acquaintance, in the moll violent fpafmodic attacks, when the prefcriptions of the ableft praaitioners could render her no fervice, and that an aflhma even of forty years (landing had been gi'eatly relieved by the inhalation of the vital NERVOUS DISEASES. ' iyt ■vital air, this gentleman was encouraged to confide himfelf to the care of Dr. Thornton. In ten days time, by cleanfing the ftomach of vifcid mucus, and re- ftoring the vital principle to the blood, his paroxyfms were fomewhat lefsviolent; after which, by ftrengthening the fyftem, and ftill con- tinuing the inhalation of an oxygenated atmofphere, he had feveral in- termiflions, and in two months he was perfectly free from afthma. He continued throughout the whole of laft winter perfectly well, and at the prefent time is, as Mr. Wathen informs me, in the full enjoyment of the bleffing of health. Species 2. Exanthematicum. From a confederation of the occafional caufes, the fpecial indication, which nat- urally prefents itfelf, is, to promote a determination to the furface, and to the lower extremities. This intention may be anfwered by mild diaphoretics, by carminative clyfters, by friaion of the feet with ei- ther a hare's fkin or a flefh brufh, and by tepid pediluviura. To thefe, gentle diuretics and cathartics, fuch as nitre, fulphur, fquills, and fait of tartar, may be added to ad- vantage. The fubfequent prefcription has produced wonderful effeas, after others had been tried in vain. Ifc> Flor. Sulph. un. i. Pulv. Sennse, Zinzib. aa dr. 2. N. Mofchat. dr. if. Mel. un. 2. M. f. Eledt. c. M. N. M. bis in die. That is, Take fulphur one ounce ; fenna and ginger, of each half an ounce ; nutmeg a dram and an half; honey two ounces. Make an elec- tuary, and take the fize of a nutmeg twice a day. This compofition has defcended in the Ferrers' fam- ily from their anceftor, who was cured by Boerhaave, when the Englifh phyficians could give him no relief. Hoffman for their common beverage gave his patients old hock and Seltzer Water. Dr. Whytt ufed blifters on the back. Species 3. Plethoricum. The frJecial indications ari- fing from the occafional caufes are, 1. To obviate plethora. 2. To reftore the accuftomed evacuations. The firft intention may be effeaually anfwered by ab- ftemioufnefs and regular exercife, by gentle laxatives, and by avoiding heat. To 272 NERVOUS DISEASES. To anfwer the fecond intention the fuitable evacuants muft be reforted to. In all cafes of afthma* more efpecially in old fubjeas, I would earneftly advife the conftant ufe of flannel next the fkin. Sir John Pringle recommends ftrong coffee during the afthmatic paroxyfm ; and Dr. Percival, of Manches- ter, has adopted this praaice with manifeft advantage. Genus XLIX. Pertussis. Chin Cough, or Hooping Cough. The fymptoms are convulfive ftrangulating cough with hooping, relieved by fpontaneous vomiting. It is contagious. • SECTION I. Of the Proximate Caufe of Hooping Cough. From all the obfervations I have made on this difeafe, it appears to be conneaed with, if not wholly dependant on, the affeaions of the ftomach, and to have for its proximate caufe morbid irritability chiefly of the ftom- ach with increafed aaion of its mucous glands. Yet fuch is the correfpondence and confent between the ftomach and the lungs, that it is not in all cafes eafy to determine, in which of the two is the original feat .of the difeafe. In catarrh this confent has been already noticed, but more particularly in tuffis ftomachalis and in afthma ; and we have occafion to make the fame remark in hooping cough. That in this difeafe there is produced a diftreffing quantity of vifcid mucus or tough phlegm, we have occu- lar demonftration, and evidently fee, that when the ftom- ach has been cleared from this, the cough ceafes for a time. SECTION II. Of the Indications of Cure in Hooping Cough. Taking therefore morbid irritability chiefly of the ftomach, with increafed aaion of its mucous glands, for the NERVOUS DISEASES. 273 tRe proximate caufe of chin cough, the indications of cure will be to remove the irritating caufe, that is, the phlegm, and to diminifh the morbid irritability of the ftomach with the increafed aaion of the mucous glands, the former by frequent emetics, and the latter by aftrin- gents, to which may be joined antifpafmodics, and the inhalation of vital air diluted with atmofpheric. §, Antimon. tartarifat. gr. 3-'Aq. Menth. un. 3. Syr. half, dr.'2. M. Capt. un. 1 omni horae quadrante ufque ad vomitionem. Take tartar emetic three grains ; mint water three ounces ; bal- famic fyrup two drama : Mix, and take one ounce every quarter of an hour till it vomits. §, Cinchon. Rub. un. 2. Aq. font. ft. 3. Coque ad %. 2. Colatu- rac un 3. adde Tind. Afae foetid.gtt. 15. Tinct. Opii, gtt. 10. om. 8a. Take red bark two ounces, fpring water three pints ; boil it to one quart, and ftrain. To three ounces of this decoction add tin&ure of affa fcetida fifteen drops, liquid laudanum ten drops. To be given every eighth hour. It frequently happens where emetics have been omit- ted, that children, after the hooping cough, are troubled with worms. Thefe may be deftroyed by calomel, and then the tonic plan muft be purfued. I had lately a lit- tle patient three years and an half old, in the hooping cough j who, when brought to me, had that morning paffed one and thirty worms, and in the preceding days, twenty eight, many of which were from fix to nine inch- es long. To this little infant I gave two grains of calo- mel every night, and three grains of jalap the fucceeding morning. Thefe procured two ftools in the courfe of the day, brought away three worms, making the whole number fixty one, and in ten days perfeaed a cure of the hooping cough, without the affiftance of emetics. v Genus L. Pyrosis. "Water-brash of Scotland, and Water-brash of the weft of England, is a copious eruaation of a watery infipid fluid, attended with heart burn. It frequently recurs, but being attended with no alarming fymptoms, it has generally been left to nature. « LI Genus 274 NERVOUS DISEASES. Genus LI. Dysenteria. Dyfentery. Of this the fymptoms are frequent griping ftools, chiefly mucos, fometimes mixed with blood and follow- ed by tenefmus. It is commonly attended by pyrexia, and appears to be contagious. SECTION I, Of the Proximate Caufe of Dyfentery. From all the obfervations I have made, I acquiefce in the opinion of Dr. Cullen refpeaing the proximate caufe of this difeafe, and have therefore ventured, to re- move it from the pyrexiae, and to arrange it under the clafs NEUROSES, in the order Spasmi. It appears to be a fpafmodic conftriaion of the colon induced by local irritation. By this conftriaion the fasces are retained, and by the aaion of the abforbents they become hardened, and therefore increafe both the irritation and fpafm. In confequence of this the mucous glands of the in- teftines are excited, either by the immediate aaion of the hardened faeces, or by confent to fupply the mucus, Sihich is hurried on by the quickened periftaltic motion of the inteftines, and appears in frequent ftools. The fame irritation, communicated by fympathy to the heart, quickens the pulfe, but in the extreme arteries of the part affeaed produces either effufion of blood or inflammation. This again increafes irritability, and con- fequently fpafm. The ftimulus applied to any part of the inteftines being propagated to the reaum, produces the tentfmus, that is, a moft urgent and inceffant defire to evacuate the faeces. That the theory of Dr. Cullen is well founded will appear from hence, that when the hardened fcybala arc evacuated, the difeafe is fpeedily relieved. Should it be fuffered to continue, the villous coat will feparate, and be difcharged, mixed with pus or putrid fanies, V *& nervous diseases. 275 fanies, becaufe the acrid matter aas like cantharides, when it brings on inflammation and feparates the cuticle, or continuing to aa when the vital energy is much di- minifhed, induces fphacelus. All this agrees with ob- fervations after death, for the inteftines have been difcov- ered, not only in all the various flages of inflammation, of fuppuration, and of gangrene, but with their diameters tontraaed, and their coats much thickened. SECTION II. Of the Remote Caufes ofDyfentary. The predifponent caufe feems, as in the cafe of fpafm in general, to Ije debility and morbid irritability, either general or partial. The occafional caufes may be, 1. Putrid acrimony generated in the fyftem. During the protraaed heat of fummer, the determin- ation, as already ftated in the obfervations on heat and cold, is to the external furface :'but when cold and damp fucceed to heat, and when the vital energy is much di- minifhed, the determination is reverfed, the perfpiration is diminifhed, the urine is increafed, and the fecretions both of bile and mucus in the inteftines are not only in- creafed in quantity, but rendered more acrid, and by ftagnation become putrefcent. Hence arife dyfenteries with putrid fevers, and the weakeft are the firft to fufi1?r. 2. Putrid infeclion. This, although apparently received into the lungs, feems to exert its firft aaion on the mucous glands of the inteftines, as appears by lofs of appetite, ficknefs, naufea, vomiting. In thefe ideas I am confirmed by revolving in my mind, what is related by Sir John Pringle in his trea- tife on the difeafes of the army. The obfervations, to which I refer, were made in Zea- land, and in Brabant, where the country is low and damp, and the fprings are near to the furface of the earth j where the noaurnal fogs are thick and fetid, and where an autumnal fun exhales putrefcent vapours. ' In # •1 1 #, 276 nervous diseases. In thefe circumftances, and in thefe fituations, the ar- my under his care was frequently attacked by putrid dif- eafes in a variety of forms ; more efpecially when hot days were followed by cold and foggy nights. Thefe at firft appeared as tertians and double tertians, with foulnefs of the tongue, bitternefs in the mouth, naufea, and defire of acids, putrid vomiting, and fenfe of oppreffion about the ftomach. Such were the fymptoms in the camp on the firft ap- proach of this difeafe. But he foon had occafion to orj- ferve a conneaion between thefe intermittents and the dyfentery, becaufe they who were firft feized with dyfen- tery, ufually efcaped the fever, if a plentiful evacuation *;. followed ; or if any of the foldiers were attacked by both difeafes, it was alternately, fo that when the flux began the fever ceafed, and when the former flopped the other inftantly returned. Even in the camp it appeared to be contagious, but in the hofpitals it took the form of a putrid malignant fever ; infomuch that their bedding conveyed infeaion, and whenever the hofpitals were crowded, a great mor- tality enfued. He had occafion to remark, when the diforder came on4#ith the moft alarming fymptoms, when the men were fuddenly feized with headach, pain in their back, heat arftf thirft, delirium, bilious vomitings and bilious ftools, tenefmus and pain in the region of the colon ; the fever remitted on the evacuation of the firft paffages of the ali- mentary canal : yet without artificial evacuations nature made no cures, unlefs when a cholera fupervened. Profiting by this obfervation, he gave emetics, which were always moft effeaual when they were powerful enough to procure a plentiful difcharge from both paf- fages. After thefe he gave yitriolated tartar, and per- feaed his cures by rhubarb and the Peruvian bark, whilft to fome patients, more efpecially if he difcovered worms, he gave for a dofe half a dram of rhubarb with twelve grains of calomel, but to other patients, who had merely dyfentery, he gave one dram of rhubarb with five grains of, calomel.' ■» As NERVOUS DISEASES. lyyV'v As to the nature of the contagion, Sir JohnJPrin- gle had occafion to obferve, that it arofe frequently from dead bodies left unburied in the field of battle ; in one inftance from the rotting of a whale ; often from putrid carcafles of cattle, and from the effluvia of marin- es in the autumn, and not unfrequently from foul ulcers, as well as from crowded jails and hofpitals. ^ SECTION III. Of the Indications of Cure in Dyfentery. *fe t The idea which has been formed of the proximate, as well as of the predifpofing and the occafioal caufe^ * 4- naturally points out the indications. ^ ~ i. To relieve the fpafm. * 2. To cleanfe the alimentary canal from putrid fordes, from fey bala, and from every fpecies of colluvies. > 3* Tofheath the irritated portions of the colon with mu- cilaginous fubftances. 0 4. To adminifter tonics with aftringents, in order to pre- vent morbid irritability and theS-ecurrence of the fpafm. 4& Suci} are the indications. And the effea of medicines, ▼ anfwering thefe intentions, confirms our ideas refpeaiag to the proximate caufe of this difeafe. ™ The firft operation of cathartic medicines is to bring away loofe ftools, but no effeaual relief is to be expel- ed till the hardened fcybala appear. Thefe being once ^ evacuated, all the fpafmodic affeaions are fpeedily re- lieved. To effeftuate this purpofe, it is found neceffary to have ^ recourfe to opium, and tmodem experience fhews, that calomel, fucceeding the operation of this powerful anti- fpafmodic, is moft efficacious in cleanfing the alimentary canal from fcybala. Sir John Pringle ordered ufually a bolus of rhubarb twenty five grains, with calomel five grains, to be taken in the morning. Whilft I was in Edinburgh I paid particular atten^n to the praaice of Dr. Whytt in the treatment of this difeafe, becaufe he feldom failed to cure-it, although net fo fpeedily as by the modern praaice. jHe began with a powerful Or we may give a decoaion of the bulbous roots of the common daffodil (hyacinthus poet.) which my friend ft* Dr. H. Smith firffrecommended to me, and which he confidered as the moft efficacious, as well as mildeft e- metic in the whole materia medica. For the Cathartic. R, Rhei, gr. 25. Calomel, gr. 5. M. Cap. mane. For the Anodyne at night. §> lpec. gr. 5. Opii, gr. 1. M. f. pil. hofa fomni fumend. For the Anodyne Clyfter. R, Enem. de Arnylo. Pharm. Edinb. un. 8. TincT:. Opii, gtt. 30. t M. pro enem. hora fomni injiciend. Or, in cafe of great putrefcency, add to this one dram 'i of Peruvian bark. * Thefe medicines muft be repeated 'till the diforder is removed j then give the" following to prevent a relapfe. R, Cort. Anguftur. fcr. 1. f. pulv. ter. in die.* fumend. Or, fhould the patient be much exhaufted, you may give, R, Infuf. Cort. Anguftur. dr. 6. -^Tin&uras ejufdem, dr. 4. Pulv. ejufdem, fcr. 1. Tin&. Opii, gtt. 30. Tin&. Lavend. Cgmpof. gtt. 40. M. c. coch. 3. omni 4a. hora. Genus LII. Colica. Colic. The fymptoms are pain in the lower belly, perma- nent, with twilling round the navel j vomiting and coftivenefs. SECTION 28o NERVOUS DISEASES. SECTION I. Of the Species of Colic. i. Spafmodica, with retraaion of the navel, and the mufcles of the abdomen fo contraaed into feparate por-% tions, as to refemble a bag full of balls. i. Piclonum, preceded by fenfation of weight and un- eafinefs in the abdomen, chiefly about the navel ; the colic pain being at firft flight, and not continual, but in- creafed after eating ; then more fevere and perpetual, with pai|| of the arms and back, terminating in palfy. 3. Ster core a, after protraaed coftivenefs. . 3 4. Accidentalis, from acrid fubftances received into the ftomach. «■•* 5. Meconialis, m new born infants, from the retention " of the meconium. 6. Callofa, with fenfation of ftriaure in fome part of the inteftines, and flatulence with pain : coftivenefs and difcharge of liquid ftools in fmall quantities. 7. Calculofa, with fixed hardnefs in fome part of the abdomen, and calculi discharged by ftool. SECTION II. Of the Proximate-Caufe in Colic, and Indications of Cure. The proximate caufe is fpafmodic ftriaure in fome part of the alimentary canal, chiefly in the colon, em- bracing a quantity of hardened faeces, which are the irritating caufe. To underftand this let the ftudent con fuit the obfervations on Genus CXIII. Obftinnie Coftivenefs. The indications of cure muft therefore be, 1. To relieve the fpafm. 2. To evacuate the hardened feces. 3. Tofheath the irritated portions of the colon with mu- cilaginous fubftances. 4. Toftrengthen the inteftines by tonics and aftringents. Thefe intentions will be effeaually anfwered, By clyfters of flarch, two drams in four ounces of water, with half an ounce of linfeed oil, and from twen- ty NERVOUS DISEASES. 2c?I ty to forty drops of thebaic tinaure. This muft be re- peated without the tinaure till evacuaticm of faeces is procured. By caftor oil, from one to three ounces,. in cafes of urgency, otherwife By calomel, gr. 3—6, made into a pill or pills with foap, to which from half a grain to a grain of opium may be added. To be taken at night going to bed, and to be followed in the morning by infufion of fenna with tinaure of rhubarb. Sir John Pringle was fond of the fubfequent liniment, to be applied with warm flannel to the ftomach : R, Camph. un. i. 01. Oliv. un. 2. Tindt. Opii, un. i. m. Dr. Percival begins with clyfters, ordering for that purpofe a ftrong decoaion of poppy heads, with thirty drops of tinaura thebaica, to be repeated till the pain and vomiting are relieved, after which he gives calomel and jalap with fenna tea. Let the ftudent confult what has been faid on the fourth indication of the preceding genus. I would particularly call his attention to one occafion- al fymptom ; which, in the iliac paflion, is inverfion of the periftaltic motion in the alimentary canal, fo as to dif- charge the flercoraceous contents of the inteftines by the mouth. This illuftrates what I have delivered on the feveral degrees of irritation, with the efforts of nature to relieve herfelf. For one degree of ftimulus accelerates, another induces fpafm, a third inverts the periftaltic mo- tion, and this either topically, or by confent, throughout the whole extent of the intef linal canal, as in the follow- ing difeafe. Genus LIII. Cholera. The fymptoms are a purging and vomiting of bile ; painful gripings ; with fpafms of the abdominal mufcles. It is a difeafe chiefly of warm climates, more efpecially when ram or heavy dews fucceed a fcorching fun. SECTION M m \ 2'6'j. NERVOUS DISEASES. SECTION I. Of the Caufes of Cholera. The ftudent may recollea what I have faid on the power of heat, in the beginning of this work, in relax- ing the fibre, and inducing debility with morbid irritabili- ty, and of cold, as caufing a determination to the interior furfaces and fecretory organs. This, with relaxation of the veflels, produces a more abundant fecretion of bile, which, like all other fecretions, becomes acrid in propor- tion to the quantity poured fourth. The bile thus produced, either accumulates, corrupts, is abforbed, and diffufed over the fyftem, caufing, with other ftimuli in the alimentary canal, the yellow fever of the Weft Indies; or, from the increafed irritability of the ftomach and of the inteftines, it is rejeaed by fpontane- ous purging and vomiting, as the moft natural efforts of nature fpeedily to relieve herfelf. Hence we trace the conneaion between thefe two dif- eafes, and clearly underftand why a cholera fupervening, cures the yellow fever of warm climates, or the bilious autumnal fever of more northern latitudes. The fuperabundance of bile, now acrid and highly flimulant, being diffufed through the whole extent of the alimentary canal, in addition to the debility induced by heat, increafes irritability at every inftant, with all the violent effeas commonly produced by exceffive ftimuli; which are, as ftated above, acceleration or inverfion of periftaltic motion and convulfion rapidly fucceeding to each other. As the debility proceeds, the external parts are drawn into confent, and the fpafms are communicated, not only to the abdominal mufcles, but to the extremities. SECTION II. Of the Cure of Cholera. From what has been faid, it will be clear, that the ali- mentary canal muft, without lofs of time, be cleared of bile and fordes. But NERVOUS DISEASES. 283 But then, confidering the increafed irritability of the ftomach and bowels as a chief part of the difeafe, the praaitioner muft be extremely cautious how he ventures to prefcribe emetics ; and in faa it has been too fre- quently obferved, that in this difeafe vomiting, excited by emetics, is not eafily reftrained. For the fame reafon cathartics muft be carefully avoided. The moft fafe and efficacious mode of treatment is, to dilute with plenty of water gruel, and emollient clyfters frequently injeaed ; then to exhibit opium with cordial ftimulants, and to clofe the whole with bark. Let the ftudent confult what has been delivered on dyfentery and colic, between which and cholera there is an evident conneaion. Genus LIV. Diarrhcca^ The fymptoms are frequent liquid ftools, with nat- ural excrement; but not contagious, and feldom attend- ed with pyrexia. SECTION I. Of the Caufes Remote and Proximate of Diarrhoea. In fubmiffion to my mafter, I have left Diarrhoea in the clafs NEUROSES, and in the order spasmi, wherft it appears to have been attraaed by colic and cholera. Yet reverence and fubmiffion to a mafter were not my only motives ; for in truth, I knew not where elfe to ar- range it, unlefs I had either taken PROFLUVIA for a clafs, which I am not prepared to do, or removed it to the CACHEXIiE, where under the order of marcores, one fpecies of it might find a better place. I fay one fpe- cies, for we fometimes find a diarrhoea, which evidently depends on fpafm, and may be therefore cured by calo- mel with antifpafmodics, as colic is when hardened feces have been difcharged. The proximate caufe of Diarrhoea, when not depend- ent on fpafm, is, increafed aaion of the exhalants and excretories, with a proportionate increafe in the periftal- tic 2 84 NERVOUS DISEASES. tic motion of the inteftines. The predifpofing caufe is morbid irritability. The occafional caufes may be the paflions of the mind ; poifons; cathartic medicines; the ftimulus of food, offending either by quantity, by quality, or by fermentation, whether acetous or putrid ; fup- preffed perfpiration, more efpecially from cold applied to the feet ; and in children, worms and dentition. SECTION II. Of the Indications of Cure in Diarrhoea. For the indications of cure we attend, i. To the occafional caufe. 2. To the proximate and predifpofing caufe. To obviate the occafional caufe, we confider its nature, and if there be acrimony, we endeavour, i. To cor reel it. 2. To expel it. 3. To dilute it. 4. To lubricate the inteftines by mucilages. If the perfpiration is fuppreffed, we endeavour to re- ftore it ; If there are worms, they muft be deftroyed. If there is acidity, as in the cafe of infants, magnefia and teftaceous powders muft be given ; or, if the exci- ting caufe of diarrhoea is putrid fordes, acids muft be ufed as occafion may requrie. Emetics ferve a double purpofe, as they evacuate of- fending matters, and as they determine to the furface, reftoring obftruaed perfpiration. With this view, ten grains of ipecacuanha, with one grain of blue vitriol, may be given in the morning. To cleanfe the inteftinal canal, R, Pulv. Rhei, $j. Syr. Cort. Aurant. 3ij. Aq. N. mofchat, 5fs. Aq. font. |j. M. f. H. h. s. s. 6 That is, Rhubarb one fcruple ; fyrup of orange peel two drams ; nutmeg water half an ounce ; pure water one ounce. To be taken at going to reft. Or, if this fhould not fpeedily effea a cure, give one i grain of ipecacuanha every three or four hours. To dilute, nothing is better than broth and water gruel alternately. For NERVOUS DISEASES. 285 For fheathing and proteaing the inteftines from irri- tation, mucilage of gum arabic has been recommended, but in pure diarrhoea this can be feldom needful. After having cleared the inteftines, tonics and aftrin- gents fhould not be forgotten. Among thefe, in cafes of diarrhoea, the fimarouba flands preeminent, being at once tonic, antifpafmodic, diaphoretic, and promoting fleep. The decoaion may be made by boiling half an ounce in three pints of water, till it becomes a quart, and of this three or four ounces may be given three times a day. Where the ftrength is much reduced, with a quick fee- ble pulfe, and increafed irritability in the alimentary canal, the Anguftura bark combined with opium, as rec- ommended in dyfentery, produces excellent effeas. Tanners, when they have diarrhoea, are in the habit of curing it themfelves, without the aid of a phyfician. For this purpofe they drink about half a pint of their ftrongeft oofe made warm, that is, their ftrongeft infufion of oak bark ; and if occafion fhould require, they repeat the dofe. The younger ftudents muft be careful to diftinguifh one cafe, which has been frequently treated as a diarrhoea with emetics, cathartics, demulcents, and aftringents, not o- mitting antifpafmodics, but all to no effea. Such a cafe I remember was fubmitted to my friend Dr Bar vis of Devizes, whofe attention and fagacity few circumftances could efcape. Every thing had been tried, and the pa- tient was confidered as incurable, till application was made to him, who at once declared it to be a cafe of confti- pation. He took notice, that, with incellant tenefmus and irritation in the reaum urging the patient continually to go to ftool, fcarcely any thing was voided, but fmall quantities of liquid, fometimes however jnixed .wj^ a few fcybala, or portions of#the hardened excrement.. Yet there was no colic^ for the pain was referred chieffy to the reaum. From thefe fymptoms, the doaor was purfuaded that the conftipation was in the laft gut, and by a marrow fpoon the fervant extraaed fuch a quantity of indurated fasces, that with the next cathartic the whole was cleared away, 286 NERVOUS DISEASES. away, when it appeared, that more than a quart meafure full had blocked the paffage. Genus LV. Diabetes. The fymptoms are fuperabundant difcharge of urine, which is limpid and fweetifh to the tafte; voracious appe- tite ; thirft perpetual; fkin dry ; pulfe more frequent and feeble than in a ftate of health j emaciation. SECTION! Of the Proximate Caufe of Diabetes. A nofologift may be doubtful where to clafs diabetes; but the praaitioner, with whom the rank it holds, is on- ly a fubordinate confideration, may be fatisfied to leave it where he finds it, among thofe difeafes which have mor- bid irritability for the predifponent caufe. For my own part, I acknowledge freely a fufpicion, that I fhould have arranged it under the clafs CACHEXIA. To form any plaufible conjeaure refpeaing the pathol- ogy of this difeafe, it will be neceflary to afcertain our faas. 1. The quantity of fluid difcharged by urine is, in di- abetes, ufually more than has been vifibly received. A patient of Dr. Homes drank four pints a day, and paffed from eleven to twelve. 2. Even folid food increafes the urine ; yet this moft frequently exceeds the quantity of meat and drink uni- ted.^ Dr. Dobson mentions one, who took in, between liquids and folids, fourteen pounds a day, and paffed by urine eight and twenty pounds. ,3. The urine of diabetes is fweet to the tafte, and read- ily paffes through the vinous and acetous fermentations. It contains mifch fugar, and being fermented with yeaftj makes a liquor refembling fmall beer. 4. It is well known, that punch fometimes paffes ai- moft as foon as it is fwallowe^hat afparagus quickly give a peculiar odour to the urine, that in a very fhort fpace of time caffia renders it aimoft black, and that fome liquids pafs unchanged. • • 5. When NERVOUS DISEASES. 287 5. When this, at the commencement of the prefent century, was obferved by M. Morin, of the French academy of fciences, he concluded, that liquids have a fhorter paffage to the bladder than by the arteries and the kidneys. To afcertain the faa, philofophers have tied ligatures round the ureters of dogs, who have continued to pafs urine as if no fuch operation had been performed on them. And Baron Haller has particu- larly noticed the produaion of urine after the kidneys themfelves had been totally deftroyed. 6. It was generally admitted, that the cutaneous ab- forbents imbibe a quantity of moifture from the atmof- phere. I know a gentleman who after hard exercife quickly gains fome pounds, and Dr. Keil without exer- cife acquired eighteen ounces in one night. Yet the experiments of Drs. Currie and Gerard prove either that there muft have been fome error in thefe obferva- tions, or that the acquifition of weight was derived through the lungs. Dr. Gregory indeed caufed a diabetic patient to be anointed with oil, after which the flux of urine, to ap- pearance, was diminifhed : but Dr. Ferriar particularly flates, in his late valuable publication, that in two cafes of diabetes, the patients complained of profufe fweats at a time when the difcharge by urine was confiderable. And in the cafe of Clark, as publifhed by the ingenious Dr. Rollo, it was evident that there was no abforption of fluids by the fkin. 7. That liquids have a fhorter paffage from the ftomach to the bladder than through the arteries arid the kidneys, feems to be rendered probable by recent obfervations. I underftand that M. Carlifle, an amiable young fur- geon, who purfues his anatomical refearches with more than common ardour, has lately made ligatures on the pylorus after having filled the ftomach of animals with aqueous fluids, by which he has been convinced, upon diffeaion, that fome confiderable abforbents, more than have been hitherto difcovered, pafs immediately from that vifcus, for he found it empty. M. Gimbernat of Madrid, who, when he was a young man, diffeaed more bodies 2SS NERVOUS DISEASES. bodies than any anatomift in Europe, deteaed veflels leading from the ftomach, which he was not able to pur- id?., but which induced him to believe, that liquids may rJafs direaiy from the ftomach to the bladder. Under this perfuafion he has colleaed a variety of faas, all tending to confirm his opinion on this fubjea. It has often happened, that on examination of ftones extraaed from the bladder, fome extraneous body has been deteaed as the nucleus, which could not have paffed in the common way of circulation. Some of thefe, as Van Swieten has very judicioufly obferved, had been in- troduced by the urethra : but others, I apprehend, are clear from this fufpicion. The poilibility, therefore, ftill remains, that chyle may find' its way unaltered to the urinary veffels. 8. On the other hand, if we admit with Dr. Baillie that in diabetes the kidneys are morbidly affeaed ; that they are, as Dr. Cullen has remarked, in a flaccid flate, and that? the arteries of the kidneys are preternaturally enlarged, particularly thofe of the cryptce or minute glands, which fecrete the urine, as obferved by M. Cruik- fliank ; we may be inclined to think that the proximate caufe of diabetes is to be fought for in thefe veflels. We know that fecretory organs in different ftates fe- crete fluids of very different qualities. Thus it is with the glands fecreting the tears, which are fometimes acrid and corrofive; and with the falivary glands, which un- der the influence of mercury no longer fecrete a fapona- ceous fluid. Thus it is with the ftomach, which by the mere influence of the mind, ceafes for a time to fecrete a gaftric fluid fit for digeftion, in confequence of which fymptoms of. dyfpepfia immediately enfue : but with the refloralion of tranquillity there is a reftoration of the di- geftive powers. The glands of the bread, when cancerous, fecrete no longer milk, but the moft offenfive and corrofive matter; and, not to mention the wonderful alterations in the bile produced under the influence of heat and cold, of poifons, and of the paflions of the mind, we may remark the mere* wonderful changes which take place in the dif- charge NERVOUS DISEASES. 2S9 charge of ulcers, for this may be either inodorous, thick and yellow, or ichorous, pale, watery, acrid, and offen- five to the noftrils. The enlargement of the arteries in the cryptse of kid- neys, fuppofing this faa to be admittedv would fhew in- creafe of aaion, and the flaccidity of thofe organs would demonftrate their want of tone. But ftill it -would be far from evident, that this organic affeaion is the caufe and not the effea of the difeafe in queftion. 9. Dr Rollo, in his ineftimable work, proves that in diabetes there is diffufion of faccharine matter over the whole fyftem, and that the quantity of fugar in the urine is increafed by a vegetable diet, and diminifhed by ani- mal food. From all that has been advanced it feems to follow, that the proximate caufe of diabetes muft .be fought for in the procefs of digeftion. Befides this genuine diabetes, whofe effential charac- ter is not merely a preternatural flow of limpid water, but water of a fweetifh tafte, and abounding with faccha- rine matter, we have other fpecies which are purely fymptomatic : for a profufe difcharge of urine may be produced by fear, by the application of cold, by hyfteri- cal, febrile, and gouty affeaions, or by ligatures on the veffels of the fpleen. Hence are derived the diabetes in- fipidus of Cullen, and diabetes hyftericus, D. arthriticus, D. febrieofus, and D. artificialis, of Sauvage. SECTION II. Of the Indication of Cure. This, from the view we have taken of the difeafe, will be to prevent the faccharine procefs in the organs of di- geftion, which muft be attempted bv total abftinence from vegetable food. By this praaice Captain Mere- dith was cured in the firft inftance, and Dr. Rollo adds the cafes of others who were either perfeaiy cured, or furprifing!v,and fpeedily relieved. Dr. Griffith recommended the following : IJ, Myrrh, dr. 1. folve terendo in mortario cum Aq. Alex. fimp. Nn 29© NERVOUS DISEASES. un. 7. Aq. N. M. dr. 4. Tina Cort. Per. dr. 6. adde Kali. fcr. 2. Ferri vitriolati, gr. 16. Sach. alb. fcr. 2. M. c. cochl. 4 : ter in die. Dr. Ferriar cured a patient with bark and elixir of vitriol. Dr. H. Smith recommended a dram or two of the fat- urnine tinaure to be taken thrice a day ; but, as it ap- pears to me, rafh muft be the phyfician who ventures to prefcribe this dofe. Dr. Brocklesby ordered the flores martiales, with fea bathing ; and when his patient, after a cure, relapfed, he gave the following : R, Flor. Chamcemel. gr. 25. Pulv. Aromat. gr. 3. Rhei, gr. 2. M. c. ter in die. With this he gave alum whey half a pint twice a day. Dr. Beddoes was intimately acquainted with a gentle- man who was thrice cured by Briftol water, and numer- ous patients have borne teftimony to its falutary effeas in this difeafe. Genus LVI. Hysteria. The pathognomonic fymptoms are, a grumbling noife "in the belly followed by globus hyftericus, or a ball afcend- ing to the throat with a fenfe of fuffocation ; ftupor ; in- fenfibility ; convulfions; laughing and crying without vifible occafion ; fleep interrupted by fighs, and attended by a rumbling in the bowels. SECTION I. Of the Attendant Symptoms. Hoffman calls hyfteric affeaion a cohort of difeafes; Sydenham compares it, for the infinite variety of its forms, to Proteus, and for the mutability of its appear- ances, to a chameleon. Among the moft diftreffing fymptoms may be reckon- ed a pungent pain in fome part of the head, called clavus hyftericus, attended by vomiting ; cough ; colic, imita- ting iiiac paflion, and terminating by fuffufion of bile ; diarrhoea ; ftrangury ; fpafms ; nephritic pain ; fwelling NERVOUS DISEASES. 20i of the ancles, chiefly in the morning and without put- ting ; pains in the back and in the teeth ; coldnefs of the extremities; flatulence, laffitude, and palpitations. We obferve, likewife, remarkable fenfibility and irri- tability of mind ; fpirits elated, depreffed, and variable, independent of vifible occafions, with a difpofition equal- ly to laugh or to cry upon the moft trifling excitements; ridiculous fancies ; frequent, fudden, and profufe dif- charge of limpid urine, more efpecially previous to the paroxyfm. When this diforder terminates fatally, it is, like as in epilepfy, by the apopleaic ftroke. But commonly the paroxyfm quiets for a time all fpafmodic fymptoms, leaving the patient languid and univerfally relaxed. SECTION II. Of the Predifponent Caufe of Hyfteria. The perfons moft liable to this difeafe are females, from the time of puberty to the age of thirty five, un- married women, and young widows, chiefly thofe of the fanguine temperament ; of a relaxed habit; of great fen- fibility ; and of an irritable fibre j more efpecially after profufe evacuations, whether fanguine or ferous ; the in- dolent, and thofe who are exhaufted by either long pro- traaed fevers or habits of intemperance ; and fuch alfo in whom the uterine haemorrhage is unfeafonably flop- ped, or habitually obftruaed. Can we therefore hefitate to aflign as the predifponent caufe, debility with morbid irritability ? SECTION III. Of the Occafional Caufes of Hyfteria. i. Violent excitement in the brain. a. By the fenfations of pain or pleafure. b. By the paflions of joy, grief, anger, fear, fur< prife. c. By diftention of the blood veffels. 2. Irritation 292 NERVOUS DISEASES. 2. Irritation. a. In the ftomach. b. In the urterine veffels. c. In the ovaries and fpermatic veffels. d. hi the olfaaory nerves. SECTION IV. Of the Proximate Caufe of Hyfteria. Sydenham, for the proximate caufe, affigns an ataxy, or diforder of the animal fpirits, that is, vehement aaion ,in particular parts of the fyftem, which being endued with exquifite fenfibility, are thereby affeaed with pain and fpafm, whilft the other parts fuffer equally from de- fea of nervous energy ; and by this unequal diftribution all the funaions are difturbed. But Dr. Cullen confiders the chief part of the prox- imate caufe to be mobility of the fyftem, depending gen- erally on its plethoric ftate. This opinion feems to con- found the proximate with the remote caufes : for debili- ty with irritability are the predifponent caufe, and the ftimulus of diftention can be only an occafional caufe of this affeaion. To me it appears, that the proximate caufe is nearly the fame as in epilepfy, with which the hyfteric paroxyfm has a remarkable affinity. Hoffman has left us two valuable cafes, in which the two difeafes were combined ; and Dr. Woodford has favoured me with an account of Mr. P-—- a furgeon at Trowbridge, who after either intoxication, or agitation of mind, was ufually feized with violent convulfions, rolling of his eyes, frothing at the mouth, complete infenfibility, followed by deep fleep : yet thefe* fits were always at- tended by violent laughter and globus hyftericus. SECTION V. Of Hyfteria as diftinguifhed from Hypochondriafis. The older phyficians, Boerhaave, Sydenham, Van Swieten, nervous diseases. 293 Swieten, with the fagacious Whytt, confider thefe dif- ^ eafes to be the fame : and even Hoffman, notwithftanding his efforts to diftinguifh, yet confounds them ; for of fourteen cafes, fuppofed by him to have been hypochon- driafis, fome are evidently hyfteria. This confufion is the more remarkable, becaufe in the firft place Dr. Whytt, although he declares thefe affec- tions to be one, yet moft clearly diftinguifhes them, Ha- ting hyfteria to depend on morbid irritability, and hypo- chondriafis on torpor, as appears by his fecond chapter on nervous diforders : and Hoffman, in his cautions and praaical direaions, fea. ifi. makes the fame accurate * l diftinaion. .'*• It is to Dr. Cullen we are indebted for the juft ar-' rangement of thefe difeafes, which have nothing in com- mon, but dyfpepfia, flatulence, and debility ; yet even in this they differ, for in one we have debility with irrita- bility, in the other the debility of torpor. SECTION VI. Of the Indications of Cure in Hyfteria. These are, ill, to remove thofe,predifponent caufes in the body, which render it peculiarly liable to hyfteria. 2. To remove or correa the occafional caufes, which, efpecially in fuch as are predifpofed, produce the numer- ous train of hyfteric fymptoms already mentioned. '■. - I. The firft intention may be anfwered by bitters, bark, fteel, a generous diet, cool air, cold bathing, regular horfe exercife, and agreeable amufement. For bitters we may take myrrh, gentian, centaury, orange peel, or quaflia. To the infufion thefe may be added, caffia lignea as an ufeful aromatic ; fteel, which is the moft powerful remedy, may be given as recom- mended by Sydenham, in filings, from five grains to fifteen, twice a day ; or the celebrated prefcription of Dr. Griffith, mentioned under Phthifis, may be here advantageoufly adopted. This venerable doaor relates the cafe of a young \? tender, delicate, hyfterical, who fcarcely flept ; humed bv 2qa NERVOUS DISEASES. r by opiates and diftreffed by foetid medicines, receiving no relief from bark and cordials, who had frequently ' profufe fweats, which lafted for twelve hours at leaft. t* This young lady voided much pale urine j had great * thirft ; no appetite ; fpafmodic retchings, with pulfe quick and low. In addition to thefe fymptoms of debility and irritability fhe was much inclined to faint; yet by the foregoing preparation of myrrh and fteel, fhe was foon reftored to health. In cafes of hyfteric affeaion Dr. Whytt depended chiefly on the bark with gentian, and from him I took my ideas in the treatment of hyfteria, having obferved that his praaice was ;fuccefsful. The inftruaions de- livered in his public lectures, and the information with wluch he honoured me in private converfation, are the ftmeas have been communicated in his treatife on this fub- ject, a work which is ineftimable for ftrong reafoning, and for faas clearly ftated. He recommends the following: R, Cinchonas, un. 4. Gentian. Cort. Aurant. aa. un. 1^. Sp. Vin. gal. jfc 4. Digere per 6 dias. Capt. dr. 4 bis die. That is, Take Peruvian bark four ounces ; gentian and orange peel of each one ounce and an half; brandy twt> quarts ; digeft for fix days. Take half an ounce twice a day, and continue it for months. With the fame intention the learned and ingenious Dr. Lettsom recommends white vitriol with aromatic bitter. §» Ligni Quaffiae, dr. •§•. Aq. font, ferventis un. 6. Digere, cola, & hujus colaturae un. l±, adde Zinci vitriolati, gr. fs. ad gr. 4. Tinft. Cardam. dr. 1. Teft. Oftr. ppt. fcr. 1. M. f. H. terde die fumend. That is. Take quaffia half a dram ; boiling water fix ounces ; let them ftand isntil cold j ftrain ; and to one ounce and an half of this add white vitriol from half a grain to four grains ; tin&ure of cardamoms one dram ; oyfter fhell one fcruple. Mix. To be repeated three times a day. A generous diet is effential in every cafe where debili- ty and irritability prevail. Sydenham relates that he was fent for to a convalef- * cent, who having been, during a fever, feverely handled by his phyfician, and, alter exceflive evacuations, forbid the NERVOUS DISEASES. 295 the ufe of animal food ; became fo enervated, that with-, out vifible occafions, he frequently, as if overwhelmed with grief, fhed floods oPtears, attended by deep fighs, and fobbing, which bordered on convulfions. Syden- ham immediately ordered him a fowl and wine, with fuch an excellent effea, that the convulfive weeping nev- er more returned. One caution however is needful. Let hyfteric patients be extremely careful not to overload the ftomach. They muft eat little and often. If the ftudent recolleas, what I have faid upon digef- tion, he will fee the reafon for this caution, a caution the more needful becaufe fuch patients are aimoft uni-^**. verfally inclined to tranfgrefs in this refpea. The confequence of this tranfgreffion is flatulence, with fpafmodic affeaion in the alimentary canal, which, if neg- leaed, will draw other parts of the fyftem into confent. When I was in London laft winter, I had the pleafure of meeting, at the houfe of my friend Dr. Thornton, an amiable young lady, who fpoke with rapture of the benefits fhe had received from the vital air. Since her arrival from Italy, which was two years ago, in the viciffij'1 tudes of this climate, fhe early experienced a confiderable diminution of ftrength, appetite, and fpirits She took in confequence a vaft quantity of bark, fteel, and other tonics, under various phyficians, but with no alleviation of the fymptoms. When fhe became a patient to ~ Dr. Thornton, fhe was fo weak, as fcarcely to be able to walk a- crofs the room ; fhe was fubjeft to hyfteric fits, which occurred three or four times each day ; and the leaft angry word, or flighteft contra- diction, excited a flood of tears. Her feet were cold as ice i,but after taking food, more efpecially if fhe ufed an acid, fhe had heat and flufh- ings of the face, while the reft of the body remained nearly as coldfls her extremities. Having the greateft averfion to every kind of medicine, fhe made trial only of the vital air, except an occafional aperient draught of, rhubarb and fal polychreftin fome peppermint water. In a fortnight,* by the daily inhalation of vital air mixed with atmofpheric, the hyfter-, ic fits returned no more ; her appetite improved ; her fpirits rofe ; cold* - was lefs feverely felt; and her ftrength was fo far increafed, that fhe £ was able, after a fortnight, to walk near a mile, to attend on Dr. Thornton. If at any time fhe left off for a few days the inhalatiorr of the vital air, fhe experienced the moft uncomfortable filiation of cold, and lefs mufcular powers, with pain in her ftomach; all which fymp- * toms w.re removed as often as fhe recurred to the ufe of vita! air. T **' ICfS NERVOUS DISEASES. I took occafion to remark, at the conclufion of the cafe of bilious autumnal fever, that when the typhus was completely cured, nothing remained but hyfteric affeclion, and that a remarkable conneaion was to be obferved between thefe two difeafes, fuch as may direa our prac- tice in the treatment of them both. In typhus, debility and irritability are feen in the ex- treme ; hence the impatience of light and of found, and the quick fenfibility of both the tafte and fmell. This irritability is not however confined to the organs of fenfe: it affeas the mind. It is manifeft likewife in the pulfe, which is quick, weak, and fmall. Thefe, but not in the fame degree, are the fymptoms of hyfteria. In both, we find the patient equally difpo- fed to laugh or cry. In both difeafes, the indications are to correa the morbid irritability by aftringents and by tonics, and in both, the effea upon the pulfe is fimilar, this being ren- dered flower by animal food, by opium, and by wine. When the typhus fever, in the cafe already ftated, was fucceeded by hyfteric affeclion, the cure was effeaed by Dr. Thornton in the following very judicious manner: $> Cinchonas, fcr. 2. Serp. Virg. fcr. 1. Cafcaril. gr. 10. M. f. Pulv. 2 a. q. h. s. fuperbibendo Vin. Rub. un. 2. This^ promoted a gentle perfpiration at the fame time that it increafed the power of life, as appeared in the firft inftance by the pulfe, which gradually became ftronger and lefs frequent. ^ In a few days the fnakeroot was omitted, and in its place was fubftituted the ruft of iron in this form : §, Cinchon. un. 2. Chamremel. un. 14, Fer. Rubig. fcr. 1. Syr. fymp. q. s. f. Eleft. c. c. M. 1ST. M. 4 a. q. h. To keep the body foluble, butter milk was given in the evening, which affifted likewife to procure refrefhing fleep. a ^ Particular care was taken not to overload the ftomach with food, and for this purpofe is was frequently exhibit- ed in -fmall quantities, but never till the appetite was keen. By this condua, the gaftric juice, being always ready, and fnfficiently abundant to prevent fermentation and NERVOUS DISEASES. 297 and the evolution of air, whilft at the fame time it a&ed as a folvent, nutrition made a rapid progrefs, and flatu- lence was totally avoided. All his nourifhment was given him by weight and meafure, and fo regular was the procefs of digeftion, that Dr. Thornton knew, precifely by the clock, when his patient would awake and call for food. If nourifhment was not immediately at hand, the ge- nial warmth and moifture of his extremities was fucceed- ed by drynefs in the palms and coldnefs in the limbs, which fymptoms were fpeedily removed by either wine or food. Thefe never failed to produce a univerfal glow and gentle perfpiration. It was likewife remarked, that when at any time there was irritation in the reaum, with tenefmus and colliqua- tive ftools, thefe fymptoms were inftantly relieved by food and wine. II. In hyfteria, the fecond indication of cure is, to re- move the occaflonal caufes. If the irritation be from indigefted food, bile and vif- cid mucus in the firft paffages; thefe muft be removed by emetics, which fhould be taken dry ; for warm liquids relax the fibre and increafe debility. One grain of blue vitriol and two of tartarized antimony may be given ear- ly in the morning, and muft be frequently repeated. To cleanfe the bowels, you may order four or five grains of rhubarb, before breakfaft and dinner, with a double dofe at night, always remembering to admifiifter tonics after evacuants. Hoffman on this fubjea fays, experientia duai affe- veramus, primam regionem, quse vitioforum humorum colluvie plerumque valde repleta eft, accomodatis reme- diis effe expurgandam. And Sydenham univerfally began his curative procefs by three or four cathartics, before he exhibited the fteel and tonics. I muft here requeft the ftudent to confult the cafe of the young woman mentioned by Dr. Whytt, in chap. viii. fea. ii. p. 469, of his Treatife on Nervous Difeafes. July 2©. She was feized with violent convulfions, fol- O ° lowed 298 NERVOUS DISEASES. lowed by fyncope, and returning from 12 to 18 times every day on hearing the leaft noife, even of a tea cup, or the opening of a door; yet between the fits fhe was un- commonly cheerful and jocofe. After having tried in vain all that mufk, camphor, caftor, afa fcetida, and laudanum, could do for her, fhe took bark and valerian; Soon after this fhe was feized with fevere afthmatic fits, which together with the faintings and convulfions often made the number of paroxyfms amount to thirty in a day. Auguft 9. She took an emetic, threw up much bile, and efcaped her fits. This was repeated nearly every oth- er day with fimilar fuccefs, and by following this procefs every other morning, with a fmall dofe of elixir facrum fometimes at night, before the beginning of September fhe was perfeaiy recovered. Should there be much tough phlegm or vifcid mucus in the alimentary canal, you may prefcribe limewater three times a day, in addition to the emetics and moder- ate cathartics. As for opium, camphor, caftor, mufk, and afa fcetida, fo frequently recommended as antifpafmodics, they are merely palliative, and to be reforted to on the moft ur- gent cafes of diftrefs, fuch as violent hyfteric colic, in which Dr. Whytt ufually ordered a, clyfler, with feventy or eighty drops of laudanum, that by favour of this opiate fome pills of* aloes and calomel might be thrown in. In ordinary cafes of flatulence, with coftivenefs, he combined afa fcetida with aloes and fteel. R, Afas foetid, dr. 2. Aloe. Soc. Ferri Vitriolat. Zinzib. aa. dr. I. Elix. propriet. q. s. ut fiant PilL gr. 4. c. c. 3. o. n. Take afa fcetida two drams. Socotrine aloes, fait of fteel, and ginger, each one dram. Elixir proprietatis a fufficient quantity. Make pills of four grains each, and take three of thefe every night. For the fait of fteel, I ufually fubftitute fteel filings, and for the aloes I order rhubarb. Many phyficians are fond of bleeding in fpafmodic af- feaions, and it frequently relieves the patient; but then it fhould always be remembered, 1. That plethora implies a laxity of the. folids, and therefore fome debility in the moving fibres. 2d. That NERVOUS DISEASES. 299 2d. That lofs of blood brings on debility, and being repeated ultimately increafes plethora. 3d. Thefe propofitions have been demonftrated by Dr. Cullen. But in addition to thefe, I muft obferve, that by frequent bleeding, the^moft moderate diftention, fuch is the force of habit, becomes a powerful ftimulus and produces fpafm. It is remarkable that parrots, if highly fed, not having exercife in proportion to their food, are apt to fuffer by the diftention of their plumage. To relieve themfelves, they pluck out the moft luxuriant feathers. Others quickly fupply their place, and in fucceflion are deftroy- ed, till the ftimulus of even the fmalleft feathers become intolerable, and are plucked out as foon as they appear. This reafoning might be extended, for the fame prin- ciple prevails in a variety of cafes interefting as well to the moralift as to the medical praaitioner. A venerable profeffor of Edinburgh, recommending venefeaion, mentioned to his pupils, as an example of the facility with which the body creates new blood, the cafe of a lady, whom he bled more than an hundred times in the fpace of three years for fpafmodic affeaions. Yet he confefiV "lat the laxity of the folids, and the confe- quent morbid irritability of the moving fibre increafed daily, in proportion to the lofs of blood. Sydenham bled once, and then having cleanfed the alimentary canal, placed his whole dependance on tonics, aftringents, pure air, and conftant exercife. Inftead therefore of repeated bleedings, fhould there be diftended veins, a florid countenance, a ftrong pulfe with vertigo and dyfpncea, it will be needful to advife more exercife and a lefs nutritious regimen than ufual. Should hyfterical affeaions be induced by worms, thefe muft be deftroyed by anthelmintics; after which the tonic plan muft be purfued. When atonic gout, amenorrhcea, or fluor albus, are the occafional caufes of hyfteria, the attention muft b# turned to what has been faid on thofe primary difeafes. In the hyfteria libidinofa, it will be particularly necef- fary to obviate morbid irritability by tonics, aftringents, the 300 NERVOUS DISEASES. the cold bath, cool air, and conftant exercife : we may give wine and animal food, but in moderation, and muft forbid the ufe of fpices with high feafoned difhes. The patient muft be cautioned to avoid crowded affemblies and hot rooms. So much for the predifponent caufe of this affeaion. The occafional caufes call for more particular atten- tion. Thefe are commonly mental excitements by im- proper converfation or by books. Such therefore muft be carefully avoided ; and in their place muft be fubfti- tuted whatever can agreeably occupy the mind and not inflame the imagination. Solitude muft be ftriaiy for- bidden, and a change of fcene refpeaing fociety, refi- dence, and ufual haunts, muft be ftrongly recommended. This may moft effeaually be obtained by travelling, which implies inceffant change of company, of place, of air, with unremitting exercife both of body and of mind. By thefe means the affociated ideas and excitements will be changed, bad habits will be broken ; accumula- ted irritability will be expended ; mental and corporeal ftrength will fpeedily return ; and the humiliating dif- eafe in queftion, will no longer caufe diftrefs. I have frequently obferved, with pity, this affeaion in the fouth of Spain, and have known it moft abfurdly treated by the confeffors, who fhould have been the laft confulted'. Thefe blind leaders of the blind, inftead of committing their tender charge to the care of the phyfi- cian, recommended every thing which could confirm the evil. They charged guilt, where no guilt exifted ; they increafed diftrefs of mind, and they impofed penance ; all tending to induce debility with irritability ; to rivet the attention, which ought to have been diverted ; to in- flame the imagination ; and to render thofe affeaions permanent, which, if left unnoticed, would have been tranfient as the vernal breeze. Genus LVII. Hydrophobia. Canine Madnefs. The charaaeriftic fymptom is a dread of water, as inducing painful convulfions of the pharynx. We NERVOUS DISEASES. 30I We have a very accurate defcription of this difeafe by Dr. Wolf, in five cafes of perfons who died.of this dreadful diforder. The eye, as in typhus fever, is im- patient of the leaft light ; any bright colour creates un- eafinefs ; the mind is very irritable ; the beft friends ara difliked. It is remarkable that the lint, or other dreff- ings, when taken off difcover a black furface, even though the wound may difcharge good pus; the fauces have no appearance of rednefs ; the face, which at firft is pale, becomes brown, and during each fpafmodic attack turns aimoft quite black ; the lips are extremely livid ; as the difeafe advances each paroxyfm is lefs violent; the patient has intervals of reafon ; the dread of ftrangula- tion from water goes off; the pulfe becomes weak, quick, and fluttering ; and the body feels remarkably cold ; he then compofes himfelf as it were to fleep, and expires. Upon diffeaion there is not to be found the leaft trace of inflammation. From this appearance of things, have we not reafon to expea fome advantage from the inhalation of vital air ? Opium, camphor, mufk, and fubmerfion, have from repeated trials juftly loft their reputation in this fatal difeafe. M. Matheu, after bleeding and purging, excites as foon as poffible falivation. He fays, " the hydrophobia " yields, as it were, by enchantment, when the falivation " appears; and it muft be kept up according to the de- " gree of the difeafe and the ftrength of the patient." The illuftrious Sauvage, fpeaking of mercury, declares, " After many enquiries, I know not whether mercury " has ever failed, even when the hydrophobia had com- " menced." When the contagion of a putrid fever is taken by the faliva into the ftomach and bowels, which is its conftant road, if the patient, the moment he finds himfelf attack- ed with a fenfe of chillinefs, lofs of appetite, and an u:v pleafant tafte in his mouth, has recourfe to two emetics at proper intervals, and after the operation of the firft emetic, takes a cathartic, he has certainly got rid of the infeaion : in the fame manner, even after three days, or perhaps 302 NERVOUS DISEASES. perhaps a week, if the part bitten by the dog be cut out with the knife, the danger is efcaped. But fometimes it will happen that the patient will not fubmit to this op- eration, or to the application of the lunar cauftic, which perhaps may be preferable to the knife, and it then be- comes an objea of enquiry, what next fhould be done ? This was the cafe three years ago. Five men were bit- ten by a dog fuppofed to be mad, and which was fhot. The village doaor, who knew in this difeafe nothing be- yond the knife, finding his patients refufe the operation, had recourfe to Dr. Thornton for his advice. This phy- fician recommended the application of hot vinegar fharp- ened with vitriolic acid, the wounds being firft fcarified; and the events turned out favourable. Clafs II. NEUROSES. Order IV. Vesanue. Judgment impaired without either Coma or Pyrexia. In this order Dr. Cullen has enumerated four gen- era, Oneirodynia, Melancholia, Mania, and Amentia. Genus LVIII. Oneirodynia. Incubus, or Night-Mare. The pathognomonic fymptom is, vehement or diftreff- ing imaginations during fleep. INTRODUCTION. The difficulties attending methodical arrangement muft here be pleaded as an excufe for giving oneirodynia a place with the vefanias : yet this difeafe, I truft, will throw light on others, in the front of which it Hand's. SECTION I. Of the Species of Oneirodynia with Synonima. Dr. Cullen has two fpecies. I. Gra-vav.s, with a fenfe of weight and preffure on the cheft. II. Aaiva, nervous diseases. 303 II. Acliva, exciting to various motions, and more par- ticularly to walk. I. Oneirodynia gravans is the common incubus or night mare. This by Sauvage, is called ephialtes, and is diftinguifh- ed by him into fix fpecies. i. Ephialtes plethorica. 2. Ephialtes ftomachica. 3. Ephialtes ex hydrocephalo. 4. Ephialtes verminofa. 5. Ephialtes tertianaria. 6. Ephialtes hypochondriaca. But his ephialtes tertianaria taken from Foreftus, although at- tended with peculiar fymptoms, belongs to one of his preceding fpecies. II. Oneirodynia activa is the Somnambulifmus of Sauvage, which he confiders as a genus and divides in- to two fpecies. 1. Somnambulifmus vulgaris. In this the patients may be awaked." It admits, how- ever, of a diftinaion, for fome never leave their beds but bawl and talk, and by their geftures feem to be de- fending themfelves from thieves. Others leap from their beds, put on their clothes, kindle a light, feek for the key, unlock the door, wander far from home, avoid oppofing obftacles, pafs over narrow bridges, or, by fwimming acrofs the ftreams, return to the houfe, undrefs and go to bed again, unconfcious of all that paffed. 2. Somnambulifmus catalepticus. Of this fpecies, wherein aaive night mare is combined with catalepfy, feveral inftances have been recorded. A- mong thefe Sauvage relates the cafe of a married wom- an, who was committed to his care. This lady at the time of menftruation, being infulted by a peafant, fud- denly loft her fenfes and walked about muttering, talk- ing and difcovering by geftures the refentment of her mind. When the furgeon entered the room, fhe flew at him in a rage, but foon after was engaged in purfuing her fhadow on the wall: yet fhe neither faw nor heard her hufband, when he fpoke to her, nor gave any figns of feeling, although punaured with a pin. During the par- oxyfm her fingers, hands, and arms, retained the pofi- tions in which they were placed by the obfervers. Thefe fits 3°4 NERVOUS DISEASES. fits frequently returned for many months, whenever her mind was in the leaft difturbed, and lafted commonly from half an hour to an hour. They were at laft reliev- ed by change of fcene, amufements, and conftantexer- cife. SECTION II. Of the Caufes Remote and Proximate of Oneirodynia Gra- vans. The predifponent caufe is, beyond a doubt, debility, for not the robuft, not men of a rigid fibre, but the relax- ed and irritable, are moft liable to thefe complaints. The occafional caufes may be, i. Indigefted fordes in the ftomach, more efpecially if the perfon fleeps upon his back. 2. Ebriety, whether . vora opium or fermented liquors. 3. Vifcid mucus. 4. Worms. 5. Obftruaed catamenia. 6. Heat with un- ufual weighty of clothes. 7. Hydrocephalus internus. 8. Mental irritation arifing from anger, terror, and dif- guft, or from any other paflion excited in the day, and recurring to the imagination during the time of fleep. For the proximate caufe, Hoffman afligns flagnation of blood in the veffels of the hmgs during fleep, and with this the Pathology of Etmuller fubftantially agrees, for he attributes incubus to defeaive refpiration, whether arifing from diftention of the ftomach, which prevents the free defcent of the diaphragm, or from an affeaion either paralytic or fympathetic, and fpafmodic of the nerves, which ferve for refpiration. To me, agreeable to this opinion of Etmuller, it ap- pears that the proximate caufe of oneirodynia gravans is fpafmodic conftriaion of the lungs, induced by fome ir- ritation in the fyftem. Hence the tremor with the fenfe of laffitude. Hence alfo the violent and rapid vibration of the diaphragm, all which remain for fome time, after every other fymptom has ceafed with fleeo. Some praaitioners imagine, that a loaded and diftend- ed ftomach, preffing on the aorta in its defcent, fends the blood too copioufly to the head ; but Dr. Whytt wa«. NERVOUS DISEASES. 305 was clearly of opinion, that it originated in nervous ir- ritation, and his doarine is confirmed by a confideration both of the occafional caufes and of the perfons moft li- able to this complaint. This fubjea however will be refumed when I come to treat of mania. Before we attempt to inveftigate the caufe of oneiro- dynia acliva, or even hazard a conjeaure, it will be prop- er to examine the brain, and to afcertain, if poflible, the proximate caufe of fleep and dreams. SECTION III. Of the Brain. This wonderful compages ; this fource of fympathy and bond of union to the whole machine ; this centre of fenfation, thought, volition ; this repofitory of con- fcioufnefs and fupport of memory ; this field, in which imagination ranges unreftrained ; this fanauary of hope and fear ; this refidence of reafon ; this microcofm ; this manfion of an immortal fpirit j demands particular at- tention. We obferve it placed in the moft elevated region of the body, as in a citadel, defended by the arms and cov« ered with abundant caution, by a vaft variety of tunics. Externally we fee a garment of hair ; under this a thick tough fkin, with a fubjacent membrane ; and then arrive at the cranium, which anfwers the purpofe of a wall. Within we find the brain invefted by its meninges, the dura and the pia mater, with the tunica arachnoides in- terpofed between them. Thus proteaed, it is preferved, not only from wounds and bruiies, but, which is of the laft importance, from external preffure. The brain is the part firft formed, and that from which the heart and arteries, the ftomach, the abforbents, the mufcles, and the bones originate. Some accurate ob- fervers with Malphigi, have diftinaiy traced this prog- refs in the incubated egg. For in this, when not im- pregnated, they difcerned only the fhell, the membranes, the albumen, and the yolk, with a little empty fack : but when impregnated, this fack evidently contained a fpeck P p fo 306 NERVOUS DISEASES. fo minute indeed as to efcape the eye, yet vifible by the aid of a powerful lens. After fome hours of incubation, ivith the heat of 980 of Farenheit, the fpeck became, as in the firft rudiments of all animals, a vermicle, and they remarked a head and tail, which are the brain with its appendage the fpinal marrow. The heart next appear- ed, at firft only as a vibrating arch, but by degrees it af- fumed auricles and ventricles. After this the lungs and vifcera with the limbs began to take their proper form, and the perfea chick appeared. Thus precifely is it, at leaft as fuppofed by Boerhaave, Hervey, and Aquapendente, in the human fpecies ;—in which the brain lays the foundation for the arterial fyf- tem, for the vifcera, for the mufcles, and even for the bones, all deriving their origin from it, as the root, the trunk, the branches, and the leaves, in plants fpring from the little corculum of their feeds. How beautiful in this view of the fubjea are the pious breathings of the royal prophet ! " I will praife thee, for I am fearfully and wonderfully made. My fubftance was not hid from thee, when I was made in fecret and curioufly wrought in the loweft parts of the earth. Thine eyes did fee my fubftance, yet being imperfea, and in thy book were all my members written, which in fucceflion were formed, when as yet there was none of them." Pfalm cxxxix. When we have removed the coverings of the brain, we obferve in the cerebrum two hemifpheres curioufly divided into lobes, with deep and multiplied circumvo- lutions, by which mechanifm, the cortical part, every where covered by the pia mater, is much increafed. This is cineritious in its appearance and vafcular in its texture ; but the medullary part is white, fibrous, and fomewhat harder than the cortical, from whofe ultimate arterial branches it is derived. A continuation of the medullary fibres forms the nerves. It is now univerfally agreed, that the cortical fub- ftance is not glandular, and indeed where a conftant and regular fupply of a fecreted fluid without interruption is required, the glandular mechanifm with its refervoirs would NERVOUS DISEASES. 307 would be improper. That in this cafe to have a perfea intermiflion of the influx would be dangerous in the ex- treme, is evident, becaufe no fooner is there a deficiency of arterial blood in the encephalon, than fyncope enfues, which is inftantly relieved when the vital ftream returns. We can readily affign the reafon why it was needful, that the cortical fubftance fhould have a great extent of furface, for by this contrivance it is able to contain the numerous orders of fecreting veffels, from the fmalleft which are difcernible to thofe which are invifible, and which terminate in the nervous tubuli of the medulla. The cerebellum, feated in the inferior and pofterior part of the head, is divided into two lobes ; but it has not fuch circumvolutions as appear in the cerebrum. In this, as well as in the brain, the cortical part abounds, but the feparation between the cortical and the medulla- ry fubftance is not fo well defined, for the latter takes a ramifying courfe, and is thence denominated arbor vite. From the medullary fubftance both of the brain and of the cerebellum is derived the medulla oblongata, and from this originate both the fpinal marrow and the nerves, which either fupply the organs of fenfation or attend the moving fibres. The brain is fupplied with blood by the carotid and vertebral arteries, the former derived immediately from the aorta, the latter rifing up from the fubclavians. Thefe are well proteaed in their afcent towards the head, and, as they enter the cranium, are infleaed in curious arches to reftrain the impetus of their contained fluids, which might be otherwife injurious to the tender fub- ftance of the brain. The carotids are diffufed over the cerebrum ; and the vertebral arteries convey the vital ftream more immediately to the cerebellum. Yet thefe communicate by innumerable branches, fo as to form a wonderful contexture of inofculating arteries, which con- tribute to impede the rapid progrefs of the blood, whilft at the fame time they effeaually prevent ftagnation and diftention. Thefe arteries depofit their ftrong mufcular integuments, before they enter the cranium. When they have entered, lofing a fecond coat, they have no pulfa- tion, o0S NERVOUS DISEASES. tion and therefore refemble veins, only they are defti- tute of valves. Under this form they conftitute the moft extenfive contexture of the pia mater, and from thence pafs by innumerable and infinitely fmall ramifications into the cortex both of the cerebrum and of the cere- bellum. In the dura mater, the arteries are of a different con- ftruaion, for they retain their coats, and have ftrong pulfations. They feem to have no comm-unication with the cortical part either of the brain or of the cerebellum, for the dura mater and the pia mater appear to be per- feaiy diftina and feparated by the cellular membrane, known by the name of tunica arachnoides, which con- tains a rofcid lymph. From the carotid and vertebral arteries, the two later- al ventricles derive branches to fupply with blood their plexus choroides, which is a wonderful reticular mem- brane, confifting of arteries, veins, and, as Dr. Ridley reports, lymphatics. The veins fcarcely penetrate the medullary fubftance of the brain, but turn back, and from the cortex haften to difcharge their blood into the finufes of the dura mater, which, running along the inner furface of the bones, and defended by a thick dehfe membrane, are preferved not merely from rupture, but from diftention, which is likewife prevented by ftrong filaments ftretched acrofs them. It is thus fufficiently provided, that the veins fhall not caufe compreflion ; but left they fhould be themfelves compreffed, the confequence of which would be ftagnation, artd a fatal apoplexy, they neither in any part of the brain attend the arteries, nor do they enter by the fame foramina. That a conftant fupply of blood, circulating throuo-h the veffels of the brain, is needful for the purpofes°of life, was early noticed by phyfiologifts, who called the carotids by that name, from x«p-, fleep, becaufe Erafif- tratus obferved that when ligatures are faftened on thefe arteries, the animal becomes lethargic. Drelincourt who tried his experiments on tiofiz, affures us that he made them apopkaic at his pleafure. As NERVOUS DISEASES. 3©9 As this effea may arife from deficiency of blood ; fo a redundance, caufing diftention of the veffels and pref- fure on the brain, produces the fame apoplectic fymp- toms. Hence Pyerus, having tied up one of the jugular veins in a dog, obferved that the animal was become ilu- pid and lethargic. That plethora in this cafe aas by compreflion, will be demonftrated when I come to treat of hydrorachitis, and is evident by a fimilar effea having been produced on the Parifian beggar mentioned by every anatomical pro- feffor. This man, to excite compaflion, and for a tri- fling recompenfe, fubmitted to preffure on the brain, hav- ing a portion of the fkull bare. In confequence of this, he firft perceived innumerable fparks, then loft his fight and fell into deep apopleaic fleep, all which fymptoms gradually vaniflied when the preffure was removed. To avoid the hazard of needlefs and uncertain preffure, it was provided that the brain fhould have no mufcular fi- bres, and that in the cranium there fhould be no refer- voir of fat. In the brain we remark four ventricles ; two anterior, which are the largeft ; a third formed by the thalami of the optic nerves, and the crura of the medulla oblonga- ta ; and the fourth between the crura of the cerebellum and medulla oblongata. When thefe are empty, they collapfe and leave no vacant fpace. With regard to the benefits refulting from different proportions between the cerebrum and the cerebellum, Boerhaave has remarked, that wifdom and fagacity de- pend upon the former, whilft ftrength is univerfally de- rived from the latter; and it has been obferved by oth- ers, that in proportion as animals approach to vegetables the brain diminifhes, whilft the cerebellum is proportion- ably increafed. The cerebellum is carefully proteaed from every kind of preffure, particularly from that of the fuperincumbent brain, and has neither finus, ventricle, nor pulfatile artery. It is remarkable, that when the brain is extirpated, the vital, although not the voluntary, motions are continu- ed ; but no fooner is the cerebellum injured, than the vibration ~IO NERVOUS DISEASES. vibration of the heart is ftopt, and refpiration ceafes. Drelincourt, who made numerous experiments on dogs, difcovered, that when he had deprived them of their brain, they lived indeed, but like vegetables, without fenfe or motion. Such is the wonderful machine, to which, as both Hoffman and Boerhaave ftate it, one third of the blood, chyle, and lymph, is fent frefh from the fountain, that is, when it has recently received a fupply of oxygen in its paffage through the lungs. But for what purpofe is this abundant treafure fent in- to the brain ? Not merely for nutrition, but chiefly for fecretion. The heart has commonly two fmall arteries, the liver only one, whilft the brain receives blood from four, and thofe confiderable. That the nerves derive a fluid from the brain is rendered probable, by the exper- iment of Hoffman, which Dr. Monro repeated, who having tied up the phrenic nerves, obferved that the diaphragm no longer moved: yet, when thefe nerves were preffed below the ligatures, fome palpitation of the diaphragm returned. The nerve commonly examined is the left phrenic, as being moft favourable for experi- ments, becaufe it is longer than the right, and gives no filaments till it arrives at the diaphragm. On opening the cheft, it is feen palling down the fide in the form of a white thread. From all that has been faid, it may fairly be conjeaur- ed, that the nerves and fibres of the brain are pervious, although, from their extreme tenuity, no one, except Lewenheuk, was ever able to affirm that he had occular demonftration of the faa. Nor fhould this be matter of furprife, when we confider that no eye has yet difsover- ed hollow tubes in the peduncles, through which fruits are fed, as in the gourds of Spain, weighing from fixty to one hundred pounds, although it is certain that in this manner nutriment is conveyed to them. It is com- puted that the fmalleft nervous filaments are no bigger than the hundredth part of an hair. By what means therefore can they be injeaed, and without injeaions howcan their permeability receive occular denionftration'? In NERVOUS DISEASES. 311 In various cafes of difeafe a vifcid lymph is difcovered in the ventricles of the brain, and to this we attribute coma: but, independent of difeafe, it is notorious, that the longer after death diffeaion is performed, the great- er is the quantity of lymph, for as Sauvage expreffes himfelf, Nihil vulgatius quamferum infinubus cerebri reperire,fi longo poft mortem tempore aperiatur cadaver: qub longius, ed uberius invenietur ferum. Tom. ii. p. 630. It is true, abforbents have never been difcovered - in the brain: yet, as there are undoubtedly exhalants, it, is reafonable, both from effeas and from analogy, to con- clude, that fome correfpondent veffels to abforb, as in all other cavities, muft exift, although from their mi- nutenefs they efcape the fight. Dr. Cullen fuppofes that the extremities of the veins may perform this office. It matters not, however, what kind of abforbents are employed by nature, becaufe, whatever they are, they muft be fubjea to the laws of irritability, and liable both to the accumulation and exhauftion of their vital energy. Hoffman, in his treatife on the nervous fluid, delivers an opinion, derived, as I imagine, either from Baglivi or Pachioni, which, although not adopted by fubfequent profeffors, yet, as coming from fuch an eminent phyfiol- ogift, cannot pafs without our notice. According to him the dura mater has its fyftole and diaftole, its dilation and contraaion, by which the refluent blood, returning through the veins from the arteries of the pia mater, and received into its finufes, is affifted in its progrefs to the heart, whilft the fecretion and motion of the nervous flu- id is increafed by the fame contrivance. In confirma- tion of his fyftem, he confiders the mechanifm of the du- ra mater, and particularly notices the ftruaure and di- reaion of its membranaceous and nervous fibres. Hence he concludes, that the dura mater is not merely a cover- ing of the brain, but that it ferves the purpofe of fecret- ing and propelling the nervous fluid to the moft diftant movements of the animated fabric. In proportion there- fore to the ftrength, tone, ftriaure, laxity, or atony, of this elaftic membrane, the nervous fluid moves with greater -JI2 NERVOUS DISEASES. greater or lefs celerity, and from hence arife the peculiar affeaions of motion and fenfation obfervable in different conftitutions. If this membrane labours under atony, the blood moves more flowly, whence a vifcid lymph is feparated in greater abundance, and comatofe difeafes are induced. If the dura mater is fpafmodically affeaed, and that for any length of time ; the arteries, veins, and medullary fubftance, are compreffed ; circulation ceafes; the fenfes, internal as well as external, are abolifhed ; and apoplexy follows, which may be either flight or fatal, according as either blood, by rupture of the veffels, or ferum, by exudation, is pouredforth.-—If the dura mater is, with celerity and force, alternately conftriaed and re- laxed ; the motion of the blood is quickened ; fecretion is augmented, and the nervous fluid, propelled with vio- lence, produces epilepfy. Such is the fyftem of this accurate obferver ; yet Boer- haave, not lefs attentive to nature, nor lefs diligent in his anatomical refearches, differs from him in opinion, and conceives the nervous fluid to be protruded merely by the aaion of the heart and arteries. In order to folve the difficulty, why under this fuppofition fenfations have not their pulfations, according as the nervous fluid is ac- celerated or retarded by the aaion of the heart; he inge- nioufly remarks, that the firft impreflion is not loft be- »fore it is fucceeded by a fecond and a third. This obfer- vation might have been illuftrated by the whirling of a firebrand, which exhibits light in one continued circle. SECTION IV. Of Sleep. The end and defign of fleep is both to renew, during the filence and darknefs of the night, the vital energy, which has been exhaufted through theday,and to aflift nutrition. Among the exhaufting powers may be reckoned heat, light, motion, found, and thought, with the exercife of reafon, imagination, defire, and volition. And if to thefe we add fenfations, accompanied by pain or pleafure, we fhall complete our cata>cpue. When NERVOUS DISEASES. 313 When therefore we are, to a certain degree, exhauft- ed by thefe powers, we are taught by nature to retire, that, recumbent in fome fequeftered fpot, unmolefted by light, by heat, by noife, and free from the excitements of volition, fleep may quietly fleal upon our fenfes and clofe the avenue to "thought. In this fituation all the mufcles, excepting the fphinaers, are relaxed, and voluntary motion ceafes, but not the vital and involuntary, for thefe, far from exhaufting, ferve only to recruit our ftrength. Such is the periftaltic motion of the alimentary canal, on which depends nutrition ; fuch refpiration, which fup- plies the pabulum of life ; and fuch the motion of the heart, which diftributes the energetic principle to every part of the animated frame. When all ftimulating powers, excepting thofe which immediately excite the vital funaions, are removed, fleep firft takes poffeffion of the limbs and blunts fenfation ; then impairs the recolleaion with the reafoning power, and finally precludes volition. If profound, it puts a to- tal flop to all the imaginations of the mind. Such are the phsenomena of fleep. But how is it pro- duced ? What is the proximate, what the remote caufe of fleep ? I am inclined to think that there are abforbents in the cavities of the brain, as in all other cavities of the body, to take up and carry off what the exhalants have depofited, and I imagine that, during our waking hours, their aaivity is great in proportion to the intenfity of thought, of volition, and of mufcular exertion. Should this be granted ; it will follow, from the laws of the an- imated fibre, that thefe abforbents, exhaufted by incef- fant aaion, will become torpid in a degree, whilft the exhalants continue to pour forth into the ventricles of the brain their vifcid lymph, as happens even after death, according to the affertion already quoted from Sauvage. Hence may arife that degree of preffure on the veffels of the brain which blunts the faculties, produces a ceffa- tion of voluntary motion, and terminates in total abfence of fenfation. l;or the occafional caufes of fomnolency we may look Q.9 to 314 NERVOUS DISEASES. to fuch as diminifh the vital energy and aaion of the ab- forbents by excefs of ftimulus: which may be heat, ani- mal food, fpices, fpirits, opium, and either violent or long continued exertions, whether mental or mufcular. A- mong thefe we find the fame caufes which occafion drunkennefs in its feveral degrees of intenfity, with deep fleep and death. Or, the occafional caufes, diminifhing the vital energy, maybe direaiy fedative, fuch as excefs of cold, which is attended by infuperable defire to fleep ; fear, when ex- treme ; profufe. evacuations ; exhaufting difeafes ; and whatever either diminifhes the fupply of blood to the veffels of the brain, fuch as ligatures on the carotids, and preffure on the cortical fubftance of the brain by plethora, or impedes the return of blood by the veins, as happens to decrepit age, and to fuch as are oppreft with fat. Hoffman, when treating of fleep and wakefulnefs, re- marks, that the tone and vigour of the brain being much diminifned, partly by vigilance through the day, and partly by languid circulation of the blood by night, this gives occafion to more copious exhalation of lymph, which flagnates in the veffels of the brain, and impedes the fecretion of the nervous fluid. He obferves, that whatever regards the circulation of the blood produces fleep, and that fleep itfelf retards the circulation of the blood; for during fleep the pulfe is flow, and the refpi- ration is both deeper and flower than when we are awake. That during fleep the whole fyftem is relaxed is evi- dent, becaufe every part of the body becomes turgid; and that fome of the exhalants aa more freely than the abforbents, with which they are conneaed, is manifeft by the pearly drops of fweat flanding like dew upon the face of children, or flowing from every pore of heaic patients, in the morning. To this obfervation it may be added, that children and people of lax habits fleep more than old people or fuch as are diftinguifhed for rigidity of fibre. That there is fome accumulation in the veffels of the brain is rendered probable by obferv- ing, that when any one is fuddenly awakened from pro- found fleep& he is convulfed ; weight and torpor in the head \ NERVOUS DISEASES. 3'5 head are felt for fome confiderable time ; the fenfes are flow in their return, and the mufcles do not readily obey volition. Thefe fymptoms are frequently rendered more remarkable when weakly fubjeas fleep after a full meal before the fire. ■„ . During quiefcence the abforbents, having accumula- ted vital energy, aa with renovated vigour, and a difpo- fition to wakefulnefs enfues. Thus this wonderful machine,by its alternate accumu- lation and exhauftion of energetic power, feems to re- femble, in fimplicity 2^ aaion and contrivance,the fyphon fountain, or an engine kept in motion by the alternate colleaion and condenfation of the fleam. In fupport of this theory the ftudent may confult wha-t I have delivered refpeaing the proximate caufe of ferous apoplexy. One degree of preffure produces, as I imag- ine, drowfinefs, and a greater "brings on fleep in its fever- al flages of intenfity, from that which is lighteft, to leth- argy, apoplexy, death. If any one retires to a fequeftered fpot, undifturbed by light, by noife, by pain, or mental paflions, when every mufcle is quiefcent, and when volition ceafes ; when there is nothing to excite the fyftem ; his ftate of fomnolency will be prolonged, attended firft by found and refrefhing fleep, afterwards by dozing. Boerhaave relates the caie of a wealthy young nobleman in Holland, who, having overdrank himfelf, was, by orders from the prince of Orange, carried into a dark and quiet place, where he flept three days and as many nights, not inceffantly, for he awoke often, but whenever he opened his eyes, believ- ing it to be the middle of the night, he turned round and dozed again. From what has been faid, it fhould appear, that fleep may arife from either exhaufted energy or want of ex- citement in the abforbent fyftem. Many animals, fecluded from light, heat, and the free accefs of atmofpheric air, doze through the whole win- ter. In this cafe the vital funaions are fcarcely percep- tible, for although the lamp of life is not extinguish jd, it burns dim ; the animal funaions are fufpended ; and the 316 NERVOUS DISEASES. the natural funaions are nearly fo ; for nothing paffes either by urine or by ftool, little efcapes by perfpiration, and in the torpid ftate digeftion ceafes. In this condi- • tion of the animal little oxygen is received into the fyf- tem by the lungs ; no great quantity of hydrogen is confumed in any given time for the purpofes of life, and confequently the vital heat is much diminifhed. Although I have fuppofed that fleep may be induced by preffure and accumulation of lymph in the ventricles of the brain ; yet we muft remark that during fleep the abforbents are certainly at work.—i. In the urinary blad- der ; for the urine is fmall in quantity, and high colour- ed. 2. In the alimentary canal ; for the feces are hard- ened. 3. In the membrana adipofa ; for the fat after long protraaed fleep is confiderably wafted, and at the end of winter, in the torpid animals, is commonly con- • fumed. 4. In the ventricles of the brain, for were it otherwife, not merely fleep, but apoplexy and death, would be the confequence. In the torpid and quiefcent ftate the appetite for food is loft, for it ufually bears proportion to the quantity of exertion, whether mental or mufcular;. and as no frefh fupply of hydrogen is received into the ftomach, the lit- tle required to feed the lambent flame is readily derived by abforption from the cells or refervoirs of fat difperfed over the body, and more efpecially about the loins. During our time of fleep, when every mufcular fibre is relaxed, and when nutritive particles are diftributed whereverthey are wanted ; provifion of oil is made for the confumption of the waking hours. Hence animals, who eatand fleep immoderately,are apt to be oppreffed with "fat. Somnolence, too much indulged, brings on fatuity. Boerhaave relates the cafe of a phyfician, who took fuch delight in fleeping, that he retired to a quiet and fequef- tered chamber, where, in perfea darknefs, he flumbered aimoft inceffantly, till he loft his intelleas, and perifhed in an hofpital. The duration of fleep, with the alternate periods of fe- pofe and vigilance, depend much on habit ; and this ones acquired is with difficulty changed. SECTION NERVOUS DISEASES. 3*7 SECTION V. Of Vigilance. Vigilance, when attended by anxiety, pain in the head, lofs of appetite, and diminution of ftrength, is by Sauvage and Sagar confidered as a genus, and is called agrypnia. They have claffed it under the vesani^, im- mediately after their deliria ; and of this genus Sauvage enumerates eleven fpecies. 1. Agrypnia arthritica, arifing from retrocedent or atonic gout. 2. Pathematis, induced by paflions of the mind, fuch as anger, fear, and ftrong defire. 3. Hyfterica, attended by palpitations, flarting, fub- fultus tendinum, impeded perfpiration, fpafmodic con- traaion, and convulfive motions, at the inftant when fleep is fleafing on the fenfes. 4. Cephalalgia, attended by violent headach, induced by inflammation in the pia mater. 5. Ex pancreate, arifing from an abfcefs in the pancre- as, and attended by cold fweats with fyncope. 6. A dolore, induced by grief, and therefore coinciding with his fecond fpecies. 7. Ab indigeftione. 8. A.febrilis. 9. A.fenilis. 1 o. Critica, preceding epiftaxis and other critical dif- charges. n. Ab infeclis, fuch as bugs, lice, fleas, gnats, ants, &c. In treating of this fubjea I fhall, without following ftep by flep the fpecific arrangement of Sauvage, confid- er what are the remote caufes, and then venture to fug- geft what may be the proximate caufe of vigilance. The occaflonal caufes are evidently fuch as ftimulate the fyftem. 1. The ftimuli may.be purely mental, fuch as anger, fear, joy, grief, with intenfity of thought and volition. I was acquainted thirty years ago with a moft amiable lady, Mrs. Mitchell, of Glafgow ; who having the mif- fortune to lofe a hufband, by whom fhe was tenderly be- ' ved, never flept a moment for fix weeks : and Sau- vage >m8 nervous diseases. vage makes mention of a young lady at MontpeHier, who having feen her hufband murdered by affaflins, was deprived of fleep for more than three months. 2. The ftimuli may be material, including fuch changes in the body as excite fenfation. Thefe ate hun- ger and thirft, ftrong light, loud founds, offenfive fmells, difgufting tafte, hard touch, if thefe are unufual, or fuch as commonly call forth volition, for none of thefe pro- duce watchfulnefs, when the mind has been accuftomed to regard them with indifference. The moft powerful ftimulus is pain, becaufe by this the animal is warned of immediate danger, whether the uneafy fenfation arifes from fpafm, diftention, laceration, or any folution of continuity produced either mechan- ically or by chemical attraction. When pain has been for any length of time endured, it proves, like all other ftimulants, a powerful fedative. 3. The ftimuli, if not fo powerful as to excite fenfa- tion or volition, may yet produce irritation, as I have ex- plained at large in the feaions of irritability and ftim- ulants. The irritation may be, a. In the lungs ; as in cafes of afthmas and catarrh. b. In the ftomach ; arifing from indigefted fordes, vifcid mucus, worms. Hoffman fays, Ventriculo bene habente, totum corpus alacrius eft, fomnus fit placidus, fi vero onuftus eft alimentis incon- gruis, fomnus deficit vel infomniis terrificis inter- turbatur. c. In the bowels ; from bile and flatulence, from fae- ces in the rectum. d. In the urinary bladder, e. In the feminal veffels. /. In the brain, or its meninges, either arifing from or attended by a quickened circulation of the blood, for whatever accelerates the motion of the circu- lating fluids in the veffels of the brain, induces vigilance. Thus far all is clear ; but as we advance we fhail find ourfelves in the regions of doubt, of darknefs, of conjec- ture. How NERVOUS DISEASES. 3*9 How then fhall we account for vigilance ? Borrowing a ray of light from chemiftry, fhall we venture to fup- pofe it may arife from the uninterrupted fupply of oxy- gen and hydrogen to the veffels of the brain ? If we fuppofe fleep to be produced by the preffure of rofcid lymph in the ventricles of the brain, and particu- larly, as I may now proceed to ftate it, by preffure on the plexus choroides and the minuter or fecreting veffels of the brain ; may we not indulge our imagination, and conjeaure that vigilance is produced by the union of ox- ygen and hydrogen, the latter perhaps fecreted by fome of the veffels of the brain, the former derived by chemi- cal attraaion from the arterial blood of the plexus cho- roides ? We know that by vigilance and thought, as well as by motion in the fyftfln, whether vital or voluntary, both oxygen and hydrogen are confumed and loft, whilft heat and water are produced ; and it is now underftood that the chemical union of thofe principles generates wa- ter and difengages heat. Let the ftudent recollea, that in the ventricles of the brain, he finds no coagulable lymph, but the pureft wa- ter, which is therefore denominated rofcid lymph by Boerhaave. I have already ftated, that the abforbents recover their tone merely by quiefcence ; but fuppofing the ftimuli above ftated are applied to any part of the fyftem ; the abforbents, agreeable to the laws of the animal economy, will be excited by fympathy, for it is obferved, that irri- tation draws into confent the neareft exhalants and the remote abforbents. The faa is certain, and the wifdom of this economy will be obvious to the ftudent, if he recolleas what has been delivered on the efforts of na- ture to relieve herfelf. In fupport of thefe theoretical conjeaures I would fuggeft the fubfequent confiderations. i. A fuperabundant fupply of hydrogen from ferment- ed liquors received into the ftomach, at firft brightens all the faculties and gives increafe of vigour, but fpeedily brings on intoxication followed by apopleaic fleep : but the infpiratk n of oxygenated air, as my friend Dr. Thornton ^2^. NERVOUS DISEASES. Thornton has clearly proved, flops the progrefs of in- toxication, and therefore prevents apopleaic fleep. 2. We obferve in crowded rooms, when candles burn dim for want of air, the human underftanding it confu- fed, and all its powers are enfeebled ; but the imagina- tion kindles, when the lungs take in a frefh fupply of well oxygenated air. 3. The infpiration of foul air in mines, whether hy- drogenous, carbonic, or the two combined, brings on deep fleep and death ; but by the admiffion of uncon- taminated air the miners are fpeedily revived, and the fame happens frequently in Spain to thofe who fit too long, or fleep in a clofe room with burning charcoal, which confumes the oxygen and difcharges carbonic air. 4. Boerhaave has remarked;*that in acute difeafes, the blood is found chiefly in the arteries, while the veins are comparatively empty. For this phaenomenon he in vain endeavours to account ; but the caufe is evidently this : the blood in all inflammatory fevers, being highly ox- ygenated, ftrongly ftimulates the heart, and is therefore propelled into the arteries in great abundance, and quick- er than the veins can receive it. But when highly oxygenated blood, as in acute dif- eafes, fuch as fynocha, pleuritis, phrenitis, moves with rapidity through the fyftem, and therefore in the veffels of the brain, vigilance, particularly in young fubjeas, fometimes continues night and day for a whole week to- gether. In fuch circumftances, as Boerhaave, with his ufual accuracy of difcernment, well obferved, their body- has been rendered lighter by one third part of its weight, fo that thofe, who had been very fat, have been reduced aimoft to fkeletons. , See his leaures on the theory of phyfic, feaions 599, 600. ^ In fuch circumftances, whilft the fever rages, the pa- tient can rife up with eafe and fupport himfelf in bed ; but when the fever is exhaufted, weak and relaxed, he fleeps inceffantly, or only awakes to lake in more food, that is, to fupply the lamp of life with hydrogen, then. fleeps again. My friend Dr. Thornton informs me, that when he exhibits oxygenated air to thin people, it in- cre Pulv. Aloes, cum ferro, dr. I. Calomel, gr. 10. Tinft. Aloes, q, s. f. pill 20. Cap. Pil. j. o. n. h. s. Should onepill every nightbe found infufficient tokeep the body reafonably open, the quantity muft be increaf- ed ; but as it will be in vain to evacuate the bowels, un- lefs the tone of the fyftem is reftored, five grains either offerrumtartarifatum, ofrubigo ferri, or of Iimatura ferri, in conferve of rofes,fhould be given twice or three times a day. Thefe may fometimes give place to the Peruvian bark, or both may be united, as occafion may require. This treatment will be found equally efficacious in both fpecies of oneirodynia. Genus LIX. Melancholia. Melancholy. The pathognomonic fymptom is erroneous judgment, not merely refpeaing health, arifing from imaginary per- ceptions or recolleaions, influencing the condua, dif- treffing the mind with ill grounded fears, and not com- bined with either pyrexia or comatofe affeaions. INTRODUCTION. Dr. Home confiders melancholia and mania as two fpecies of infania, and this he defines permanent delirium without fever. Melancholy then, according to him, is infanity accom- panied by fadnefs ; madnefs is infanity attended by rage. In the former, fear prevails ; anger in the latter ; but in both we have delirium. SECTION NERVOUS DISEASES. 327 SECTION I. Of Delirium. When treating of fevers I had occafion to diftinguifh delirium, as occurring either in fynocha or in typhus, without however flaying to confider the proximate caufe of thefe affeaions. It will be needful to refume the fubjea in this place, to which it more immediately belongs. Delirium, as defined by Dr. Cullen, is, in a perfon awake, a falfe judgment arifing from perceptions of imag- ination, or from falfe recollections, and commonly pro- ducing difproportionate emotions. Of this he very properly diftinguifhes two fpecies, confidering it either as combined with pyrexia and com- atofe affeaions ; or as totally free from fuch a combina- tion. He likewife marks the affinity between delirium and dreams, or rather proves that delirium is a waking dream. Whatever then I have fuggefted refpeaing dreams is applicable to delirium. Dr. Cullen imagines it arifes from unequal excitement in the brain, and I fee no reafon to differ from him in opinion. That he is right in his conjeaure is probable, becaufe ftrong excitement, as by any loud or fudden noife, calls back the recolleaion, and for a fhort interval reftores the fenfes. Van Swieten in his comment well remarks, Si fubitanei quid et improvifi ipfis accident, pro momento bene refpondent ; paulo poft, deleta hac vivida im- preffione, relabuntur. Sea. 700. In adverting to this fubjea, we cannot but call to mind the difference between the deUrium of fynocha and the de- lirium of typhus. In the former we find a pulfe full, ftrong, and vibrating from 90 to no ftrokes in a min- ute, and the heat much increafed. In the latter the pulfe is weak, fmall, and fluttering, with the vibrations aimoft innumerable. Here is at the fame time remarkable prof- tration of ftrength, but the heat is moderate. In the former, fubftances producing hydrogen, receiv- ed into the ftomach, increafe delirium j but acids tend greatly i2g NERVOUS DISEASES. greatly to diminifh it. In the latter, no benefit is deri- ved from acids in the ftomach, but whatever moft abounds with hydrogen removes the fymptoms of debility and reftores ferenity. In the former, to infpire oxygenated air is hurtful : in the latter it is highly beneficial. In the former all is in a blaze : in the latter the lamp of life, for want of pabulum, is well nigh extinguifhed, and the vital energy is fo far exhaufted, that, for a confider- able time before the diffolution, the iris ceafes to con- traa by the ftimulus of light. Of this diftinaion every praaitioner is fufficiently aware ; but it is far from being univerfally underftood, that delirium may be occafioned by vifcid mucus, and corrupted bile in the firft paffages. Van Swieten ingen- uoufly confeffes, that he is indebted for this informa- tion to his mafter Boerhaave, and adds, Monitus ab Opti- mo precept ere, frequentem fatis delirh in febribus cau- fam effe fordes circa precordia colleclas ; poftea attentus hide rei, vidi fapius hoc veriffimum effe ; et unicovomitorio data, excufd hacfaburrd recordorplures ilicb refipuiffe, fedi. yoi. And Dr. Whytt, who ftudied in the fame fchool, relates the cafe of a delirium in a boy, who flept well, had a fharp appetite, was not coftive, and whofe pulfe was full and flow. This boy, after having been bled and blifter- ed to no purpofe, was cured by calomel and rhubarb, which brought away a great quantity of flime. I remember a patient, attended by my much lamented friend and fellow ftudent, Dr. Stack, of Bath, who for a length of time was delirious every night, and conceiting, from pain in his bowels, that he was devoured by dogs, thrafhed with his cane every one who approached him, or in their abfence beat the bed polls to drive away the furious animals. In this cafe, when other remedies had failed, his fymptoms were relieved by evacuants produ- cing a difcharge of vifcid mucus and of bile. Thus we may diftinguifh three fpecies of delirium, as it i? found either in the fanguine temperament or in the melancholic, becaufe the former may have either the ro- buit and' elaftic fibre, which 5s effential to ftrength, or the lax and irritable fibre, which accompanies debility. This NERVOUS DISEASES. 329 This diftinaion is important, as having a reference to praaice. Delirium may indeed be occafioned by mental irrita- tion : yet fuch is the connexion and confent between the mind and body, that what originates altogether in the former is foon communicated to the latter, and then ac- tion and reaaion proceed continually till the diforder is confirmed, and delirium terminates in madnefs. To inveftigate this matter, as far as we are able, we muft confider what are the laws of the animal economy. i. The more vivid the fenfation when the image is impreffed, the ftronger is its difpofition to return, and the fhorter are the intervals of abfence, till by intenfity of application the idea becomes permanently fixed. Thus if you look fteadily at the fun, fo as moderately to fa- tigue the fight, then retire to a dark room, the image of the fun will alternately vanifh and appear for a confider- able time ; but if you continue gazing for a greater length of time, the image will remain for hours or for days. 2. The more deeply interefted we are in any objea, that is, the more forcibly it excites either hope or fear, the more frequently will the idea of that objea be pre- fented to the mind. ^ 3. Every idea, which has frequently recurred, has a difpofition to return, and, by returning often, becomes both permanent and vivid. 4. Whatever ideas have been either ufually, or even accidentally, yet powerfully affociated, have fuch a dif- pofition to affociate, that any one of thefe, refpecting ei- ther hope, fear, time, place, perfons, things, or even ar- bitrary charaaers, being prefented to the mind, excite all the reft either in regular or in confufed fucceflion. 5. Thefe ideas commonly return and wanton in the imagination during the filence and darknefs of the night, or even by day in the abfence of more powerful fenfa- tions. In fome circumftances clofing the eyes may be fufficient to produce them, as the ftudent may recollea in the cafe of bilious autumnal fever, to which I called his attention in the beginning of this work. Dr. Whytt relates the cafe of a patient affeaed with eryfipelas, who, S f when 33® NERVOUS DISEASES. when his eyes were open, was free from confufion in his • ideas; but no fooner did he clofe them, although not a- fleep, than he thought himfelf carried fwiftly through the air to diftant regions, or that his head, arms, and legs, feparated from his body, were flying off in different direaions. In thefe cafes the irritation is weaker than the ufual fenfations conveyed by light, for it vani-fhes like the glow- worm's feeble glimmering at the rifing of the fun. 6. When the image is vivid, and forcibly impreffed upon the mind by frequent recurrence, or by rivetted attention, and when the paflions of hope or fear have been ftrongly interefled by its prefence j it will continue undifturbed by new fenfations more permanent than the image of the fun, which Boerhaave had the rafhnefs to receive on his retina from the focus of a convex lens, and which, as he informs us, remained immutable for many days. y. Thefe ideas, with their affociated train, although at firft excited by mental irritation, may be renewed by ir- ritation in other parts of the fyftem, precifely as I have ftated in the cafe of dreams. 8. When thefe ideas are renewed by irritation, wheth- er mental or material, the impreffion will bear propor- tion to the debility of the fyftem, and to the ftrength of the irritating caufe: or, this being given, it will be di- reaiy as the dibility. If therefore delirium fupervenes^ when debility and irritability do not prevail, we may be certain, that there is fome powerful ftimulus either on the brain, or in the firft paffages of the alimentary canal, as will be explained in the fifth feaion under mania. 9. When images are permanent and vivid, the mind has no criterion by which it can diftinguifh fuch as are excited by irritation in the fyftem, from thofe that correfpond with, and are immediately produced by external objeas. SECTION II. Of the Hiftory and Progrefs of Melancholy. The perfons moft liable to this difeafe are men of the melancholic NERVOUS DISEASES. 33,1 melancholic temperament, particularly thofe who from ac- tive life retire to folitude, and, without employment for either the body or the mind, overcharge the alimentary canal, more efpecially if the place of their retreat is low and damp, or if, in fuch circumftances, they meet with keen vexation, and are haraffed with anxiety. It is likewife the difeafe of fludious and fedentary peo- ple, who neglea mufcular exercife, whilft they exhauft the powers of the mind. With them, however, it does not ufually affume the moft hideous features of defpair, but is often fo mild and gentle in its afpea as to claim affinity with a difeafe between which and it the refemblance is too ftriking to efcape our notice. In both there is errone- ous judgment; but whilft in hypochondriafis this has re- fpea to health alone, in melancholia it is not thus confined. When the literary man conceits that he is converted into wax ; when with Dr. Watts he imagines that his nofe is bigger than his chamber door ; or, fuppofing himfelf a clock, Hands upright in the corner of his room, moves his head from fide to fide, and clicks to this mo- tion, fo as to imitate the found and vibration of a pendu- lum, without any other fymptom of derangement ; we do not hefitate to pronounce him deeply hypochondriacal. But when he becomes habitually gloomy, fretful, and fufpicious; when his diftreffing apprehenfions are not confined to health, but arife from other fources ; more efpecially if he continues free from dyfpepfia ; the beft phyficians are agreed to confider him as attacked by melancholia. Yet between thefe difeafes the limits are not in all cafes eafy to be traced. The ufual progrefs of melancholy is well defcribed by Boerhaave. Patients in this difeafe are pale and bloated ; but by degrees they contraa a livid hue and grow very thin. They lofe their fleep, and commonly their appetite, al- though many inftances are found of aftonifhing voracity. Refpiration and the pulfe become weak and flow ; the habit coftive in the extreme ; the whole fyftem torpid. A fullen gloom takes poffeffion of the countenance, anxie- ty and grief hang heavy on their eyelids, and their im- agination 33* NERVOUS DISEASES. agination is haunted inceffantly with fearful apprehen* fions. The perfpiration and all the fecretions are dimin* ifhed, and coldnefs prevails in the extremities. An ob- flinate jaundice fometimes fupervenes, and when the body is diffeaed, the gall duas commonly are found dif- tended with black and flagnant bile, which refembles liquid pitch. Van Swieten attended a lady in melancholia, who, af- ter fhe had often attempted to deftroy herfelf, lay fleep- lefs with her eyes open for fix weeks, during which peri- od fhe fcarcely either ate or drank, and, never paffed a ftool. For the firft five weeks fhe made little water, and in the laft week none. Her tongue and mouth were dry, and her extremities cold like marble. After death no effufion was difcovered on the brain, but the veffels of the pia mater were diftended with black and pitch- like blood. See his Comments, fea. 1010. Foreftus mentions an old man who had no ftool for three months. When nature fpontaneoufly effeas a cure, it is either by inflammatory gout in the extremities, as mentioned by Dr. Whytt in his treatife on nervous diforders ; by the haemorrhoidal flux, as ftated by Hippocrates, and his •commentator Galen ; by an eruption on the fkin, as par- ticularly noticed by the fagacious Boerhaave ; by a diar- rhoea, as remarked by Dr Hulme ; or by the return of the monthly evacuation, as obferved by all who are con- verfant with this difeafe. SECTION IIL * Of the Remote Caufes of Melancholia, with Cafes. From what has been already delivered, it will appear that the predifponent caufe of melancholia is debility, and it will be feen that the occafional caufes are fuch as are direaiy or indireaiy fedative, and therefore tend to debilitate the fyftem. Among the latter may be reckoned violent and long continued and mental exertions, with intenfity of thought and protraaed vigilance, as in poets and mathematicians. Of thefe, fome, who are of a pecu- liar NERVOUS DISEASES. 333 liar conftitution, may efcape with impunity, although, like Francis Vieta, the algebraift mentioned by Boerhaave, they fhould pafs whole days and nights fucceffively in fuch profound meditation as neither to eat nor drink, nor fee, nor hear; yet in general they are the firft to fuffer. The fame may be faid of the intemperate, whether they indulge themfelves in gluttony, drunkennefs, the ufe of opiates, or in that fpecies of intemperance which commits greater ravages in the mental faculties than ei- ther of the former. Exceffive heat with immoderate exercife, when expo- fed to a fcorching fun, as in Italy and Spain, will pro- duce the fame effea. Even Joy in the extreme, terminates in melancholy. It was obferved by medical praaitioners, A. D. 1720, when the South Sea bubble produced fpeedy revolutions in the fortunes of the credulous, that by far the greater num- ber of patients were among, not the unfuccefsful, but the fortunate adventurers, and fuch as were fuddenly over- whelmed with wealth. All thefe caufes are direaiy flimulant, and therefore indireaiy fedative. Others are direaiy fedative. Such is cold with humidity and ftagnant vapour. Such are vifcid aliments, which containing little matter fit for nutriment, needlefsly opprefs the ftomach and the bowels. The fame may be faid of ill cured agues, which leave corrupted bile and vifcid mucus in the alimentary canal. The moft powerful fedatives are grief, anxiety, and fear. This may be feen in difappointed ambition, the ruined gambler, the perplexed by litigations, and fuch as are croffed in hopelefs love, who immure themfelves in cloif- ters, or wander in the folitary fhade, the viaims of defpair. Terror, which is fudden fear in the extreme, produ- ces not only the moft violent, but the moft permanent effeas. Van Swieten faw a lady, who having been ex- ceedingly alarmed by thieves at night attempting to break into her chamber, never loft that idea for a moment, but was unremittingly afraid, more particularly towards the evening, ):A NERVOUS DISEASES. evening, when fhe conftantly began to look round with terror, to tremble and turn pale; and although attended by her fervants, no fooner had fhe clofed her eyes to fleep, t nan fhe ftarted up affrighted, fo that fhe never could procure refrefhing fleep. Haraffed thus inceffantly by fear, fhe foon became a prey to melancholy, and died of that difeafe. Fear rendens the pulfe weak, flow, fmall j checks the refpiration ; leffens the vital heat; relaxes the ftomach and the bowels; impairs digeftion ; deftroys the appetiteJ; difturbs the reft by frightful dreams ; brings on palenefs; diminifhes perfpiration, or covers the face with cold drops of fweat; prevents the due fecretion of the bile, and pro- duces univerfal torpor. Anxiety and grief have the fame effeas, and although flowly, yet certainly deftroy by lofs of tone and relaxa- tion of the folids. Profeffor Hoffman, contrafting the- operation of the paflions, judicioufly obferves, that anger quickens the circulation, and drives the blood impetu- oufly from the center to the circumference ; terror with equal force fends it from the furface to the internal parts, the one producing fever, the other fpafm ; but grief re- tards the motion of the blood, and tends to atony. As the ftomach fympathizes with every part of the fyftem, and is the firft to fuffer by any paflions of the mind, more efpecially by grief and fear ; fo every part of the fyftem, more efpecially the mind, is drawn into confent and fuffers by the affeaions of the ftomach. Van Swieten has well defcribed this aaion and reaaion in the cafe of melancholy. -In Melancholia dum uni et eidem cogifaiioni inheret perpetuo mens, nafcitur in cor- pore humorum cacochymia : contra ubi talis humorum deven- eratip ab aids caujis nata fuit, uni et eidem cogitation) in- heret homo etiam inviiia et rcpugnans.. Comment. Q 1090. In fpafmodic diforders the connexion between every part of the fyftem and the ftomach has been clearly dem- onftrated ; and, whoever has paid attention to melan- cholic patients, will be' fatisfied that the feat of this affec- tion is moft often in the alimentary canal. Baglivi, NERVOUS DISEASES. 335 Baglivi, as quoted by Hoffman, is decidedly of this opinion, and advifes medical praaitioners in all mental diforders to pay their firft attention to the ftomach. To this advice the profeffor adds ; I have frequently obferv- ed men, who were before of a cheerful difpofition, and of a fanguine temperament, reduced, by diftrefs of mind, to fuch a ftate, that, without any manifeft and fubfifting caufe for grief, they have funk into the deepcft melan- choly, conftantly difturbed with apprehenfions of impend- ing evil. In thefe circumftances they complained of flatulence, pain, and diftention about the praecordia, want of appetite, and coftivenefs. Van Helmont teaches diftinaiy the fame doarine, and in his quaint manner fays, " The archer dwells in the praecordia, and if, in delirium or any fpecies of in- fanity, he aims his arrows at the head, this fhould not induce the phyfician to direa his attention or to apply his remedies immediately to the brain itfelf; for this would be to refembie one, who fhould attack the arrows whilft he overlooks the archer." Van Helmont how- ever is miftaken, when he attributes every fpecies of de- lirium to this caufe, for, as we have already ftated, it fometimes derives its origin from inflammation and men- tal irritation. The opinion of Galen therefore, when he fays that in fome cafes delirium and melancholy arife from weaknefs and relaxation of the ftomach, " confen- tiente principio quod in cerebro et nervis eft," feems to be more agreeable to truth. Among the occafional caufes of melancholia we have already confidered the operation of heat, cold, joy, grief, anxiety, and fear. It remains to enumerate fome others, which have been noticed by praaitioners. When atonic gout, as ftated by Dr. Whytt, occafions melancholia, the fedative effeas are firft perceived in the ftomach and the bowels. This may be particularly no- ticed in two cafes related by him in his treatife on the nerves, ch. vi. § 17. to which I muft refer the ftudent. The drying up of ulcers flands particularly charged by Amatus Lufitanus, as the occafional caufe of melan- choly. A cafe, which occurred to him, has been refer- red 336 NERVOUS DISEASES. red to, and other inftances of the fame nature have been recorded by praaitioners. Obftruaed catamenia fome- times brings on melancholia, and, according to Hip- pocrates and Galen, the fame effea has been produced when the hsemorrhoidal flux has been unfeafonably fup- preffed : but they and all the difciples of that fchool prin- cipally ace ufe their atrabilis. SECTION IV. Of the Proximate Caufe of Melancholia. Professor Hoffman, for the proximate caufe of mel- ancholy, affigns ftagnation of thick blood in the weak and flaccid veffels of the brain : Sanguinis crajfioris nimi- us ad imhecille et ftaccefcens cerebrum appulfus, ftagnatio et difificilis progreffus. But although the blood moves flow in this difeafe, there is no reafon to imagine that it either flagnates in the veffels of the brain, or moves flow- er there, than it does in other parts of the fyftem. Dr. Cullen, taking no notice of this opinion of his mafter, feems inclined to attribute melancholia to a pre- ternatural drynefs and firmnefs of texture in fome por- tions of the brain, giving occafion to inequality of ex- citement. But my valuable friend Gimbernat, firft fur- geon to the king of Spain, after having diffeaed more than fix hundred heads of wife men, fools, and madmen, affures me, that he never could difcover any thing re- markable in either texture or colour to diftinguifh them. Any preternatural hardnefs in the texture of the brain muft be confidered either as accidental, or as the effea, and not the caufe, of infanity, for this circumftance will not affift us to account either for its fudden and fponta- neous folution, or its cure by medicine, neither could it lead us to any rational indications. The fagacious Boerhaave, treading in the fteps of Hip- pocrates and Galen, confiders atrabilis as the caufe of melancholia, and at the fame time ftates, that melancholia is the caufe of atrabilis. His words are thefe, Hie mor- bus oritur ex ilia fanguinis et humorum malignitate, quam silem atram dixere veteres et rurfum idem morbus a mente NERVOUS DISEASES. 337 toente initium ducens, brevi in corpore bene fano ipfam bilem atramfacit. Sea. 1090. From what fymptoms then does he conclude that atrabilis prevails in this difeafe ? 1. From black fubftances, evacuated either by the ac- tion of emetics, or by ftool, and found after death in the inteftines. 2. From the black pitch like fubftance frequently difcovered in the bilious duas, and fometimes in the fpleen. 3. From the colour of the blood, becaufe in melan- cholia the craffamentum, if covered and preferved from communication with atmofpheric or oxygenated air, is of a dark crimfon colour bordering upon black. The firft of thefe fubftances muft be either corrupted bile or extravafated blood. Fourcroy informs us, that he has fometimes difcovered a biliary lining in the fmall inteftines, black, of the con- fidence of falve, and more than a quarter of an inch in thicknefs. This, by the aaion of the abforbents, acquires the toughnefs and tenacity of glue. See the Memoirs of the Royal Society of Medicine at Paris for the years 1782 and 1783. The fecond is certainly corrupted bile infpiffated by the aaion of the abforbents, but by no means anfvvers to the idea of Hippocrates, who imagined that two fpecies of bile, yellow and black, exifted in the healthy body, and that health itfelf depended on the due admixture of thefe principles. That the bile fhould thus concrete, cannot excite our wonder, when we confider, that it is compofed of coagu- lable lymph, animal gluten, the mineral alkali, and a ref- mous fubftance, according to the analyfis of Jaquin, and of the beft modern chemifts. As to the colour of the blood, it is now put beyond a doubt by the experiments of Dr. Prieftley, that blood receives a florid colour from oxygen, and becomes black when deprived of that pabulum of life. This circumftance may poffibly aflift us to explain the • moft interefting fymptoms, as ftated by Boerhaave, and * * with 338 NERVOUS DISEASES. with fome degree of probability to fuggeft what may be the proximate caufe of melancholia. Thefe fymp- toms are, i. Pulfe flow, fmall, weak, and the balance of the fanguiferous fyftem on the fide of the veins. See Cul- len's Firft Lines, § 1589. This proves that the vital en- ergy of the heart is fo much diminifhed, as not to bal- ance the natural elafticity of the arteries. Hence they contraa more forcibly than the heart, and protrude the blood into the veins fafter than it can return. The flow- nefs, fmallnefs, and weaknefs of the pulfe feem to be pro- portioned to the diminution of oxygen. When this fails, pulfation ceafes ; and the blood being colleaed wholly in the veins, the arteries are altogether empty. 2. Refpiration flow. The refpiration feems to be gov- erned by the pulfe, as I have already had occafion to ex- plain, when ftating the confent between the heart and lungs. It certainly bears proportion to the demand for oxygen, as may be feen in dogs, who have confumed more than their ufual quantity when in purfuit of game. And I may here be permitted to obferve, that in the an- telope, who moves with inexpreffible velocity, the lungs are capacious, the trachea is two inches widej and the noftrils are remarkably dilated. Vide Pallas's Voyages. The more pure the air, the flower is the refpiration ; but in proportion as the air is vitiated, either by fubftances, which are deftitute of oxygen, or by thofe which greedi- ly combine with it, the more laborious is the refpiration. This I have already noticed, and it may be proved by the breathing of fome afthmatic patients, Who are radically cured by well oxygenated air. Since then the refpira- tion in melancholia is flow, it is evident that the demand in the fyftem for oxygen is fmall. If more were de- manded, more would be fupplied, and refpiration would be quickened. 3. Palenefs. This univerfally is a fymptom of debili- ty, and proves that the balance of the fanguiferous fyftem is on the fide of the veins, or, in other words, that the vital energy of the heart is much diminifhed. This may be clearly proved by the palenefs of fyncope and death. 4. Perfpiration NERVOUS DISEASES. 339 4. Perfpiration and all the fecretions much diminifhed. Thefe effeas naturally follow the weakened energy of the heart, but they do not altogether depend upon that caufe, for the fecretions are promoted by oxygen, and fuffer lofs by its deficiency. 5. Coldnefs of the extremities. That vital heat de- pends on oxygen, is put beyond a doubt by the experi- ments of Drs. Crawford and Thornton, which prove that it bears proportion to the quantity of this received into the lungs. Heat however is not generated merely in the lungs, but throughout the fyftem, wherever there is either mufcular motion or animal fecretion. The pul- fation of the arteries, and the ofcillatory motion of the extreme veffels, with the fecretions, being, as already fta- ted, all diminifhed, the vital heat muft confequently be diminifhed to the fame degree, and this diminution will be therefore moft perceptible in the extremities, where the quantity of blood is leaft and its circulation floweft. 6. Digeftion much impaired. This effea feems to arife from the diminution of the vital heat, for by the experi- ments of John Hunter on various animals, which fleep through the winter, it appears, that the digeftive procefs is quickened by heat, and checked, or totally fuppreffed, by cold. But if the ftudent recolkas what has been delivered on refpiration and digeftion, he will be inclined to think that digeftion is promoted by the infpiration of oxygen, and impeded by vitiated air received into the lungs. Digeftion however is not produced by either heat or oxygen, but by the gaftric juice. We have rea- fon therefore to conclude, that for want of oxygen, the gaftric juice is either deficient in quantity, as we may be the more inclined to think, when we confider, that all the fecretions are diminifhed, or vitiated in quality, as may be readily conceived, when we reflea, what chang- es in the whole fyftem are produced by air and heat. 7. Lofs of appetite. This naturally follows from the deficiency of gaftric juice. But when the appetite, inftead of being impaired, is exceedingly voracious, this may arife from the ftimulus of indigefted fordes. 8. Coftivenefs; This likewife may be attributed to want 340 NERVOUS DISEASES. want of oxygen, for when Dr. Thornton, as he informs me, made his dyfpeptic patients breathe fuper-oxygena- ted air, they not only acquired appetite and fpirits, but be- came more regular in their bowels. Oxygen increafes the fecretions in general, and therefore may increafe the quantity of bilev which is the natural cathartic of the body, and at the fame time, giving tone and vigour to the fecreting veffels, it is probable that it may improve the quality of the fecreted fluid. But independently on this we may obferve, that the perfpiration being dimin- ifhed, the determination is naturally increafed to the in- ternal furface, where at the fame time, the glands being much relaxed, a fuperabundant quantity of mucus, of vifcid mucus, is colleaed, fo as to feparate between the bile and the animated fibre, and thereby prevent the op- eration of that natural cathartic. It is not however an univerfal fymptom, or conftantly prefent in melancholic patients. 9. Spirits deprejfed. My friend Dr. Thornton, in exhib- iting vital air to his numerous patients, conftantly obferved, that the eye became more animated, and that the counte- nance brightened with hilarity, which effeas we univerfal- ly experience in a pure atmofphere. If then the fpirits are elated by a plentiful fupply of oxygen, are we not war- ranted in our conclufion, that depreffion of fpirits may be caufed by its deficiency ? Should we enquire how it happens, that the lungs do not derive a proper fupply from atmofpheric air ; I might fimply appeal to faas, leaving others to affign the caufe and to account for this defea. But I fhall rather make the attempt myfelf, and at the fame time remind the ftudent of the hints, which I ventured to throw out in the beginning of my work. Every procefs in nature feems to depend on either at- traaion or repulfion. Of attraaion, we diftinguifh various kinds ; the at- traaion of gravitation ; magnetic attraaion ; the attrac- tion of elearicity ; and chemical attraaion. But befide thefe we obferve another, which may be called vital at- traction. On this depends the growth of the living fibre. Vegetables atiraa their nutriment both by their leaves and NERVOUS DISEASES. 341 and by their roots, which in extent are proportioned to each other. Animals go in fearch of food; but after they have fwallowed and the ftomach has digefted this, the laaeals make their fefeaion, and abforb fuch parts as are beft fuited to nutrition. In them the abforbents of the alimentay canal, at the different periods of their growth, and the pulmonary air veffels, bear proportion to each other, and I have already ftated a relative pro- portion between the oxygen attraaed by the lune:s, and the quantity of food digefted by the ftomach. If there- fore the procefs of digeftion is impeded, the attraaion for oxygen and its feparation from azot, with which it is combined, or blended, according to Jacquin, in atmof- pheric air, will be diminifhed. But when the air is over- charged with oxygen, the quantity feparated by the lung.1: in refpiration, even in the moft unfavourable circun fen- ces, will be increafed. Thus we fee in the burning of a culinary fire, when it is aimoft extinguifhed ; let the atmofpheric air be over- charged with oxygen, or give it nitre, and the effea im- mediately produced will be rapid combuftion with vehe- ment heat and vivid flame ; or fuppofing the air to have only its ufual proportion of oxygen, let more combufti- ble matter, fuch as fulphur, ether, ardent fpirits, or even oil, be added to the fuel, and the effea will be the fame. In fome cafes it may be fufficient merely to blow away the duft which feparates between the combuftibles and ox- ygen. Thefe attraaions and combinations are governed Dy the laws of relative affinity, fome of which, accurate!y determined by the fagacious and moft laborious Kirvvan, he has been fo fortunate as to exprefs by numbers. In accounting for the coftivenefs, I mentioned my o- pinion, that it might arife from vifcid mucus in the ali- mentary canal. This caufe, as I am inclined to think, will at the fame time prevent nutrition, and leffen in the fyftem the demand for oxygen,and then we muft not won- der that the lamp fhould emit a feeble light. With a plen- tiful fupply of oxygen and hydrogen, the (lame is bright; but a fingle drop of water floating on the furfaee of the melted y*z NERVOUS DISEASES. melted wax, will be fufficient to gut off the communica- tion and prevent their combination; and fuch appears to me the effea of vifcid mucus in the alimentary canal. 10. Jaundice. This will be confidered largely in its proper place. n. Vigilance. Of this I have already treated in feaion V. From all that has been fuggefted, I am inclined to think with Dr. Cullen, that in melancholia there is tor- por in the motion of the nervous power, both with re- fpea to fenfation and volition, (fee his Firft Lines, § [589) ; and this., in my opinion, feems to depend on vifcid mucus lining the inteftines ; for no fooner is it, by a ju- dicious treatment, cleared away, than vital heat increafes, the pulfe acquires ftrength, torpor is relieved, and the fpirits rife. This perfeaiy agrees with what I have ftated refpea- ing the remote caufes of melancholia, all which relax the glands of the inteftines, and produce accumulation of their mucus. And upon this principle, Hoffman in melancholia approves of antimonials, £>uodfi. enim tena- ees,vifcidi et biliofi in duodeno ftabulantes humores vomitu evocandi funt; fiores antimonii engregium pollicenturfruc* turn. Vol. III. p. 261. SECTION V. Of the Indications of Cure in Melancholia. From what has been delivered, warranted by experi- ence, it will be found that our indications muft be, 1. To free the inteftines from indigefted fordes and from vifcid mucus. 2. To excite the vital energy by ftimulating tonics and to brace the relaxed fibre by aftringents. The first intention may be anfwered by, a. Emetics, and for this purpofe we may order, §, Palv. lpec. gr. 6. Antimon. tartarifat.gr. 3. M. f. Pulv. Emet. mane fumend. & repet. omui horu ufque ad vomitionem. The young praaitioner muft not be furprifed if he fhould be obliged to give four or five emetics, before he obtains an operation. Dr. Pellet, of St. Alban, whofe praaice NERVOUS DISEASES. 343 praaice in this line is fo extenfive as to occupy much of his attention, informs me, that for one patient he order- ed twenty four grains of tartar emetic in the fpace of four and twenty hours, before he could procure an evac- uation. At laft the operation, which was by ftool, was moderate, and he recovered. Others have given nearly twice that quantity before they could obtain any vifible effea. Thefe emetics muft be repeated every morning for fome confiderable time, then twice a week, or feldomer, according to the flime evacuated. In this difeafe, timid- ity, if combined with ignorance in the medical praai- tioner, is moft injurious to the patient; for if after the firft or fecond emetic he flops fhort, the glands will be foon overcharged with vifcid mucus, and he will have loft his labour. On this praaice Dr. Monro placed his chief dependance. b. Cathartics. Thefe muft not be draftic, becaufe they would defeat our purpofe in more ways than one ; for they would not only increafe debility, but by powerfully ftimulating the mucous glands produce a plentiful fecre- tion, and confequently aggravate the fymptoms they were intended to relieve. The beft cathartic for our purpofe is foluble tartar, as prefcribed by Dr. Whytt. §, Kali Tartarifat. 3iij. Solve in aq. font, gviij. Cui adde Aq. Cinnamom. Syr. Violar. aa. gj. M. f. H. m. s. Soluble tartar three drams, difTolved in eight ounces of fpring water, with cinnamon water, and fyrup of violets, of each one ounce. In the morning. This, adopted from the Germans, muft be frequently repeated for weeks or months, if needful; or inftead of this, §, Gum Ammon. dr. 2. Extr. Gent. Aloe Soc. aa. fcr. r. OL Menth. pip. gtt. 7. Balf. Peruv. q. f. M. f. pil. 36. Cap. Pil. 2. M. & v. cum Tir.a. Cafcar. dr. 2 in lnfuf. Flor. Chamaemel Unc. 2. Calomel, in dofes of two to ten grains, given at night, avoiding acids and every kind of medicine which can quicken its operation, is excellent. This commonly lies quiet in the bowels all the night, and when the patient rifes, brings a ftool, not watery, but of due confidence with faeces, black bile, and vifcid mucus. In the morn- ing 344 NERVOUS DISEASE*. ing this maybe affifted by any of the preceding formulae. Itmuft not, however, be exhibited too often, left it fhould either affea the mouth, debilitate the fyftem, or ftimulate too frequently the mucous glands. For the ufe of emetics and mercurial laxatives in mel- ancholia we have the authority of Boerhaave. Van Swieten very properly recommends plenty of de- tergent vegetables, fuch as are commonly ufed for fallads at our table, particularly endive, lettuce, cellery, fpinnage, and dandelion ; to which he adds, with equal commen- dation, goofeberries, currants, rafberries, ftrawberries, and cherries. In fupport of his recommendation he af- fures us, that he has feen patients in the moft diftreffing cafes of melancholia, perfeaiy reftored to health by cher- ries and ftrawberries alone ; of which, refufing all other food, they devoured more than twenty pounds a day, and that for many weeks together. It is true this enor- mous quantity of fruit brought on a diarrhoza, but then he adds, per ahum exibat foluta fjex atrabilaria, that is, undoubtedly they paffed ftools of corrupted bile and vifcid mucus, after which they fpeedily recovered ; a healthy appetite returned, and, although much weaken- ed by this difcipline, they foon regained their ftrength. He adduces likewife the teftimony of Hoffman in favour of a detergent diet, and forbidding the ufe of draftic purges, he adds moft judicioufly cum autem picea fere te* nacitate vifceribus hereat atrabilarius humor, non facile purgantihus dbedit. Let the ftudent confult the paffage at large in § i ioo of this learned profeffor's commentary, and he will comprehend the dilemma, which has per- plexed praaitioners from the time of Hippocrates to this day. 5/ malum perfeverat,fit incurabile : fi evneuantibus pugnatur,fane et facile mobiles humores expellunter, tena- ces malique herent, undepejor morbus. In this dilemma are involved all the draftic purges, diftinguifhed by the name of hydragogue, becaufe they evacuate, not always the natural fasces, but chiefly lvmph, and that in great abundance, fo as to increafe debility. Such are helle- bore, fcammony, colocynth, jalap, gamboge ; and I have ' frequently had occafion to obferve, when thefe cathartics have NERVOUS DISEASES. 345 fcave been given, that the ftools refembled the wafhing of a tub, whilft the hardened fcybala had been left behind. A tepid bath, recommended by Boerhaave and Hoff- man, may be ufed with fafety and advantage. The second intention may be anfwered by bark and bitters, but more efpecially by chalybeates affifted in their operation by the infpiration of well oxygenated air. The myrrh and fteel, as recommended by Dr. Griffith, may be here ufefully applied. It will be found as pre- fcribed for phthifis and for hyfteria; but the doaor him- felf informs us, that he had given it in melancholia. To the myrrh and fteel, bark may be added in this form, which may be varied as occafion fhall require. §> Cinchon. JFj Limat ferri. Myrrh, aa 5ij. Syr. Cor. Aurant. q. s. M. f. Ele&. c. c. M. N. M. i. o. 8. h. Bark one ounce ; myrrh and fteel filings of each two drams ; fyrup of orange peel fufficient to make an electuary. Dofe the fize of a nutmeg three times a day. Or the following may be adopted. I£> Cinchon. Ferri. rubig. aa §j. Pulv. Aromat. 3ij. Conf. Cort. Aurant. §ij. Syr. Zinzib. q. s. f. Ele£t. cujus M. N. M. ter in die fumend. Bark and rufl of iron of each one ounce ; aromatic powder two drams ; conferve of orange peel two ounces ; fyrup of ginger fuf- ficient to make an ele&uary. Dofe as in the former. In addition to the bark and fteel, Dr. Thornton makes his patients refpire well oxygenated air, and in- forms me that he has found it efficacious in a great vari- ety of cafes. Mr. Windy having been for fome time indifpofed, Became at length perfeaiy infane. He was placed in a madhoufe at Chelfea, where for the firft five months he raved, and after that for four months he fcarcely ever uttered a fingle word. When he was removed fiom this place to be under Dr. Thornton's care he was gloomy, fullen, and filent, or muttered only expreflions which evinced what were the terrors of his difturbed imagination. He had no recollection of his wife or children, and the only notice he took of his attendants, was to mani- feft fufpicion that they meant to injure him. He was coftive, and had remarkable coldnefs of the extremities. As Dr. Thornton had fucceeded with the vital air in a cafe of hy- pochondriafis, he determined to give this air a fair trial in the prefent inftance. He began therefore with giving four quarts of vital air to ten quarts of common air, which produced no change. He then gave ether and brandy, hoping thereby to increafe the vital heat, but without the leaft effeft, for his hand continued cold as clay.. U u Thus 346 NERVOUS DISEASES. Thus difappointed in his firft effort to relieve his patient, he gave an emetic in the evening, which brought up a vaft quantity of vifcid mu- cus. At bed time he ordered a calomel pill, which was worked off in the morning with rhubarb and fal polychreft. Having thus cleanfed the alimentary canal, he gave the day following ether and brandy as before, and caufed his patient to inhale the fame quantity of vital air, which inftantly produced a genial warmth extending to his fingers* ends. Nor was this a tranfitory effect, for it continued all the time he was under Dr. Thornton's care. In ten days from this time he became confcious of the prefence of his wife and children, whom he called by their proper names, walked out and returned home, and, before the month was concluded, recol- lected the fortune he was poffeffed of, fent for the guardian of his wife and family (Mr. Ledeker, who lives in Greek Street, Soho),and entered minutely into the ftate of his affairs. Some phyficians have recommended opium as the moft powerful in this difeafe, and have given it in large dofes to remove anxiety, and to bring on fleep : but the misfortune is, that when the flimulant effect is over, the fedative effea takes place, and the patients fink lower than before they took this cordial foporific. The dofe muft be then increafed, perhaps to ten or fifteen grains, and a conftipation of the bowels is produced. At beft it palliates one fymptom, but ftrengthens the difeafe. Baron Haller, for the four latter years of his life, funk into a relig- ious defpondency that robbed him of all enjoyment, and aimoft of all the functions of life. Through the whole of that period he ceafed to exift, or exifted in mifery, whenever he was not occupied by the pen or engaged in his ftudies. In cenfequence of ill health, he had gradu- ally habituated himfelf to an exceffive ufe of opium ; and at laft, by the violent application of that drug, as Zimmerman informs us, main- tained himfelf in continual fluctuation between a ftate of mind unnat- urally elevated, and the faddeft dejection of defpair. It is faid that in fome cafes of melancholia we muft de- pend chiefly upon tonics and aftringents ; but thefe I apprehend do not frequently occur. When they do. the preceding evacuants muft be ufed with caution. Exercife in the open air, cheerful fociety, change of fcene and agreeable purfuits, are the moft efficacious tonics. Hence nothing in the cure of melancholia is more to be recommended than travelling, which quick- ens the circulation, fharpens the appetite, promotes per- fpiration, increafes all the fecretions, procures refrefhing fleep, and, completely changing all habits and aflbciations of NERVOUS DISEASES. 347 of ideas, puts an end to the delirium. The poet fays, " throw but a flone, the giant dies ;" and Dr. Mead re- lates a cafe, which clearly proves the benefit to be receiv- ed from exercife. A fellow of a college, in the laft ex- tremity of melancholy, ordered his paflingbell to toll, and liftened to the knell with deep attention. Perceiv- ing, however, that the fexton was a novice in his art, he loft all patience, rofe from his bed, and crept away to church, where he gave inftruaions how to toll the bell and how to ring a peal. From verbal inftruaion he proceeded to fet the fexton an example, and having fa- tigued himfelf effeaually, he returned to his chamber and went again to bed. Here he flept profoundly, fweat freely, and when he awoke, forgot that he was ill. When this difeafe is fymptomatic of atonic gout, ob- ftruaed catamenia, or the haemorrhoidal flux fuppreffed, attention muft be paid to the primary difeafe. Hitherto I have mentioned only what is to be prefcri- bed by the phyfician; but he is not the only perfon who is to contribute towards the cure. The friends of the melancholic patient muft lend their affiftance to the medical advifer. If the difeafe originates in grief, in anxiety, in fear, moral arguments muft not be forgotten. * If fome idle fancy, having pofleffion of the mind, pre- vents refrefhing fleep, reftrains from change of air and exercife, or keeps the patient from taking wholefome food ; his friends muft counteraa this fancy, not openly and direaiy, but fecretly and with much addrefs. Boerhaave tells us of a melancholic patient, a counfel- lor at Paris, who retained his urine, left he fhould deluge the whole city, till his friends raifed a cry of fire, and prevailed on him to lend his affiftance towards extinguifh- ing the flames. His commentator, Van Swieten, mentions a patient, who, by immoderate application to his ftudies becoming deeply melancholic, conceited that his legs were made of glafs, and therefore caufed himfelf to be carried from his bed to an armed chair, in which he fat perpetually hefore the fire: till the maid fervant threw a block of wood -48 NERVOUS DISEASES. wood upon his fhins, which excited pain, and with it fuch indignation, that he forgot the tranfmutation of his limbs, and purfued her in a rage to take revenge. Thus convinced, the imagination left him, .and by proper ex>- ercife he perfeaiy recovered. Genus LX. Mania. The fymptoms are, an erroneous judgment arifing from imaginary perceptions, or falfe aflbciations, and producing difproportionate emotions, with a hurry of mind in purfuing a train of thought, or in running from one train of thought to another, attended with incohe- rent fpeech, called raving, and violent impatience of ei- ther contradiaion or reftraint. SECTION I. The Hiftory of Mania. This difeafe is commonly preceded by rednefs in the eyes, headach, quicknefs of hearing, noife and finging in the ears, abfence of fleep, with more than common ir- ritability, manifefted either by unfeafonable laughter or by unprovoked difpleafure. Its approach may be appre- hended when we difcover unufual fufpicioufnefs of tem- per with pride and haughtinefs of carriage, ftrong felfwill, eagernefs and impatience of contradiaion, with capri- cious likings and diflikes. Women fometimes difcover blood colleaed in their nipples. During the paroxyfms of rage and fury, the force of the animal funaions is prodigioufly increafed, fo as fome- times to require four or five ftrong men to reftrain its violence, whilft the vital funaions, as appears by the pulfe, are little altered. Perfons in this difeafe are remark- able for bearing hunger, vigilance, and cold, without ap- parent inconvenience. When they refufe all kinds of food, it. is frequently under apprehenfions of treachery and poifon. Their neareft relations and beft friends, the objeas of their former attachment and affeaion, are ufu- ally thofe to whom they manifeft the moft indignant ha- tredo NERVOUS DISEASES. 349 ired. The unhappy fufferers, in addition to thefe diftreff- ing fymptoms, however before diftinguifhed for purity and piety, are apt to difcover the moft libidinous defires and to utter inceffantly their obfcene and blafphemous expreflions. Their eyes feldom harmonife with the oth- er features of their countenance, but are either fixed, fierce, malicious, or unmeaning. They excel in artifice and conceal their mifchievous defigns, when they are contriving to indulge their brutal rage. They are con- fcious of their own aaions, and perfeaiy fenfible to every thing about them of which they retain the recolleaion. Mania is either continued or periodical, either without perfea intermiflions, although it may frequently remit, or returning only by intervals, which may be either folfticial, equinoaial, or lunar. On the decline of the paroxyfm maniacs remain quiet, exhaufted, flupid, inoffenfive, gloomy. It is worthy of our obfervation, that mania has a ten- dency to cure all other difeafes, excepting thofe which immediately affea the brain : and that perfons fuffering by this, are not liable to receive infeaion during the prev- alence of any epidemical difeafe. The natural and fpontaneous folution of mania merits our attention and may direa our praaice. It has been known to terminate by a copious bleeding of the nofe, by the menftrual or by the haemorrhoidal flux, by diar- rhoea and dyfentary, by cuticular eruptions, and by the breaking out of ulcers. Intermittent fevers have produ- ced the fame benign effea. It has given place to dropfy, for|thefetwo difeafes can fcarcely fubfift together. Pregnan- cy is favourable according to the axiom of Hippocrates, Si conceperint, fanae fiunt. When mania terminates fa- tally, it is by phrenitis commonly, fometimes by epilepfy, or mould it be protraaed after repeated paroxyfms, the patient lofes both underftanding and memory, and be- comes an idiot. SECTION II. Of the Species of Mania. Hoffman was of opinion, that there is but one fpecies of 35® NERVOUS DISEASES. of mania, and that this differs only in degree from its parent melancholia. Boerhaave partly agreed with him, and aflerted in general terms, Si melancholia eoufque increfcit, ut tanta accedat agitatio liquidi cerebrofi, qua in furorem agantur, fevum mania vocatur. Shiagradu modo diflfert a melan- cholia trifti ; hujus proles eft ; ex iifdem caiifis oritur ; iifdcm fere remediis curari folet. § 1118, 1119. Yet he afterwards diftinguifhes three fpecies of mania, re- quiring different indications of cure. Thefe eminent profeffors are wrong in flating mania and melancholia to be the fame difeafe, differing onlv in degree. Certain it is, that melancholia very ferquently, as I fhall have occafion to fhew, runs up into mania ; yet we have inftances of mania, wholly and permanently dif- tina from melancholia. Dr. Cullen has made this diftinaion, and has at the fame time fuggefted an idea of two fpecies of mania, ac- cording as it appears in the melancholic, or hi the fan- guine temperament. § 1574. His idea is certainly well founded, and leads to prac- tical improvements in the ufual treatment of maniacs ; yet we cannot help exprefling our furprife, that he fhould have difcovered any hefitation in making this diftinaion, when he found it fo clearly marked in the aphorifms of Boerhaave. In his nofology, Dr. Cullen has three fpecies, 1. Mania mentalis omnino a pathemate mentis. 2. Mania corporea a vitio, corporis evidente. 3. Mania obfeura praegreffo nullo vel pathemate men- tis vel vitio corporis evidente. And for thefe diftinaions likewife there is fome foun- dation ; but as my plan is to aflift the young praaitioner, I fhall in my arrangement fix upon fuch fpecies only as require medical diftinaion. Thefe are to be found in Boerhaave; but as it will be needful at all hazards to diftinguifh them by name as well as by chafer, I fhall venture to call them, 1. Mania melancholica. 2. M. phrenitoides. 7. M hyfiertca. ° Mania nervous diseases. * 351 Mania melancholica effentially agrees with Hoff- man's delirium melancholicum et maniacum, and with the firft fpecies of mania defcribed and treated of by Boer- haave in his aphorifms, from § 1119, to § 1124. It al- fo perfeaiy coincides with Cullen's idea in his Firft Lines, § 1574. ' My two other fpecies are comprehended in what he would have denominated mania fanguinea ; but if, in deference to his fuggeftion, I had adopted that appella- tion, there ftill would have been room for a diftinaion. This diftinaion of two fpecies, both belonging to the fanguine temperament, is marked, as I fhall prove, by Sydenham, by Boerhaave, and by his learned commen- tator. In the mean time I muft requeft the ftudent to recollea what I have delivered on the fanguine tempera- ment in the third feaion of the order fpafmi, where it ap- pears that, in proportion to the tenfion or laxity of the fimple folids, we may in this temperament expect either inflammatory or fpafmodic affeclions. The ftudent may likewife recollea that, in my obfervations on apoplexia, a difeafe which has fome affinity to mania, becaufe in it there is a determination to the head, he had a glimpfe of the fame diftinaion in the apoplexia fpafmodica of Hoff- man, which, as I ftated, flriaiy fpeaking, is a fpecies of apoplexia fanguinea. Thefe therefore are the fpecies I fhall labour to eftab- lifh, as requiring each of them a diftina mode of treat- ment. For the mania mentalis of Cullen I fhall referve a feparate feaion. His fpecies of infanity, which he de- fcribes in § 1576 to 1581, and for which he was unable to find a generic term under his order of vesani^e, can fcarcely be confidered as a difeafe. Sauvage has called it melancholia moria ; but, as it is attended with agreeable impreffions, the man when cured may fay to his phy- fician s, Pol me ocadifiis, amid, Cuijic extort a voluptas, Et demptus per vim mentis grattffimus error. I once faw an inftance of this, I was going to call it delightful melancholy, in a reverend divine, who took to a 352 nervous diseases. a fedentary, folitary life, and fared fumptuoufly every day. He was perfeaiy -rational in his difcourfe, unlefs when you afked him how he did ; but then he felt fa- tigued after hunting with the king, or he had rather drank too much Burgundy whilft dining with the prince,. or was fomewhat troubled wkh the colic after feafting on the moft delicious melons fent him by the emprefs : in a word, he was always overwhelmed with fome felicity, SECTION III. Of Mania Melancholica. This fpecies of mania is commonly preceded by and alternates with melancholia. For the general fymptoms, therefore, we muft refer to what has been already ftated as the fymptoms in both thefe difeafes. But in addition to thefe we may obferve with Boerhaave, that in this fpecies of mania, all the fecretions and excretions fail, or be- come exceedingly diminifhed;. Such patients obftinately refufe both meat and drink for a cqnfiderable time ; their mouth is dry, their urine is little in quantity, and, if they take nourifhment, it moves flowly through the inteftinal canal, where the abforbents take up all that is fluid. Hence the faeces are fmall and'hardened fcybala, and re- main colleaed in the greater guts. Vide § 1122 of Bo- erhaave's aphorifms. Sauvage attended one in this dif- eafe who refufed every kind of fuftenance, except tobac- co, for forty days, and confequently had little or nothing to pafs by the excretions. The predifponent caufe is debility, increafed by indo~ Q lence ; and the occafional caufes are commonly anxiety * and grief, intemperance, deep fludy, violent paflions and emotions, with difappointed love, and 'wounded pride. But the moft ufual caufe is fear, for, as Sauvage has well expreffed himfelf, Maniaci, utcunque audaces fint re- ipfa metu maximo quodam ad infaniam fere omnes ducuntur. As to the proximate caufe of mania, various opinions have been delivered ; but thofe of the beft mafters effen- tially agree. Hoffman conceives it to be a vehement and impetuous circulation of denfe and melancholic blood NERVOUS DISEASES. 353 blood through the weakened and flaccid veffels of the brain. Dr. Cullen is inclined to think it is increafed and unequal excitement in the brain. That in mania there is a preternatural determination to the head, is evident by the rednefs of the eyes, and may be put beyond a doubt by preffing the carotid arte- ries of a maniac in the way firft communicated to the public by my ingenious friend Dr. Parry. The mania inftantly ceafes, and for the time reafon refumes her empire. Whence then arifes the preternatural excitement in the brain ? Certainly from this undue determination of blood to the fuperior regions, and from its impetuous circulation in the veflels of that organ. Should the ftu- dent again inquire what caufes this determination of blood to the fuperior regions; I can anfwer with confidence, that in mania melancholica it arifes from affeaions of the alimentary canal. In confirmation of this opinion, I muft requeft the ftudent, who wifhes to have clear and diftina ideas of the caufe, before he attempts to cure this deplo- rable difeafe, to confider what I have faid in the feaion on delirium, and in that which treats of the remote caufes of melancholia, all which agrees with Aretjeus, who fays that the principal feat of mania and melancholia is in the inteftinal canal. Boerhaave has diftinaiy marked a connexion between mania, melancholia, apoplexia, and epilepfia, as re- lates to their occafional caufe, Si melancholia diu perfeve- rat, producit dementiam, epilepsiam, apoplexiam, maniam, convulfionem,ccecitatem,&c. § 1109. Nov if the ftudent will take the trouble to confult what I have delivered on the proximate and occafional caufes of apo- plexy and of epilepfy, or if he will confult what Hoff- man has written on thofe moft interefting fubjeas : he will be fatisfied, that although in mania melancholica the archer has direaed his arrows to the head, he himfelf, as I fhall endeavour to explain in the fifth -U-Ton, has ta- ken his flation in the alimentary canal. In praaice it is frequently curious to obferve, when flufhing of the face with hear, pulfation of the arteries W w i\-.U 354 NERVOUS DISEASES. felt by the patient in his brain, and a fenfe of coldnefs in bis feet, all proving a ftrong determination to the head ; how foon thefe fymptoms are relieved, and the equilibri- um in the circulation is reftored, fometimes by a gentle emetic, and at other times by one dofe of calomel, pro* ducing copious evacuation of faeces, of vifcid mucus, and of bile. It is of this fpecies of mania in particular that Boer- haave fays, Fruftra tentata per omnia remedia, varix, ha- morrhois, dyfenteria, hydrops, hamorrhagia magna fponta- nea, febres tertiane, quartaneve, aecedentes, falutaria fuerunt. From all that I have ftated, it will follow that the in- dications of cure muft be, i. To leffen the determination to the brain, and thereby to moderate the preternatural excitement of that organ. 2. To remove the material and occafional caufe of that determination by reftoring the natural fecretions. J' To ftrength en the whole fyftem, more efpecially the alimentary canal and the veffels of the brain. Thefe indications coincide with thofe of profeffor Hoff- man, and I am happy to find that they agree with thofe alfo of the moft diftinguifhed praaitioner in this line, Dr. Foart Simmons, phyfician to St. Luke's. To anfwer the two firft intentions, we begin with emetics and cathartics, precifely as recommended in melancholia to which I muft beg the attention of the ftudent. In this all the beft praaitioners, ancient and modern, are aoreed Dr. Monro affures us, that the evacuation by vomiting is infinitely preferable to any other. The prodigious quan- tity of phlegm with which patients in this difeafe abound he fays, is not to be got the better of but by repeated emetics. Nor have purgative medicines their right ef- fea, till the phlegm is broken and attenuated by frequent emetics He mentions inftances of inveterate cafes cured whohy by emetics and a proper regimen The emetic muft be adminiftered with a liberal hand • for whether it be that a more powerful irritation in the ;;^S the irritability of the alimentary canal, -u that a vifcid and tenacions mucus lining the ftomach and NERVQUS DISEASES. 355 and the bowels is interpofed between the medicine and the animated fibre, certain it is, that thefe maniacs require the ftrongeft dofes of emetics to procure an operation. Hence it happens frequently, that fix or feven grains of tartarifed antimony muft be repeated five or fix times, at fhort intervals, to produce effea. When I was laft winter at Southampton, a Guernfey merchant was brought by his keepers to be confined in a madhoufe, but fortunately for him and for his friends, a young apothecary.of my acquaintance, who, on his be- ing landed in a furious ftate, was confulted where to place him, gave him before night twenty nine grains of tartarifed antimony, which brought up a great quantity of vifcid mucus, and the next morning he was calm and recolleaed. What became of him afterwards I was not informed. Dr. Cox relates a cafe, in which, after tartarifed anti- mony, he had adminiftered a decoaion of digitalis, made from the dried leaves, in the proportion of one ounce to three half pints of water, giving three fpoonfuls every three hcHirs. This brought up a great quantity of vifcid phlegm, and the fubfequent naufea continued for two days, when a fecond exhibition produced the fame effea ; after which a third, with the afliftance of opium at night, in nine days effeaed a cure. The cathartics muft be gentle ; as the intention is not to procure a copious difcharge by draftic purges, but to evacuate quietly the hardened faeces, and the tough of- fending mucus. The ufual cathartics are, as already ftated in melancholia, either kali ppt. or kali tartarifatum. Thefe may be given in the manner there prefcribed. Cal- omel is excellent, but the cautions fuggefted in melan- cholia merit attention in its exhibition. Sir Clifton Wintringham recommends the following : ]J, Rad. Helleb. nigri. Kali tartarifat. aa dr. 2. Fol. Sennse, un. 4. Aq. font. ftj. Coque & adde Oxym. Scillae, dr. 3. Syr. e. Spin. Cervin. dr. 6. M. c. c. o. 4. h. q. s. ad naufeam ciendam. This proves cathartic, and evacuates the vifcid mucus. Every night he gives half a dram of camphor. The tepid bath is ftrongly recommended, and may be nfefully applied to the feet and legs, if the heat is not too 356 NERVOUS DISEASES. too much increafed, for the heat of 96 is ufually fedative, relaxes the extreme veffels, confequently the whole fyf- tem, and produces a derivation from the head. With this degree neither the heat of the body nor the frequen- cy of the pulfe are changed, but the urine and perfpira- tion are increafed. When the heat rifes up above this degree, it is flimulant, quickens the pulfe, and produces a determination to the head. In fome experiments, re- corded by the ingenious Dr. Duncan in his Medical Commentaries, a heat of 102° raifed the pulfe from 60 to 92, and the heat of the body from g6° to 1000, pro- ducing at the fame time a flufhing of the face at 1060, the pulfe became quicker, the face was more flufhed, the veins were fwelled, and in five minutes vertigo came on. In a cafe of mania melancholica, in which I was lately confulted, the patient fuffered when the heat of the bath rofe above 95 ; when it was at 97 fhe had ftrong flufh- ing in her face and became very furious, and with a higher degree of temperature, although fhe only put her feet in water, her face flufhed, and from being reafona- ble, fhe became violent in lefs than a quarter of an hour. Galen afferts, that he has effeaed many cures both in mania and melancholia, merely by means of the tepid bath ; and no one can entertain a doubt of its utility in promoting a derivation from the head. In this fpecies of mania Boerhaave recommends fud- den and long continued fubmerfion in the fea. Precipi- tatio in mare,fubmerfio in eo continuata, quamdiu ferri pot- eft, princeps remedium eft. This praaice was fuggefted by an accident, when the carpenter of Antwerp, who was raving mad, broke his bonds, and threw himfelf into a deep pool; but, being taken out again to all appear- ance dead, not only revived, but recovered inftantly the ufe of reafon, which he enjoyed to the day of his death at the diftance of eighteen years. From the propitious event in the cafe before us, Van Helmont derived his prac- tice of keeping his patients under water whilft he repeat- ed the miferere, and Boerhaave after him advifes to have the maniac kept in that fituation till he is aimoft drowned, availing himfelf thus of three rowers, all ftrongly fed' ative. NERVOUS DISEASES. 557 ative, fear, continued cold, and the exclufion of vital air from the lungs. To anfwer the third intention we muft have recourfe to bitters, bark, and fteel, precifely as recommended in melancholia. To thefe muft be added exercife in the open air and change of fcene, which may be beft pro- cured by travelling. By thefe means we fhall reftore ten- fion and tone to the relaxed folids, more efpecially.in the ftomach, and in the whole of the alimentary canal. Dr. Cullen recommends reftraining the angry paflions by fear, and preventing the effeas of them by force : but my obfervations on this fubjea will be found in the fixth feaion by themfelves. To render what I have delivered more ufeful to the ftudent, I fhall here fubjoin two cafes from the ineftima- ble works of Hoffman. Case I. An ecclefiaftic, aged 37, of the melancholic temperament, for many years had every month the haemorrhoidal flux, during which time he enjoyed his health. But when, neglecting exercife, he purfued his ftudies even beyond the middle of the night, and iruaddition to this met with domeftic trouble ; the haemorrhoidal flux diminifhed and ulti- mately failed. Soon after this he became hypochondriacal, and was troubled with flatulence, obflinate coftivenefs, and dyfpeptic fymptoms. By degrees he became timid, when he had no caufe to fear, iufpicious, fond of folitude, wakeful in the night, or difturbed with frightful dreams, and continued aimoft inceffantly muttering to himfelf. At times he became violent. This man was cured by tepid pediluvia, and the ufe of neutral falts, given in the following form : §> Pulv. ex. lapid. Cancr. Kali vitriolat. CremcrTait. Nitri, aa dr. 2. Cinnab. ppt. dr. \. 01. Cumin, gtt. 6. Liquor. Ano- dyn. Mineral, gtt. 20. Aq. font, un 8. M. alternis diebus fum. Case II. A Jew of the melancholic temperament, aged 40, ftudious a;:d £'-ve -j to a fedentary life, hearing fuddenly of the death of his fon, became gloomy, affe&ed folitude, and was fo coftive as to have ftools only or.ee a week. His lower extremities were cold, and his reft was exceeding. Iy difturbed. At the end of fix months, being terrified, he became iurious, and refund both food and medicine, 'cut by vcnel;ftion h:s mania was fubdued, and melancholy alone remained. This man was roftored to health chiefly by the vegetable falts and tho tepid ped'.iuvi- um, with exercife. followed by frelh rinimal food, and g<;nercus wme. If the ftudent will take the trouble to look at the exam- inations on a cafe in which the whole nation felt deeplv interefted, he will fee, that the cu;e v. x> f'T&cd by copi- ous 35§ NERVOUS DISEASES. ous evacuations, after which tonics and aftringents were prefcribed to reftore the ftrength. In all the cafes with which Dr. Pellet of St. Alban's has been pleafed to favour me, the cures were conduaed on the fame plan, and confirm the fyftem I have endeav- oured to eftablifh. Thefe, however, although highly in- terefting, are not reported fufficiently in detail for the public eye. His well approved integrity, humanity, and (kill, muft continually increafe his practice in this line, and fhould he have leifure to report his cafes, they will be a valuable acquifition to the medical praaitioner. SECTION IV. Of Mania Phrenitoides. The perfons moft fubjea to this fpecies of mania, are not, as in the preceding, of the melancholic, but of the fanguine temperament. It may be readily diftinguifhed by fymptoms of plethora, by firmnefs and fulnefs of the pulfe, by increafe of heat, efpecially in the fuperior re- gions^ by flufhing of face with rednefs of eyes, by ftrong pulfation in the temporal and carotid arteries, and by the occaflonal caufes being fuch as either produce fudden rarefa6lion of the blood, or ftrongly promote its deter- mination to the head. This fpecies, with which the preceding and the fubf- quent, although diftinguifhed by Boerhaave, have never yet been named, I have ventured to denominate mania phrenitoides, becaufe from an attentive confideration of the.fymptoms, of the remote caufes, of its natural ter mmation and of the means which are moft effeaual for its relief, I am inclined to think that there is local inflam mation, although not fufficient to draw the fyftem inTo confent, and produce a fever with delirium/as ?nThe true parents. U the delirium of phrenitis, the patient o.^i,, un.tL excited by fome powerful fenfation and W- o, e, ..ry ,h:.ug around nm,, and retains both confciouf- nefs NERVOUS DISEASES. $$f nefs and recolleaion : yet the affinity between the dif- eafe in queftion and phrenitis will appear from hence, that they very frequently run into each other ; phrenitis produces mania ; and mania, when fatal, terminates in phrenitis. I am fupported in my opinion by Van Swie- ten, who informs us, that he has often obferved a flight fever and delirium fucceeded by the moft furious mania; and this effea he attributes to inflammation of the men- inges, and of the cortical fubftance of the brain. See his Comment. § 774, and the phrenitis apyreta of Sau- vage. The occafional caufes of this mania may be, fuppreff- ed evacuations and eruptions, pregnancy, poifons, and heat, with violent paflions and emotions in plethoric habits. For the proximate caufe I would aflign a preternatural determination of blood to the veflels of the brain. According to this view of the fubjea our indications muft be to leffen the determination to the brain, and to moderate the excitement of that organ. To anfwer thefe intentions, 1. We muft diminifh the general tenfion and tone of the arterial fyftem, which may be accomplifhed by the antiphlogiftic regimen ; by venefeaion and a vegetable diet, aflifted by evacuants, fuch as emetics, cathartics, di- aphoretics, and diuretics. In this we are fupported by the authority of Boerhaave, who fays, Mania vero enata in robuftis, vegetis, fioride etatis,plethoricis, calidis,fanatur miffionefanguinis iterata ; purgatione forti inter fingulas interpofita ; dein, impetrata fedatione, opiatis et cardiacis. Aphorifms, § 1127. In bleeding, the blood may be taken either from the temporal artery, as ftrongly recommended by Hildanus, who affures us that he has feen many fpeedy cures per- formed by this alone, or it may be drawn from a vein, according to the ufual praaice of the prefent day. In this cafe Dr. Cullen advifes us to take fuch a quantity of blood as may nearly bring on a deliquium animi. The emetics fhould be frequently repeated, more ef- pecially when by the evacuation, it is evident, that ths mucous 3°° NERVOUS DISEASES. mucous glands are loaded. This may be compofed of tartarifed antimony with ipecacuanha in fufficient quan- tities, or to thefe may be added oxymel of fquills ; or any of the formulae, from No. i to No. 5, of my Phyfi- cian's Vade Mecum, may ferve the purpofe. Bernard Huet, a celebrated practitioner, whofe method of cure is recorded by Wepfer, and* highly" approved of by Van Swieten, was fond of the more draftic cathartics, fuch as are denominated hydragogue. Thefe he exhib- ited once a week, and this praaice, although perhaps not the bed, is frequently adopted. Among the hydragogue cathartics we may reckon fena, aloes, jalap, fcammony, colocynth, gamboge, which are given either feparately in appropriate dofes, or varioufly combined. To thefe, either calomel or tartarifed tartar are occafionally added. The former, when given, fhould be exhibited at night alone, in the dofe of three to ten grains, and may be the next morning affifted in its operation by the following : }$> TincX Aloe. c. un. \. Infuf. Sen. un. 1. ; Kali Tart. dr. 2. M. R, Extract. Colocynth. comp. gr. 6. f. Pill. m. s. R, Scammon. G. Guaiac. aa fcr. 1. Aq. Cinnam. Syr. Rofas aa dr. 2. M. f. hauft. m. s. But the neutral falts appear to me moft fuitable to this difeafe. As a diuretic in this fpecies of mania, digitalis has high prentenfions, becaufe no medicine fo rapidly evacuates water, or fo fpeedily as a fedative finks the pulfe. We have already feen it given by Dr. Cox as an emetic, but as a diuretic we muft moderate the dofe, and be content- ed with one or two grains of the powdered leaves'twice a day. Diaphoretics are ftrongly recommended ; and fhould the praaitioner have recourfe to them, he may either give Glutton's Febrifuge Spirit, Dover's powder, or the com* pofition recommended by Dr. Whytt. fj, Tina. Opii, gtt. 40. Tinft. Ipecacuan. gtt. 45. Ammonia acetat. un. \. Aq. Rofar. unc. i. Sacch. Alb. dr. 2. M. h. s. s. In preparing Glutton's Febrifuge Spirit, M. Corbyn, as he had the goodnefs to inform me, ufes only vitriolic acid, without attempting to make the oil of fulphur hy the bell, as ordered by Clutton. My friend Dr. Fother- giU NERVOUS DISEASES. 361 gill confiders this preparation as a combination of vitriolic acid with the muriatic, dulcified by alcohol, and confti- tuting a compound ethereal fpirit. He finds it diapho- retic, diuretic, anodyne, and fedative. He gives from thirty to feventy drops every three, fix, or eight hours, according to the urgency of fymptoms, and obferves, that it not only abates febrile thirft and heat, but dimin- ifhes the quicknefs of the pulfe, removes delirium, and procures reft with refrefhing fleep, where opiates have not only failed, but have increafed inquietude. Doaor Locker, of Vienna, affures us that he cured eight patients by diftilled vinegar given to the quantity of an ounce and an half every day, for three months, which aaed as a diaphoretic, and the more it fweated the fooner they were cured. I have not heard, whether this praaice has been adopted in England ; but I am in- clined to think favourably of it, where the vital heat is preternaturally increafed. Doaor Cullen informs us that fome maniacs have been cured by being compelled to hard and conftant labour. This does more than divert the attention, for it exhaufts the irritability and inducesfleep. 2. To promote a derivation from the head, fome have depended on cold induced either by a bag of fnow, by cold water falling from a height direaiy on the head, or by a moift clay cap ; but Celsus made an improvement on this plan, and caufed his patients to fit in a warm bath of oil whilft they had cold water poured upon their heads. This operation feldom fails to procure fleep, which in many cafes has continued more than thirtyhours. 3. Some praaitioners place their chief dependence on fedatives, to diminifh the preternatural excitement of the brain. At the head of this laft, as the moft natural fedative, flands hard labour. Bernard Huet was accuftomed to rely on opium, of which he gave two grains twice a day, and if by this dofe he failed to bring on fleep, he increafed it gradually, even as far as fifteen grains, till he obtained his end in the ceflation of the furious fit. Sydenham followed his example, for after repealed vensefeclion, he X x gave « 362 NERVOUS DISEASES. gave once a week a draftic purge, and in the intermediate fpace Venice treacle (theriaca Andromachi) in confidera- ble dofes. This praaice has been pufhed to the greateft -* length by Drs. Brandreth, Binns, and Currie ; the latter of whom is faid to have given, with remarkable fuccefs, two fcruples of folid opium at one dofe, and at the dif- tance of four hours one fcruple more. The patients, who took this enormous quantity of opium, are reported, from the moft violent furor, to have been rendered there- by in a few hours perfeaiy calm and rational. The celebrated Dr. Dobson in one cafe gave a fcruple 4. of camphor every three hours, which in twenty four # hours reduced the pulfe from 80 to 70. The next clay, he gave three drams in twelve hours, which brought on :jj| profufe fweating, funk the pulfe to 55, and cured the dif- ^* order. Encouraged by this fuccefsful ufe of camphor, Dr. Oliver gave two fcruples for a dofe. In a quarter of an hour the matiiac fell down infenfible ; but from that , time recovered fo as to attend his duty in parliament. At*g the end however of about eighteen months he became hypochondriacal, and foon after funk into melancholia. He then repeated the fame dofe, and in ten minutes became pale, and fick, reeled into the arms of his phyfician, drooped his head and difcharged by his mouth a quanti- ty of thick vifcid rheum : his refpiration became labo- rious, his pulfe weak and intermitting, till he broke into # a fweat. He got no reft till the next day, when a fleep of eight and forty hours commenced, accompanied by fweat. The camphor was then continued in dofes often grains twice a day, till the patient was well enough to go into the country. This interefting cafe may be feen at large in the fifth volume of the Medical Journal. Sennertus and Riverius combined nitre in a large pro- portion with the camphor. Some patients are faid to have been cured by mercuri- al falivation, but this method has been feldom reforted to. It is in this fpecies of mania that my valuable friend Dr. Thornton has propofed to try the infpiration of hydro- gen, of carbonated hydrogen, or of azotic air. Thefe are certainly NERVOUS DISEASES, 363 certainly the moft powerful fedathes, and as fuch may be fairly fubjeaed to trial. * When mania is occafioned by obftruaed catamenia, emmenagogues muft be reforted to. After the difeafe has been fubdued, it will be proper to give Peruvian bark and bitters to ftrengthen the fyftem, but as to chalybeates, I fhould exhibit them with caution. For the formulae I may refer to melancholia. To elucidate this moft interefting fubjea, and that I may render the diftinaions I have made familiar to the ftudent, I fhall fubjoin two cafes. Case I. A military prefea of the fanguine temperament, and a hard drinker ^ from his youth, from diftrefs of mind loft his fenfes, and became furi- -> ous in the extreme. Having been however copioufly bled three times within the month, and taken nitre, fome remiffion of his diforder, but no perfea intermiflion, was obtained. In this fituation, with confti- pation of bowels, flufhing of face and fulnefs of its veffels, to which were added inceffant vigilance and raving, Hoffman was confulted. This eminent profeffor, with a view of making a derivationsfrom the ^diftended veflels of the brain, in the firft inftance evacuated the alvine -Faeces by gentle laxatives, for, as he moft judicioufly obferves, a deter- mination to the head never fails to he fupported by conflipation of the bozusis. In curatione eo potiffimum refpeximus, ut sanguinis impetus a ca- PITE DIVERTATUR ; QUI VERO QUUM AB ALVI OBSTRUCTIONS NUN- QUAM non sustentetur, primo omnium prafcripfi laxans mannatum " &f lac recens emuldum. §>uod in prafenti agroto infignem ahum laxandi exferuit efficaciam. Nitre was given frequently during the day, and be- fore he went to bed his feet were put into a tepid bath. For his * common drink he had fpring water, and his head was kept moift by the fubfequent compofition : Ijo Aq. Rofar. Aceti Rofar. aa un. 2. Nitri purificati dr. 2. 01. lig. Rhodii, gtt. 12. M. f. Epithem. Within the month this patient was perfectly recovered. Case II. 15. M. of the fanguine temperament, aged thirty feven, was feized in the winter of 1790 with mania, and raved night and day inceffantly for eight days. Pulfe full and ftrong, tongue clean, eyes wild and flaring, his ftrength fo much increafed, that even when he had the ftrait waiftcoat on, three men could fcarcely reftrain his violence, and his mental exertions, though erroneous, were extremely vigorous. What occafioned this derangement, his phyfician, Dr. Nankivell, of Cannon- ftreet, London, could not conjecture, except that probably young Bac- chus might have had an hand in it, for D. M. at times had no mercy on the bottle. The antiphlogiftic regiment to its fulleft extent was immediately adopted. He was bled plentifully. The blood exhibited no fign of inflammation. 364 %' NERVOUS DISEASES. * inflammation. His head was fhaved, and cupped and bliftered.? His bowels were kept freely open with neutral falts. He had no food but "* * bread, tea, and gruel, with cold water for his only drink. He was ^* lafhed down in a ftrait waiftcoat on a mattrefs with very little covering, and no other companion but his keeper, who never fpoke to him, un- lefs when abfolutely needful. His room was darkened. From the beginning Dr. Nankivell ftrongly impreffed his mind with fear, both for the fake of its fedative effects and to fecure obedience. In this plan he perfevered for feven days without perceptible alter- ation in the fymptoms. On the eighth day the fcalp was covered with a moift clay cap, whilft the feet were bathed in tepid water. This application was continued more than half an hour, when the cap being removed, he was replaced in his cool hard bed, where he fell immedi- ately afleep, and flept profoundly for three and thirty hours. When he awoke he was clearly convalefcent, but ftill raved. On the evening of the tenth day, recourfe was had again to the cold clay cap, and warm pediluviHm; but in about four minutes he was feized with an hyjleric fit, which being noticed by his fagacious phyfician, the ftrait waiftcoat was inftantly ordered to be taken off, and he was pronounced to be free from mania. Being put into his bed, he flept foundly for many hours ; after which he was perfectly calm : and from that time he has conftantly enjoyed the mensfana in corpore fano. SECTION V. 4; Jm Of Mania Hyfterica. This fpecies may be diftinguifhed from the two former by its common fymptoms of debility/ irritability and f fpafmodic affeaion, and not unfrequently byfvividnefs of imagination. tfjk ^ The perfons moft liable to it are thofe of an irritable fibre and of a relaxed habit, that is, fcrophulous and hyf- * ferical fubjeas, more efpecially if they have been previ- oufly weakened by difeafe. It has the fame affinity to^ «. the delirium of typfeus, as mania phrenitoides has to the delirium of fynocha,'for it is the difeafe not of the fthenic, but of the afthenic diathefis, and is more nearly related to hyfteria than to hypochondriafis. This idea is fuggeft- I ed by Van Swieten, §1125, for, defcribing the remote caufes of this fpecies of mania, he obferves, hec autem obtinent in hyfteric is dicl is muliSribus. I. For the predifponent caufe, therefore, we may af- fign debility with morbid irritability, induced by debili- ' tating difeafes, particularly protraaed intermittents, ■&Z\ chieflv NERVOUS DISEASES. ^^. 365 ^F chiefly of the quartan type, with profufe evacuations, whether natural or artificial, and whatever tends greatly ^ to debilitate the fyftem. II. The occaflonal caufes are, 1. Strong mental paflions, emotions, and exertions. Sydenham, who was the firft to diftinguifh this fpecies of mania, defcribes it as peculiaris quedam acfui generis mania, intermittmtes diuturniores, quartanas prjeci- pue, nonnunquam exc^mns : and Boerhaave, who himfelf learnt from SydenhamTuiis and many other diftinaions of the laft importance, repeats the fame expreflions, § 1125. They both agree that repeated venaefeaions and copious evacuations, injudicioufly prefcribed in quartans, bring on this difeafe and caufe it to return. To what they delivered, Van Swieten adds, Tales manias aliquo- ties natas vidi in puerperis, fi validd excandefcerent ird primis diebus puerperii ; and he might have extended this obfervation not merely to the period of the lochial, but alfo to the time of the- menftrual difcharge," for in both, jM^ violent paflions of the mind occafion either mania or a fatal apoplexy. ^ 2. Whatever induces fpalfcodic affeaion. - HI. "The^ proximate caufe therefore, as it appears to me, is preternatural determination to the brain induced ...by fpafm. <» ^ Van Swieten attributes this determination, i. To the fpafmbdic conftriaion of the arteries themfelves; fpafi jmodrca vaforum conftricliones pojfunt ejjicere, ut nimiapkyj- ftudo fiat in vafis cerebri ; becaufe they aa not fimpjyas elaftic tubes, but have mufcular^feres, by whofe construc- tion their diameters may be readily diminifhed. § i»io. ''3. To fpa£modic conftriaion in the^abdominal vifcera, fuch as hyfterical WQinen frequently experience. Si et:- am in a His partibus corporis nafcatur impedinentumfangii- ni per vafa moto ; "potent verfus caput majori impetu £if copia derivari : fpafrriba'icas tales conftricliones in vifceri- bus abdominalibus hystericJE. toties experiuntur, uti notum eft. § 1125. His obfervations are acetate; but it is to the immortal Hoffman that we jBiuft grve the £rafr of (his ineftimable rem%"k. V * i 366 *K; NERVOUS DISEASES. In Edition to thefe caufes of determination to the , brain, afligned by Sauvage and Hoffman, I fhall venture to fuggeft a third, which I am inclined to think both "%ore common and more powerful than either of the former. It is fpafmodic conftriclion of the diaphragm comprejfing the aorta. To explain this effect, I muft call to' the recolleaion of the ftudent the anatomical ftruaure of the parts in queftion. v«. The aorta defcends from the thorax into the abdomen, between the two tendinous produaions of the inferior mufcle of the diaphragm, which are attached to tne vertebras. It is therefore evident that it muft be fubjea to compreflion, whenever there is ftrong fpafmodic con- traction of thefe tendons, and it is equally clear that fuch compreflion muft prevent a free defcent of the blood. The.tonfequence of this will be a preternatural determi- nation to the brain. ^ That ftrong aaion of the diaphragm, whether in vom- t&L king, in coughing, in immoderate laughter, the ytkae. W! wfcoc of Artaeus, in the expulfion of the faeces, in par- turition, or in {training to raife great weights, caufes a determination of blood to the head, is not only rendered at all times vifible by rednefs of face, protrufion of the &*' eyes, and diftention of the veffels, but is fometimes evin-3f ced by apoplexy, as noticed by Aretaeus, Boerhaave, and *' Vaa Swieten. For although thefe effeas have been at- ,v triouted to ftagnation of venous blood* in the right fide of the heart ; this circumftance alone will not account JM> ifoijia,preternatural proportion of arterial blood being ei- ther Tent towards the head or accumulating there. Spafmodic conjlri&ion of the diaphragm may be oc- cafioned either by mental paflions, or by morbid affeaions of the ftomach. The confent between the ftomach and the diaphragm has been already noticed, and may be ob- ferved in hiccough and in the aa of vomiting ; but to account for thjs confent, we need only call to mind the nervous communication between tfeefe fympathizing or- t^W A 1. The NERVOUS DISEASES. '$ 367 W 1 jji. The ftomach is fupplied with nerves from the/tfr vtigum, many ramifications of which are loft in the plexus folaris and the femilunar plexus. 2. The diaphragm derives its two diaphragmatic or phrenic nerves from the cervicales, and receives branches both from the intercoftal, and more particularly from the par vagum. Hence arifes the wonderful confent between thefe or- gans, conftantly main|ained by means of the par vagum and the intercoftal or great fympathetic nerve united in the folar plexus, which Fabre denominated centre des fen- fations. From what I haye delivered it will appear that the pbrenMt^ inanitorum of Sauvage is precifely the difeafe I have been defcribing, and the attentive reader will dif- cover that the fame may be affirmed of his paraphrofyne a pathemate. His fubfequent fpecies paraphrofyne puer- perarum, paraphrofyne calentura, paraphrofyne febricofa, .^paraphrofyne critica, et paraphrofyne hysterica, all A^throw light upon the difeafe in queftion. **^r Ifjjthe ftudent will look back to the delirium of typhus, which is the paraphrofyne febrilis of Sauvage, or if he will confult my tnird feaion of the order fpafmi; he \V will be fatisfied, that what I have been flating has fome J&daim. to his attention. '.fPfh My ideas of this difeafe are confirmed by a very judi-. * cious^remark of Dr. Ferriar, who in his late publication £ r~ fays, %jfterldv$> not unfrequently converted into epilepfy and infanity by thd continued aaion of its remote caufes, . ^f I have feen the difcriminating fymptoms of both difeafes jg fo intermixed in"'the paroxyfms, that it was impoflible to determine which'^)f them predominated. In one cafe of this fort, a converfion into mania took place, but the f change was perhaps decided by the violence of the paf- fions ; in another inftance, after a long ftruggle, hyfteria prevailed. See Medical Hiftories, p. 9. ^i* From this view of the fubjea our indications of cure may be : *• * 1. To procure a derivation from the head. ✓ «.- z. To diminifh the preternatural irritability of thefyftenL- : a,-^ e • ?68 * Wt ' ^ NERVOUS DISEASES. : „. * - .-"*' •* -Hi 7. Totemove morbid ftimulants. *\ 4. Tfativert theattet&onfrom'VhefrevaUingidea'kvhich '• ^j £ Ele^f. gScpfd. dr. 1. Elaeofacchar. ex 01. Citri. dr. 2. En- f' ulas. un/7. Syr/5 Rad. aperient, q. s. M. f. Ele&. c. dr. * R,'Zinzib. cbfcdit. un.3. Cort. Aurant. condit. un. 2. Nucis Mofch. dr. 4. Sjrr. Artemis, q. s. M. f. "Eleft. c.idr. *. c. 3,jh. ^ ^ dLr l£Theriac. Androm. Pulv. Diateffaron. Pharai. Ed., aa un. 1. Confer^ Abfinth. dr. 4. R\id. Angelic, dr. 2. Syr. Caryo-* phyll. Rub. q. s. M. f. Eledl. dr. 1. o. 6. h. ^ Cinchon. Cort. Winteran. Cort. Citrei. Cort. Aurant. Cin-^ nar-i. aa un. 1. Summit. Serpill. Thymi, Marrr, aa dr. 4. Fl.BT Stxchad. Arab. ^Fl. Lavand. Fl. Tanacet aa un." 1. Lig- ^ , ni. Agalloch. LT Saffafr. aa dr. 6.' Vin. Hifpan. ft 6. M. f. «. A. Vin urn medicatum Cardiacum Calidum, Roborans. J c. un. 2. o. 6. h. Thefe prefcriptions are worthy" of the great praaition- er from whom they came, and perfisaiy anfwer the fo- il w»' tention i # f to NERVOUS DISEASES. » 369 jr tenOTn by giving vigour to &e fyftem. For ihe fame purpofe the following, by way of change, may be .occa- fionally ordered. -.- *" f$> Cinchon, Confec% ,Aromat. Cinchon. un. I. Cafcar. dr. 2. Coq. in Aq. font. un. 20. Ad. un. 16. Cola. IJ> Decoft. Prefcript. un. 2. Tin&. Cinchon. Hux. Coch. j. parv. Confeffc. Aromat. gr. x. Aq. Cinnam. dr. 4. Syr. Cort. Au- rant. dr/i. M. f. H. o. 8. h. s. tTo thefe may be added from five to ten for fifteen drops of Tinc- tura Opii, when it fhall be though expedient. III. To aafwer the third- intention, fhould acrid bile, or vifcid mucus, be collected in the firft paffages, thefe muft be evacuated by emetics. It is moft aftonifhing to *■ fee the effeas produced by the paflions of the mind, more * efpeciallytoy anger, grief^and fear, in the whole extent * of the alimentary canal. Anger promotes a fudden and plentiful difcharge of bile, which ftimulates the firft paf- fages, and brings on fpafmodic conftriaion. Grief and .+$ £$a.r relax the mucous glands j and although the latter, * «.. in the firftinftance,, quickens the perfftaltic motion of the bowels, they both terminate in coftiveflfefs. But if the ucous glands are not relaxed, and if the food is well di- gefted. m the ftomach, little benefit can be e^eaed from Jjplhe action of emetics. Should a los^of fflfies in the J^bowels prove the caufe of irritation, thefe 'muft be re- ~\no^gd by gentle cathartics, fuch as,manna, caflia, tam- ' arinds, foluble tartar, rhubarb and fenna, by linitive d^c- Uiary; or by the fubfequent compofition. *f£, Tamarind, un. \. Fol. Sennae. dr. 2. Rhei. gr. 10—to. . Aq. font.un. 4. 'Cfbq. et Colature,'un. 3. EjiHTolve Mann, ef Syr. Rof. Solut. aa un. 1. ' M. f. H. m. s. A This was a favourite prefcription of our Sydenham, Jtvhen the moft linitive cathartic was required. But Should this fail of its effea ; calomel, from one grain to «b three, according to the irritability of the bowels, may be ^Sl given the preceding night, with twenty grains of afafcet- T^Pida and five drops" Ol. Carui. This may be followed in the mornitigby fome gentle evacuants. Yy . In 370 NERVOUS DISEASES. In a cafe, in which I vifited a patient after Dr. Wil- /^^ lis had left her, he had j>refcribed as follows : V* ^ IJ, Antim. Tart. gr. iij. Kali Tartarifat. gj. Sue. Cicut. 3ifs. \T" Gum. Ammon. Ammon. ppt. aa 5j. Aq. Diftil. gxiij. Sp. ^' Nucis Mofch. Syr. Croq aa gj. Terendo. M. f. H. Cap. 3xiv. Statim et rep. 65 horis et con. t .^* Here the dofe of folubie tartar is about one dram four*' $4 times a day, and is quickened in its operation by other powerful detergents. The prefcription- is certainly a &* good one, but as it was continued only for three days, there was no opportunity in that cafe to judge of its «* % effeas. W> ?« Should there be fymptoms of worms thefe muft be^ ' deftroyed by anthelmintics, keeping clear however of the ]f, more powerful cathartics; and the catamenia, if ob- : ftrufted, muft be reftored by emmenagogues of the anti- fpafmodic or of the aftringent orders. ?' IV. To anfwer the fourth intention, change of fcene, *' cheerful fociety, and agreeable purfuits, are the only t ^ remedies. Hence it is that fome have been cured in the> v courfe of a long journey. I fhall here fubjoin fome cafewSL Case I. . *- '".j. An amiable lady, aged 41, of an irritable habit, renouncing air and , *-: exercife, employed herfelf unremittingly in reading, Writing, and con- * verfjng on religious fubjeds. To .clear her head, when fhe wifhed UM*\ . e^refs her Noughts with energy, fhe drank a quantity of fbong,• '"' green tea, after which jhe wrote or talked inceffantly, but loft her rel§> V$tm *fe appetite diminifhed and became depraved. ►Her ftrength V arid, fpirits felled. Her feet and hands.were dry and cold as ice, vet * fhe had frequent flufhing of face, more .efpecially after eating. Shi" became extremely cpilive, and when fhe took cathartics, they brought away ftools like water, yet offenfive and fmelling like cat's urine, with winch were evacuatetja few fmall, hardened fcybala! Even without the aid of medicine fhe'had fometimes five of fix motions in a day,' wf T V°^f Wlth- diffi,uIty a few of *efe compafted button^ When fhe paffed her urine, the flow was frequently interrupted, yet fhe had no fymptoms of the (tone. The urine was mo% limpid and^ in great qUantlty Her reft was much difturbed for three days befor# the appearance of her catamenia, and during that period fhe was al?" ways more than commonly fretful. Her fpirits being depreffed, fhe^ tit Laa eflght g]?Vi ftroJniwine ev^da^ b^the «w ^ ting effeft was foon exhaufted, and fhe conftantly funk lower than be As the fummer advanced her principal article of diet was green pea foup with f„ed bread ; and in the autumn ftc attaches VgJetf abundance reatfl* NERVOUS DISEASES. * 371 *». abundance; her courfes gradually diminifhed, and when the time of their appearance was at hapd„fhe became mentally deranged ; yet in about ten days afteTOey were'paffed, fhe was perfectly reafctaable a- V?V gain. The laft time of their appearance they continued only for one day and fhe was rational: but putting her feet in hot water for a quar- ;. .,,' ter of an hour, fhe had flufhing of face and became outrageous : her ,l,^''''jCOurfe3 flopped, and have not fince returned. The fubject of her raving regards herfpiritual eft ate, concerning \ which fhe feems to entertain unfavourable apprehenfions. Yet her at- tention is readily~ recalled for fhojrjrintervals to rational difcourfe, in which fhe difcovers a perfect recollection, and remarkable vivacity of imagination",* Her hearing, tafte, and fmell, are uncommonly acute. •jJJjT Her pulfe is fcnall and frequent, her tongue is clean, and her appetite .now is ravenous.^ She has had emetics, cathartics, and a variety of antifpafmodics, 'and has been confined chiefly to her room and to her bed. Opium, which fhe has taken for a long time in confiderable quanti- e'^i ties, never .fails to bring on flufhing of face, to leffen her appetite, to increafe her coftivenefs, to give a wildnefs to her eyes, to make her more violent, and to deprive her totally of reft, till its operation as a # „. flimulant is over ; after which fleep, but not refrefhing fleep, fucceeds, * jf followed by languor in the extreme. For a few days fhe has omitted ^^Vopium, and been confined to the following compofition : i ' IJo Caftor, gr. 15. Gum. Ammon. gr. I2V Mift. Camph. un. 1*. f*' ' Sp. Ammon. comp. gtt. 30. M. f. H. om. fexu horft repet. * Since fhe has taken this her reft has been more natural. The tepid pediluvium, with the^heat at 970, brings on ftrong flufh- ing of her face, and makes her furious. ,-; s Cathartics, fuch as jalap, fcammony, and colocynth, aft as hydra- gues, but do not clear away the fasces, and magnefia'gripes her much. Emetics.remainjtang inactive in> her ftomach, and then come up un- changed* with ftrong convulfions, followed by numerous and copious ftools,'confifting of feces with much vifcid mucus. Case II. A lady of an iilitable habit, being alarmed "at the piercing cries of her child, was feized with an hyfteric fit. Peppermint water, fpirits, ■V^JrJfed magnefia difclftrged much wind ; but the globus hyftericus con- •"* tinued. Her teeth were clofed, her eyes were fixed and much infii - J% med, and convulfion of the limbs fucceeded. She fnapped ;;t her at- tendants, fcratched them with her nails, and tore the pillow cafe with violence. When this fit, after continuing for fix hours, was aggravated by cordial ftimulants, Dr. Thornton ordered an emetic of ipecacuanha, feven grains with one grain, of tartarifed antimony. The maniacal fymptoms appeared to be aggravated : fhe feized the pillow with her teeth, and the fpafm of the oefophagus was diftreflingly increafed : but a repetition of -the emetic produced the defired effect, and a whole bafon full of vifcid flime came »p, when the patient inftantly recovered -. * . the 37* NERVOUS DISEASES. M? the ufe of reafon, called for he** child, and the next day felt herfelf only to a flight degree indifpofed. This appears to be the paraphrofyne a pathemate of Sauvage, and refembles the cafe of Charles VI. of France, excepting only its fpeedy termination by a judi- cious treatment. The cafe of M. P. mentioned by Dr. Ferriar, vol. ii. p. 95, feems to have been fimilar to thefe. At leaft it fhews fimilar benefit received by one emetic in a cafe of receat infanity. Case III. A man aged 50, of an irritable temper, full of blood, and a hard drinker from his youth, having been for fixteen years accuftomed to lofe blood twice a year, omitted this practice, yet continued to drink hard. In thefe circumftances he was provoked to anger, and to fuch a degree, that he was inftlmtly feized with violent vomiting and purg- ing, and loft his appetite for food. Soon after this he became reftlefs and watchful, and fhewed evident tokens of infanity. Sometimes he was violent, at other timel he was gloomy and fled from fociety ; yet M^ frequently his forrow was fuddenly turned to joy, when being more than commonly affable,his raving was inceffant. Thefe fits of infani- ty were never of long continuance, yet returned on the flighteft mental difturbance, and were readily induced by the moft trifling error in his diet. ° Hoffman,,being confulted, was of opinion that the determination to the head was occafioned by a fpafmodic affection of the int?Ri„es in- duced by effufion of bile, and this effeft he attributed to mental pertur bation. He therefore ordered only antifpofmodica and tonics, with a diet confifting of fuch articles as are eafy of digeftion, which, with the affiftance of the tepid pediluvium, in a few months perfefted a cure. Case IV. Dr. Ferriar, in his medical hi (lories, gives a very interefting cafe. which, as it appears to me, comes under mania h^mica. A fady Jf a domefticinduflrious difpofition, and of a full habit, fell by deSeeV«T into a mamacal ftate which difcovered itfelf chiefly by Z J levityinherconverfat.on.and behaviour. She could LolleclZ M never wholly, eftram herfelf; was noify, familiar, andconftantlv dif pofed to run and ump about Her oerrPnHW co»Kantly Oil- falfe. Small dofe! of mercury, n^Sf^Z TJ' ^ ** cathartics Thefe were continued for thre wee£ ZTzZn^l op diarrhoea fuper*ened. - She had then' tw7*£n7 ,af J^P J-i &££$$£** «** - K-'C ^< SECTION $• .. 1 nervous DISEASES -TT-j V v§ECTI^ON VI. V/ Of the Mania*Mentis of Dr. CuUen. If any fpecies of mania exifted in the mind, without ^ affecting the general fyftem of the Wty, and were to be P ctfredby moral arguments alon&; this might with pro- j^' priety be named mania mentalis : buft-as no racK* difeafe ™ has been difcovered by nofologifts, this diftinction i*in- j^Jteiffiblct Certain however it is,: that vehement^a^ungratified defires,* the indulgence of evil tempers, ?iic!^ as envy, pride, felf will, and malice, not only oeeafttm roemal de- rangement, but contribute to fupport it through |£s fev- eral ftages, till it terminates in death. Thefe therefore fW i in every fpecies of infanity muft'be corrected or refill- ed, and it remains only, to confider by what means.J * i.1 In tsafes of debility we muft invigorate the fyftem, and remove, if poffible, all occafio|Ktl caufes of irritajkm, whether mental or material. * ;, jpx We know that people of a relaxed and irritabfe fibre, i • are the firft to be diftreffed by their appetites and! paflions. Weakly children are commonly fretful, and all people in typhu$ are impatient, if they meet with either contra- diction dr delay; whilft the healthy and the hardy ruftic, working perpetually in the open air, has fo little irrita- *^ bility, thi§it is Tomejtimes difficult to Jay which are moft ±*P> blunt,his mental orchis ffccKly.fenfanons. "Heis patient r >'of hunger, of ig£ld, of labour, and if he has met with any j** lofs or contradiction, it makes but a faint impreiTiojj and j^ l^|s foon forgotteji. * ?0gr ^ r In all cafes, therefore, oFmorbid irritability, the legiti- flr 4 ^mate offspring of debility, we muft havereeourfe tc 'A. tonics and aftringents: we muft invigorate the fyftem by a generous dieV, by frefh air, exercife, and agreeable fo- *0L ciety, and, if need be, we muft call in the aid of bktei^" ^R bark and fteel, or, in the language of modern chemiftry, Y fB^e muft* fupply the lungs with oxygen* fnd the ftomach 'v^^with both hydrogen and carbon, which laft, as I appre- Khend, is to be derived abundantly from mineral' euers vand from. his mind j and if, in fuch circumftances, anger is excited by real or fuppofed oppofition to his^vehement defires; ^y5 NERVOUS DISEASES. the man wiil not confider -fy-hat is juft, honourable, of ultimately fafe, but without hefitation, precifely like the brutes, wiil rufh forward to revenge fome infult, to feize*f# the good which he defires, or to avert the evil which he" dri|ads. Every thing in thefe unfortunate fufferers demonftrates. that they are degraded^ to the condition of the brutes, -'" for in botsfe. we obferve the fame ferocious ftrength, the ^< fame difreg^rd for cleanKnefs, the fame want of decency and of fhame, and the fame impatience of reftraint, tillet they ?are perfeaiy fubdued. i*||v It is not confcioufnefs, which is granting in maniacs, $|,, for after their recovery they recollea what has pafled ; " it is not the defea of underftanding which is to be la- mented iu tl ? infane, for their intellects are often bright- ened by difeafe ; it is not inability to feel the influence of hope and fear, which leaves them at the mercy of their ,* paflions,* but it is their impetuofiiy of temper, it is the t J vehemence of their volitions which hurries them away. Yet whilft in this refpea they have a ftriking refemblance to the brutes, it is happy that, like the brutes, they are extremely fufceptible of fear. Of this affeaion then we may avail ourfelves not only to fecure obedience, but to reftrain their impetuofity, and to'ftifle the paflion of anger in its birth, till the habit of patter* fubmiffion is acquired, and by degrees the em- pire of reafon is reftored. 'jj Van Swieten informs us l&at in Holland there was- a • : celebrated praaitioner, who frequently cured maniacs by ^ rewards and punifliments. ^When they were frurious he flt had them dragged along by chains like wild beafts, and % either followed them with ftripes, or inceffantly dafhe'd ^ cold water in their faces; and when that was infufficient, he tamed them by hunger and by thirft ; but when they were fubdued, when they became calm and fubmiflive to his orders, he treated them with kindnefs, and granted them every fuitable indulgence. When however the authority of the phyfician is eft«<&-'y lifhed, fuch feverities are not only needlefs and cruel, bat« extremely detrimental. My friend Dr. Nankivell, whofe abundant it£ * NERVOUS DISEASES. 3^ abundant fuccefs muft vindicate his pradice, finds uni- verfally, that ftern looks an% an authdfltative tone ijof ^voice are fufficient for ^the purpofe. Should this fail, hunger will tame the moft ferocious animals; and in ai4 of this, darknefs and folitudetaay be reforted to with- out reproach. At all events, every ray of hope, that they may efcape with impunity after having tranfgrefled, ^ muft be precluded. For this reafon they muft be^m- mitted to the care of ftrangers, that they may never be encouraged to indulge > their evil tempers and volitions,"1 v.;toder the expeaation of meeting with falfe tendernafs and compaflion from their friends. As a part pf their punifhment, when they have de> ferved it by malicious violence and outrage, they may be fubjeaed to fome hard labour, which, if fufficiently pro- longed, will not only fubdue their ferocious temper*- but by fatigue will inducethe moft falutary fleep. And whea this bodily exertion is fuch as to require, in any degree, the attention of the mind, its good effeas will be more certainly infured. Genus LXI. Amentia. ,?\. This charaaer is, imbecility $f intellea, by which the relations of things are either not perceived or not recol- leaed. t -jf ', i. This, frequently depends on fome organic affeaion of the brain beyond the reacjj of fheq^cine.. Such^is the amentia congenita of Dr. Cuuln,'gnd fucbkis amentia Jvni- lis, which is the attendant of £lecrepitudef>» ^ - , 2. It is the legitimate offspring of mania; for this, unlefs phrenitis fupervenes and terminates in death, nev- er fails, after long continuance, to produce fatuity. It fometimes originates in melancholia, and is more especial- ly derived from thefe difeafes, when they have been inju- dicioufly Jreated by profufe evacuations, whether by ven- efeaion or cathartics. Sydenham particularly com- plains offhis in his obfervations on the fpecies of mania, which'fucceed s to ill treated quartans. If, fays he, we attack t|ds difeafe by repeated venasfeaion and cathartics* Z z i* * we - 378 DISTINCTION OF CLASSES. we may indeed fubdue the ferocity of mania, but we fhall:' certainly induce fatuity, and that without a poffibility of* cure. 3. Amentia very frequently remains as the confe- quence of fevers. 4. Sometimes it derives, its origin from intemperance. Hence we have in Sauvage amentia a temulentia, amentia a venere, et amentia febrifuga. 5. It has likewife been traced up to fomnolence too much indulged. 6. But the moft common fource from which it fprings is epilefy, being a fpecies of fatuity unnoticed either by Cullen or Sauvage. The only hope of relief in this humiliating difeafe muft be derived from a generous diet, cordial ftimulants, air, exercife, and the moft powerful tonics. Indeed feveral inftances have been recorded of patients, who, after hav- ing been reduced to idiotifm, have by thefe means per- feaiy recovered all their mental powers. Mr. Bell of Edinburgh particularly mentions one, who, having loft both memory and intelka by epilepfy, in four months recovered both by flowers of zink, of which he took from one grain morning and evening to twelve grains three times a day. Clafs III. CACHEXIA. CACHEXIES. X HE diftinaive charaaer of this clafs Is, A depraved habit of body, without pyrexia, and in- dependent of neuroses, as original difeafes. The orders of this clafs are three : I. Marcores. II. Intumescentire. III. Impetigines. Of which the pathognomonic fymptoms follow : I. Marcores, univerfal emaciation. II. Intumescentl/e, general fwellings. III. Impetigines, s DISTINCTION OF CLASESS. 379 jrIII. Impetigines, deformity of the external furface, by tumours, eruptions, and other preternatural affeaions of the fkin. INTRODUCTION. We have confidered the difeafes affeaing principally the heart and the arterial system, comprehended in the clafs PYREXUE. We have dwelt largely on the diforders of the brain and of the neryous system, included in our clafs NEUROSES. I now proceed to the difcuffion of thofe difeafes, which more immediately arife from morbid aaion of the fiom- ach, and of the lymphatic system. Thefe will occu- py our clafs CACHEXIA. But whilft we thus furvey detached portions of the ani- mal economy, and examine the diforders to which each part is principally fubjea, it muft be confeffed, that na- ture has not left them independent of each other. Nay, fo far is fhe from having eftablifhed an empire within an empire, that, with moft aftonifhing contrivance and unity of defign, fhe has made each power fubordinate to the reft ; and from hence it is, that if one is principally af- feaed, the others fympathize and are drawn into action by confent. This idea is beautifully expreffed by Hippocrates, when he compares the body to a circle? in which we can find neither the beginning nor the end; and then remarks, that the fame obfervation will hold good refpeaing its difeafes. Yet, notwithftanding the efforts of nature to relieve herfelf are thus combined, they require, for the fake of diftinanefs, to be feparately viewed ; and, to cure dif- eafes, the attention muft be turned towards the fyftem chiefly affeaed, whether the arterial, the nervous, or the lymphatic. SECTION I. Of the Abforbents and their Ufe. The abforbents, ftriaiy fpeaking, are either laaeal or • lympnatic j but, with greater latitude, we might confider * 3^© the absorbents. all the fecretory and execretory veflels as belonging to % the fame fyftem, becaufe they poffefs the fame vital aaion, " and are governed by the fame laws. The lacleals, firft difcovered by Afellius, an Italian, A. D. 1622, are innumerable pellucid tubes, arifing from all the inteftines, chiefly from the villi of the fmall- er, and invifible, unlefs when diftended with chyle, that is, with the milky fluid, which they felea by animal at- «. traaion from the digefted aliment. Their mouths, which are numerous in every villus, are fo fmall as not to be difcerned unlefs by the microfcope, and at their commencement, after having left their villi, they are capillary ; but as they unite in their progrefs towards the mefenteric glands, into which, by numerous ramifications, they empty their contents, they become larger. After their departure from thofe glands, which is by feveral ramifications, they diminifh in number and increafe in bulk, till they terminate in the receptacle, from whence the chyle afcends through the thoracic dua, and pafling the femilunar valves, is difcharged into the left fubclavi- an vein. Thefe ferve the double purpofe of laaeals and lymph- atics, "for they abforb not only chyle, but the lymph of capillary arteries, and aqueous fluids from the in- teftines. The lymphatics, for the knowledge of which we are indebted to Rudbeck, Bartholin, Hunter, Hew- son, Munro, and Cruikshank, are fmall pellucid tubes, furnifhed, like the laaeals and thoracic dua, with valves. They open their mouths into the cavities and cells, and upon all furfaces, as well external as internal, of the body, to collea the lymph poured forth by the ex- cretory veffels, to imbibe it from arteries and veins, which they convey to the receptacle of chyle and to the thorac- ic dua. In their progrefs they difcharge their contents into lymphatic glands, and in their whole extent they frequently inofculate, fo as to keep up the communication 4 without any hazard of interruption. Nothing in nature can be more worthy of admiration than the vital aaion of the abforbents; and it is curious to THE ABSORBENTS. 381 to obferve, that their aaivity continues unimpaired whilft fenfation and the animal funaions are perfeaiy fufpended. This will be evident if we confider, that during fleep the bronchial mucus is much thickened, and that both the urine and the faeces fhew the continued progrefs of ab- forption. In our woflderful machine, to prevent friaion and ad- hefions, it is required that vapour fhould be interpofed between contiguous parts, more efpecially if either of them is defigned for motion. This the excretcrites pro- vide, but as it muft be frequently renewed, abforbents are inceffantly at work, to convey it back into the mafs of circulating fluids. Dr. Musgrave injeaed 24 ounces of water into the thorax of a dog, and in five di>ys the whole was taken up by the abforbents, for the breathing became as free as it had been before this water was intro- duced into the cheft. In caff? of dropfy, nature, by means of the abforbent fyftem, makes wonderful efforts to relieve herfelf. John Hunter relates the cafe of a lady with fwelled legs, who made little or no urine, and was fo weak that fhe could fcarcely articulate. She dozed inceffantly, and had no defire for food. Her pulfe was hardly to T,e felt, her feet and all her extremities were cold, yet within thir- ty fix hours of her death, the whole water in her legs and thighs was abforbed, her urine was increafed, and about ten hours before fhe died her»legs and thighs were as fmall as ever. Hoffman, in confirmation of what is faid by Aretaeus, affures us, that he has feen many cured by a fpontaneous and long continued diarrhoea. But what is moft furprifing is, a cafe recorded by Fernelius, Pathol, lib. 6. in which afcites was relieved at the 'ap- proach of the menftrual period by a profufe difcharge of water, which continued for two days : and when, in the interval of menftruation, the ferous fluid had again col- leaed, it was the next month entirely difcharged by the uterus. Some kind of veffels, as I have ftated, are employed to take up the rofcid lymph from the ventricles of the brain; but the office afligned to the common cellular ab- forbents 3^2 the absorbents. forbents is two fold, for they not only imbibe the aque- ous fluid from the reticular part of the cellular mem- brane, bur, when it is needful, they abforb the animal oil from the little bags in which it is depofited, and convey it wherever it is wanted for the purpofes of life. When there is. any extravafation either of lymph, of ferum, or of blood, they remove it; and Tfrhen extrane- ous matter gets into the fyftem, if this proves injurious, they quickly go to work; or if any part is either dead cr ufelefs, it proves a fufficient ftimulus to excite their aaion. , i. In cafes of gangrene, both floughing and exfoliation are produced by the abforbents, and thus a feparation is made between the living and the dead. 2. When whole parts are to be removed, as ufelefs, without producing folution of continuity in the furround- ing parts ; this can be accompliflied only by the aaion of the abforbents. It is thus the thymus gland, the duc- tus arteriofus, the membrana pupillaris, are obliterated, and thus alfo the fangs of difeafed teeth, with their fock- ets, are quietly deftroyed. It is by this procefs that aged womqri loj&jheir breads, when thefe are no longer need- ful. When the cataraa has been extraaed, the abforb- ents take up the capfule, and frequently, more efpecially after couching, they carry off the cataraa itfelf. The difeafed tefticie is removed by them, and fometimes in cafes of necrofis they devour the bone itfelf. It is by this procefs that fchirrous tumours are removed. 3. Du Hamel has demonftrated by his experiments, that the earthly part of bones, on which they depend for fbiidity and ftrength, are unremittingly renewed, whilft the abforbents carry off, and exhalant arteries as con- ftantly depofit, calcareous matter. This difcovery he made by reeding animals alternately with common food, and with this ftrongly tinged by rubia tinclorum ; in con- \ fequence of which their bones were variegated red and white. ' But when he had ceafed to give the madder for fix weeks this rednefs vaniflied. 4. When either extraneous bodies or dead parts. which cannot be abforbed, caufe irritation in the fyftem, the the absorbents. 383 the abforbents deftroy the intermediate^ living parts be- tween the offending matter and the neareft external fur- face of the body. ' It is by this procefs that nature fre- quently relieves herfelf in cafes of necrofis and of extra uterine conceptions, as I have ftated in the former part of my work, when treating of thefe efforts. And it is thus that pusj.when produced internally,exfoliated bones, and all extraneous matters, are difcharged. But fome- times it happens, that whilft the ulcerative procefs is de- ftroying the infide of a bone, the oflifying procefs makes addition to its outfide, and the bone increafes to a pro- digious fize ; but in the end, the ulceration on the in- fide gets the better, and the matter makes its efcape. Whenever incyfted tumours are formed in the cellular membrane, the whole fubftance between them* and the fkin is in procefs of time' taken up by the abforbents, and then inflammation commences to produce a quicker abforption, which borders often upon ulceration. It is thus that the tumour is expofed. John Hunter mentions a cafe, which came under his infpeaion, in which a tumour, formed upon the brain, excited, to fuch a degree, the .?. aaion of the abforbents, that without ulceration they carried off the oppofing portions of the dura majer, of the fcull, and of the fcalp. . 5. When the exhalants are at work in floating off of- fending matters from the fyftem, as in diarrhoea, the ab- forbents become aaive by confent, and fhould it ever be proved that they invert their motion as it has been in- genioufly, but I fear not juftly, fuppofed in diabetes, it muft be ftill with the fame intention of aflifting to get rid of fomething highly flimulant. 6. When there is offending matter in the fyftgni which cannot be expelled by the ufual outlets, the Ab- forbents convey it back into the mafs of circulating flu- ids to be thrown out by the emunaories. Thus it is ev- idently in jaundice, for the bile being prevented from ^ paffmg by the common dua into the inteftines, h taken* up by the abforbents and fecreted by the kidniesV* ^ And when mania and melancholia are relieved by cuticular eruptions, I am inclined to think, that we are indebted * ■' - * to »84 THE absorbents. to the abforbents ; for upon all occafions they are ready to aflift nature in her efforts to relieve herfelf. John Hunter mentions a young man who had a large bubo in the bottom of his belly, which having fuppurated, and - being on the point of breaking, was fuddenly abforbed. While this procefs was going on, he obferved his urine wheyifh and thick, as it was coming from him ; but this went off entirely when the bubo had fubfided. . SECTION II. Of Morbid Aclion in the Abforbents. Since the abforbents aa, not by capillary attraaion, but with vital energy, which is liable to increafe and diminution ; it is evident that their aaivity may be either deficient or exceflive. But whatever produces either direa or indirea debility leffens the aaion of the abforb- ents, becaufe the vital energy is injured equally by both. I. Direcl debility is induced, A. By deficiency of whole- fome nutriment when it fails either in quantity or quali- ty. This we obferve among people who live chiefly on the legumina, peas and beans, or on other unferrhented vegetables, with dried, fmoked, and faked flefh, as in Holland ; on cucumbers, melons, pompions, and other vapid fruits, as in the watered provinces of Spain ; or on bread, water, tea, as in fome parts of England. B. By deficiency of exercife, more efpecially when the indolent and inaaive fpend moft of their time in fleep, as already fufficiently explained. C. By fudden and profufe evac- uations. D. By impure air with excefs of humidity, as I have remarked more particularly in the Afturians on th£ northern coaft of Spain. E. By fuch poifons as are direaiy fedative, among which I am inclined to reckon bile a*nd the menftrual blood retained. II. Indireel, debility is induced by excitement either violent dr long continued, and therefore by fuch poifons 'as are indireaiy fedative, that is, whofe firft operation is flimulant. We have feen, by the experiments of the reverend Dr. Hales on vegetables, that their vital energy conftantly accumulates.during'the night, and is to a cer- tain THE ABSORBENTS. 3^5 tain degree exhaufted by the ftimulus of light and heat before the middle of the day. And We obferve, not here particularly to mention heat, that wine, fpices, fpir- its, have precifely the fame effea on the abforbents, as may be feen in gluttons, and in drunkards, whofe fpleen, pancreas, and liver, are frequently difcovered to be fchirrous. The confequence of defeaive aaion in the abforbents muft be difeafe, fuch as obefity, indolent tumours, aque- ous accumulation, and herpetic eruptions, as will be ex- plained when we proceed to the genera included in this clafs. Exceflive aaion of the abforbents produces atrophy, and may arife from either general excitement, as in acute fevers, or partial ftimulants, as we fhall fee in the local difeafes. The ftimuli may be irritating fubftances, fuch as tears paffmg conftantly over the cheeks ; or preffure, whether by external objeas, by indolent tumours, by pus, or by aneurifms ; all which caufe the lymphatics to abforb^ not only* membranes and mufcular fibres, but the bones. Thus in cafe of a large aneurifm of the aorta preffing againft the back bone, the artery is firft abforb- ed where it comes in contaa with the bone, and con- tinues to wafie till the whole is taken up, after which the bone itfelf is foon confumed ; but as the furrounding parts unite by adhefive inflammation, a cavity of fome ftrength for the circulating blood is always kept entire, and no extravafation can take place, nor can the parts readily give way. Thus alfo, when in palpitations of the heart, repeated preffure is made upon the ribs, they like- wife are abforbed. We muft fuppofe not only excef- five, but miftaken aaion of the abforbents, when from external inflammation in the eye, they take up both the cryftalline and the vitreous humours, leaving only a bag of water. When this happens to cataraas produced by contufion, and therefore by inflammation, we muft attrib- ute it, not to morbid aaion, but to the well direaed ef- forts of nature to relieve herfelf. It is exceffive aaion of the abforbents, or perhaps rather deficient aaion of the exhalants, that produce^ A a a mollifies '386 the absorbents. mollifies ojfium, in which the bones being deprived of all their calcareous earth by the abforbents, and not receiv- ing a frefh fupply from the exhalant arteries, become foft and pliable. One fpecies of morbid aaion in the abforbents is not eafily reconciled with the general laws of the animal economy, but the effea is too readily difcovered ; which is when they convey poifons into the fyftem, fuch as the variolous, fyphilitic, cancerous, canine, and others. Nor can we underftand for what reafon they tranflate matter from cancers and fcrophulous tumours to diftant, and fometimes to more noble parts, than thofe which fuffer. This, however, like many fpafmodic affeaions, feems to be merely an effort of impatience, whilft the ordinary efforts appear to follow the moft calm deliberation, and to be direaed always by the beft intention. SECTION I. Of the General Indications of Cure in Morbid Aclion of the Abforbents. These muft be derived from a confideration of the caufes which produce morbid aaion, whether it be defi- cient or exceflive. In cafes of defe&ive aaion of the abforbents, the firft attention muft be paid to diet, which fhould be mild, yet generous, confifting of fuch articles as are moft eafy of digeftion, with a moderate quantity of fpice and wine. Further to aflift the digeftive powers of the ftomach, and the general aaion of the abforbent fyftem, recourfe muft be had to air and exercife. It is Boerhaave who has left us this direaion. Turn ut optime digeri queant, condimentis, potu vinofo, exercitio, aere, procurandum, § n 76. By experience, all medical praaitioners have been convinced, that health and vigour depend upon the air we breathe : but no one, till Dr. Crawford wrote up- on the fubjea, was ever able to explain what the air cori- ™ fwan?s heat and Iife. They had obferved, that the blood acquires a florid colour by paffmg through the lungs, i the absorbents. 387 lungs, precifely as when venal blood is expofed to the open air. They had remarked that the blood'of thofe people was moft florid who ufed moft exercife, and that even the blood of horfes after a long journey was more florid than when they had been confined without exercife in ftables. They faw clearly that the blood of a cachec- tic woman is watery and of an obfcure red : but that by increafing the blood's motion with friaions, exercife, and medicines, it recovers its bright colour. This change they attributed to its paffage through the lungs, where, according to Galen and the ancients, it received fome fpirit from the air imparting vital energy to the arterial blood. Boerhaave, from whofe inftitutes I have derived thefe quotations, alfo afferts that the lungs receive feme- thing from the air, the nature of which he confeffes him- felf unable to difcover ; but, in. order to account for the red blood of fifh, and the rednefs of the punaum faliens in an egg, he obferves, that the gills of fifh fupply the office of lungs, and that air penetrates the egg to fupport the life and growth of the included chick, § 200—202. It is at prefent underftood, that vital energy is derived from the oxygen of atmofpheric air: and, from the obfer- vations I have had frequently an opportunity of making on the praaice of my friend Dr. Thornton, I am in- clined to think, that oxygenated air quickens the aaion of the abforbents: but of this medical praaitioners muft judge after a careful examination of cafes fubmitted to their view. Baron Van Sweeten in his comment on the aphor- ifm of his mafter Boerhaave, wherein air is recom- mended, has remarked, that prifoners excluded from the air, and patients long confined to hofpitals, become ca- cheaic, that in fuch fituations it is very difficult to cure them, and that from hence we may underftand, why atrophy attends affeaions of the lungs, even when little is discharged by fpitting, or loft by fenfible evacuations, § 1174, §"76- Exercife increafes refpiration and promotes the oxyge- nation of the blood ; and by this it gives vigour to the fyftem, and excites the aftion of the abforbents. I have already 388 THE absorbents. already fpoken upon this fubjea; but, as patients pay too little attention to this moft important part of regi- men, I fhall enlarge upon it. It is the circulation of the blood which diftributes vital energy to every part, for in fyncope, and even in death, when it is a confequence of fuffocation, all the vital or- gans remain perfea and entire ; but for want of diftri- bution of vital energy by the circulation of blood, neither the heart, the lungs, the ftomach, nor the brain, can per- form their office ; there is neither fecretion nor excre- tion ; and all aaion, both vital and voluntary, ceafes. In thofe cacheaic difeafes, in which the circulation of the blood is languid, in vain will you pour in nutriment, unlefs at the fame time by air, by exercife, and proper medicines, you promote the circulation, and confequent- ly the fecretion, with the vital energy of the abforbents. Mufcular motion, by compreffing the veins, fends the blood with increafing vigour to the heart, which ftrongly ftimulates that organ ; the refpiration is much quicken- -, ed, the blood becomes highly oxygenated in its paffage through the lungs, and in its return excites the heart to more powerful exertion, by which the whole arterial fyf- tem is diftended. This ftimulates the veffels to contraa with vital energy; the aaion and reaaion are great; the contraaions ftrong; all is aaivity, all is vigour. Hence it is that if, of two brothers, one takes to a fed- . entary life, and the other is conftantly engaged in hunt. ing, mooting, fifhing, or in the cultivation of the earth : this, with a ruddy countenance and rigid fibre, will enjoy high health, whilft the other pale, bloated, and relaxed, will be inceffantly confulting his phyfician. Of the different kinds of exercife, none is to be pre- ferred to riding, becaufe it agita'tes every part of the ma- chine, and moft powerfully promotes the aaion both of the exhalants and abforbents. Sydenham relates the cafe of a friend, who, by neglea of exercife, had brought himfelf into fo deplorable a condition, that he was dying of a colliquative diarrhoea, which no medicines could relieve. This man, by the advice of his fagacious phyfician, mounted his horfe, defied all weather, paid no attention the absorbents. 5S9 attention to his diet, but rode, at firft fhort diftances, in proportion to his ftrength ; and continuing this praaice without interruption for many months, he came at laft to ride his twenty or thirty miles a day without fatigue, and was reftored to perfect health and ftrength. My friend Dr. Stack was confulted by the relations of a young nobleman then dying of atrophy, as it was thought, in Paris, to whom he recommended the Bath waters. The young nobleman was driven to defpair by this advice, becaufe he could not walk acrofs his room, and was confined chiefly to his bed. But the marchio- nefs his mother, a lady diftinguifhed for fpirit and refolu- tion, prevailed on him to rife, fupported him in his car- riage, revived him with cordials when he fainted, and by fhort ftages at firft, in lefs than fix weeks brought him to my friend at Bath in perfea health. In a very ancient hiftory of Cornwall mention is made of M. Atwel, a clerical phyfician, who infallibly cured all difeafes; and fo .great was his celebrity, that patients travelled to him from every part of the ifiand weft of London, to know what quantity of apples and milk, for, excepting manus chrifti, and fuch like cordials, that was the only medicine he prefcribed, would be good for them. Few of thefe, if they came from a great diftance confulted him in vain; before they got home they were reftored to health. Carew's Survey of Cornwall, p. 60. Sydenham affures us, that he has frequently cured both tabes and phthifis by horfe exercife and long jour- nies, when all medicines had been given in vain, and this not merely in the incipient ftages, but when night fweats and diarrhoea, ufually the concluding fymptoms, had ap- peared. Morton expreffes, in moft energetic language, fome fentiments refpeaing the benefits to be derived from air and exercife, and we may venture to affirm, that moft kinds of cachexy may be cured by thefe alone, even without the aid of a phyfician. Friclions, in fome degree, anfwer the end of exercife, by diffufing vital heat and promoting the circulation of the blood. The benefit to be derived from hence is evi- dent 3QO the absorbents. dent in horfes, who never enjoy high health when con- fined to ftables, unlefs they are well combed and brufhed. Bandages, by preffure, aflift weak veffels and promote abforption. It is for this reafon that Boerhaave rec- ommends compreflion in difeafes of the weak relaxed fi- bre, becaufe when either fibres or veffels are diftended beyond their tones, their vital aaion will be weakened till it is wholly loft. And John Hunter has admira- bly ftated, that the beft exciting power is preffure, which, if urged beyond the point of eafe, fets the abforbents of the part to work, for the purpofe of removing either the fubftance prefling or the part which is preffed. Thefe therefore, in fome cafes, may be ufefully applied. In cachcaic patients, attention muft be paid to the organs of digeftion, which are ufually deranged, and loaded either with indigefted fordes, corrupted bile, or phlegm. If the ftomach is affeaed, an emetic muft be given, or if the fmaller inteftines require to be cleanfed, gentle cathartics will be required, which in moft cafes may be followed by tonics and aftringents. This the in- comparable Boerhaave has enjoined. Ut vero organa primarum coclionum it idem bene difponan- tur, leni digeftivo, vomitivo, purgante roborante, profpici- endum, § 1177. But whilft emetics prepare the digeftive organs for tonics and aftringents, they in many cafes ferve another ufeful purpofe, by promoting abforption in every part of the fyllem. Cathartics have the fame effea, and among thefe none is more powerful than mercury, whether ex- ternally or internally applied. Indeed every increafed evacuation exgites abforption from diftant parts, but in- dependent of this effea, mercury ftimulates the abforb- ents, and thereby excites their aaion. Diaphoretics and diuretics will find their place, when we proceed to treat of the feveral genera comprehended in this clafs. But the moft effeaual flimulant in all cacheaic cafes,, attended by diminifhed excitement, v&fteel. This was the favourite remedy of Sydenham and Boerhaave, and it has continued to maintain its credit in the hands of all the the absorbents. 39* the moft fuccefsful praaitioners to the prefent day. To this Dr. Smith owed his celebrity, and, from the expe- rience of thirty years, I can venture to affure the ftudent, that in few cacheaic difeafes will it ever fail to cure. Pro- feffor Van Swieten fays, "In praaice I have met with innumerable cafes in which cachexy has been cured by this remedy alone joined with grateful aromatics, af- ter mild evacuants had cleared the firft paffages from mucus, filth, and indigefted food;" and he particularly affures us, that by fteel filings he never failed perfeaiy to cure cacheaic virgins, provided they confented to take air and exercife, and to avoid warm liquids. Chalybeates have certainly a two fold efi%a, for, as the natural vehicle of oxygen, and the conftituent principle of red blood, they ftrengthen the digeftive organs and they excite the abforbents. Indeed all the metallic oxyds, excepting the mercurial, aa in the fame manner, only in a fuperlative, and therefore in a lefs manageable degree. For this reafon iron has maintained its empire, and whilft we have one oxyd, which, when conjoined with the inhalation of vital air, in thefe cafes may be re- garded as infallible, we need be lefs folicitous about the reft. I cannot conclude this article without making mention of eleclricity, which, as a powerful flimulant, has not only reduced fwellings from fprains, and promoted the fpeedy abforption of confiderable glandular and fcrophulous tu- mours ; but is known to attenuate fluids, and to excite ftrong aaion in the animated fibre, by which, among other remarkable effeas, it quickens vegetation, increafes perfpiration, and reftores the menftrual flux. The fymptoms and difeafes produced by exceflive ac- tion of the abforbents belong to other claffes, either to the pyrexiae, or to the locales, as we have feen in Seaion II. and therefore will not be confidered .here: yet, from what I have already faid, it will not be difficult for the ftudent to comprehend both their nature and their cure. In cafes of inverted aaion of the abforbents, fuppofing fuch cafes to exift, we muft naturally look to tonics, be- caufe 3QJ emaciation* caufe every kind of irregular motion in the fyftem has for its predifponent caufe morbid irritability, attended by debility, or, as John Hunter has beautifully expreffed himfelf, " increafed difpofition to aa without power to aa with." Cafs III. CACHEXIA. Order i. Marcores. Diftinguifhed by Univerfal Emaciation. In this order Dr. Cullen, in his v nofology, fuppofed two genera, atrophia and tabes, but in his praaice he con- fiders them as one. Might he not with propriety have placed diarrhoea and diabetes here? They certainly would look better than where he left them. Genus LXII. Tabes. Emaciation and Debility with Heclic. SECTION I. Of Nutrition. The articles of diet are : i. Animal fubftances ; 2. Vegetables ; 3. Wine with fermented liquors ; 4. Wa- ter. Let us confider thefe in order, and examine chem- ically of what nutritive ingredients they are compofed. 1. Animal fubftances contain, a. Hydrogen, which, when combined with the mat- ter of heat, is inflammable gas ; with oxygen is water; and with azot conftitutes ammonia. b. Carbon, which, with oxygen and the matter of heat, is carbonic acid gas, commonly called fixed air. c. Azot, which, with oxygen in the proportion of two of the former to one of the latter, is atmof- pheric air ; but when the proportion of oxygen is increafed, this combination by chemical union makes nitrous and the nitric acids. d. Sulphur, which, when combined with oxygen in the proportion of 72 to 28, is fulphuric acid, ®v emaciation. 393 or if united with hydrogen and the matter of heat, is hepatic gas, that is fulphurated hydrogen* e. Phofphorus, of which, when 284- is united by combuffion with 714. of oxygen, 100 of phof phoric acid is produced, whilft the whole of their light and heat are difengaged, for in this opera- tion there is no fmoke, no vapour, to leffen the fenfible quantity of either. With hydrogen it. takes fire fpontaneoufly in air, but much better in oxygen gas. /. Iron, conftituting the red particles of blood. The bones contain, with animal gluten, and phofphor- ic acid, a confiderable portion of calcareous earth. 2. Vegetables contain chiefly hydrogen and carbon, with a quantity of oxygen in a triple combination, which continues till caloric, that is, the matter of heat, difturbs the balance of affinities: but with the heat of boiling wa- ter, the oxygen and part of the hydrogen become water, the reft of the hydrogen with part of the carbon becomes effential oil, and what remains at the bottom of the ftill is carbon. With .a greater degree of heat different com- binations are formed, for neither oil nor water are pro- ' duced. Some vegetable fubftances abound with oil, others with fugar, all contain falts, magnefia, calcareous earth and iron, with a fmall portion of azot. Oil contains nearly 79 of carbon to 21 of hydrogen. Sugar has, in 100 parts, 28 of carbon, 8 of hydrogen, and 64 of oxygen. Fruits, unripe, contain a greater proportion of oxygen; but being expofed to the fun, they part with a portion of their oxygen, and when ripe retain very little. 3. Wine contains hydrogen and carbon in different proportions according to its ftrength or weaknefs. In fermentation it takes oxygen from the atmofpheric air and becomes vinegar ; but by diftillation it yields alco- hol or pure fpirit, which contains about one fifth of hy- drogen for 16 ounces of alcohol by combuftion, uniting with oxygen from the atmofpheric air, produces 18 ounces of water. • B b b 4. Water* 394 emaciation. 4. Water, as we have juft obferved, is not a fimple ele- ment, but a compound of hydrogen 15 to 85 of oxygen. This analyfis, adopted from Lavoisier and Jacqjjun, being premifed, I proceed to ftate, that aliments, whether taken from the animal or vegetable kingdoms, are nutri- tive in proportion to the combuftible matter they con- tain. Hence it is, that of all the articles of diet, the fat of animals and vegetables, abounding either with oleagin- ous or faccharine matter, for nourifhment, command the preference. I have frequently had occafion to obferve in the South of France, and in fome parts of Spain, that during the- vintage children grow plump, and it is well known that negroes in the fugar iflands fatten quickly on the cane juice. Dates have nearly the fame effea, and in Greece the peafants thrive remarkably on figs, which, as we are informed, was anciently the food of wreftlers. In many parts of England, the farmers formerly grew fat with ale, which, being extraaed from malt, confequently contains, like all the preceding articles, much fugar. It is now underftood, that poulterers fupply their fat- ting coops, not merely with barley and oats as formerly, but with hempfeed, which contains oil in great abun- dance, and with a confiderable quantity of fuet. All the fubftances above enumerated being properly blended give vigour to the fyftem ; but there is fcarcely any combuftible, but what contributes to the fupport of life. Some tribes have lived wholly upon fifh, others upon flefh ; whilft numerous hordes have been confined to milk and vegetables. I knew one gentleman at Edin- burgh, a medical ftudent, who for a confiderable time fupported life by fugar ; another who fupplied the vital flame for many days with opium ; and it is well known that veteran fots take fcarcely any other food but gin or brandy. All nations covet the fubftances which are moft inflammable. In temperate and humid climates, where p^ures abound with herbage, butter is a part of the fupply its place. In the latter, for this purpofe, they catch EMACIATION. 395 catch fome forts of fifh; in the former they cultivate the olive. It is not, however, in thefe articles alone that combuf- tible matter conftitutes a part of diet; for ardent fpirit, either pure or difguifed under a variety of forms, is the daily beverage of all who can procure it. The fugar- cane, the maple, wheat, barley, oats, and rice, fupply it to nations who never cultivate the vine; and even the wandering hordes of Tartars have contrived to extraa it from their koumifs, the toilfome produce of mares' milk. It has been fuppofed, that water itfelf is decompofed by the organized fibre to furnifh oxygen for the purpofe of irritability and life. It is certainly decompofed by plants, from the leaves of which the oxygen, united to the folar ray, or at leaft by the folar ray combined with caloric, flies off in the form of vital air, whilft the hydrogen re- mains. The fame may be faid of fifh, for Rondelet, in his work de pifeium nutritione, cites a great number of examples of marine animals, which, by the very conftitu- tion of their organs, can derive nourifhment from noother fource but water; and he particularly mentions his having kept a fifh three years in a veffel of pure water without other nourifhment, and that during this time it continued to increafe in fize till it had completely filled the veffel. Every one knows, that frogs and toads have been difcov- ered in rocks and trees, where they could have nothing to fupport them but pure water, and that gold fifh thrive by that alone. Hence it feems to be evident, that fome animals, like plants, decompofe water to form new com- binations ; but that water, as fuch, and not merely as a folvent or vehicle, contributes generally to animal nutri- tion, has not yet been fatisfaaorily proved. I have endeavoured in my firft volume to explain the procefs of digeftion. From the ftomach the aliment paffes to the fmall intef- tines, where, as in the ftomach, numerous laaeals abforb that part, which has been previoufly digefted, and con- vert it into chyle. This they convey through the tho- racic dua into the fyftem to augment the common mafs of circulating fluids. During 39°" EMACIATION. During the courfe of circulation, the chemical opera- tions are continued, and new combinations inceffantly take place. Of thefe one of the moft remarkable is that in which the lungs affift by the plentiful fupply of oxygen, as the univerfal pabulum of life and flame, whilft they emit the fuperabundant carbon and hydrogen, which, united with caloric and oxygen, efcape in the form of air and water. Thus the ftomach is conftantly providing the inflammable principle, whilft the lungs inceffantly contribute what is wanting to feed the vital flame. We may therefore be permitted to remark, that no images could have been more agreeable to nature, than thofe adopted by the ancients, when they compared life to the burning of a lamp, and reprefented death by the invert- ed torch. Thus far I have taken notice only of the hydrogen ; but now the other component parts of animal fubftance call for our attention. Carbon feems to be the bond of union to connea the feveral principles which conftitute the animated fab- ric. When cauftic alkali or quick lime deprives animal fubftances of their carbon, this union is diflblved. In carbonic acid air flefh remains unchanged, but in oxygen gas it putrefies quickly, the balance of affinities is difturb- ed, and new combinations take place ; the oxygen difap- pears, and with it water and carbonic acid gas are form- ed. It is a weli known experiment, that hanging frefh meat in a fig tree expofed to the fun and air makes it quickly tender: and fince the experiments of Dr. Ingen- houz, we can underftand this procefs, for the green leaves yield their oxygen to the folar beams : but if hung over fermenting beer, it continues tough. By the late very valuable publication of Dr. Beddoes on faaitious air, it may be feen, that poultices in the aa of fermentation flop the progrefs of mortification, that is, whilft they emit carbon, for charco*al in powder has the fame effea. It appears likewife, that oak bark, which contains carbon in the greateft abun- dance, has the fame benign effea on fcrophulous ulcers, reftoring- EMACIATION. 397 jreftorinJ*tone and tenfion to the relaxed veffels, and dif- pofing them to heal. If I am not much miftaken, it is for the purpofe of ob- taining a greater quantity of carbon than the ftomach can derive from animal fubftances alone, that nature calls aloud for vegetables, as I fhall more particularly no- tice when I proceed to treat of fcurvy. And I am not only inclined, with many eminent profeffors, to attribute much to carbonic acid gas, whether combined in mineral waters or detached, and in a ftate of fermentation, when given internally in cafes of debility with a relaxed con- dition of the folids and diflblved ftate of the blood, as in typhus ; but to this alfo I would afcribe the fuperior ef- ficacy of the Peruvian and other barks, becaufe they abound with carbon. I muft here obferve, that both hy- drogen and carbon, although deleterious in the extreme when applied direaiy to the lungs, are moft grateful to the ftomach, and contribute both to life and health. Azot feems to be derived from atmofpheric air, but whether it be fo, or whether it was originally of animal produaion, it is not eafy to determine. All animal fub- ftances, by putrefaaive fermentation, produce it in abun- dance, and either in this way, or by diftillation, it unites with hydrogen to form ammonia, which may be pro- cured either from urine or from blood ; but it is ufually obtained from the horns and hoofs of quadrupeds. It is the azot which promotes the putrefaaive procefs, for flefh being confined in azotic gas, quickly turns black, and is corrupted fooner than in any other air. It is a perfea conduaor of elearicity ; but what purpofe it anfwers in the animal economy has not been yet difcovered. Sulphur is faid to be a component part of animal fubftance, but in what proportion, or for what end, has never been afcertained ; neither has it been demonftrated from whence we are to derive its origin. We find it faturated with oxygen, and combined with vegetable al- kali, in plants, particularly in the tamarifk (tamarix) ; and M. Deyeux has communicated feveral proceffes, by which it may be obtained pure uncombined with oxy- gen, and cryftallized, from the roots of plants. We ob- fc tain 39& EMACIATION. tain it from pyrites and from alum, but then if muft be obferved, that neither alum nor pyrites are difcovered ei- ther in granite, or in the clay that is derived from granite, for thefe fubftances are found only, as far as my obfer- vations go, in that fpecies of clay which feems to have been produced by the diffolution of organized bodies, the clay which accompanies calcareous earth and chalk. And although the latter contains fome maffes of pyrites ; yet we have no reafon to confider this as an objeaion, for pyrites itfelf is produced from vegetables, and there- fore it confirms my conjeaure, that fulphur is originally derived from organized bodies. When I was laft in Paris, M. Sage gave me fome beautiful oaaedral cryftals of fulphur, found by him near the gate St. Antoine, in the common receptacle of human ordure, and which he con- ceived to be derived from the vitriolic acid of the gypfum with which it was blended, for this was partly decompo- fed, and therefore fermented with vitriolic acid. His opinion feems to me well founded ; but ftill this fulphur appears to have been derived from animals, becaufe the calcareous bafts of the gypfum claims that origin, and in a ftate of chalk moft probably contained pyrites, or per- haps fulphur, and in either cafe with oxygen it would furnifh vitriolic acid for the gypfum. The procefs by which this fulphur was produced may be readily under- ftood, by considering what paffes in a fomewhat fimilar operation,, for if either aluminous fchift or gypfum with charcoal are fubjeaed to a red heat, carbonic acid efcapes in the form of gas, and fulphur remains with clay or lime, according as either of thefe was employed in the ftate of combination with the vitriolic acid. That fulphur may be taken into the fyftem, and pafs both by perfpiration and by urine, is moft notorious ; but even when no fulphur has been taken, hepatic gas is frequently difcharged, and therefore feems to have been generated in the bodv. Phosphorus is deadly an animal produaion, but all the purpofes it anfwers in the animal economy will not be eafily determined. We knew that it combines with calcareous earth to give foiidity ard firmnefs to the bor.es, EMACIATION. 39^ bones, and that it is difcharged in great abundance in the urine ; but how it is generated, in what way it contrib- utes to general health, or in what proportion, according to the feveral aaions or morbid affeaions of the fyftem, it is fecreted by the kidnies, does not appear, nor have praaitioners the power either to increafe or to diminifii the quantity produced. Iron is contained in blood, in which it is the natural vehicle of oxygen, and being oxygenated gives the florid colour. This metal appears to me to have derived its origin from animals and vegetables. At leaft we may remark, that it is univerfally found in vegetables and in the red blooded animals. It is a conftituent part of limeftone, often in great proportion, more efpecially in fpathous iron ore, and it abounds in the clays which attend the fecondary mountains, both which circumftances have been produced by the diffolution of organized bodies. Iron ore contains nearly pne fourth manganefe, but then manganefe likewife is found in all vegetable afhes. This wonderful metal, according to its degree of ox- ygenation, affumes all the colours of the rainbow, as may be eafily feen by putting a bright poker in the fire, and with different acids it appears either red, yellow, blue, or the intermediate colours ; but with vegetable aftrin- gents it is black. Iron is found not only in the red globules of the blood, but in the bile ; and here it may be remarked not only that the ftrongeft animals have moft red glob- ules, but that their vigour bears proportion to the red glob- ules. This obfervation agrees with what has been faid of oxygen, as contributing to vital energy ; becaufe iron is a proper vehicle of that invigorating principle. None of the perfea metals fo powerfully attraas it, for the flighteft degree of humidity calcines it quickly. The ufe of iron in the fyftem will appear from hence, that when given for thirty or forty days to a pale, bloated, languid, chlorotic virgin, who, with coldnefs of the extremities, low fpirits, lofs of appetite, feeble pulfe, palpitation, and other fymptoms of debility, is fcarcely able to walk; the vital 400 EMACIATION. vital heat increafes and is univerfally diffufed, her pulfe1 acquires ftrength, the pale and fallow countenance is painted like the rofe, her appetite returns, her fpirits rife, and by accefs to vital air, with proper exercife, fhe per- feaiy recovers her aaivity and health. Sleep, if not too long protraaed, contributes to nu- trition, for it feems to be in this quiefcent ftate, when every mufcular fibre is relaxed, that the folids are repair- ed, the fat is depofited in its proper cells, the digeftive procefs is promoted, the animal fpirits are renewed, and the vital energy, expanded and exhaufted during the day, is again accumulated during the repofe, the darknefs, and the filence of the night. SECTION II. p Of the Occafional Caufes of Emaciation and Debility. Emaciation and debility are occafioned by a variety of caufes. i. By deficiency of food, which may refpea either quan- tity or quality : for fhould even the quantity be as much as the ftomach can digeft, yet if the aliment does not fuf- ficiently abound with hydrogen and azot, as well as with carbon, the confequence will be a lofs of ftrength and flefh. If the vegetable man, eating herbs, and drinking only water, were compelled to work, like one who eats heartily of flefh, and drinks fermented liquors, he would be foon emaciated, and die perfeaiy exhaufted. What a miferable figure would a Gentoo from India make among our fire men, fugar bakers, coal heavers, or com- mon London porters I His flefh, fuch as it is, fcarcely hangs upon his bones, and is.little fuited to powerful ex- ertions ; whilft their tenfe and turgid mufcles are em- ployed in unremitted labour, and fcarcely know what it is to feel fatigue. 2. By indigeftion, when the food is either rejeaed by the ftomach, or not well concoaed there. To under- ftand this, the ftudent may confult what has been faid of digeftion and dyfpepfia under the genera i and 39. 3. By vifcid mucus lining the ftomach*and fmall intef- tines* EMACIATION. 4CZ t;p.e% as in hypotkondriafis and tujfis fiomachalis. This prevents the entrance of the digefted aliment into the laaeals, and at the fame time both impedes and depraves digeftion. * , 4. By poifons, which either deftroy, as cauftics, the veryttexture of the abforbents, or produce in them, by violence of ftimulus, either palfy or fpafmodic aaion ; and in either cafe prevent nutrition. 5. By fcrophulous mefenteric glands intercepting the chyle in its»paffage through^he laaeals to the thoracic 3ua. This however is not the only jvay in which they produce emaciation, for they are certainly more than 4 channels to convey the chyle, and therefore, when they are themfelves difeafed, they cannot perform their proper pffice of concoaion. * 6. By-profufe evacuations, whether by diarrhoea, by diabetes, by ulcers, by haemorrhage, by leucorrhsea, by the cutaneous pores in perfpiration, by the feminal vef- fels, by the breafts in nurfes, or by* the falivary glands. In all animals the adipofe membrane is a refervoir from which the vital lamp is occafionally fupplied with oil, -either for long journies, ficknefs, or protraaed fleep. Hence it is, that birds of paffage on their firft arrival, men recovering from fever, and the various tribes of animajs who remain torpid in the winter, having confumed their ftore, are remarkable for want of fat. 7. By old age. This feems to arife chiefly from the obliteration of veffels as we advance in years; but it may depend likewife on other caufes. For from the weaken- ed energy of the heart venous plethora fucceeds, and the blood* moves flowly in the veffels. Hence it derives lefs oxygen from the atmofphere, for it is aftonifhing to ob- ferve what a quantity of air children vitiate and confume when compared with old age. As jhe force of the heart diminifhes, the fluids are pro- truded lefs forcibly into the minuter veffels, and as the quantity of oxygen decreafes in the fyftem the vital en- ergy is leffened continually till it is wholly,loft. But whether it be, that the aged fibre Iofes its attrac- tion for the principle of irritability ; or whether it be, «, Ccc AJ that 402 EMACIATION. that it pertinacioufly retains it, certain it is that with in- creafing years the irritability of the moving fibre, and the aaivity of the vafcular fyftem as well as the fenfibility of the nerves, are gradually'and conftantly diminifhing from infancy to old age. Hence it is that tenfion and tone, as we advance tov/ards the decline of life, are fo much im- paired, that emaciation and debility become the, never failing attendants on decrepitude. Thefe are the circumftances which diftinguifh the fev- eral fpecies of this genus. v„ j % SECTION HI. Of Heaic. The heaic pyrexia has remiffions and ex$Cjejrbationfe twice a day, with evening chills clearly marked, followed by morning fweats. In this affeaion the appetite is vari- ous, thirft moderate, heat and drynefs of the fkin prevail, the tongue is clean, and increafes conftantly in rednefs ; the urine is high coloured, and lets fall a branlike fedi- ment ; pulfe hard, weak, and frequent, more efpecially after eating towards the evening ; the countenance is pale, but has a circumfcribed red fpot on one or both the cheeks, more efpecially during the exacerbation ; the eyes have a pearly whitenefs ; coftivenefs at firft prevails, but towards the clofe a diarrhoea fupervenes ; emaciation and debility increafe continually, the legs become cedem- atofe, and delirium clofes the fcene. It may thus be readily diftinguifhed from both fynocha and typhus. The fyftem chiefly affeaed is, in fynocha, the arterial with ftrong vafcular excitement ; in typhus, the nervous fyftem with confiderable increafe both of fenfibility and irritability ; in heaic, the abforbent fyf- tem without either ftrong vafcular excitement, remarka- ble increafe of fenfibility, or any tendency to fpafm. This affeaion attends morbid emaciation like its fhadow. It is likewife the common fymptom of dropfy, of chloro-' lis, ol rachitis, of, worms and poifons eroding the intef- tines. It attends cancerous, fcrophulous, and fyphilitic ulcers, arifing howevexnot from abforption of either pus or EMACIATION. 4©3 or matter, as John Hunter has demonftrated, becaufe till the ftimulus"for reftoring apart is given, that is, till the abfcefs is opened and proper inflammation follows, heaic does not take place, nor even then if the parts are well difpofed to heal. But When nature is haraffed by ineffeaual efforts to relieve herfelf from fome incura- ble difeafe, whether produced by the fcrophulous, can- . cerous, or by the fyphilitic virus ; then heaic com- mences, always more fpeedily in proportion as the part affeaed is important to the purpofes of life ; and no fooner is the irritating caufelf emoved, as in the extirpa- tion of the cancerous breaft, or the feparation of a fcrophulous joint, than heaic ceafes. Sauvage, who, like moft nofologifts, feems to have been perplexed where to arrange his heaic, has made it a genus under febres, and has included in it thirteen fpecies, all/which, coinciding with the correfpondent fpe- cies of his atrophy and tabes, need not to be particularly mentioned. SECTION IV. • * Of the Species of Tabes. Dr. Cullen, in his nofology, following Sauvage, has confidered atrophia and tabes a& two diftina difeafes, but he has not adopted all his fpecres, #>r Sauvage enu- merated no lefs than fixteen of the former, which Cul- len reduced to four, and feventeen of the latter, which Cullen, in his nofology reduced to three j but in his Firft Lines, dropping atrophia cacochymica, in its place he fubftituted his own tabes ferophulofa. This he was the ;more inclined to do, becaufe he felt, and jndeed acknowledged, the impropriety of feparating atrophy from tabes, fince the former may fairly be con- fidered merely as a fymptom of the latter. From what has been delivere4 on the occafional caufes of emaciation, debility, and heaic, it will appear, that tabes may claim feven fpecies. 1. Tzbe%famelicorum, arifing from •defidpney of food, as in the cafe of, infants fent out to nurfe, when perhaps * three 4©4 EMACIATION. three children hang upon the breaft, which was defign- ed for one. 2. Tabes dyfpeptica, arifing from indigeftion, when from morbid irritability the food is inftantly rejeaed by the ftomach, or from any caufe is badly concoaed there. , 3. Tabes hypochondriacal In this fpecies the nutrir ment is intercepted by vifcid mucus in the firft paffages, as happens frequently to rickety children,, to wormy pa- ■, tients, and to drunkards, in whom the mucous glands are much relaxed. With regard to wormy patients, no one doubts the exiftence of phlegm in the inteftines giv- ing harbour to thofe vermin. Of rickets I fhall fpeak hereafter ; and with refpea to the heaic atrophy of his bibulous heroes, Hoffman has moft judicioufly re- v-larked, Sepe heelicum hoc malum in principio afela atonia pendet. Vol. II. p. 182. 4. Tabes venenata. This correfponds with the heclica Jiomachica et inteftinalis of Hoffman, which he attributes to acrid bile, violent cathartics, and corrofive fubftances, 5. Tabes ferophulofa. This fpecies comprehends all cafes in which difeafed glands occafion atrophy. It takes in therefore the tabes glandularis, tabes mefenterica, atro- phia infantilis, with the atrophia rachitica of Sauvage, * and the tabes, to which inebriates are fubjea from fchir- rous glands, whether of the liver, fpleen, pancreas, or mefentery, and from tubercles feated in the lungs. 6. Tabes inanitorum occafioned by profufe evacua- tions. This includes the atrophia a fanguiftuxu ; atro- phia a kucorrheea ; atrophia ab alvi filuxu ; atrophica ptyalifmo, tabes ulcerofa, tabes fudatoria, tabes nutricum, et tabes dorfalis of Sauvage, of which the laft is perhaps the * moft deplorable of all difeafes. I have met with two * cafes of it, and hope I fhall never be witnefs to a third. It £s the fcourge of unreftrained libidinous defire, and renders life a moft intolerable burthen. The wretched viaim to his own imprudence is tormented from head to foot with pain, burnt up with heaic, wafted to a fkele- ton, and racked in every joint with fpafms. His limbs tremble j he has a loathing for his food ; his fight gradually EMAClAlION. 4°5 gradually fails him, and he becomes at laft quite blind. He is confcious that he brings all this evil on himfelf; yet his defires increafe, and he feels that he has not pow- er to reftrain them. The nigh^ brings him no relief: he fleeps, but* his defires are awake ; he dreams of happi- nefs, but he awakes to mifery^ and it is in death only that he can hope for reft j'yet fucn is the gloom which hangs heavy on his mind* that he is haunted inceffandy with terrors, and is afraid to die. * 7. Tabes fenilis. This muft not be confounded with the atrophia fenilis of Sauvage, becaufe that has merely emaciation and debility, but is free from heaic. The difeafe in queftion is the marafmus fenum of Hoffman, and is defcribed by him as a common and fatal heclic of old age. The body waftes, appetite decays, the ftrength is gradually confumed ; all the bones are vifible through the parched and rigid fkin ; the vital heat forfakes the circumference of the body, and is colleaed in the centre ; the pulfe is hard and frequent, refpiration labours, the voice is hoarfe, the tongue is dry, fleep is deficient in quantity and not refrefhing, coftivenefs prevails, and at ihe end of fix months the patient dies. S E,C T I O N* V^ Of the Indications of Cure in Tabes. These will vary according to the fpecies, yet in gen- eral we may obferve with Dr. Cullen, thaj when tabes is purely fymptomatic, the cure muft be that of thf. pri- mary difeafe ; but when it is idiopathic, it will in fome cafes be fufficient to remove the remote caufes, which, af- ter .what has been delivered, can fcarcely efcape our notice. It is obvious that in tabes famelicomm attention muft be paid to the nutriment, yet with this caution, that in point of quantity and quality united it muft not be rapid- ly chanced from bad to better. The reafon for this cau- tion has°been fufficiently explained at the commencement of this work. The change therefore mull be gradual, ami the moft nutritive aliment muft have the preference, becau& aoG EMACIATION. becaufe the load will be the lefs on the weakened organs of digeftion. Of tabes dyfpeptica, tabes hypochondriaca, and tabes ferophulofa, I need only fay, that what has been delivered, either in this work or by the beft medical authors on thefe difeafes, muft be confulted. In tabes venenata the direaions of Profeffor Hoffman are excellent. Avoid, fays he, every thing acid, faline, and ftigiulant, with fuch articles of diet as readily ferment. Take the food that is moft eafy of digeftion; and for medicine be contented with demulcents, the milder ton- ics, and the moft gentle of the vegetable aftringents. There may be a decoaion either of faffafras and cafcaril- Ia, or of chamomile flowers and the fummits of milfoil in milk : good broth with althaea root and rice ; and gum tragacanth diflblved in mint water. Clyfters, if required, may be made of milk with yolk of egg, turpentine, honey, and fyrup of althaea; and in cafe of fpafmodic pain in the bowels he recommends his antifpafmodic pills, com- pofed of the extraas of chamomile, milfoil, and faffron, with caftor and oil of nutmegs. Tabes inanitofum requires particular attention to pre- vent the profufe evacuation, whatever it may be, whether by hemorrhage, diarrbaa, diabetes, menorrhagia alba, or feminal; in all which cafes the primary difeafe muft be confulted. In cafes of immoderate falivation, brought on by mer- cury, the ingenious Dr. Garnet of Harrogate gives kali fulphuratum, which never fails to abate the evacuation in 24, or at moft in 48 hours. For this effea he very judi- cioufly accounts by fuppofing, that on the decompofition of water,, in wh^ch the medicine is given, by the kali ful- phuratum, fulphurated hydrogen gas is produced and conveyed into the blood, where the hydrogen unites with the oxygemof the acid menftruum of the mercury, and forms water; whilfl the fulphur converts the mercury into an ethiops, which is very inert. Should a nurfe prove unequal to the drain of milk made by her tender charge, no medicine willrelieve her from the diftreffing fymptoms, till fhe has weaned th« in- fant. EMACIATION. 4°7 fant. How many, from a fond and foolifh affeaion, have given fuck to a lufty child for months after it has been upon its legs! And how many, from the preffure of diftrefs and poverty, have undertaken to rear two fuck- lings, when from poverty they have not had milk enough for one! In this cafe nothing effeaual can be done till fhe has removed the occafional caufe of the difeafe. The fame may be faid of any other drain which nature is una- ble to fupport. Tabes fenilis, were it confidered merely as the confe- quence of increafing years or of decrepitude, would call for patience and resignation, not for medicines. But this is not the light in which it muft be viewed. As a difeafe, it requires medical affiftance, and Hoffman, to whom we are indebted for an accurate enumeration of its fymptoms, has given us direaions for its cure. For this purpofe he recommends temperance, exercife, and diluents, with afs's milk and gentle laxatives. In every fpecies of tabes, attention muft be paid to the alimentary canal, and if the firft paffages are loaded, they muft be cleared by emetics, after which, generally fpeak- ing myrrh and fteel may be exhibited in the manner prac- tifed by Dr. Griffith in heaic, and as mentioned in hyfteria. # • * "» Or, From three to ten grains of fteel,filings may be given three times a day, in conferve of rofes, with a few grain* of aromatic powder. Or, §, G. Myrrh, dr. i. Tinft. Cort. Peruv. unc. i. Solve terendty et adde Aq. unc. 8. Sal. Martis, fcr. I. ,;Salis Nitri, fcr. i*. Syr. Balf. dr. 6. M. c. c. unc. 2. bis die. That is, Take myrrh one dram; tincture of the bark'an ouncf ; grind it ir» a mortar, and add eight ounces of water ; fait of fteel a fcruple ; nitre half a dram ; balfamic fyrup fix dra j?. Mix and tak, two ounces twice a day. ■ . j . The various* preparations of milk, mentioned m the beginning 6f my work, are excellent, and may in fome meafure prove a fubftitute for koumifs, the teletyated in-"", vention of the Tartars. f To 408 emaciation. To make koumifs, they put new mare's milk in a woqcT* en veffel, with one fixth of water., and one eighth of four cow's milk. This they cover with a thick cloth and keep it moderately warm for 24 hours ; then with a churn ftaff they beat it till the whole is intimately blended. At the end of 24 hours more they pour it into a narrow veffel, and churn it till it is perfectly and uniformly mixed. In a clofe veffel, if not expofed to heat, it keeps three months. Dr. Grieve, to whom we are indebted for this infor- mation, affures us, that koumifs proves a wonderful ref- torative in heclic atrophy, that is, in tabes, and he recom- mends fix quarts of it to be taken every day. Horfe exercife is ftriaiy to be enjoined in all cafes in which either the glands are obftruaed, or the ftomach is relaxed, and therefore more particularly in fpecies 2, 3, 5, and 6. _ Sydenham., whofe high expeaations from horfe exercife has been already ftated, ventures to affirm, that riding for heaic is equal in efficacy to mercury for fyphilis, and the Peruvian bark for intermittents. And Morton, than whom no one ever wrote better on hec- tic atrophy, ftrongly recommends the fame praaice to excite moderate perfpiration, to ftrengthen the digeftive \ organs, and to fhake off the tough and vifcid mucus ob-. •' ftruaing the abforbents of the ftomach, and of the fmall inteftines, ex veniriculi et inteftinorum faburrd acidd, len- tdftmul et vifeidd, meatus obftruente, &c. p. 26. Clafs III. CACHEXIA. Order II. Intumescenti^e. Diftinguifhed by General Swellings. In this order we have thirteen genera; polyfarcia, pneumatofis, tympanites, phyfometra, anafarca, hydro- cephalus hydrorachitis, hydrothorax, afcites, hydrom- etra, hydrocele, phyfconia, rachitis. Genus LXIII. Polysarcia. Obefity. • m From what has been delivered on nutrition and ema- f W,on, under the preceding genus, the nature and the * cure general swellings. 409 cure of obefity may be clearly underftood. It has been univerfally obferved, that people who eat heartily of ani- mal food, and drink freely, more efpecially of ftrong beer, who take little exercife, and by fleep give long refpites to the fatigue of thought, ufually accumulate a great quan- tity of fat, and upon thefe principles poultry, pigs, and oxen are fatted for the market. For the cure of this difeafe no medicines muft be had recourfe to, becaufe no remedy is to be expeaed but from temperance, a vegetable diet, pure, air, exercife, and early rifing. A young gentleman having applied to Boerhaave for his advice, when oppreffed by corpu- lency, was ordered to keep his eyes always open, and his mouth always fhut. It has been common for young people, when appre- henfive of being corpulent to drink vinegar. By this praaice they have, indeed obtained their end ; but they have deftroyed their health. At this effea we cannot be furprifed, becaufe they invert the order of nature, by making the ftomach fupply that oxygen which fhould have been tranfmitted by the lungs. The more rational praaice, moft undoubtedly, is to limit the quantity of hydrogen received into the ftomach, and to increafe the quantity of oxygen refpired, that is, with little nutriment to take much exercife, and that in the pureft air. It is by fuch means that the Newmarket jockies reduce them- felves to a flandard weight, and by fuch means monfters for bulk have, with perfea fafety, brought themfelves to a reafonable fize. The fubjea of obefity has been ingenioufly treated on by Dr. Beddoes; and my friend Dr. Thornton has obferved, that when fat people inhale fuperoxygenated air, they eat lefs, grow thinner, an,d yet find no'deficiency of ftrength. * * Genus LXIV. Pneumatosis, An elaftic fwelling of the body, crepitating under the ► touch. It is caufed by air in the cellular texture, which com, ^ D D d t muni eating .I0 GENERAL SWELLINGS. , municating over the body, by its expanfion renders the fkin tenfe and elaftic, as may be feen when butchers intro- duce it to make their meat look plump. When the weight of the atmofphere is taken off from animals, as in the exhaufted receiver, this effea is fpeedily produced ; but no fooner is the equilibrium reftored be- tween the external and internal preffure, than the animal returns to his accuftomed fize. Dr. Cullen has four fpecies of pneumatofis : Fneumatofis fpontanea, without manifeft caufe. traumatica, from wounds in the thorax. venenata, from poifon. hyfterica, from hyfteric affeaion. In cafe of wounds and violence we can eafily account for this effea. Thus, in the foldier mentioned by Sau- vage, who fell into the hands of a banditti, we fee him wounded in the groin, and a tube thruft by thefe wretches into die wound; and, from the communication of the cellular texture, we readily comprehend, how the air forced into one part extended over the whole body ex- cepting his hands and feet. Nor do we find more diffi- culty when we are to explain, how the fame effea is pro- duced by wounds in the thorax, whether by a fword, or by a fractured rib. But all the other fpecies of pneuma- tofis are exceedingly perplexing. I fhall therefore be fatisfied with flaring faas, without attempting to account for them. Pneumatofis has frequently happened in confequence of fever. Sauvage makes mention of a boy aged only eighteen months, whofe body was fuddenly inflated, and whofe brother died of the fame difeafe. This boy was cured by copious evacuations both by urine and by ftool. He faw likewife a furgeon, who, after a protraaed inter- mittent, fwelled univerfally, in fome parts dropfically; but in his face, bread, hands, and thighs, the fwelling was elaftic. After this patient had for two years fought relief in vain, he was fuddenly reftored to perfea health by elearicity. Baron Haller has colleaed many in- ftances of pneumatofis occafioned by gangrene, fmall pox, GENERAL SWELLINGS. 4H pox, rickets, hyfteria, fcurvy, and even by the fuppreflion of the lochia, and in oxen particularly by dyfentery. Sydenham confiders pneumatofis as a common fymp- tom of hyfteric affeaion. His defcription is accurately juft. He obferves, this difeafe attacks aimoft every part internal and external ; it.feizes on the mufcles and oc- cupies the jaws, the fhoulders, the hands, the thighs, but particularly the legs and ancles, fometimes with pain, at other times with fwellings; the latter is the moft remark- able, becaufe it neither increafes towards the evening, nor pits like dropfy, but is elaftic and greateft in the morn- ing. It generally affeas one leg more than the other. Yet the refemblance deceives the patient, and he is firmly perfuaded that it is hydropic. Raulin remarks, that this fpecies of pneumatofis alternates fometimes with dia- betes, that is, I fuppofe, with a copious difcharge of hyf- teric water. I had a patient in whom this fymptom of hyfteria very frequently appeared, and continued for fome days ; but whether fhe had pain and fwelling, or only fwelling, fhe never failed to be inftantly relieved whenever either fpon- taneoufly, or by the afliftance of an emetic, fhe brought up a quantity of vifcid mucus from the ftomach. I have been fo often a witnefs of this effea, that I can have no -doubt of the accuracy of the obfervation. Poifons, according to fome naturalifts and medical praaitioners, produce elaftic fwellings of the whole body, as an example of which, Linnseus mentions perfons who have been bitten by the ferpent afping, and Willis on tympanites refers to other poifons. As to the indications of cure, it muft be confeffed that fcarifications, compreffes, and in fome cafes the pa- racentefis, are the only remedies on which we can rely. When pneumatic chemiftry fhall have made a progrefs in the world, and when philofophic praaitioners are able to explain how poifons produce their wonderful effea, we may then hope to cure without the affiftance of a fur- geon. Vide Medical Extracts, by Dr. Thornton. Genus 412 general swellings. Genus LXV. Tympanites. The fymptoms are elaftic diftention of the abdomen, not readily yielding to preffure, and founding like a drum, with coftivenefs and emaciation, but no fluauation. In the beginning we obferve flatulence and borboryg- mi, that is, hollow rumbling of the bowels. Thirft and lofs of appetite, pain in the loins, and dyfpncea, with fre- quency of pulfe, fucceed, and atrophy brings up the rear. Dr. Cullen has two fpecies; tympanites inteftinalis, and tympanites abdominalis ; but I fhall confine my ob- fervations to the former, becaufe the latter is a fpecies of pneumatofis. The perfons moft liable to this difeafe are chiefly thofe of a relaxed and irritable habit, fuch as have been debilitated by profufe evacuations, by intermittents, or by typhus fever, patients who have recently fuffered by fpafmodic and inflammatory affeaions of the bowels, and particularly women after childbirth. It is occafioned fometimes by afcites and morbid affec- tions of the liver ; at other times by biliary or renal cal- culi; frequently by worms; and in one moft curious cafe, reported by Van Swieten, it arofe from hasmor- rhagic effort after fuppreflion of the catamenia, and of the haemorrhoidal flux. It may likewife be induced by poifons, when they oc- cafion flatulence and fpafmodic conftriaion in the bowels. From what has been faid, we cannot be at a lofs for the proximate caufe of this difeafe. There is evidently a preternatural diftention of the inteftines by air, produ- cing lofs of tone in the mufcular fibres of the part dif- tended, and,^ from what has been fuggefted on the proc- efs of digeftion, it muft appear, that the extrication of this air, or gas, in the ftomach or the bowels, is to be at- tributed to fome defeft .either in quantity or quality of the feveral fluids, the faliva, pancreatic juice, and bile, which are mixed with our aliment to affift in the reduaion of it into chyle, and to reftrain the progrefs of fermentation in the faeces, whilft they are paffmg the inteftines. But this alone cannot be the proximate caufe of tympanites ; for with this muft be united fpafmodic ftriaure in fome part of GENhRAL SWLL.LIKGfc. 4! 3 of 1 tie inteftines, which prevents the efcape of wind, and this fpafmodic ftriaure muft be occafioned by fome irri- tation in the fyftem. This view o£ the proximate caufe is confirmed by anatomical obfervations, particularly by thofe of Plate- rus, Littre, and De Haen. Thefe celebrated phyfi- ologifts difcovered the color* diftended to the fize of a man's thigh, and the ftomach with fmall inteftines three times their ufual bulk. Thefe diftentions were obferve I in different parts of the alimentary canal, fometimes in the ftomach, at other times in portions either of the large or of the fmall inteftines forming conftriaed cells, and fometimes in all of them together. With air, they difcovered likewife an amazing quantity of hardened faeces. We cannot therefore entertain a doubt as to the nature of this difeafe. Heister, in his extenfive prac- tice during the fpace of fix and forty years, never found air as the caufe of tympanites in the cavity of the abdo- men, till Ruysch fhewed him one cafe in which that caufe was evident. From this view of the difeafe in queftion, fuppofing it to be juft, there can be no doubt that Dr. Cullen fhould have claffed it among the neurofes with fpafmodic affec- tion : but it appears to have been attraaed here by drop- fy, with which it is frequently combined. Agreeable to this idea of the proximate caufe, the in- dications of cure muft be, 1. To relieve the fpafm. 2. To reftore the tone of the inteftine-. Thefe intentions may be anfwered by opiates, bitters, bark, and fteel, with aromatics : but as in fome cafes, either worms, acrid bile, or vifcid mucus, which is the materia verminofa of Sauvagk, may contribute to the fupport of the difeafe ; thefe muft be evacuated, and the belt medicines for this purpofe are, calomel, rhubarb, fenna, fquills, foluble tartar, and the foflil alkali, which laft may be made into pills with foap. Carminative clyfters muft be frequently injeaed. For Boerhaave very judicioufly remarks, if the bowels are cleanfed be- fore 414 GENERAL SWELLINGS* fore they have loft their tone by exceflive diftention, the difeafe is cured. The cathartic may be calomel from two to five grains at night, to be carried off in the morning by rhubarb and foluble tartar, of each fifteen grains, with ten grains of either ginger or aromatic powder, made into a bolus with fyrup of orange peel. Or at the commencement might not caftor oil (ol. ricini) be tried with a probabili- ty of fuccefs ? For the opiate we may take either of the following, as occafion may require, to be repeated every night. R> Aq Menth. un I. Sp. Ammon. c. gtt. 20. Tind. Opii,gtt. 15 ad gtt. 30. Sach. Alb. dr. 1. M. f. H. h. s. s. I£> Aq. Menth. un. 1. Acet. Scillae, dr. 1. Tinft. Opii, gtt. 15—30. M. f. H.h. s. s. Twenty drops of vitriolic tartar may be added to the opiate. The aftringent may be, I£> Cinchon. Rad. Calam. Aromat. aa un. ^. Ferri Vitriolat. dr. 1. Conf. Rof. un. 1. Syr. Cort. Aurant. q. s. M. f. Ele&. c. c. M. N. M. bis die. We find a praaice recommended by Sauvage which merits attention on account of its fingular effeas in the cafes in which it has been tried. That is, to foment with water, juft above the freezing point, at the fame time giving ice internally to condenfe the gas, or abforb it if it be fixed air, and he particularly fiates, that in the fpecies of tympanites, which he de- nominates fpafmodic, this praaice perfeaed a cure, with this remarkable circumftance, that in both the cafes fpec- ified a bilious diarrhoea, producing an abundant dif- charge of flatulence, was ultimately the means of remov- ing the difeafe. This effea is rendered the more ftrik- ing by what he adds refpeaing the praaice of Hippo- crates, triginta urceos aquefrigide effundi jujfit fupra corpus mulieris robufte, que a fumpto medicamine ventre iniumuerat cum dolore, dyfpnea, animi confternatione, hinc vomitu ex aqua frigidd nee dolor nee dyfpnoza remiferant, quinquies mortua vifa fuerat ; hac affufione frigide fuble- vaia eft, bilem copiofam dein ejecit, et vixit. Here we have the fame appearance of bile, as the ilimulating caufe of this fpafmodic affeaion in the ali- mentary canah IJOFFMANT general swellings. 425 Hoffman has left us fome valuable cafes of tympa- nites. The firft occafioned by worms, and cared by anthel- mintics, by tanfy, wormfeed, gum ammoniac, aloes, rhu- barb, and calomel. The fecond, occafioned by indolence, improper food, and an ill cured intermittent. This was cured by car- minative clyfters, by moderate aperients, and by gentle tonics, which laft were compofed of balfam of amber, orange peel, zedoary, and Hoffman's anodyne, in equal parts. The third, occafioned by menorrhagia alba being fud- denly flopped by means of alum locally applied, and cured by moderate aperients, balfamic pills, and by what he calls his vifceral elixir, continued for four days. Af- ter which period for four days, fhe fat every evening one hour in a decoaion of the aromatic herbs with laurel and juniper berries. By this procefs the young lady difchaig- ed from the uterus a great quantity of glutinous and vifcid matter, the flatulent fymptoms were removed, and fhe was reftored to health. Galen reports a cafe fimilar to this, and many fuch have been recorded. The fourth was merely diftention of the caecum in a young man of a phlegmatic habit, of a fedentary life, and accuftomed to a grofs diet. He was cured by gentle evacuants, carminatives, and tonics, as in the two pre- ceding cafes, with the afliftance of a plaifter to the fide affeaed. This was made with Venice turpentine, Maf- tich wax, and Peruvian balfam ; and was renewed twice a week. The next cafe was of a clergyman in Holland, aged 30, exceedingly fludious, fedentary, and accuftomed to a grofs diet, that is, to dried flefh, fifh, legumina, milk, and tea. This patient, at the end of three years intenfe application, became pale, emaciated, tympanitic, and afcitic. Hoffman being confulted, put him tfpon a gen- erous regimen ; made him take exercife ; and, to cleanfe the firft paffages from vifcid mucus, which he confidered as the occafional caufe of flatulence, he ordered a mineral water, 416 general swellings. water, and twice a week gave balfamic and cathartic pills. In the Edinburgh Medical Obfervations we have a remarkable cafe, which was cured by reftoring the haem- orrhoidal flux ; and they who are well acquainted with fpafmodic affeaions, will not be furprifed to fee what confufion the haemorrhagic effort creates, when it occurs in weak and irritable habits. Many fuch inftances are produced by Dr. Whytt, in his incomparable trea- tife on the difeafes of the nerves, and merit the attention of the ftudent, particularly thofe which appear in his fourth chapter on the retention of accuftomed evacua- tion, fuch as the menfes and haemorrhoidal flux. With refpea to the borborygmi, which ufually occur in the falutary termination of this difeafe, I muft remind the ftudent of an axiom of Hippocrates. Dolores ex hypochondriis et tumores, ft recenies funt, et fine inflamma- tione, folvit borborygmus in hypochondrio excitatus et max- ime exiens cum ftercore, urina etftatu, becaufe thefe dem- onftrate that the fpafm has been relieved. Genus LXVI. Physometra. A permanent elaftic fwelling in the hypogaftrium, ari- fing from flatulent diftention of the womb. This frequently deceives the barren female with the hope of pregnancy, till nature explains the myftery, and her expeaation vanifhes in air. Genus LXVII. Anasarca. Univerfal Dropfy. Swelling on the furface of the body, not elaftic, but pitting by preffure of the finger, and rifing flowly to its former fulr±efs. It is a preternatural colleaion of ferous fluid in the cellular membrane, immediately under the fkin, an*d ufu- ally appears firft in the lower extremities towards night, but difperfes before the morning. The urine is dimin- ifhed in quantity. Thirft increafes and becomes intenfe. Atrophy GENERAL SWELLINGS. 417 Atrophy attends, and all the fat with the oily portion of the marrow is carried off by the abforbents. SECTION I. Of the Caufes Remote and Proximate of Dropfy. A preternatural colleaion of ferous fluid, whether in the cellular membrane, or in the cavities of the body, is caufed by abforption falling fhort of exhalation in thefe cells and cavities; and this effea may be produced either by increafed effufion from the exhalant arteries, or from diminifhed aaion of the abforbents. But as in dropfy the lymphatics and thoracic dua are much enlarged; it is clear that abforption is increafed, although not in pro- portion to the exhalation, and that therefore the caufe of dropfy is in the exhalants. Increafed effufion from the exhalants may arife, 1. From their relaxation, which may be occafioned by fevers, whether typhus or protraaed intermittents ; by continued grief ; by exceflive evacuations of any kind ; by the feveral fpecies of intemperance ; by indolence and inaaivity ; or by drinking only flagnant water, as in Holland. 2. From fuperabundance of ferum in the blood, which may be occafioned by all the abovementioned caufes ; by a penurious diet ; by profufe haemorrhage and re- peated venefeaion ; by weakened powers of digeftion, defeaive chylification, and diminifhed energy of the laaeals ; by interruption of the watery excretions, whether of urine, or of perfpiration ; by jaundice. It might be thought, that the fuperabundant ferum would more readily pafs by the kidnies, as" aqueous fluids do in healthy fubjecls, than by the exhalant arteries : but when the ftimulus of well oxygenated blood is wanting, as we fee in pale, languid, and hydropic habits ; the kid- nies become torpid, their vital aaion ceafet, and the quantity of urine is diminifhed. This we have feen ex- emplified in the beautiful experiments of Hales, who produced an artificial dropfy in dogs, by pouring abun- dance of warm water into their arteries throu^I a tube E e e of 41S GENERAL SWELLINGS. of fuch a height, that the preffure of the column equalled the force of the heart, yet none of the warm water paffed through the kidnies. 3. From continued preffure on the veins, as in preg- nancy, obftinate flatulence, and fchirrous tumors, increaf- ing the determination of blood to the exhalant arteries, in which cafes dropfy is merely fymptomatic, for when the obftruaion is removed the dropfy ceafes. 4. From the ftimulus of inflammation. A blow on the tefticles produces inflammation, of which the confe- quence may be dropfy of the tunica vaginalis. A child's brain inflames, and hydrocephalus enfues. Pleuritis fre- quently terminates in hydrothorax, and peritoneal in- flammation in afcites. It is in this way that cold water drank by dancers or by reapers, when heated by exer- cife, produces dropfy. Mr. Cruikshank has often taken away fifty or fixty pints of water from a patient, which had colleaed in the abdomen, in the few days the peritoneal inflammation lafted, during the ufual fpecies of puerperal fever. He very properly remarks, that when the arteries of the part have once got a habit of increaf- ing their fecretions, they commonly go on for a long time, or the lymphatics may befo altered by the inflam- mation, as not to abforb in proportion to the difcharge by the exhalants. The proximate caufe therefore of dropfy is not as Sydenham conceives, the ferous fluid itfelf as colleaed in the cells, but diminifhed tone in the fyftem, as more accurately ftated by Dr. Cullen. 'SECTION II. Of the Indications of Cure in Anafarca. From what has been delivered, it will follow, that our indications of cure may be, 1. To evacuate the ferous fluid already collected. 2. To reftore tone to the fyftem in general, and tfkreby fo the exhalants in particular. ^ I. The firft indication may be anfwered, by either fcanfication or by punctures., which certainly ie the moll obvious GENERAL SWELLINGS. 4IO. obvious and expeditious method of evacuating the dif- tended cells ; and, fuppofing the ftrength is not much impaired, may be reforted to with fafety. But where the conftitution is greatly weakened by difeafe, even punaures are hazardous, and fcarification would be dangerous in the extreme. Yet fome cafes occur in dropfical habits, where from debility no inflammation takes place after fcarification, and therefore no mortifica- tion, but the wound continues to tranfmit water for many weeks. Should however the fyftem have fufficient ftrength to produce inflammation, but not to fupport vital energy in the wounded part during the fucceeding ftages, gangrene muft be the confequence. If, therefore, it fhould be found neceffary to draw off the water, it fliould be certainly by punctures, and thefe fhould not be too near together, that they may have the better chance of healing by the firft intention. The ferous fluid, colleaed in the diftended cells, may be evacuated by exciting the abforbents to more vigor- ous aa^on, which may be accomplifhed either by means of friclions and by preffure, or by confent. 1. It is well known that preffure, if urged beyond the point of eafe, fets the abforbents of the part to work for the purpofe of removing either the fubftance preffing, or the part itfelf when preffed. A lefs degree of preffure produces thickening, and a greater terminates in ulcera- tion. For this purpofe, bandages may be ufefully applied. for they not only, as Dr. Cullen well obferves, fupport Weak veffels, but certainly promote abforption. Fric- 5 tions are no lefs efficacious, whether adminiftered by a . flefh brufli or by the hand ; and I remember the cafe of a gentleman who in two months was perfeaiy cured of cedematous fwellings in his legs, by his daughter's gently ftroking them with her hand for m,any hours every day, from the inftep upwards. Mufcular exertion likewife has a good effea in preventing ftagnation of yhe fluids. 2. The abforbents may be excited to vigorous aaion by confent. If the emunaories are violently ftimulated, whether it be by emetics, cathartics, diuretics, or by diaphoretics, they will copioufly pour forth aqueous fluids, 420 GENERAL SWELLINGS. fluids, and the abforbents over the whole fyftem will go to work for the purpofe of fupplying them abundantly, and aflifting them to wafh away the offending matters from the body. For an emetic we may give the following in the morn- ing : 5> Antimon. tartarifat. gr. iv. Merc. Vitriolat. gr. v. M. f. Emet. mane fumend. Or, an ounce and a half of antimonial wine, with half an ounce of oyxmel of fquills. Sydenham recommends three handsful of the inner bark of elder (fambucus nigra) boiled in a quart of milk and water to one pint. Half a pint of this decoaion is to be taken morning and evening every day fill the cure is perfeaed. If this quantity does not both purge and vomit brifkly, it is of no ufe. For a cathartic we may order calomel and rhubarb, calomel and jalap, calomel and fquills, elaterium, fcam- mony, gamboge, according to the ftrength of • the pa- tient and the urgency of the cafe. Or, we may give calomel at night, to be purged off iri the morning, either with jalap, or by fenna. Or thefe cathartics may be combined in the fubfequent forms. R, Calomel j}ij. Rhei 5'ij- Jalap "^j. Gambogii 3j. Syr. Simp. q. s. f. Pill. n°. 56. c. c. Pill. ij. m. et. v. Calomel two fcruples ; rhubarb three drams ; jalap one fcruple ; gamboge a dram ; fyrup a fufficient quantity to make fifty fix pills ; of which take two morning and evening. Or with Hoffman we may give manna three ounces, lenna and cream of tartar of each two drams, infufed in water for one dofe. Sydenham, to delicate people of irritable bowels, gave \ either an ounce of fyrup of buckthorn every morning ; or the following : R? Rad Jalap. Hermodaciyl. aa §fs. Scammon crud. 3iij. Sennre §ij. Glycyrrhiz. Sem. Anis. Carui, aa gfs. Sum. Abfinth. Fol. Salv. aa m. j. Infunde frigide in ftiij Aq. vitas vulgaris, et coletur tantummodo ufus tempore. Capt. Cochlear, j. h. s. et ij. mane fequenti, aw- gendo vel minuendo dofin pro ratione operationis. Jalap and hermoda&yl of each half an ounce ; fcammony three drams ; fenna two ounces ; liquorice root, anife, and caraway feeds, of each half an ounce ; wormwood tops and fage leaves, of gaeh one handful; common brandy three pints. Infufe and flrain GENERAL SWELLINGS. 421 i* i-^in it as wanted. Take one fpoonful at night and two in tbr morning.—Hermoda&yl is now rejected as inert. To the more robuft he gave the following .: P> Tamariid. ?fs. Sennas 3ij. Rhei. 3ifs. Coq. in q. ?. Aq. fovt. ad. §iij. in Colatur. diffolv. Mann. Syr. Rofar. folut. aa |j. Syr. e Spin. Cervin. ^fs. Elect, e Succ. Rofar. 3ij. M. f. H. Tamarinds half an ounce ; fenna two drams ; rhubarb a dram'and a half; boil in water to three ounces and drain. In this diffoWc ' manna and folutive fyrup of rofes of each one ounce ; fyrup of buckthorn half an ounce ; elecluary of rofe juice two dramc fcr one dofe. Electuary of rofe juice not beinrr found among the officinal prepara- tions of the ptefent day, folutive fyrup of rofes may fupply its place- The obfervations of Sydenham refpeaing the ufe of cathartics in dropfy merit our attention. 1. In dropfies, when the intention is to evacuate ferous fluids, cathartics, which are flow in operation, harafs the fyftem to no purpofe. To be ufeful they muft be hydra- gogue and pafs the inteftines, fpeedily. If they are too violent, opium will eafily reftrain them. 2. They muft be repeated daily, unlefs a day of reft is abfolutely needful, becaufe by intermiflions the water would collea again. 3. When the bowels are not readily moved by mild cathartics, the more violent muft not be given alone, but muft be added in fmall quantities to quicken the opera- tion of the former. In confiderable dofes they deceive our expeaations, and excite a tumult in the fyftem. 4. The peculiar habit and conftitution of the patient muft be confulted, becaufe the fame cathartics are not fuitable for all. Sydenham relates of himfelf, that when he was a young praaitioner, having fpeedily cured his firft patient of a dropfy, by fyrup of buckthorn, he thought he was poffeffed of a fpecific; but, unfortunately perfevering too Ion? in the ufe of this, when in the next cafe of dropiy it gave no relief, he had the mortification to find himfelf difmiffed by the wealthy dame, who was afterwards cured by a more difcreet phyfician. Both emetics and cathartics, if draftic, are improper in irritable habits. They weaken the fyftem, and mcrea- the 422 GENERAL SWELLINGS- the proximate caufe of the difeafe. In fuch conftitutions therefore, if ferous fluids are to be evacuated, recourfe muft be had to diuretics. For diuretics we may take our choice out of four or- ders, according to the nature of the cafe and conftitution of the patient. We have among the diluents, water and whey. Among the ftimulants garlic, fquills, broomtops, juniper, meadow faffron, aether, and cantharides. Among the refrigerants, tartar and nitre. And for a fedative, the foxglove ("digitalis.J Sydenham placed his chief dependence on the lixivia! falts, which he confidered as the moft efficacious of all the diuretics. He thought it a matter of indifference from what afhes the vegetable alkali was taken, yet he himfelf generally ordered the afhe3 of the broom (genif- taj, which were after his time regarded as a fpecific, and rendered famous by the cure of marefchal S.vxe, when he had been twice tapped. Sydenham commonly order- ed a pound of thefe allies to be infufed in two quarts of Rhenifh wine; but cyder is equally as good. Of this filtered folution he gave four ounces three times a day, and found it efficacious in many cafes which had been regarded as incurable. This would be much improved by one ounce of iron filings. Hoffman depended principally on fquills and nitre. Of the former he fpeaks in the higheft terms of approba- tion, yet not more than it deferves. His form was this: R, Rad. Vincetox. ^fs. Seillas, Nitri. aa. gr. iij. M. f. Pulv. The root of the afclepias vincetoxicum ten grains, with fquills and nitre of each three grains. Thi3 may be taken three times a dzy, gradually increafing the dofe. Dr. Gregory, who as a praaitioner ranks among the ~rft in Europe, treads nearly in the fame fteps with Hoff- man, and commonly orders two grains of fquills, made 'nto a pill with crumbs of bread and gum arabic. To be taken in the morning and at noon. R, Pulv. Rad. Scill. gr. 30. Mic Panis Mud!. Gum. Arab. aa. q, s. utfiant Pill. 15. Quarvm c?.pi?>.t j. Mane et Meridie. With this he gives a mercurial pill everv night. J.V'tretics may be ufefuily combined with either emetics or cathartics, or, which amouc . to the fame thing, the dofe GENERAL SWELLINGS. 423 dofe of the diuretic may be fo increafed as to aa either as an emetic or cathartic. Sir John Pringle ufed to give the following : $» Ja*aP g1'- xv- Nitri. gr. viiij. Simul Tiitisad. Rad. Scillae, recent gr. viij.—xij. Syr. Simp. q. s. M. f. Bol. m. s. et per biduum repetend. interpcfito dein uno die repetatur. Jalap fifteen grains ; nitre eight grains ; grind thefe together, and add frefh fquills from eight to twelve grains ; fimple fyrup fuf- ficient for a bolus. To be take:', in the mornings for two days ; then, retting a day, repeat. Dr. Whytt was very fond of tartarifed kali, which he gave in dofes of about half an ounce: but Dr. Home increafed his dofes of tartar from half an ounce as far as two ounces, and then quitted it for fome other diuretic. The phyfician who has made the moft accurate experi- ments in the cure of dropfy, is Dr. Ferriar. In his medical hiftories we find, that of 43 patients, 33 were cured by cream of tartar, whereas out of 29 cafes, only 11 were cured by digitalis. Dr. Ferriar gradually increafes his dofe of tartar from two drams to twelve, and when this lofes its effea, he quickens the operation by a grain or two of gamboge, reducing the tartar to four drams. When the evacua- tions, by urine and by ftool, are profufe, he fupports the ftrength by wine; or if a refpite is required, he omits the tartar for a day and interpofes tonics. When* a change of medicines is required ; or when a diarrhoea prevents the exhibition of tartar ; he gives digitalis gr. 1—4, with a dofe of aether and about twenty drops of laudanum, or calomel and fquills may be taken every night in this form. jg, Pulv. Scill. gr. 3. Calomel gr. 1—4. Sapon. Hifpan. gr. 10. Syr. q. s. f. Bol. h. s. s. Dr. Ferriar very judicioufly remarks, that the more brifk the operation'of the tartar as a cathartic, the more copious is the flow of urine. After what has been delivered, it may be thought fu- perfluous to add more refpeaing diuretics, or of diuretics united with cathartics ; but every praaitioner is ready to acknowledge, that .in protraaed cafes a change of medicine is frequently required. Dr» GENERAL swellings. Dr. Duncan, in his valuable commentaries, tranfmits the following : R, Refin. Jalap, v. o. folut. gr. 10. Sal. Nitri ^j. Sal. Succin. vol. gr. 10. Sir. s. Aq. Cinnam, aa. |fs. M. m. s. et alternis diebus repet. Refin of jalap ten grains ; diffolved in yolk of egg ; nitre one fcru- ple ; volatile fait of amber ten grains ; fimple fyrup and cinnamon water, of each half an ounce ; to be taken every morning. This proves a powerful diuretic, when the fimple diuretics fail. To this gentleman we are indebted for introducing to ©ur notice the laauca fcariola, the extraa of which Dr. Collin of Vienna has given with fuccefs, in the dofe of from two grains to five, four times a day. This he in- forms us evacuates from one to twelve pints of urine du- ring the night, and he adds that it is a mild aperient and grateful to the ftomach. Digitalis has been ftrongly recommended by Dr. Withering, who had given it in 163 cafes, and in many of them with manifeft advantage; but as in the hands of Dr. Ferriar it claims only eleven cures out of twenty nine cafes, in which it was fairly tried, and in the extenfive praaice of Dr. Lettsom it "never perfeaed one cure ; we have little reafon to expea great things from it in dropfy. Yet as it finks the pulfe in a degree unobferved in any other medicine, I wonder that it never has been tried inpleuritis. A conftant naufea might be kept up with it for days, and fhould it prove either emet- ic or cathartic, no danger could be apprehended from fuch operation. Diaphoretics have been fometimes ufeful, and exercife. promoting perfpiration, feldom fails to produce a good effea ; for which reafon Hippocrates particularly recom- mends hard labour. Dampier in his voyages relates, that one of his men having a dropfy, was buried up to the neck m hot fand, which brought on ftrong fweat and cured him. Dr. Marryat fometimes purfued this plan. lie gave opium and ipecacuanha, of each four grains, with vit- nolated mercury two grains, and made his patient fleep between the blankets. ■ Dr. Uv.gh Smith frequently gave purified opium two grains, general swellings. 425 grains, with three or four grains of emetic tartar, to whicji he occafionally added five grains of camphor, and twenty of gum guaiacum, made into a bolus with common fyrup. This certainly is a good compofition, and in his praaice it was remarkably fuccefsful. II. The fecond indication may be anfwered by a gener- ous diet, good air and exercife, with bitter aromatics, bark and fteel. Such is the efficacy of a generous diet, that I have known poor people cured by this alone. In thefe cafes the ftimulus of animal food and wine is new, and there- fore has the fame tonic power on them as bark, fteel, and opium, have on the exhaufted fibres of the rich. Nothing, however, contributes more to vital energy, or more powerfully excites to aaion, the whole of the abforbent fyftem, than pure air with exercife. Yet medicines are not to be negleaed. For when the ferous fluids are evacuated, we muft haften by every means to invigorate the fyftem, or they will foon collecT: again. Sydenham, as a tonic, recommended a diet drink of bitter and aromatic herbs infufed in either ftrong ale or wine. Thefe were horfe radifh, worm wood, garden fcurvy grafs, fage, leffer centaury, and broom tops. To them he fometimes added nutmeg and orange peel. The fame intention may be anfwered.by the following, or by fomething fimilar. R, Rad. Columb. dr. 4. Quaffiae. Caiuae lig. aa. dr. 1. Aq. fer- vent, lib. 1. Macera per no&em et Cola. Co^itu:^, adde Eif. Lignor. dr. 4. f. M. c. c. un, 4. bis vel ter in die. Our principal dependence muft be on fteel, as the moft powerful of tonics. This Sydenham, this Boerhaave-, Hoffman, and all fubfequent profeffors, have uniformly recommended in the ftrongeft terms for dropfical com- plaints ; and with this Peruvian bark may be profitably joined. Boerhaave combined them in this form : R, Limat. Ferri. Cinchon. Cort. Winteran. aa. gij. Rhei exiic. dr. 4. Vin. Rhenani generofiffimi ft, 4. f. Infuf. c. c. |ij. ter in die. Iron filings, Peruvian bark, Winter's bark, of each two ounces; ftrong Rhenifh wine, two pints. Take two ounceb of this infu- fion three times a day. If the form of an eleauary is preferred, we may fub ftirute the following : F F f R> C:i.,h^ 426 GENERAL swellings. R, Cinchon. £j. Limat. ferri. tyv. Mucil. Gum. Arab. q. s. f. Elecl;. c. c. m. N. M. bis in die. Peruvian bark one ounce ; iron filings four fcruples ; mucilage of gum arabic, fufficient to make an electuary. Take the fize of a nutmeg twice a day. One obfervation more will conclude what I had to fay of dropfy. It has been ufual to limit the quantity of drink, and fometimes a total abftinence has been required by thofe, who, with Sydenham, confidered the colleaion of watery fluids as the proximate caufe of this difeafe ; but fuch reftraint is not agreeable to reafon, nor is it warranted by careful obfervation. Nature pleads power- fully for diluting liquids, and many cafes have been pro- duced of dropfy cured by gratifying this importunate de- fire, whilft no inftances appear of injury received by mod- erate indulgence. Even Hoffman, although he forbade his patients to fatiate their thirft, yet, particularly orders that all diuretics fhall be plentifully diluted either with whey, with parfley water, or with old hock. It muft be acknowledged, that a total abftinence from liquids fets the abforbents to work, and thus it was, that the two afcitic patients, mentioned by Dr. Mead, were cured. But then it muft be confidered, that the ferous fluids colleaed in dropfical cafes become frequently fo vifcid and tenacious as to flow out with difficulty, when the patient has been tapped. In fuch cafes, therefore, plenty of diluting liquids muft expedite the cure. Thus it was with him whofe cafe Sir John Flo ye r has report- ed. This man, when given over by his phyficians, hav- ing obtained leave to quench his thirft, was, at the end of five or fix hours, fatisfied that he had drunk enough. A cold fweat came over him, and his friends laid him in bed for dead. But in the fpace of half an hour his urine began to flow, and flowed inceffantly till he had evacuated one half of what he drank. He opened his eyes and called for wine, drank it and went to fleep ao-aiii. But whilft he flept, the flux of urine was inceffant; he had copious perfpiration, and a difcharge of aqueous fluid from the rea.im. In lefs than a week this man, drink- ing freely, was, without any other medicine, reftored to health. Genus. general swellings. 427 Genus LXVIII. Hydrocephalus externus. Distinguished by an external fwelling of the head, foft, and not elaftic. It is the difeafe of infants. As the water is colleaed between the fkull and its in- teguments, the cure is obvious, for it may be eafily per- formed, either by punaure, by fcarification, or by cauftics. Hydrocephalus internus, although, in deference to the authority of my venerable mafter, already included in the clafs of neurofes, belongs rather to the cachexie. My reafons for this opinion are the following : 1. Becaufe the difeafe confifts of a preternatural col- leaion of ferous fluids in the ventricles of the brain, pro- duced by difproportionate aaion between the exhalants and abforbents. Therefore, whether it arife from cxcefc of exhalation or from deficient abforption, it is certainly an affeaion of the lymphatic fyftem. 2. Becaufe the laffitude, pain in the head, drowfinefs, and dilated pupils, which charaaerize hydrocephalus in- ternus, although nervous affeaions, are not the difeafe itfelf, but merely fymptoms. 3. Becaufe this difeafe is cured by medicines which are commonly reforted to in the cachexise, and not in the neurofes. Genus LXIX. Hydrorachitis. A dropfical tumour in new born infants, commonly on the lumbar vertebras, foft, fmall, and with a dilatation of the vertebra. It is not however abfolutely confined to the lumbar vertebrae, for it has been found both in the dorfal ver- tebras, and in the facrum. The lymph in this tumour is derived from the fourth ventricle of the brain, where it conftituted hydrocephalus internus, and from thence defcending between the tunica arachnoides and the vagina of the fpinal marrow, which is a' prolongation of the dura mater, it diftends this mem- brane, and with it penetrates the vertebra. This in new born infants is not difficult, becaufe the annular part is compofed 42S general swellings. compofed of two diftina bones united pofteriorly by a ligament. From this effea, Ruyfch, after the Arabians, calls the difeafe in queftion fpina bifida ; but Morgagni, with greater propriety, has named it, from two,Greek ex- preflions implying water in tj|ftfpine hydrorachitis. This dreadful difeafe hashitherto eluded all the re- fources of art, for in vain the medicines ufed in dropfy have been reforted to, and to punaure the tumour is in- evitable death. Hence it is, that infants attacked by it, whether before or foon after their birth, foon come to the period of their exiftence. Yet, amidft multitudes who have lived for a few days only in this terrible difeafe, my friend M. Gimbernat attended one, a lovely youth, who completed his fifteenth year before he died. The tumour, which was on the fuperior part of the facrum, was at his birth no bigger than a hazel nut, but by degrees it grew to the fize of a hen's egg, when it became difficult to avoid compreflion. At this period he was brought to Mr. Gimbernat, who obferving that when the tumour was compreffed, whether by accident or by defign, the boy firft complained of head ach, then felt vertigo, after that became lethargic, and fo continued till the preffure was removed ; he contrived fn inftrument, which at once proteaed the tumour from external injury, and by means of a fpring made fuch preffure on the part as the boy was able to bear without either pain or lethargy. The defign of this preffure was7 to promote abforption, which effect it produced to fuch a degree, that the tumour decreafed in fize, and the fixed pain in the centre of his head, of which he before complained, had left him. Thus relieved, the boy negkaed to call from time to time upon his furgeon till the leather covering of the in- ftrument was worn out, and the iron circle had ulcera- ted the tumour; in confequence of which the lymph was fuddenly difcharged. M. Gimbernat and his fon, from whom I have this relation, were inftantly called in. They found him f'enfe- lefs, with a very quick pulfe, and violent convulfions, particularly in his lower extremities. They obferved likewife, GENERAL SWELLINGS. 429 7ikewife, that a very confiderable quantity of a limpid fluid, exceedingly faline, had been difcharged, and was then flowing to a moft aftonifhing degree. They applied ftrong flicking plafter to the opening of the tumour, and no fooner was the communication with the external air cut c?, than the patient began gradually to regain his fenfes; but the convulfions, chiefly of the lower extremities, ftill continued, and he complained in- ceffantly of excruciating pain in the interior of his head. In a few hours the quantity of lymph colleaed in ihe- tumour was fo great, that the flicking plafter, although affifted by fomentations with calcined alum, was carried off. No fooner was the communication renewed between the atmofpheric air and the brain through the vertebral canal, than lethargy returned and continued, till frefli plafters were applied, when, as before, the excruciating pain in the interior of his head produced inceffant lam- entation, till at the end of two days he died. On diffeaion, the bones of the head, by a preternat- ural accumulation of blood, were found livid and much difcoloured : the dura and pia mater were much infla- med, and the fourth ventricle was fo much dilated as eafily to admit the introduaion of the thumb, but the other ventricles were in their natural condition. The tumour was fituated on the pofterior part of the facrum, through an opening which arofe from defea of oflification, and its cavity communicated with the fourth ventricle jhrough the vertebral canal. All thefe parts tare to be feen in M. Gimbernafs mufeum. From this beautiful cafe we may fee clearly the nature of the difeafe in queftion, and the means by which we may attempt the cure with fome profpea of fuccefs, Thefe are the exhibition of fuch medicines as are ufually recommended in fimple cafes of hydrocephalus internus and external preffure, gradually and moft cautioufly pro- duced with a view of exciting the abforbents to more vig- orous aaion. If thefe fail to reduce the tumour, the cafe is defperate arid admits of no relief. Genu> 43° GENERAL SWELLINGS. Genus LXX. Hydrothorax. Dropfy in the Cheft. The fymptoms are difficulty of breathing, palenefs of face, cedematous fwelling of the feet, fcarcity of urine, impatience of an horizontal pofition, fudden ftarting from fleep with palpitation, fluauation of water in the cheft. Sometimes there is cough, numbnefs in the arms, in- termitting pulfe, thirft, and feverifhnefs. This colleaion of ferous fluids may be either in the cavities of the thorax, in the pericardium, in the cellu- lar texture of the lungs, which furrounds the bronchiae, or in all of thefe at the fame time, but between thefe feveral cafes the difcriminating fymptoms have not been afcertained. It acknowledges the fame caufes with anafarca ; but the moft ufual fource, from which it is derived, is the fudden application of cold when the body has been much heated by mufcular exertion. Hence it is that reapers, hence that young people after dancing, if they drink freely of cold lemonade or water, are apt to bring on a dropfy of the cheft. Boerhaave particularly flates, that in Holland, where the wherries, when the bell rings, are punaual in their departure to a moment, paffengers who arrive too late, frequently run to overtake the boat, heat themfelves exceedingly, and, bathed in fweat, enter the veffel, where they take their feat, expofed for hours to the ftroke of the cold winter's blaft. The confe- quence of this indifcretion, he remarks, is moft often afthma, which terminates in dropfy of the cheft. The indications of cure are the fame as for anafarca. Dr. Ferriar informs us, that among his 43 hydropic patients, of whom he cured 33 with cream of tartar, fome had hydrothorax. There can be no doubt, that if the abforbents are excited to vigorous aaion by confent. and if the tone of the fyftem is reftored, hydrothorax,' like every other fpecies of dropfy, may be effeaually relieved. This therefore fhould be attempted firft. And, when we call GENERAL SWELLINGS. 43 J call to mind the experiments of Dr. Mufgrave, already mentioned and recorded in the Philofophical Tran fac- tions for 1683,' we can nave no reafon to defpair. Should however medicines fail, we may fafely have re- courfe to tapping ; and the paracentefis, althojjgh it can- not remove the caufe of this difeafe, may at leaft procure a refpite, and give both nature and the phyfician time to exert new efforts. This operation, recommended by Hippocrates, although not infallible, is frequently at- tended with fuccefs. The inhalation of vital air has been found of the greateft fervice in this difeafe. Genus LXXI. Ascites. Dropfical Swelling of the Abdomen. The fwelling is tenfe, fcarcely elaftic, but fluauating. When confiderable it has thirft, fcarcity of urine, and fome degree of fever. SECTION I. Of the Caufes of Afcites. It has the fame caufes, both proximate and remote, with anafarca ; but the moft ufual fource from which it is derived, is morbid affeaion of the liver, occafioned either by the fudden aplication of cold, when the body has been heated, as I remarked in hydrothorax ; by in- dolence and a fedentary life ; by the abufe of acids ; by the unfeafonable exhibition of powerful aftringents in haemorrhages and intermittent fevers, or by hard drink- ing. In cafes of afcites, it is not uncommon to obferve the fpleen, the pancreas, and the mefenteric glands, as well as the liver, enlarged and fcirrhous ; but in the opinion of Hoffman, the former are affeaed merely by confent with the latter, which is the vifcus firft injured by intemperance. Sauvage has no lefs than 29 fpecies of afcites, which Dr. Cullen has very properly reduced to two, afcites abdominalis and afcites faccatus. \. Afcites 43* GENERAL SWELLINGS. i. Afcites abdominalis with uniform fwelling of the abdomen and evident fluauation, preceded commonly by fymptoms of relaxation and debility. 2. Afcites faccatus with fwelling of the abdomen, at firft partial, and lefs evident fluauation, not preceded by palenefs, reftleffnefs, lofs of appetite, or other fymptoms of relaxation and debility, nor attended by either much thirft or paufity of urine. It is confidered as incurable in this fpecies ; the fack is generally formed by a collec- tion of hydatides. 'Hydatides are membranaceous bags, not organic, but foluble in boiling water. They are produced by the tenia hydatigena for its habitation, and each veficle is filled with lymph. Van Swietena Comment. § 112% § I226\ SECTION II. Of the Indications of Cure in Afcites. The indications of cure in afcites abdominalis are the fame as for anafarca. In this difeafe the Batavian Hippocrates, treading in the footfteps of our Sydenham, more particularly recom- mends emetics, to fhake the whole frame, to open ob- ftruaed veffels, to render their contents more fluid, and to prevent ftagnation. Per vomitus folvuntur cuncla tenacia, concutiuntur obftrucla, expelluntur ftagnantia, unde mirabiliter in hoc morbo profunt, § 1244. He adds, they muft be ftrong, and often repeated at fhort intervals. With this view Sydenham gave crocus metallorum ; but any other antimonial calx, in fufficient quantity, is equal- ly as good. Yet in either debilitated or very irritable habits he, with the greateft propriety, forbids the ufe of drafti- evacuants, and recommends tonics with gentle diuretics. Hoffman agrees with him in fentiments. No advice can be more judicious, than that of the late f/; FA°lHERG*LL- Str?nS Purgatives, fays he, weaken and deftroy the tone of the abforbent fyftem. Squills, alkahnes, neutral falts, and terebinthinate balfams, fhould be GENERAL SWELLINGS. 433 be firft tried ; then, if ne^d be, tap, and after that give fquills, chalybeates, bitters, with exercife and a generous diet. Under this management he pleads for early tap- ping. In this he perfeaiy agrees with Boerhaave, who in recent cafes of afcites fays ftatim inftituenda par- acentefts. It fometimes happens, that nature, without the afliftance of art, takes this method to relieve herfelf. Schenkius in his medical obfervations produces many examples of fuch an effort, by which the navel gave an outlet to the waters, and thus perfeaed a cure. Other inftances are related by Benevoli and Foreftus. But the moft curious cafe is reported by Dr. Mead, in his Mon- ita Medica. The Doaor, who had feen one lady tap- ped fixty times before fhe funk into the arms of death, was confulted by another, whom, as being in a ftate of extreme debility, he was afraid to,tap. She was fo big, that he pronounced her cafe incurable ; yet nature came to her relief, and made two perforations near the navel, by the firft of which fhe paffed twelve pounds of water, and by the fecond, the next day, fix pounds more. The cure was perfeaed, and nature healed the wounds. This procefs is beautifully explained by John Hunter in his ineftimable treatife on inflammation, wherein he fhews that, according to an eftablifhed law of the ani- mal economy, fuch apertures are produced by the ab- forbents, when they are drawn into aaion by the ftimu- lus of preffure. It fometimes happens, that inftead of water in the cav- ity of the abdomen, there is only a gelatinous matter. In this cafe the paracentefis gives no relief, becaufe it comes too late, and the only refource is in emetics, which, by agitation and concuflion wafh away tenacious lymph from the mouths of the abforbents, and powerfully, as already ftated, increafe their aaion by confent. SECTION III. Cafes of Afcites. Sydenham has left the record of a moft interefting cafe, which exhibits to our view the wonderful operation ef emetics. Gog A. 434 GENERAL SWELLINGS. A poor woman, aged 55, Being fliut up three years in prifon, after fhe had fuffered much by a protra£led intermittent, and being expofed to cold, became afcitic to fuch a degree,, that her belly was bigger than Syden- ham had ever feen. In this fituation he began with an- timonial emetics, which he repeated every morning for three days, then every other day till fhe had taken fix emetics. When fhe began this courfe, her urine was to- tally fuppreffed, but increafed gradually in proportion to the number of emetics, and towards the conclufion of this procefs water flowed freely by very outlet of the ► body. In fourteen days fhe meafured three feet lefs than fhe had done before, and could lie down in bed to fleep without fear of fuffocation. When he thought it no longer fafe to harrafs her ftomach with emetics, he pro- ceeded with cathartics in proportion to her ftrength. And here he had occafion to obferve, that even on the days of refpite, when fhe took no cathartic, fhe fome- times evacuated a great quantity of water by ftool, and towards the clofe, by the urinary duas, even to the quan- tity of a gallon, although he allowed her only two pints a day, fo that all the paffages were open. But what is ftill more remarkable is, that the menftrual flux, which had difappeared for many years, returned and flowed abun- ' dantly. The confequence of all thefe evacuations was hyfteria with tympanites, and tuffis ferina : but all diftreffing fymptoms were effeaually relieved by refiing from ca- thartics, and by fyrup of white poppies in the dofe of one ounce and an half given every night for four nights. The following cafe will be found very interefting : Sarah Kimber, aged eight years, had her belly very much diftended, and upon preffure there was an evident fluauation of water. This diforder had fubfided more than two years, and went on conftantly in- creafing, till her phyfician (Dr. Myers) gave up all hopes of her fur- viving many days ; in this ftage of the difeafe, Dr. Thornton was confulted. He began with an emetic, and the fubfequent day he gave a brifk cathartic of rhubarb with neutral fait. He applied a ii^ht bandage of flannel about the abdomen, and ordered the ftrong mercu- rial ointment to be rubbed in each evening. He put her upon milk diet, with onion and toafted bread for fupper. In a few days the emetic was repeated, and when the mouth became fore, fhe had for two GENERAL SWELLINGS. 435 two mornings brifk faline cathartics. He then gave bark and myrrh in port wine twice a day, affifted in their operation by the inhalation of vital air. Thefe powerful tonics were accompanied with fwinging until naufea or ficknefs was produced, and at night fhe took half a grain of opium. At the end only of ten days the belly was diminifhed more than one half. After fifteen days, emetics at intervals, with faline cathartics, and the mercurial ointment, were repeated ; the opium pill at night, and the tight bandage were ftill continued. Chalybeates were then thrown in, and the emetics with cathartics were employed at more,diftant intervals ; in confequence of which her complexion affumed the rofy blufh of health, and the difeafe was perfectly removed. Genus LXXIL Hydrometra. Dropfy of the Womb. The fymptoms are a fwelling in the hypogaftrium without fuppreflion of urine or pregnancy, attended with fluauation, and having fome refemblance to the gravid uterus. To thefe fymptoms Sauvage has added borborygmi, dyfpncea, uncommon fcetor of the ftools, obftruacd catamenia, pain in the abdomen and the loins, noc- turnal pollution, rigor, febrile fymptoms, foftnefs and flaccidity of the breafts, and difficulty in either walking or bending the body forwards. This affeaion of the womb is fometimes the confe- quence of abortion, when the placenta is left behind, for this may degenerate into a congeries of hydatides : but the unmarried and the barren are more fubjea to it than the parturient. With regard to the treatment, Boerhaave obferves, curabilis laxatione oris uterini per fomenta, vapores, uterina adhibita. For the fomentation he recommends the aro- matic herbs, and as uterine ftimulants he mentions the ufual emmenagogues, aloes, myrrh, briony, gum ammo- niac, fagapenum, opopanax, galbanum, and afa fcetida. When, inftead of the uterus, the ovaries are attacked by dropfy, it is difficult to fettle the diagnofis, and the difeafe is confidered as incurable : difficulter cognofcitur9 curatur vero nunquam Boerhaave, Aphor. § 1223. Genus 43^ GENERAL SWELLING'S. Genus LXXIII. Hydrocele. Dropfy of the Scrotum. A tumour of the fcrotum increafing flowly without pain ; fluctuating and generally pellucid. The ferous fluids, which caufe this tumour, may be contained either in the cellular tunic, as in cafes of anaf- arca ; in the hernial fack, produced from the peritonae- um, when hernia and either tympanite or afcites have preceded ; or in the vaginal tunic of the tefticle, which is the moft common form of hydrocele. In the firft cafe the difeafe may be treated as anafarca. In the fecond cafe the tympanites or the afcites muft be cured, and then the hernia muft be reduced. In the third cafe, if recent, Boerhaave and his com- mentator recommend cathartics, as in anafarca and af- cites, or difcutient cataplafms and fomentations, for which purpofe they propofe the following : R, Rad. Bryon. Jal-p. Fol. Rutae, Abfinth. Cinaras Hortenf. Flor. Melilot. Centaur Min. Bulb. Cepar. Allior. aa unc. 2r Aq. font. q. s. ut fiat Cataplafma, fub finem, adde Galbani v. o. s. unc. 2. Farin. Lini. unc. I. Ol. Lini. Sal Ammon. aa dr. 4. M. f. Cataplafma difcutieus tefticulis applicandum. R, SapoH. Venet. dr. 4. Sp. Vini Theriacal. un. 12. M. pro fomento cum laneis pannis applicando. R, Sal. Marin. Decrepit. Sicciffimi, Calidi, tenuiffime triti, q. s. intra lintea confuta applicetur renovando finml ac maduerit. R, Benzoin. Olibani, Sarcocollae, Refin. Guaiac. aa dr. 4. Cam- phor. dr.£. Maftich. un. 1. Sal. Ammon. fcr. 2. M. f. Pulv. Cujus incenfi vapor excipiatur nudo fcroto, dein panni laneifumo hoc vaporofi, calidi, fuper applicantur. From long experience I can venture to affirm, that a fufpenfory trufs, fo contrived as to prefs the fcrotum clofely againft the os pubis promotes abforption, and radi- cally cures, without the afliftance of the knife. For this purpofe, by means of a waiftcoat, I fufpended the trufs from the moulders, becaufe the girdle alone does not fuf*- ficiently fupport it. But fhould thefe applications have been too long neg- leaed, the hydrocele muft be tapped. This operation frequently effeas a cure, fometimes at the firft tapping, often by a repetition. But fhould this fail, the tefticle may GENERAL SWELLINGS. -k':> may be laid open, or red wine and water may be inje&- ed, which will briiy on adhefive inflammation, and the parts will heal. My refpeaed friend, Mr. Gimbernat of Madrid, has a method peculiar to himfelf, which he affured me, in his extenfive praaice had never failed to cure with lit- tle confinement to the patient. He paffes a filver trocar, of the fize of a goofe quill, through the fcrotum, and having withdrawn the perforator, he leaves his perfora- ted canula fufpended in the fcrotum. When the water 4 is evacuated, he blows in air twice a day, and, leaving it for ten minutes in the fcrotum, he then preffes it out again. In about ten days the parts unite by the adhefive inflammation, and he removes the canula. The patient is at liberty, all the time required for this operation, to *valk about his room. Genus LXXIV. Physconia. Tumour occupying the abdomen, increafing flowly, and neither fonorous, nor fluauating, nor induced by pregnancy. Sauvage enumerates no lefs than 15 fpecies of phys- conia, the denomination of which he derived from ana- tomical infpeaion, and for which he refers either to his own obfervations or to thofe of the moft expert patholo- gifts. Thefe are, 1. Phyfconia hepatica. 2. P. fplenica. 3. P. rcnalis. 4. P. uicrhia. 5. P. ab ovario. 6. P. mef- enterica* 7. P. innftinalis. 8. P. omeidalis. 9. P. polyfplach- na. 10. P. vifcera lis. 11. P. externa kipiaiis, 12. P. exter- na fcirrhodea. 13. P. exXtnaihydatUicfe. 14. P. ab adipe fubcutaneo. 15. P. ab excrefceniia. Of thefe tumours fome were fimple, a. Hydatidofa. b. Strumofa. c. Sarrhodea. d. Sarcoma a. e. Suatmnaiofa. f. fungofa, or compound tumours ; but unfortunately we have no pathognomonic fymptoms to diftinguifh the fpe- cies from each other, nor can we afcertain precifely the nature and the feat of the diforder, till thefe circumftan- ces are difcovered by the knife. Br. Cullen has adopted all thefe fpecies from Sau- vage; ^28 GENERAL swellings. vage ; but neither of thefe profeffors have ventured to fuo-geft any thing refpeaing the indications of cure. If the tumour is fuppofcd to be fcirrhous, that is itfelf a oenus: if it is fat, we muft confider it as a fpecies of polyfarcia: if it is caufed by hydatidcs, it belongs to afcites. Genus LXXV. Rachitis. Rickets. The fymptoms are large head ; prominent forehead j protruded fternum ; fwelled joints ; flattened ribs; big belly -, emaciated limbs ; great debility. SECTION I. Hiftory and Progrefs of Rachitis. It is ufually confined in its attack between the two pe- riods of nine months and two years of age, feldom ap- pearing fooner than the former, or fhewing itfelf for the firft time after the latter period. The mufcles become flaccid, the head enlarges, the carotids are diftended ; the limbs wafte away, and their epiphyfes increafe in bulk. The bones and fpine of the back are varioufly diftorted ; difinclination to mufcular exertion follows ; the abdomen fwells and grows hard ; the ftools^ are fre- quent and loofe ; a flow fever fucceeds with cough and difficulty of refpiration. Atrophy is confirmed, and death enfues. Frequently it happens, that nature reflores the general health and leaves the limbs diftorted. After death, the liver and the fpleen have been* found enlarged and fcirrhous ; the mefenteric glands indurated, and the lungs either charged with vomicae or adhering to the pleura ; the bones foft, the brain flaccid or oppreffed with lymph, and the diftended bowels loaded moft fre- quently with flime, fometimes with worms. See Van Swieten, Comment. § 14,85,6. It is remarkable, that in the kindred difeafe, which Hoffman and Sauvage call the atrophy of infants, we have many of the fame fymptoms, and the fame appear- ances nearly after death. They who perifh by this dif- eafe, GENERAL SWELLINGS. 439 cafe, fays Hoffman, have the mefenteric glands enlarged and fcirrhous; the liver and fpleen obftruaed and in- creafed in fize; the inteftines are much inflated and are loaded with black and fcetid matters, and the mufcles, more efpecially of the abdomen, wafle away. They have the fame predifponent, the fame occafional caufes, and the fame indications of cure. SECTION II. Of the Caufes Remote and Proximate of Rachitis. The predifponent caufe muft be fought for in laxity and debility, as more particularly obferved in the chil- dren of enervated and vicious parents, and in thofe whofe nurfes are oppreffed with poverty. See Boerhaave's Aphorifms, § 1482. The occaflonal caufes may be traced to diet, bad air, humidity, previous difeafe, and want of exercife. It is effential to the health of infants, that they fhould be kept clean, regularly fed, well exercifed, and breathe frefh air. All their motions fhould be governed by the clock. Yet, if the parents were hyfterical or fcrophu- lous, and of an irritable fibre, the children, even with the beft nurfing, may be delicate, relaxed, and fubjea both to troublelome acidities, and to morbid affeaions of the alimentary canal. In this cafe they fhould have frequently magnefia and rhubarb, or teftaceous powders ; and to the negka of fuch precautions we mufl attribute the dif- eafe in queftion. Dr. Cullen, for the proximate caufe of rickets has afligned deficiency of bony matter in the fluids, which, fays he, in fome meafure depends upon a general laxity and debility of the moving fibres of the organs that perform the funclions of digeftion and aflimilation. My opinion virtually coincides with his. The proximate caufe afligned by Hoffman for his atrophia infantum is deficiency of nutrimental juices, which he fuppofes to depend on depraved digeftion, ill conditioned chyle, and obftruaed laaeals ; and then he adds, £ Limat. Martis §j. Aceti Stillat. acerrimi ^x. Sacchari ^iij. In phiala alta ebulliant leniter fpatio 26 horarum, filtratus liquor fervetur vafe claufo. Datur gtt. vj. horis njedicis quotidie ex pauxiilo vini hifpanici. Filings of iron one ounce ; ftrongeft diftilled vinegar, ten ounces ; fugar three ounces. Let thefe boil gently in a tall vial for twenty fix hours. The filtrated folution is to be kept in a clofe veffel, and fix drops may be given three times a day in ftrong white wine. Boyle's Ens Veneris is not a preparation of copper, as the name feems to imply ; but is moft undoubtedly pro- duced from green copperas (ferrum vitriolatum) by means of fal ammoniac. Mr. Boyle, on whofe veracity we may indulge the moft implicit confidence, affures us that he and his friends, including fome phyficians, cured two or three hundred children, and that aimoft always without the help of any other internal medicine or exter- nal application : yet many of thefe were in a defperate- condition. He gave from two or three grains to ten or twelve, and in fome cafes to twenty or thirty, and found it operate by urine and by fweat. This medicine may be prepared from iron filings with twice their weight of fal ammoniac, as firft recommended by Boerhaave and or- dered by the London college. It is thef en-urn ammoniacale, of which the common dofe is from fix grains to twenty. Hartmann's cacheclic powders, compofed of iron filings, cinnamon, and fugar, in equal parts, is certainly an approved medicine, and by a few grains of rhubarb may be rendered ftill more efficacious. Dr. Smith gave fteel in every form. Frefh air, exercife, and more efpecially cold bathing, fo much celebrated by Sir John Floyer, have frequent- ly alone been fufficient to effea a cure. Clafs TUMOURS AND ERUPTIONS. 443 Clafs III. CACHEXIA, Order III. Impetigines. Cachexia deforming the external parts of the body with tumours, change of colour, and eruptions. In this order we have nine genera ; fcrophula, fyph- ilis, fcorbutus, elephantiafis, lepra, frambcefia, tricho- ma, iaerus, chlorofis. Genus LXXVI. Scrophula. King's Evil. The fymptoms are fwelling of the lymphatic glands, chiefly in the neck ; thick upper lip ; tumid abdomen ; fmooth fkin; florid complexion, and obftinate ulcers. SECTION I. Hiftory and Progrefs of Scrophula. It appears moft often between the third and the feventh year, yet fometimes later, even to the age of puberty, particularly in perfons of a fine fkin, an irritable fibre and a relaxed habit. Frequently it has attended or has followed rickets, and we fee it apparently produced by fmall pox. The ulcers break out chiefly in thefpring, and are very commonly healed before the approach of winter. Thefe moft frequently are upon the fides of the neck below the ears ; but fometimes in other parts, par- ticularly about the joints. In fome 'patients we obferve only a tendency to opthalmia tarfi, or perhaps the upper lip tumid and deeply chapped. It is the difeafe of hu- mid climates. I never met with it in the fouthern prov- inces of Spain. Scrophulous tumours come on infenfibly, proceed flowly, do not readily produce the ulcerative procefs, and the formation of matter in them is not preceded by adhefive inflammation to limit their extent. Hence it is that fcrophulous colleaions of matter are always larger than they would have been if they had been either a con- fequence of inflammation, or attended by it. The 444 TUMOURS AND ERUPTIONS. The matter poured forth from fcrophulous tumours is not pus, but is generally a kind of vifcid ferum, and con- tains a curdly or a flaky fubftance, which, as John Hun- ter obferves, is the coagulating lymph deprived of its ferum ; nor is pus produced till inflammation is excited in the abfcefs and nature proceeds towards a cure. This feldom happens before the colleaion of matter has been opened, fo as to give it a free difcharge, for then inflam- mation comes on, and fpreads to a wide extent, and when the abfcefs is difpofed to granulate, it pours forth good pus; but when the fecreting veffels have loft either their tone or ftruaure, they are not difpofed to take on heal- ing aaion, and the difcharge is not true pus. Scrophulous ulcers have ufually their edges irregular, fmooth, and flat, without the leafl difpofition to contraa for a confiderable time, unlefs frefh ulcers appear in oth- er parts; fo that when one is healed, little progrefs is made towards the general cure. Sometimes thefe ulcers are difpofed to fpread, both in extent and depth, eroding cartilages, and affeaing the contiguous bones with caries, till the conftitution, haraffed inceffantly by fruitlefs ef- forts to relieve itfelf, is exhaufted of its ftrength and finks into a mortal heaic. On diffeaion the mefenteric glands are generally found to be difeafed, and tubercles are frequently dif- covered in the lungs. SECTION II. Of the Species of Scrophula. Sauvage enumerates eight fpecies; but Dr. Cullen reduces thefe to four : fcrophula vulgaris, fcrophula mef- ehteri'ca, izronhx&zfugax, fcrophula Americana. . i. Scrophula vulgaris, fimple, external, permanent. •To this fpecies the general defcription is more particular- ly applicable. It frequently terminates in phthifis. \ 2. Scrophula mefenterica, fimple, internal, with pale- nefs, want of appetite, tumid abdomen, and unufual fee- tor of the excrements. It terminates in atrophy. On 4ifTeaion the mefenteric glands are found to be difeafed. 3. Scrophula eruptions. 445 3. Scrophula fugax, moft fimple, and only about the neck, quickly yamfhing, and as fpeedily returning. It is occafioned, [ays Dr. Cullen, by ulcers in the head. Sauvage particularly ftates the drying*up of tinea, or the fudden ftoppage of a purulent difcharge from the ears of children, as the occafional caufe of ftrumous glands, and his ftatement is certainly well founded. But jieither of thefe profeffors have noticed a very common caufe of fcrophula fugax in children of an irritable habit, which is lice. Thefe vermin harbour much about the nape of the neck, and by their irritation occafion the glands in the vicinity to fwell ; but no fooner are they deftroyed than the fwelling of the glands fubfides. 4. Scrophula Americana combined with framboefia. The ftrumous fwellings are in the neck ; the black and fungous excrefcences are on the head. S E CTION III. Of the Proximate Caufe of Scrophula. From a confideration of all the fymptoms we cannot hefitate to agree with Dr. Cullen, that fcrophula depends upon a peculiar conftitution of the lymphatic fyftem ; but this conclufion will not affift us in our indication of cure. It is neceffary therefore to advance another flep. The proximate caufe then of fcrophula, as it appears to me, muft be either a lax, inert, and paralytic ftate of the lymphatics, or preternatural excitement of the exhalant arteries, of which debility and morbid irritability confti- tute the predifponent caufe. In either of thefe fuppofi- rions the effea will be fimilar, for ftagnation of the fecreted fluid and diftention of the glandular veffels muft be the confequence. SECTION IV. Of the Indications of Cure in Scrophula. If we fuppofe the proximate caufe of fcrophula to be a lax, inert, and paralytic ftate of the lymphatics; the indication will be, as in palfy, to reftore their energy by tonics. Should we however be more inclined to think that 446 eruptions. that preternatural excitement of the exhalant arteries is the caufe, we may vary the terms of our indications, but the remedies will be ftill the fame ; for here it will be required, i. To remove the ftimulating caufes whatever they may be. 2. To obviate the predifponent caufe, for which pur- pofe we muft have recourfe to tonics. Praaitioners have recommended a variety of medicines for the cure of fcrophula, and every one is partial to his own ; but all, who have been moft fuccefsful in their treat- ment of this difeafe, have adopted fuch as coincide with thefe intentions. When air, exercife, and a generous diet, with fea bathing, the Peruvian bark, and fteel, are ordered, it is obvioufly with a view to their tonic power ; and when cathartics are prefcribed, it is not for the pur- pofe of exciting the aaion of the abforbents by confent, nor fhould it be with the idea that they will be conveyed as deobftruents to the glands affeaed, but that by mod- erately cleanfing the organs of digeftion, and the mouths of the inteftinal abforbents, they may promote a plenti- ful fupply of wholefome chyle, which is the moft power- ful tonic ; nay, fuch a tonic, that with air and exercife fcarcely any other is required. Lord Bacon fays, nothing contributes fo much to longevity and health as frequent and domeftic laxatives. Dr. Russel fent his patients to the fea fide, and or- dered them to rub their glandular fwellings with the alga marina ; but we muft take efpecial notice, that he never omitted fea bathing, with fmall dofes daily of fait water, as a moderate cathartic. Dr. Garnet recommends Harrowgate water in fmaU quantities as a gentle cathartic, to be frequently repeat- ed. Mr. Morley of Effex, juftly celebrated for innume- rable cures, tied, with fuperftitious rites, a root of ver- vain on the breafl near to the cartilago xiphoides ; but then, it muft be obferved, he frequently repeated fmall dofes of cathartics joined with antimonials and the ex- traa of conium maculatum. Roncalli, eruptions. 447 Roncalli, who for ftrumous fwellings applied ox gall, nut oil, and fait, twice a day ; with this external application occafionally gave cathartics. Dr. Collin cured 41 cafes of glandular fwellings with hemlock, raifing the dofe from fifteen grains to twenty, three times a day. The late Dr. Fothergill preferred the extraa, two drams of which he made into thirty pills. Of thefe he gave two in the morning, two at noon, and four at night, increafing the dofe. He in- forms us in his works, that they promote reft, eafe pain, and procure a laxative ftool the day after they are taken. Thus exhibited they have no difagreeable effea, but change a thin corrofive ichor into good pus. The ftudent muft be careful not to be deceived, when he orders either the leaves or the extraa of conium macu- latum ; for, as Dr. Buckhave informs us, the ethufa cynapium, the cicuta verofa, the cherophyllumfylveftre, and the phellandrium aquaticum, with other umbellate, are fre- quently miftaken for the hemlock, and produce delete- rious, or at leaft moft diftreffing effeas. Dr. Marryat, of Briftol, ufed to give the following: 5> Merc. Muriat. gr. x. Acid. Muriat. gtt. 10. Vin. Antimon. gj. M. c. gtt. 20. bis die. Dr. Whytt, as a more rational praaitioner gave rhu- barb and calomel every fourth night in fuch a dofe as to procure two motions; or if that failed to cure, he order- ed an ounce of Spanifh foap to be taken daily to clear the glands, and Peruvian bark to brace the relaxed lymphatics. Dr. Fothergill did not in all cafes confine himfelf to hemlock, but frequently prescribed calomel and ful- phur auratum antimonii, of each one grain, to be taken every night with the following : R, Cinchon. gj. Coque in Aq. ftij. ad ftj. fub finem addendo Glycyr. incif. |fs. Colatune adde. Aq. Nucis Mofch. gij. M. hujus capiat Co. iij. cum. Tin&ur. Guaiac. vol. gtt. 20 ad gtt. 60, ter in die. Peruvian bark one ounce ; boil in a quart of water to a pint, and add liquorice root half an ounce ; filtrate and put to it nutmeg water two ounces. The dofe is three fpoonfuls with from twen- ty to fixty drops of volatile tinclure of guaiacum three times a 448 ERUPTIONS. Dr. Cullen fays little in favour of bark, and of botfe antimonv and mercury, in every fhape, he confeffes, that he never found them ufeful in this difeafe. Yet many of our moft eminent praaitioners, as we have feen, place their whole dependence on thefe medicines, and find them fufficient to effea a cure. Dr. J. Fordyce fpeaks in the higheft terms of the Peruvian bark, and Sir Clif- ton Wintringham agrees with him, but adds chalybeates to increafe its tonic power. The1 late Dr. Crawford recommended to our notice muriated barytes as at once an evacuant, deobftruent, and tonic, when given in dofes of two drops, and gradually increafed to ten drops of the faturated folution in a cup of water twice a day. In larger dofes, as he informs us, it produced naufea, vomiting, and purging : but Dr. Ferriar never found any fenfible effea from it even in dofes of twenty drops given twice or thrice a day. Elearicity has been efficacious, and may be tried with fafety. In cafe of white fwelling, the moft approved praaice has been to apply a large blifter to the knee, which was kept on for three or four days at a time, and frequently renewed ; but the inhalation of fuperoxygenated air feems to promife more effeaual relief. From what I have witneffed of the praaice of my friend Dr. Thornton, I am perfuaded, that in white fwellings and foul ulcers it^will greatly expedite the cure. For in this new mode of treatment with vital air, ener- getic aaion in the part is fupported by the fyftem, where- as in the old praaice, with external applications only, it is kept up for a fhort time by partial ftimuli on weak and difeafed veffels. But on this fubjea I fhall enlarge when I am to treat of ulcers. When medicines fail to effea a cure, a change of climate muft be recommended, and no climate, in my opinion, can be fuperior to that of Valencia, either for this difeafe or for that fpecies of con- fumption which originates in fcrophula. But independ- ently of climate, the cicuta certainly grows there in fuch perfeaion, as never yet has been difcovered in cicuta of our eruptions. 449 bur ifiand, and the phyficians have had fufficient expe- rience of its ufe in thefe deplorable complaints. Should the fcrophulous or confumptive patient be in- clined to make the trial, he will have an eafy route by Paris, Lyons, MontpeHier, and Barcelona, and for lefs. than fifteen guineas he will find himfelf tranfported into a paradife, in which nature exhibits an everlafling fpring. Genus LXXVII. Syphilis. Venereal Difeafe. The fymptoms are, after impure conneaion, gonor- rhoea, chancres ; noaurnal pain in the bones ; ulcers in the mouth and nofe ; cluftered pimples of a copper col- our, ending in fcabby ulcers, chiefly fituated near the hairy fcalp, with blotches on the furface of the body, often in the face. On diffeaion, the bones, particularly of the fkull, are found eroded like a honey comb. This difeafe, imported from America, made its firft ravages in the French and Spanifh armies at the fiege of Naples, in the year 1493, from whence it fpread with fuch aftonifhing rapidity, that within four years it reach- ed every part of Europe. In the year 1497, a procla- mation appeared in Scotland, ordering all who laboured under the grand gore, to quit the continent, and to re- pair without delay to a little illand in the Frith of Forth, where the king flationed furgeons to attend them. The introduaion of fuch a fcourge to the human race diffufed univerfal terror, yet the infeaion fpreads in eve- ry nation ; moft, however, among thofe who are leaft acquainted with its nature and its cure. We may confider the operation of the fyphilitic virus as either local or univerfal. 1. The local operation of the fyphilitic virus is inflam- matory, and muft be treated as fuch by adhering ftriaiy to the antiphlogiftic regimen. With this intention a vegetable diet muft be adopted with demulcents, and fuch cooling laxatives as are not apt to excite the aaion of the kidneys. I 1 i For 45° eruptions. For a demulcent, order a decoaion of either linfeed or althaea, with gum arabic or gum tragacanth, or the fubfequent compofition may be occafionally taken : R, 01. Olivarum. Gum. Arab. Syrup. Limom aa dr. 4. M. Should the inflammation run high, either apply leeches near the part affeaed, or let about twelve ounces of blood be taken from the arm. Dr. Whytt, as I remember, found it neceffary to take an hundred and thirty ounces of blood from one patient before he could fubdue the inflammation. But if by the neglea of thefe evacua- tions, ulcers fhould be formed in the urethra, corrofive fublimate much diluted muft be injeaed. When by the antiphlogiftic regimen the inflammation has fubfided, the ftrong mercurial ointment of the Lon- don Pharmacopoeia may be rubbed on the perinaeum, and either the pilulse hydrargyri, or fmall dofes of calomel, may be prefcribed, at the fame time cautioufly avoiding falivation. The fubfequent compofition has been much recommended. R> Merc. Muriat. gr. 10. Acid. Muriatic, gtt. 10. Tinft. Lavend. comp. unc. 1. M. The dofe is from ten to thirty drpps morn- ing and evening in water gruel, with two fcruples of gum arabic. Should a purging be induced by this quantity, the dofe muft be diminifhed, and at all events the patient muft take plenty of dilu- ting liquids, and a free perfpiration muft be encouraged. After fuch evacuants, the cure muft be perfeaed by tonics. 2. When the operation of the fyphilitic virus is ex- tended to the whole fyftem ; the difeafe then by foul ulcers and eruptions on the fkin affumes its cacheaic form, and vindicates its claim to rank with the impetigines. In this cafe it requires fomewhat of a rougher treatment by mercurials externally and internally, exhibited with a more liberal hand, yet fo as not to bring on falivation. With this intention Dr. Wright of Jamaica prefcribed the following, and in four or five weeks perfeaed his cures : R Gum. Guaiac. 5x. Serpent. Virgin, giij. Pimento. 5ij. Opii, Si Hydrargyr. Muriat. 3fs. Sp.Vin. Reft. fty. Digere per tres dies. Cola. c. Co. ij. paro in decod. Sarfaparil. ftj. bis die. Dr. H. Smith ufually gave calcined mercury two grams, with three or four grains of fulphur of antimony, to eruptions. 451 trj which he added purified opium one grain, made into a bolus, to be taken every night at going to reft, and in his experience he found this cured with as much certain- ty as a falivation. An Italian phyfician, who was intimately acquainted with Dr. Cirillo of Naples, in the year 1782, has been fo kind as to communicate to me his celebrated ointment for the lues, by which this eminent praaitioner had then cured more than five thoufand patients, of whom fcarcely one had ptyalifm. Take corrofive fublimate, two drams, hog's lard well wafhed, two ounces ; mix them thoroughly by long continued triture in a marble mortar. Of this ointment half a dram muft be rubbed into the foles of the feet for three days fucceffively, and muft be then intermitted for one day. In the mean time the patient may take extract of the gums. Thefe frictions muft be contin- ued till all the fymptoms vanifh. To prevent a falivation, perfpiration is to be encour- aged and cathartics muft be occafionally interpofed. But ihould thefe precautions prove infufficient, recourfe may be had to fulphurated kali, in the manner communicated to Dr. Beddoes by his ingenious correfpondent Dr. Thomas Garnet of Harrowgate. This gentleman affures us, that he has tried it feveral times, and that he has never feen it fail to abate the falivation to a confid- erable degree in 24, or at moft in 48 hours. The new chemiftry throws much light upon this interefting faa, and enables us clearly to fee the modus operandi. For, as Dr. Garnet has .obferved, the fulphurated hydrogen, refulting from the decompofition of water by kali ful- phuratum, is conveyed into the blood, and there the hy- drogen, uniting with the oxygen of the mercurial oxyd, forms water, whilft the fulphur converts the mercury into an sethiops which is inert. Dr. Duncan in his valuable publication mentions a Dr. Thusink, who gives opium in confiderable dofes, and informs us, that in Lifle five hundred patients had been cured by it alone. Time will difcover whether this high charaaer of opium is well founded. But the moft interefting communication is the cafe of a wealthy merchant, for which we are indebted to my ingenious 452 eruptions. ingenious friend Dr. Thornton. When this Proteus difeafe, as he properly flyles it in his letter to Dr. Bed- does, had laid afide its inflammatory form,, and appeared for two years in its cacheaic charaaer, with an ill con- ditioned ulcer in the lungs, dreadful blotches on the fkin, and other moft diftreffing fymptoms of debility, Dr. Thornton made him infpire fuperoxygenated air whilft he was taking muriated mercury, ftrong decoaion of cinchona with the bark in fubftance, affifted in its tonic power by two grains of opium every night. By this plan, the cure of this deplorable cafe was per- feaed in fix weeks. This cafe feems to confirm the hypothefis of Dr. Gir- tanner, who attributes the antifyphilic effeas of mer- cury to oxygen, and the incidental cure of lues by Mr. Scott, furgeon, at Bombay, in 1793, whilft he was giving nitric acid for difeafes of the liver, adds weight to this opinion. Encouraged by thefe recorded faas, Mr. 1 Cruickshank of the Artillery, exhibited oxygen in various forms. 1. One ounce of lemon juice in three ounces of water, being adminiftered from three to eight times a day, cured chancres and buboes in lefs than feven weeks. 2. Concentrated nitrous acid, from one to three drams a day, well diluted with water, cured in three weeks. 3. Oxygenated muriatic acid, from five to fifty drops in water, four times a day, was ftill more efficacious. To thefe fugar may be added. 4. Oxygenated muriate of potafh, from three to twelve grains, four times a day, completed many cures, fome fpeedily, and others within eight weeks. In thefe cafes no medicines had been previoufly tried, and no particular regimen was ufed, nor was there any inftances of relapfe. As the oxygenated muriate of potafh contains more than half its weight of oxygen in a concentrated form ; we are not furprifed that it fhould, as reported, have pro- duced increafed aaion of the fyftem, with fizy blood. Mr. Hoyle, ]un. of Mayfield near Manchefter, fell: this eruptions. 453 ■.his fait at two (hillings an ounce, but fhould any chemift choofe to prepare it for himfelf, he may procure good Manganefe from Upton Pine near Exeter, and the fame quantity being for fome time expofed to the influence of the atmofphere, will, with a ftrong. heat, yield an equal produce of the pureft air. Genus LXXVIII. Scorbutus. Scurvy. The fyTtnptoms are indolence and laffitude; counte- nance bloated, gloomy ; gums livid, fpmgy, apt to bleed: fkin dry and fhining, with livid fpots, more efpecially at the roots of the hairs ; breath offenfive, and cedem.itous fwelling in the legs. As the difeafe advances the patient becomes fubjea to profufe haemorrhages from every part of the body ; ul- cers break out and are very foul; the urine is extremely rank and foetid; and he has moft offenfive ftools; the pulfe is commonly flow and feeble ; the refpiration is la- borious, and his death, more efpecially if fuddenly ex- pofed to frefh air, is fudden. The perfons moft fubjea to fcurvy, according to Hoffman, are delicate females, old people, and young men who have either fuffered by anxiety and grief, or have been exhaufted by previous difeafes, fuch as haemor- rhage and fever, but more efpecially they who are re- markable for fat. This curious obfervation is confirmed by fucceeding praaitioners, and particularly by Dr. Trotter, who, among other inftances, mentions five natives of China returning on board the Chefterfield Indiaman, in the year 1788. Thefe men were fo fond of flufh, which is the fat of fait meat fkimmed from the water in which it is boiled, that, with a cunning not to be defcribed, they evaded the quick fighted vigilance of the cook, and in five weeks from the time of their leav- ing England became monftroufly corpulent. ^ In confe- quence of this they were fhortly over run with fcurw, and although none of the crew, not even the landfmen, 454 ERUPTIONS. , had the leaft fymptom of that difeafe, they fuffered by it the whole voyage to a moft dreadful degree, till the Chef- terfield arrived in port. The occafional caufes commonly afligned are, cold, moifture, vitiated air, fait provifions, inaaivity, and more particularly a fcarcity of recent vegetables. It is not confined to thofe who are at fea, for it is frequently obferved on land in low fituations, where hu- midity prevails with cold. Here it is endemic, more ef- pecially near the fea, particularly if the inhabitants live chiefly on fifh and fait provifions. As to the proximate caufe of fcurvy, it appears to be relaxation of the folids and a diflblved ftate of the fluids, or, in other words, a deficiency of well oxygenated blood. With this idea of the proximate caufe, Dr. Ttotter tried diluted fulphuric acid in fufficient dofes, concentra- ted acid of tartar to the quantity of fix drams a day, the beft wine vinegar to the amount of a quart a day, and even nitre half an ounce a day, without any remarkable benefit; neither did his patients derive advantage from either fpruce beer or fugar. But when he gave them oranges, lemons, apples, or, for want of thefe, the citric acid in dofes of two ounces three times a day ; their re- covery was rapid, and he remarks, that by throwing in acid fruits fcurvy may be effeaually cured, even when all the remote caufes, excepting fcarcity of recent vegeta- bles, are left to aa in their full force. But whilft oxygen is thus conveyed into the fyftem by the organs of digeftion, the more natural and regular fupply by refpiration muft not be negleaed. The patients fliould either be removed to a diftance from vitiated air, or where they are flationed fliould have a conftant fup- ply of that which is moft pure. For the latter purpofe, in a fhip, no contrivance is to be preferred to the inven- tion of Dr. Papin, which was originally deftined to that ufe, as well as to fill deep mines with wholefome air, but has been fince confined wholly to the winnowing of corn. For this purpofe it has for more than a century been every where ufed in Holland ; and for half a century in the north of Britain. It is to be feen in the repofitory of the ERUPTIONS. 455 fhe fociety of arts, manufaaures, and commerce, at the Adelphi. This inftrument, by means of canvas pipes, will convey a plentiful ftream of air with a ftrong blaft to the moft diftant receffes of a mip, and no licenfe for its ufe is needful from any patentee, becaufe, although little noticed till of late, it has no claim to novelty. Exercife increafes refpiration and quickens the circula- tion of the blood, deriving thereby a greater quantity of oxygen from the furrounding atmofphere, and diftributing that pabulum of vital energy to every part ©f the ani- mated frame. Hence it is, that in pure air, exercife ftrengthens; but in vitiated and foul air, it relaxes, de- bilitates, and tends quickly to exhauft the powers of life. Hope, in all difeafes of debility, is to be reckoned among the firft of efficacious remedies. It quickens the circula- tion and invigorates the fyftem in the fame proportion as fear enervates and finks the pulfe. In fcurvy, more ef- pecially, it is found, that whatever infpires confidence and hope tends to expedite the cure. The experiment was fairly tried at Breda, where, during the fiege, when the garrifon, reduced in their number by the ravages of this difeafe, were ready from defpair to deliver up the town; a medicine fent by the Prince of Orange, the preparation of which was reported to have been expen- five in the extreme, was diftributed to the furgeons and adminiftered in drops. This medicine, boafting of prop- erties, to which it had no equitable claim, wrought won- ders, and all who took it in the confidence of hope were fpeedily reftored to health. Genus LXXIX. Elephantiasis. The fymptoms are fkin thickened, rough, wrinkled, unauous, and void of hair ; face deformed with tubera; voice hoarfe or founding through the nofe, and want of feeling in the extremities. Hoffman remarks, that in one fpecies of elephantiafis the legs fwell up as high as the knees to a moft enormous fize, that they are covered with a fcaly cruft, which being abraded leave red marks, and that thefe with intolerable itching ,-g ERUPTIONS. itching pour out a thick humour, which foon condenfe^ into frefh fcales. But for the true elephantiafis of the Greeks he refers us to Aret^us. In this, according to that author, the fuperior parts have many fpots and tu- mours, the rednefs of which is foon converted into black. The fkin is in fome parts much thickened, hardened, fcaly; the body becomes atrophic, yet the mouth, the thighs, and the feet, fwell. In the inveterate difeafe the fingers and the toes are buried and hid with tumours. A flow fever fucceeds, and deftroys the patient. It might have been fufficient to have ftated the fymp- toms of this difeafe, and with Dr. Cullen to have left it where I found it; but having already hazarded fo much in other parts of my work, I fhall venture, fup- ported by Van Swieten, to hazard fomething here. Boerhaave informs us in his aphorifms, that a kind of elephantiafis cures melancholia, Attulit fepe curatio- nem fuperveniens feabies fozda, aliquando elephantiafin emulans, § mo; and his commentator particularly ftates a cafe of inveterate melancholy thus cured. The learned Baron fuppofes his atrabiliary matter to be taken up into the fyftem, and to be thrown out again by the emunaories of the fkin, where it irritates the cu- taneous veffels and produces the difeafe in queftion. To this fuggeftion he adds the fubfequent remark.- So in other difeafes we obferve morbific matter, being carried to the cutaneous veflels, obftruas, inflames, and produces in them various puftules and eruptions which irritate the fkin. From an attentive confederation of the aftonifhing ef- forts of nature to relieve herfelf, together with the won- derful power of aaion of the abforbents, I am inclined to think the fuppofition of Van Swieten fubftantially juft and his remark well founded. Of the atrabilis I have already fpoken when treating of the proximate caufe of melancholia, and although the original idea of atrabilis has been proved to be errone- ous, yet certain it is, that bile and vifcid mucus in the in- teftines produce much difturbance in the fyftem. Diar- rhoea is one of nature's efforts to get rid of thefe, but another ERUPTIONS. 457 another effort, as I apprehend, is fometimes made by means of the abforbents. They certainly take up ftag- nant bile in jaundice, and convey it both to the kidneys and to the cutaneous yeffels, where it caufes fometimes a moft intolerable itching, and therefore, confidering their extenfive powers, it is by no means improbable that other offending matters, fuch as frequently harafs nature in the alimentary canal, may be abforbed and thrown out upon the furface of the body. See the feaion on the abforbents and their ufe in the introduaion to this clafs. If this idea of the difeafe in queftion is well founded, we cannot be at a lofs for the mode of treatment. Are- tasus recommends, as a fpecific, the fhavings of an ele- phant's tooth. But this eminent praaitioner, although infeaed with the medical fuperftition of the age, did not confine himfelf to fuch fpecifics ; for every other day he gave fmall dofes of white hellebore, of which he fpeaks in the higheft terms of commendation. Indeed he con- fidered this cathartic as of all others the moft efficacious, not only in this difeafe, but in all inveterate and deep rooted complaints, and in reftoring to the pale counte- nance its florid hue. Gelfus feems to prefer the black hellebore, but both thefe herbs were in the higheft efti- mation for all difeafes fuppofed to arife from atrabilis. Aretjeus, in order to prevent the ftagnation of acrid matters on the furface, where they muft naturally irritate the cutaneous veffels and produce a greater determina- tion to the fkin, ordered thefe foul eruptions to be wafh- ed in a bath with foap. For the tumours he prefcribed fuet taken in equal parts from a lion and a bear, to be united with alkali, by which he compofed a foap, but a foap of no uncommon virtue, for any other would have precifely the fame effea. Both he and Celfus recommend ftrong exercife. In the Eaft Indies, after venefeaion and gentle cathar- tics, they give the following : IJo Arfenic, fcr. j. Piper nigr. dr. 2. optime tritur. in Mort. ferreo per intervalla & per 4 dies tunc u\ Mort. Marmor. cum aqua: pauxil & M. f. Pill granarum 4. Cap. JEgcr Pil; m. and v. fuperbibende haurc aquje frigidx.—Vid. Aliatic Differt. Vol. II. p. 214. K k k Genus. 458 ERUPTIONS. Genus LXXX. Lepra. Leprofy. The fymptoms are the fkin rough and chopped, with white furfuraceous fcales and crufts, under which is fre- quently a moifture, with itching. The obfervations I have made on elephantiafis are ap- plicable to leprofy. Dr. Whytt confidered a morbid ftate of the veffels under the epidermis as the proximate caufe of this difeafe ; but then he never attempted to ac- count for that morbid ftate of the cutaneous veffels, any otherways than by fuppofing an acrimonious matter to fall on them. This indeed fubftantially agrees with the doarine of Van Swieten. And then, as thefe veffels a^e difeafed, they muft throw out a matter of a different kind and in greater quantity than they do in a ftate of health : in confequence of which, inftead of a cuticle, their natural produaion, we have a hard, white cruft, and furfuraceous fcales. Moft phyficians are agreed in leprofy to give antimo- nials and mercurials, or thefe powerful evacuants com- bined with opium, camphor, and guaiacum. Ijo Calomel, gr. vi. Camph. gr. iij. Conf. Rofar. q. s. M. f. Bol. 6a. quaque nofte fumend. et die fequente. IJo Kali Tartarifat. 3j. Mannas, 3vj. Aq. fervent gii}. Tindl:. Car. damom. |j. M. f. H. m. s. Calomel fix grains; camphor three grains ; conferve of rofes, fuf- ficient to make a bolus, to be taken every fixth night; and the next morning take tartarifed kali one dram, with manna fix drams, diflblved in three ounces of boiling warer, to which add tin&ure of cardamums one dram. In the intermediate fpaces the patient may drink half a pint of fea water every morning. T^, Calomelanos, gr. xv. Sulph. Antimon. Precipit. 3fs. Opii, gr. x. 01. Saffafr. efs. gtt. xx. Extra&. Lig. Guaiac. 3ij. Syr. Papave- ris Alb. q. s. f. Pill. 36. Cap. Pill. iij. mane et vefp. Calomel, fifteen grains; precipitated fulphur of antimony half a dram ; opium ten grains; extract of guaiacum two drains ; fyrup of poppies fufficient to make thirty fix pills, of which take three morning and evening. ]£> Merc. Muriat. gr. x. Acid. Muriatic, gtt. x. Vin. Antimonii, |j. M. c. gtt. 20 bis die. Thefe muft be followed by tonics and aftringents. £> Cinchon. plica polonica. 459 T$„ Cinchon. |ij.Mucil. Gum. Arab. §j. tereetadde Elix. Vitriol. Acid. gtt. 90. Syr. Cort. Aurant. §j. Aq. Rofar. gvj. Tinft. Cardamomi Comp. §j. M. c. Co. iiij. bis die. Bark three drams; mucilage of gum arabic one ounce; grind them together ; add acid exlixir of vitriol ninety drops ; fyrup of orange peel one ounce; rofe water fix ounces ; compound tin&ure of cardamoms one ounce. Take three table fpoonfuls twice a day. Some have found benefit by tar ointment, and, when the eruption is not confiderable in extent, mercurial oint- ment has been added to advantage. A praaitioner of eminence reports his having cured one patient by tinaure of cantharides, thirty drops twice a day, increafing the dofe to one dram three times a day. He cured others by dulcified fpirit of vitriol, beginning with thirty drops, and increafing the dofe to two drams, thrice a day. For further obfervations confult Herpes in the order dialyses, of the clafs Locales. Genus LXXXI. Trichoma. Plica Polonica. The hair grows long and coarfe, matted and glued into inextricable tangles. This difeafe is commonly preceded by 1. Palenefs. 2. Weaknefs of the joints. 3. Pains in the head and in the joints of the hands and feet. 4. Noifes in the ears. 5. Convulfions. 6. Contraaions. 7. Rickets and fragility of the bones, and fometimes mania. It was imported into Poland from Tartary about the year 1687, and fpread through Silefia and Hungary in lefs than forty years. In autumn, the peafants fince that period have been fubjea to an eruptive fever, which principally infefts the head, and terminates in this difeafe. It is indeed regarded as a critical difcharge. No medi- cines relieve it, but in procefs of time the plicae fall off fpontaneoufly. If however they are prematurely cut oft, the conie- quence according to Hoffman, is either a dreadful head- ach, epilepfy, phrenitis, mania, melancholia, guttaferena, ' r r J pleuntis, 46© JAUNDICE. pleuritis, haemoptyfis, or phthifis pulmonalis. All thefe difeafes, if occafioned by a latent plica, vanifh as foon as the plica appears. For this reafon they aflift this effort of nature to relieve herfelf by embrocating the head with a warm decoaion of club mofs (lycopodium clavatum) twice a day. This in about a week produces the plica, and relieves the patient from the acceffory difeafe. Genus LXXXII. Icterus. Jaundice. The fymptoms are yellownefs of the eyes and of the fkin; faeces white; urine high coloured and tinging linen yellow ; univerfal langour, and laffitude with coftivenefs. To thefe fymptoms, Aret^us adds, Idem frigent im? becilli, defides, trifles atque demiffi animofunt. -SECTION I. Of the Caufes Remote and Proximate of Icier us. The predifponent caufe is debility, as attended either by morbid irritability or by torpor. The occafional caufe may be imwholefome diet, fuch as unripe fruits or an over proportion of the legumina, with auftere and acid wines, or malt liquor when the acetous fermentation has advanced too far ; hard drinking ; agues, when pre- maturely cured by bark; protraaed grief; anger; vio- lent emetics; poifons, particularly of ferpents, and pref- fure. r ^ The proximate caufes of jaundice is evidently obftruc- tion to the natural paffage of the bile by the inteftines caufing it to be taken up into the habit and to circulate in the veffels. This obftruaion may be either in the duodenum, at or below the entrance of the common dua, or in the dua itielf In the former cafe the bile paffes by the laaeals mto the thoracic dua ; in the latter it may either regur- gitate by the hepatic veins, as proved by Dr. Saunders, or be abforbed by the lymphatics, which are derived from jaundice. 461 from all the branches of the hepatic dua, as he and Cruickfhank have frequently obferved in their diffeaions. That obftruaion may take place in the duodenum is evident by diffeaions, and has been particularly noticed by M. Portal. In the yellow fever of the Weft Indies, of which jaundice is a fyftem, the exceflive quantity of bile in the inteftines proves that the biliary duas are free. And when with jaundice, we have regurgitation of bile into the ftomach, as in cafe of gaftrodynia flatu- Unta, it is plain that the obftruaion is not in the dua, but in the fmall inteftines. SECTION II. Of the Species of Iclerus^ Sauvage has no lefs than fourteen fpecies, which Cullen has reduced to five, viz. \t\eru% fpafmodicus ; Ic- terus calcuiofus ; \t\erus hepaticus ; laerus gravidarum ; and laerus infantum : but to thefe I think it expedient to prefix another, which more commonly occurs than either of the others, and to which I have given the name of laerus mucofus. I. laerus mucofus, not attended by pain nor by fpaf- modic affeaions. No gall ftones are obferved in the fseces, but with cathartics a quantity of vifcid mucus is discharged. I have frequently met with iaeric patients, who have evacuated more than a pint of gelatinous mat- ter unmixed \vith faeces at one ftool ; and I met with one who, for feveral days together, paffed fuch a quan- tity of mucus that he thought his bowels were diflblved. The only modern author, who has laid a foundation for this fpecies "of jaundice, although it is certainly com- mon, is baron Van Swieten in his commentaries, § 950; where he judicioufly obferves, Imo et in adultis pituitofa colluvies in primis viis herens^icleri caufafuit. This ob- fervation he confirms by a reference to Hippocrates, who, with the greateft propriety, declares it eafy to be cured. It is this fpecies which has for its predifponent caufe :he debility of torpor. The occafional caufes are un- wholefome 46i jaundice wholefome diet with unripe fruits, or with an over pro- portion of the legumina ; humidity and marfh miafmata; ill cured intermittents ; indolence and want of exercife ; hard drinking and cold liquids after violent exertion ; anxiety and protraaed grief. I fhall enlarge on the ac- tion of thefe caufes. The ftomach and inteftines are conftantly fupplied by appropriate glands with mucus, which lubricates their internal furface to prevent attri- tion and adhefions, and to defend them from* immod- erate irritation. This, in a ftate of health and vigour, is produced only in fufficient quantity to anfwer thefe in- tentions ; but the effea of grief and fear is to relax the glands and to increafe the quantity of mucus. Their aaion is excited by the ftimulus of ardent fpirits, fpices, and fermented liquors, and as, when once morbid habit is eftabliflied, they continue to pour forth their copious ftreams, a conftant determination from thefe glands takes place. The fame determination is created by hu- midity, which checks perfpiration and increafes the dif- charge of mucus by the inteftinai glands, as well as the flow of urine by the kidneys. The poveriy of diet above defcribed, and want of exercife by caufing generally de- bility, tend to produce the fame effea. Ill cured inter- mittents leave the bowels loaded with flime, and for this reafon certainly it was, that in the cafes of remitterit fever, obferved by Sir John Pringle, " if evacuations were either negleaed or too fparingly ufed, the patients fell into a continued fever, and fometimes grew yellow as in a jaundice." See his Difeafes of the Army, part i. chap. 3. This mucus, when firft fecreted by the glands, is fluid although vifcid, but when, by its accumulation, it has prevented the action of the bile, as the natural cathartic, upon the intejlines, and produced fome degree of cof- tivenefs ; the abforbents, taking up inceffantly the aque- ous particles, render it more tenacious, till it refembles glue, or becomes, as I have ftated in tujfis ftomachalis, tough as leather. Unripe fruits, auftere or acid wines, and ardent fpirits, as Boerhaave and Van Swieten have well Jaundice. 403 well obferved, render this vifcid mucus ftill more tena- cious, § 69. From a confideration of thefe remote caufes, and of the effea immediately produced by them, with attention to the anatomy of the parts concerned in jaundice, we fhaH not be at a lofs to aflign the proximate caufe in that fpecies which we have now in view. It is certainly tena- cious flime obftruaing the orifice of the common dua at its entrance into the duodenum. This effea may be the more readily conceived, if we call to mind the very oblique direaion in which it penetrates the coats of that inteftine, and that it paffes for a fhort fpace between two of them. When thus-the mouth of the common dua is clofed, we have commonly not only obftruaion to the paffage of the bile into the inteftines, but of the pancre- atic juice ; becaufe moft frequently the pancreatic dua enters the duodenum by the fame orifice ; and then, for want of thefe detergent and ftimulating fluids, tenacious flime accumulates, and the difeafe naturally goes on con- ftantly increafing. Thefe ideas, I expea, will be confirmed by the cafes I fhall produce, and by a confideration of thofe medicines which at any time have been found effeaual in the cure of jaundice. II. laerus fpafnodicus, not attended by pain, but fub- fequent either to ipalhiodic affeaions or to mental paf- lions, and apt to be both fudden in its attack, tranfitory in its duration, and, fometimes, periodical. The perfons moft liable to this difeafe are, thofe of the fanguine temperament, and of an irritable habit ; the hyfterical, and fuch as are fubjea to either iliac paflion or the common bilious and fpafmodic colic. For the predifponent caufe we may aflign debility with morbid irritability, and for the occafional caufes, 1. Vio- lent anger. 1. Venom communicated by the bite of an- imals, as of vipers, fquirrels when enraged, mad dogs, and even fpiders. 3. Stimuli applied to the inteftines, whether violent emetics, draftic cathartics ; bile either in cholera or the beginning of bilious fevers, as in the yellow fever of warm climates, or the bilious autumnal fever of our ifland ; worms ; and even mucus, witfe either bile or undigefted fordes, in very irritable habits. From what has been faid, it will appear, that for the proximate caufe we may aflign, with Mead, Hoffman, Sauvage, and Cullen, fpafmodic ftriclure, either in the duodenum, or at the mouth of the common dua. The exiflence of fuch a fpecies is confirmed by ana- tomical obfervations, becaufe in thefe cafes, after diffec- tion, neither calculi nor vifcid flime have been-deteaed. III. laerus hepaticus, not attended by pain. It follows difeafes of the liver, and is therefore fymptomatic. IV. Icterus gravidarum, originating from pregnancy, and vanifhing with parturition, or from the preffure of hardened faeces in the colon, and difappearing when thefe have been evacuated. V. laerus calculofus, attended by acute fhooting pains in the epigaftric region and right hypochondrium, which are increafed after eating, and by evacuation of biliary concretions. It has fometimes ftraitened refpiration, com- preflion of the cheft, naufea, frequent efforts of the ftom- ach to get rid of its contents, and difficulty of walking upright. The ficknefs, with inceffant vomiting, generally precedes the jaundice, which is apt fuddenly to difap- pear, after which gall ftones are to be difcovered in the .ftools. For this reafon Baglivi ventured to fay, Si vi- deris icieros fanatos, fed recidivos,eos certe a calculovefice fellee progigni predicito : but this rule, as we have feen in the preceding fpecies, wHl not always guide us right; for in that the attack of jaundice is fometimes fudden, tranfitory, and periodical. This fpecies of jaundice, I apprehend, is feldom if ever an original difeafe, but is occafioned either by iaerus mucofus, iaerus fpafmodicus, or iaerus gravidarum. For when the bile flagnates in the gall bladder, whether that ftagnation is occafioned by mucus, by fpafm, or by pref- fure, biliary concretions may eafily be formed, by fub- fidence, attraaion of the groffer and homogeneous par- ticles to each other, or by the aaion of the abforbents taking up the more fluid parts till the remaining bile be- comes a folid mafs. Van Swieten informs us, that he has jaundice. 46$ has feen bile, tenacious like glue, brought up by the aaion of emetics, after which the jaundice never return- ed again : and Hoffman, in a cafe hereafter to be men- tioned, found the gall bladder filled with black and vifcid bile refembling pitch. Others have difcovered this receptacle wholly occupied by one mafs of bile, the ex- ternal coat of which was folid and compaa, whilft the interior coats were fofter, and at the centre contained liquid bile. More than a hundred gall ftones have been difcovered in one patient after death, even in cafes where no fymp- toms of jaundice had appeared. Heister, diffeaing the body of a woman, found one calculus as big as a wal- nut, and the common dua fo much enlarged, that he could thruft his little finger into it. But one of the moft uncommon cafes is related by Van Swieten of his mother in law. This lady, after repeated paroxyfms of jaundice, was fuddenly feized with a violent pain in the re- gion of the duodenum, followed by fyncope, which con- tinued only one quarter of an hour. At the end of two days, they difcovered in the faeces a gall flone large as a joint of the thumb, and two more nearly of the fame fize, which, by correfponding impreflion*, appeared evi- dently to have been formed at the fame time. Having paffed thefe calculi, fhe became free from jaundice. Yet confiderable as were thefe for magnitude, much larger than thefe have been evacuated, which had therefore paff- ed the common dua. Mrs. Floyer, mentioned by Dr. Johnstone in his Medical Effays, after excruciating pain and vomiting for feven hours, voided a gall flone i| inch by -rV, after which fhe had exceflive difcharge of bile, up and down ; yet fhe had no jaundice. As neither the gall bladder nor the common dua is fupplied with mufcular fibres ; when they have been dilated by calculi, they do not readily contraa again. In one cafe, recorded in the Edinburgh Medical Effays, vol. ii. p. 303, we find the common dua obftruaed by calculi, and the gall bladder extended to fuch a furpril- ing bulk as to contain eight pounds of bile. j< l ! Sometimes, 466 jaundice. Sometimes, when gall ftones caufe irritation, sftid are? vet too large to pafs the common dua, nature in her efforts to relieve herfelf, excites inflammation, fuppura* tion, ulceration, and the adhefive procefs tofurround the whole with an impenetrable wall, for the boundaries are circumfcribed by effufion of coagulating lymph, fo changed in paffmg through inflamed veffels, that the parietes of the abfcefs become a compaa mafs. See Dr. Saunders's moft interefting Treatife on the Difeafes of the Liver. Mr. Cline has met with cafes where this kind of conneaion between the biliary fack and the con- tiguous inteftine having been perfeaiy eftablifhed, large gall ftones efcaped through the aperture, in confequence of which the cyft, being no longer diftended by bile, contraaed. And Dr. Johnstone, in his Medical Ef- fays, p. 207, mentions the cafe of Sarah Ewdall, wha after violent pain in the region of the gall bladder, paff- ed biliary concretions from an abfcefs at the pit of her ftomach. The cafe of my old friend O'Neille, captain general of Arragon, was highly interefting. When I quitted Spain, I left him labouring under obftinate jaundice. After that time a confiderable impoftume appeared in the region of the liver, formed by enlargement of the gall bladder, which united by the adhefive inflammation with the peri- toneum, and this, when opened by the lancet, gave iffue to feveral biliary concretions, which were of a confidera- ble fize. He was attended by the moft able furgeons, with whom M. Gimbernat was joined in confultation, and be- fore they ventured to open the abfcefs, they were fatisfi- ed that the adhefive inflammation, which was to connea the parts in contaa, had taken place. Had they doubt- ed of this, they would have applied cantharides or fome other irritating fubftance to the abfcefs, before they at- tempted fuch an hazardous expedient ; for had they been miftaken in their judgment, the contents of the ab- fcefs would have been difcharged into the cavity of the abdomen, and the admiflion of atmofpheric air into this cavity might have produced inflammation and gangrene on jaundice. 467 en the internal furfaces, that is, on the peritoneum, the inteftines, the omentum, and all the other contents of the abdomen. It is not the prefence of gall ftones in the cyft that caufes jaundice, for there, as we have feen, they may remain without creating disturbance in the fyftem; but when, by fneezing, coughing, vomiting, jumping, wreftling, fud- denly falling, by convulfions, or by any other means, a ftrong preffure is made upon the liver, they are brought down into the common dua ; they muft either pafs freely or they will caufe obftruaion to the natural paffage of bile into the inteftines, and produce a jaundice. VI. iaerus infantum, occafioned by the meconium. SECTION III. Of the Indications of Cure in Iclerus. From what has been delivered, it is evident that the indications of cure muft vary according to the nature of the caufes which occafion the feveral fpecies of this dif- eafe. Quacks univerfally prefcribe either to the moft • diftreffing fymptom, or at beft to the generic charaaer, that is to the name of a difeafe and not to the difeafe itfelf : but the rational praaitioner confiders, before he ventures to prefcribe, the whole of the difeafe in quef- tion, with its caufes both remote and proximate. He diftinguifhes the fpecies from each other, as charaaerifed by their peculiar fymptoms, and is never fatisfied till he ascertains not merely the prefence of this or that difeafe, but by what caufe it is produced. The importance of fuch diftinaion is no where more confpicuous than in cafes of jaundice, for which innumerable remedies are offered, but not one of them admiflible without attention to the fpecies. This obfervation can never be too much inculcated on ftudents ; and, although it might with propriety have appeared with others in fome general introduaion to my work, I truft it will not be thought improper here. I. iaerus mucofus. The curative indications are, 1. To 468 JAUNDICE. i . To evacuate the vifcid mucus from the duodenum, 2. To reftore tone to the mucous glands. To anfwer the firft intention, we muft have recourfe to emetics, giving from three to ten grains of ipecacuan- ha with a grain or two of tartarifed antimony every other morning. The emetics may by followed by cathartics. Thefe however muft not be draftic and hydragogue, for fuch not only defeat our purpofe by increafing debility, but by their highly ftimulating powers they excite the aaion of the inteftinal exhalants, and are foon wafhed away out of the body. Small dofes of calomel may be given at night, either alone or combined with afa fcetida. R, Calomel, gr. iij. Afas feetid. 9j. Ol. Carui. gtt. v. M. f. Pill. vj. h. s. s. Calomel three grains, with twenty grains of afa foetida, and five drops of oil of carraways, made into pills, and taken at night. This may be repeated twice a week, and worked off the next morning with rhubarb and fenna, warmed by either cinnamon or nutmeg water. R, Rhei, gr. xij. Infuf. Amar. Purg. un. 3. M. f. H. m. s. §> Rhei, gr. xij. Tinct. Sense, un. 1. Aq. Menth. vulg. un. 2. M. f. H. m. s. Or, in place of thefe, two ounces of the elixir falutis, which is the only genuine Daffy's Elixir, or occafionally caftor oil. Ol. Ricini u 1. ad un 2. may be given in the morning. Dr. Darwin has brought away from 30 to 50 ftones by calomel grains fix at night, and oil of almonds four ounces in the morning. Sir E. Hulse gave fal vol. cornu cerv. fcr 1. in mint water three times a day. The pills recommended by the ingenious Dr. Beddoes in cafes of urinary calculi, are powerful detergents. To compofe them you muft take cryftals of fal fodae coarfe- ly pounded, and expofe them to a warm dry air, till they crumble into a white powder. Seven drams of this with one ounce of foap being made into pills, the dofe may be from ten to twenty grains twice a day. No medicine has been more univerfally recommended by JAUNDICE. 469 by the moft eminent pra ^ifioners, and no one can be more worthy of the reputation it has hitherto maintain- ed than tartarifed kali. Of this, from one fcruple to a dram may be given twice or three times a day, either alone or combined with rhubarb. Dr. Nico'ai, recommending among other aperient fubftances this compofition, fayvS of it, Egregiam exferit efficafiam in iCTERO,y? a ducluum bi liar urn obftruc- tione, quam materia tenax et fpiffa producii, oritur. R, Rhei, 5fs. Kali, tartarifat. 5j. Confed. Aromat. ^j. Aq. Menth. vulg. gij. M. f. Hauft. 8. q. h. 3. Rhubarb ten grains ; tartarifed kali a dram ; aromatic confection a fcruple ; mint water two ounces. To be taken three times a day. In the Canary iflands, where jaundice is prevalent, M. Bctancourt feldom fails to cure it in a few weeks by means of emetics, followed by pareira brava. Of this he makes a decoaion, putting an ounce of the root to eight pints of water, and reducing it thus to fix pints. The dofe is half a pint three times a day. I have given it with great advantage. After having cleanfed the firft paffages, we muft have recourfe to tonics and aftringents, for fhould we proceed with evacuants, we fhould not only debilitate the fyftem and deftroy the tone of the mucous glands, but we fhould eftablifh a determination of the fluids to thofe glands, and caufe them to acquire a habit of fuperabundant fe- cretion, thereby increafing the difpofition to jaundice. A powerful tonic, and the moft proper in cacheaic pafes, more efpecially in jaundice, is iron ; of the beft form of it, in the opinion of both Sydenham and Hoff- man, is that of filings, of which from five to twenty- grains may be given at a dofe. Hoffman combined it with vitriolated kali, ordering as follows : R, Limat. Ferri. dr.' 2. Kali vitriolat. fcr. 2. OL Menth. gtt. 6. M. f. Pulv. c. c. dr. h bis die. Hoffman was very partial to his tinclura martis pomata et cydoniata, which are excellent preparations, combined with the peruvian and cafcarilla barks, but he condemns bitters, and affures us that by long experience he had found them detrimental. As a deobftruent and tonic in jaundice no medicine is to „ -n JAUNDICE. **r/ ^ to be compared to "horfe exercife. This fupplies the place of emetics and cathartics in feparating vifcid mucus from the inteftines ; and, promoting infenfible perfpira- tion, it prevents determination to the mucous glands. Van Swieten, § 69, judicioufly obferves, that for want of exercife the ftomach and bowels become internally coat- ed with tough phlegm (lento glutine) but that by in- creafed refpiration and alternate aaion of the abdominal mufcles, thefe vifcera are fhaken, preffed, and fcrubbed, as it were, by attrition, fo as to be effeaually cleanfed.' Hoffman ftrongly recommends a journey, not merely for the fake of air and exercife, but for the cheerfulnefs, the change of fcene, and the diftance interpofed between the man and his domeftic cares, for in jaundice he re- gards tranquillity of mind as moft effential to a cure. II. iaerus fpafmodicus. The curative indications are, r. To relieve the fpafm. 2. To obviate its recur- rence. I. The firft intention may be anfwered, 1. By remov- ing, when it is poffible, the morbid flimulant, fuch as worms, by anthelmintics ; vifcid mucus and acrimoni- ous bile by gentle emetics and cathartics, more efpecially by caftor oil; and the mental ftimuli, particularly anger, "by moral arguments. But all violent emetics and cathar- tics muft be carefully avoided, becaufe they increafe the fpafm. 2. When the ftimulants applied to the inteftines are not removable by the milder evacuants, their power muft be weakened by diluents and demulcents, fuch as warm liquids, and emulfions made with linfeed, oil of almonds, fpermaceti, and gum arabic, as in the feveral Formulae of my Phyfician's Vade Mecum, in the clafs demulcents. 3. When the fpafm is occafioned by fome general flimulant, fuch as venom communicated by the bite of animals, which can neither be removed nor yet relieved by diluents and demulcents, we muft have recourfe to more powerful ftimulants. Thefe are afa fcetida, cam- phor, mufk, ether, opium, elearicity, and heat. Dr. Darwin informs us, that a gentleihan, who for jaundice JAUNDICE. 47C had taken emetics, mercury, bitters, fteel, effential oils, and ether, without benefit, was cured by ten fmart fhocks of elearicity from a quart phial taken through the liver. A certain degree of heat, that is a genial warmth of about 960 or 970, is friendly to the fyftem, and effica- cious in relieving fpafm. This may be applied either in a bath ; by carminative, demulcent, antifpafmodic clyf- ters, by fomentations to the part, or by all of them fuc- ceflively. The fomentation may be with chamomile flowers, or a plafter may be made with treacle, expreff- ed oil of nutmegs, and fpermaceti in equal parts, and camphor for the pit of the ftomach. The clyfter may be made with milk, oil, ginger tea, and fome drops of laudanum. . II. The fecond intention requires tonics and aftrin- gents, cold bathing, bitters, bark, and fteel. R, Cinchon. gj. Ferri tartarifat. gfs. Pulv. Aromat. 3iij. Conferv. Cort. Aurant. gij. Syr. Zinzib. q. s. M. f. Elect c c. M. N. M. bis die fuperbibend. Cyath. lnfuf. feq. R, Quaffise, Rad. Columb. aa gfs. Caffiaf Lign. 3j. Aq. fervent. foi. Macera per nodem et cola, Colaturae adde Efs. Lignor gfs. Bark one ounce ; tartarifed iron half an ounce ; aromatic powder three drams ; conferve of orange peel two ounces j fyrup of ginger fufficient for an eleduary. Take the fize of a nutmeg ^ twice a day with a cup of the fubfequent infufion. & Take quaffia and columbo root, of each half an ounce ; caffia lignea, one dram ; boiling water a pint. Steep for a night and ltrain : add to this, effence of the woods half an ounce. III. iaerus hepaticus. Dr. Cullen confiders as in- curable. \V iaerus gravidarum. If from pregnancy, it van- ifhes on parturition; if from hardened feces in the- colon, it is cured by clyfters and cathartics. _ V. iaerus calculous. The curative indications are pointed out by nature in her efforts to.relieve herfel\: for when a gall ftone paffes with difficulty inceffant vomiting is excited to expedite its paffage, and if either the pain or the ftraining to vomit » «^vc'^^h occafion fpafm, fvneope enfues, and then moft common- Wthe biliary concretion paffes, for in fyncope fpafmodic aaion ceafes, and every fibre is relaxed. Her-ce the only indications are, 1. lo produce, b) ncixc T. emetics, ,-, JAUNDICE. **/ ' emetics, repeated concuflion of the vifcera. i. To anm' the free paffage of gall ftones, when needful, by anti- fpafmodics, precifely as in fpafmodic jaundice, by cam- phor, Hoffman's anodyne, and opium, by warm bathing and fomentations, with antifpafmodic and emollient clyfters. 3. To unite thefe means by giving our emetic whilft our patient is in the bath. And we may fafely pafs fhocks of elearicity through the region of the liver. When the gall ftones are paffed ; if their formation was occafioned either by iaerus mucofus, or by iaerus fpafmodicus, we muft give tonics and aftringents, to pre- vent the recurrence of the difeafe. VI. iaerus infantum is fpeedily and effeaually cured by clearing the meconium. SECTION V. Cafes of Jaundice. Case I. A. M. aged 40, of a relaxed and irritable habit, was attacked by Jaundice, at the firft approach of which he obferved morfels of undi- gefted food to have paffed by ftool, then fulnefs in the epigaftric re- gion, followed by white ftools and yellow urine. An emetic brought up the half digefted food of two days, and with that fome morfels of veal perfectly unchanged, which he had eaten the firft of thefe days for dinner. By two grains of calomel, taken every night, in four days he evacuated much vifcid mucus, his urine became limpid in the night, al- though very yellow through the day, but by two dofes more of calo- mel, followed by tin&ure of rhubarb, he had many proper ftools, fol- lowed by one of pure mucus refembling jelly, after which, by horfe exercife, he was perfectly reftored to health. Three years from this period, in the beginning of February after having been frequently wet in riding, he was feized with pain in the right breaft, of the fame kind as ufually preceded gaflrodynia flatulenta, fo which he had been fubjeft. He took an emetic, threw up a tea- cupful of pure bile, and was free from pain : but his ftools became white and his urine yellow. He h?d again recourfe to calomel, but without any effeft, till he increafed the dofe to ten grains at night, followed by an aloetic and alkaline cathartic in the morning. Thefe produced a copious evacuation of the alvine faeces, followed by about a pint of pure mucus' refembl«ig jelly, befides much which was ex- tremely vifcid. From this time the fymptoms were alleviated, and by moderate cathartics the difeafe appeared to be perfectly removed. la the beginning of May in the fame year he was able to walk from twelve JAUNDICE. 473 ♦welve to fourteen miles a day without fatigue, till he happened to go vj.i miles with a fcorching fun in front, and a coldjsorth wind behind, by which he was much exhaufted, and the next day perceived at dinner fuch convulfive motions in his under lip, that whilft eating it was inceffantly drawn in between his teeth. At night he was reftlefs, and the next day had white ftools, yellow urine, conftant chillinefs, with a flow pulfe, and fo weak as fcarcely to be perceived. Strong cathartics were reforted to with confiderable dofes of calomel, .followed by tartarifed kali, all which brought away much vi/cid mucus and relieved the fymp- toms ; but they fpeedily returned. In this fituation he applied to Dr. Fothergill, of Bath, who confid- ering that merely to evacuate the vifcid mucus left the glands relaxed to pour forth a frefh fupply, refalved to try the tonic plan. With this intention he gave fteel, columbo root, and aromatics, which foon perfe&ed a cure. • Case II. A councilor, aged 37, after protracted grief, took to a fedentary life, and inftead of wine, his ufual beverage, drank fpirits in too great abundance. The confequence was, that with flow fever he loft his ap- petite and became iderical. After various remedies had been tned in vain, he took two emetics, each compofed of tartarifed antimony one grain, with fifteen grains of ipecacuanha, and was perfeftly reftor- ed to health. Some years after this, jaundice returned again with greater violence than before. Rhubarb, bitter extrads, balfams, fedatives, and anti- fpafmodics, all excited naufea, and even vomiting. In this fituation the only medicine he could bear was a mixture of clauber falts, nitre, vitriolated kali, and crab's claws, in wine and water with lemon juice, in fmall but frequent dofes. He had a cataplafm at the region of the liver compofed of wormwood (artemifia abftnthium), water germander (teucriumfcordium), chamomile flowers, and cummm feeds, boiled in wine. This was applied warm, and when cooled was frequently renewed. . At the end of two months, he had a fpontaneous difcharge ot alvine faces, dry, clay coloured, and mofl abundant, which continued for four days, when they began to affunfe a yellow colour, and he foon recover- ed health, appetite, and ftrength. Hoffman remarks upon this cafe, that he has always obferved cataplafms and fomentations highly beneficial in obftinate jaundice, and frequently attended with in- ftantaneous relief of all the fymptoms, which have revert- * ed on the omiflion of thefe external applications. Cas* HI. Baron Van Swieten in his Commentaries relates the cafe of an old lady aged 60, who had been idencal for twelve years. At hrft the paroxyfms were periodical, but latterly it W3> a confirmed and contin- ued jaundice tinging the whole body black e.xcect the eyes, wine, were of a deep yellow. Bv Mm m - 474 JAUNDICE. By his orders fhe perfifted for two years in the ufe of whey with juice of grafs infpring, Spa water in fummer, and honey with foap in winter. At the end of eighteen months a copious evacuation of argillaceous and moft offenfive matter, interfperfed with calculi, fucceeded, and con- tinuing for fix months, with a manifeft relief of all the fymptoms, fhe was perfectly cured. It muft be added, that to fupport her ftrength, the profeffor indulged her with a generous diet. Case IV. A gentleman, aged 50, fendentary and accuftomed to good living, yet mixing with a generons diet much milk and acid fruits, became, after protracted grief, cachectic. His countenance was livid and much fuffufed with bile ; he loft his appetite and ftrength ; fuffered much by flatulence and borborygmi in his bowels ; had difficulty of breath- ing, and complained of coftivenefs. His pulfe was weak, fometimes intermittent,' and always unequal, faundice followed with fwelling of his feet, and after a time he became hydropic. For this complaint he called in a phyfician, famous for the cure of dropfy, who gave him an extract of elaterium and enula one dram, which being repeated, evacuated both up and down a great quantity of vifcid mucus (cmu x.cu Kd-ra fortier expurgabatur ingens vifcidi muci copia). On diffe&ion, water was difcovered in his cheft ; and biliary con- cretions, one of which weighed three drams, were taken from the gall bladder. The liver and fpleen were flaecid^ and the blood in them was very black. Case V. A gentleman, aged 40, who from his youth had been devoted tXf°rexia. 3. Dyfeinefie. 4. Apo- cenofes. S.Eptfehefes 6. Tumores. 7. Eclopia. 8. Dialyfes. Of which the pathognomonic fymptoms follow • 1. Dysesthesia. The fenfes injured or deftroved by the imperfection of the organs. Proved 2. Dysorexia. LOCAL DISEASES. 479 2. Dysorexia. The appetites deficient or depraved. 3. Dyscinesia. Motion impeded or depraved from an imperfection of the organ. 4. Apocenoses. Superabundant flux of blood, or humours, without pyrexia. 5. Epischeses. Suppreflion of excretions. 6. Tqmores. Partial fwellings without inflammation. 7. Ectopia. 8. Dialyses. Solution of continuity. Clafs IV. LOCALES. Order I. Dysesthesia. The fenfes injured or deftroyed by the imperfection of the organs. In this order we have nine genera. 1. Caligo. 2. Amaurofis. 3. Dyfopia. 4. Pfeudoblepfis. 5. Dyfeccea. 6. Paracufis. 7. Anofmia. 8. Ageuftia. 9. Anefthefia. Genus LXXXIV. Caligo. Darknefs. Sight diminifhed or deftroyed by the interpofition of a dark body between the object and the retina. In this genus Dr. Cullen includes five fpecies. 1. Caligo lentis. Cataracl. The fymptoms are, opaci- ty behind the iris in the pofterior chamber of the aqueous humour, to be difcovered by infpectiqp; the iris con- tracts by a ftrong light, and in the fhade expands; vifion is lefs perfect in proportion to the quantity of light re- flected from an object; minute objects appear to be cov- ered with a mift increafing in denfity, as the opacity ex- tends. The approach of the difeafe is announced by mufee volitantes. This opacity may be either in the cryftalline lens itfelf, or in its capfule; or it may arife either from a membrane formed in the pofterior chamber of the aqueous humour, and therefore eafily to be diftinguifhed by infpection, o: from portions of infpiffated pus floating in the aqueou humour. 4 So LOCAL DISEASES. humour, and moveable by the flighteft inclination of the head. The latter conftitute the fpurious cataract ; the former only is the genuine. The occafional caufes of cataract are commonly exter- nal violence, fudden expofure to great heat after cold, and to ftrong light after obfcurity. From thefe laft cir- cumftances it may p«rhaps arife, that cataracts abound in Spain, more efpecially at Madrid, where my friend Gimbernat extracted more than a hundred in one year. In addition to thefe caufes we may remark from Lom- mius, as quoted by Hoffman, that in fome cafes cataract: originates from affections of the ftomach, and this feems to be rendered probable, when head ach precedes a cataract* In fome cafes the lens has fpontaneoufly recovered its tranfparency. Mr. Wathen mentions two cataracts in one patient having been thus difperfed, after continuing 18 years. It is well known, that the capfule is abforbed after a cataract has been extracted, and that after couch- ing, nature fometimes excites the action oPthe abforbents to carry off, as an extraneous body, the cataract itfelf. The fame effect is often produced by external inflamma- tion of the eye, and for this reafon it is that cataracts oc- cafioned by contufion are more frequently abforbed, than thofe which proceed from conftitutional affections. Sometimes indeed it happens, as in the cafe of one of our princes, that from external inflammation the abforb- ents carry off both the cryftalline and the vitreous hu- mour, leaving only a bag of water. It was upon this principle that my friend Wathen Phipps, to cure a cataract, which it was not proper to ex- tract, excited violent inflammation in the eye by means of corrofive fublimate, and thus caufed the difeafed lens to be perfectly abforbed. His grandfather records a cafe, in which the operator being obliged to defift becaufe he could not fix the eye; in about a fortnight from that time the patient began to fee a little, and in lefs than a month perfectly recovered his fight. As to the medical treatment of cataract little can be faid. * It has certainly been cured by electricity. As this effect LOCAL DISEASES, 4^* effect muft in all cafes have been produced by the ab- forbents, calomel, which excites their action, feems to promife fome relief, but I do not recollect having feen it tried. When medicines fail, the only hope is from extraction. In fuch circumftances the firft point to be determined is- its fitnefs for the operation, on which we are affifted in our judgment by the publications of Mr. Wathen, who in this line is the moft experienced practitioner in Eu- ' rope. • He obferves that if the eye can difcern a bright light; and if on fudden expofure to light the pupil con- tracts, if the eye retains its natural fize and figure, if the cataract is not red, blue, yellow, brown, or of a fnowy whitenefs, but of a pearl or light grey colour, and if it was preceded not by fenfations like thofe produced by flies moving before the eyes, but by a miftinefs hanging over objects and increafing with the difeafe : in thefe cir- cumftances the cataract is in a fit ftate for operation, but in oppofite circumftances the cafe muft at leaft be doubtful. As to the mode of operation, I fhall not here repeat, what in his works he has clearly pointed out, but having had frequent opportunities of feeing him extract, I am decidedly of opinion, that no country practitioner fhould ever prefume to undertake the operation, nor any chirur- geon, even in great cities, who is not aimoft in the daily habit of performing-it. 2. Caligo Gomee. The cornea is compofed of many " lamina, which are liable to be feparated by ftagnant lymph, and this according to the quantity may produce either femi-pellucid fpecks, or perfect and complete opacity. Specks may be removed with fafety by means of lapis calaminaris and fugar in equal parts, either blown upon them through a fmall quill, or applied with a pencil brufh. The leucoma, if extenfive, may require cathartics with calomel to excite the adion of the ab- forbents, and aftringent applications to the part to brace the relaxed veffels. An hernia of the cornea, with prolaplus ot the uvea, called ftaphyloma, requires aftringenis. M. Gimber;:.:, of Madrid, has cured manv by dropping three times a day N n n a 482 LOCAL DISEASES. a few drops of a very ftrong cold infufion of myrtle- leaves into the eye, keeping the bowels foluble by cool- ing cathartics, and making the patient avoid fpices, fpir- its, and whatever increafes the motion of the fluids. Sometimes the cornea is fuffufed with blood, when there are no fymptoms of inflammation, as may be feen in fcrophulous fubjects. In this cafe our dependence muft be on tonics and aftringents externally and internally ap- plied. Excrefcences from the cornea may be taken off by a thread, by the knife, or by an efcharotic, which may be compofed of fugar, ten grains, to one grain of alum finely powdered ; after which the eye muft be wafhed for fome days with brandy and water, then with the following aftringent collyrium. IJ, Zinci vitriolati, 3j. Aq. Rofar. ftj. M. f. Solutio. Cola. White vitriol a dr-am, diflblved in a pint of rofe water and filtrated. Or the following, adopted from the Germans, may be perhaps preferred : R, Margarit. ^j. Ceruffas acetat. gr. vj. Zinci vitriolati, gr. iij. Aq. Rofar. Aq. Plantaginis, aa §j. M. Mother of pearl one fcruple ; fugar of lead fix grains ; white vitriol three grains ; rofe water and plantain water, of each one ounce. 3. Caligo pupille. '■ The clofing of the pupils, which may be occafioned by inflammation of the iris. 4. Caligo humorum. This may be produced either by effufion of blood, of pus, or of milk, as mentioned by Haguenot, into the chambers of the eye ; by deficiency of aqueous humour ; by its morbid abundance, as in dropfy of the eye ; or by diffolution and diforganization of the vitreous humour, which is the amaurofis a fynchifi of Sauvage. 5. Caligo palpebrarum. In this fpecies the eye lids may be fixed to the eye by the adhefive inflammation ; or the two lids may be united by the fame procefs ; or the fuperior lid may be clofed either by palfy of the muf- cle, called elevator palpebrse fuperioris ; by tubercles and warts thickening the membranes; by flefhy excref- cences, by fteatomatous tumours, or by cancer.. Thefe five include the twenty fpecies of Sauvage, not excepting his caligo venerea, although unnoticed by Dr. Cullen. LOCAL DISEASES. 483 Cullen. True it is, that the infants of proftitutes and of women infected with the lues, often fuffer blindnefs; but then this blindnefs is not of any particular fpecies, for it may arife either from cataract, or from morbid affections, either of the cornea or of the humours of the eye. Genus LXXXV. Amaurosis. Gutta Serena. Sight diminifhed, or deftroyed, without vifible injury to the eye : the pupil moftly dilated and immoveable. SECTION I. . Of the Hiftory of Amaurofis. Amaurosis fometimes comes on fuddenly, more ef- pecially if produced by violence, whether by concuffions or by wounds. Sometimes the fight is gradually loft, as in old people and in paralytic fubjects. Sometimes again the gutta ferena is periodical, rapid in its progrefs, and continues only for a few hours or days, after which it fuddenly and fpontaneoufly departs, yet frequently re- turns, as may be obferved in hyfterical and in parturient women. Sometimes we find it affociated with head ach, vertigo, fleepinefs, and finging in the ears : at other times it appears unconnected with thefe fymptoms. It is commonly preceded by the appearance of duft, cobwebs, and flies, called mufca volitantes, and when re- cent, has vifion cleareft in a ftrong light. S E CTION II. Of the Proximate Caufe of Amaurofis, and Diftinaion into Species. The proximate caufe of amaurofis is interruption of the nervous influence in the optic nerve or retina, which may be either perfect or imperfeft. Sauvage enumerates feventeen fpecies or this dileale; but Cullen, transferring two of thefe to caligo pupille, where certainly amaurofis afynchifi fhould not be placed, has included the other fifteen in his own four fpecies, viz. 1. Amaurofis 484 LOCAL DISEASES. 1. Amaurofis compreffionis. 2. Amaurofis atontca. 3. Amaurofis fpafmodica. 4. Amaurofis venenata. Without particularly ftating my objections to his fec- ond and fourth fpecies, as being included in the third, I fhall only make fome obfervations on his firft. The preffure, forming his fpecific character, may be either on the thalami of the optic nerves, or on the nerve itfelf in any part of its extent, and may be made by ex- oftofes produced by fhe fyphilitic virus ; by fteatoma- tous, or fcrophulous tumours; by calculi, as noticed by, Bonet; by lymph, as happens after ferous apoplexy and palfy; by blood, either extravafated or in its proper vef- fels, as happens either from external violence, or from internal caufes, as after acute fevers and the fanguine apoplexy. This preffure on the optic nerve by diftended veffels may arife from a ftrong determination to the head, which may be caufed by fpafm, and this again may be occafion- ed either by poifons or by any acrid matter, particularly in the alimentary canal. What numerous caufes have "' . we here, each requiring a fpecific mode of treatment to itfelf! yet all are included in one fpecies ! Surely thefe obfervations are fufficient to evince the impropriety of the diftinctions made by Dr. Cullen. I fhall therefore venture to fuggeft a more natural divifion, and fhall endeavour to eftablifh the following fpecies. 1. Amaurofis fanguinea, related to the Pyrexia, has fymptoms of plethora, and frequently begins with deep* feated pain in the head, or diftreffing weight at the bot-, torn of the eye. It follows acute fevers and the fanguine apoplexy, and it is frequently occafioned by violent con- euflions, fuch as may produce extravafation of the blood, whether by blows, by falling from a confiderable height, * or by fneezing. It may likewife be occafioned by anger ;• by violent mufcular exertion, as in parturition; by the hot bath ; or by whatever caufes a determination to the ' head. On diffection the arteries in the 01 bit of the eve have been found exceedingly diftended, and extravaia- ,; tions of blood have been difcovered comprefling the op-«.«y tic nerves in patients who had fuffered by amaurofis, . This '• ." LOCAL DISEASES. 4J5 This fpecies comprehends the firft ajid fourth fpecies of Sauvage, which are his traumatica and plethorica. 2. Amaurofis fpafmodica, related to the Neuroses, has fymptoms of debility and irritability.i It follows -convulfive and. fpafmodic affections, and is peculiarly the difeafe of hyfterical and epileptic patients. It has beau f* obferved to attend intermittents, atonic gout, and hemi- s crania, which came on after child birth. It is often oc- cafioned by colic and cdnftipation of bowels, particularly ^by colica pictonum, by the irritation of .calculi in the kid- neys, and by ftoppage both of the haemorrhoidal and of the menftrual flux. It is likewife confequent on the fweating of the feet imprudently repreffed, on the exan- themata repelled, or any herpetic eruptions checked ; and it is particularly induced by exceflive indulgence in the moft exhaufting of all fenfual pleafures. It is faid to be occafioned alfo by application of ftramonium to the eyes. This comprehends eight fpecies of Sauvage, among which we find his amaurofis a fpafmo, caufed by fjsai- , K. modic conftriction of the annulus moderator of Vafralva. This ring is formed by the four ftrait mufcles with the obliquus major, all which arife from the bottom o£ the * orbit, and together embrace the optic nerve. The caufe here afligned is certainly adequate to the effect produced. * But befides this we muft recollect, what has been deliv- ered in the preceding volume, on fpafmodic ftricture, asA the occafional caufe of apoplexy ; and more,particularly* * - what I have faid upon the fubject, when accounting for the determination to the brain in'mania hyjlcrica, 3. Amaurofis ferofet, related to the Cachexia, has fymptoms of*relaxation,, debility,* and* torpor. It is in- deed a genuine cachectic difeafe, arifing from morbid % ' affection of the lymphatic fyftem, being produced either : by increafed action of the exhalants, or by diminifhed action of the abforbents. It is the difeafe of hydropic habits, and attends apoplexia ferofa. I need fcarcely add, .' that it is occafioned by% poverty of diet, exhaufting dif- eafes, haemorrhages, anxiety, protracted grief, hard ftudy, > yt * vigilance, application &f cold after exercife, by dram * * thinking, and by every kind of intemperance. * ^ w • ♦ • '.. This 486 local diseases. This fpecies is the amaurofis pituitofa of Sauvage. . 4. Amaurofis organica has none of the preceding fymptoms, or at leaft not as connected with this affection of the eye. It is occafioned commonly by external violence, fuch zi wounds dividing the optic nerve itfelf, or by fuch effulgency of light as may be fufficient to change the or- ganic ftructure of the retina. But Bonetus difcovered the optic? nerves atrophic and wafted to half their ufual fize, which muft have arifen from fome internal caufe, and my friend M. Gimbernat in the place of the retina had once occafion to obferve a bony fubftance, which muft Jjave been either an incruftation, or the oflification of that medullary expanfion of the optic nerve, produced by the fame procefs as oflifications in the brain. M. Gim- bernat has preferved this curious production in his Mu- feum at Madrid. Hydatides have been difcovered by Boerhaave on the retina, and exoftofes very frequently . produced by the venereal poifon, are apt to prefs upon the optic nerve. , ** Sauvage difcovered by diffection ftrumous glands in- cumbent on the optic nerve, and various tumours pro- ducing the fame effect have been noticed by Hoffman. As to the amaurofis foricariorum of Sauvage, I know ' not where to clafs it, nor do I believe that the nocturnal Scavengers of London are acquainted with this wonder- ' ful difeafe : -yet fuch is the authority of Ramazzini, from whom Sauvage has adopted it, that I cannot doubt of its - * exiftence. As however it is fufficient for thefe men to cover their eyes with glaffes in order to avoid the dire effects of their needful, although humble, occupations, we need not be very anxious to difcover the pathology , • of this difeafe. , u SECTION III. Of the Indications of Cure in Amaurofis. These muft depend on the nature and caufe of the . - * difeafe, for no medicine has ever been difcovered, which •* •»..', can cure indifferently every fpecies of the fame difeafe. 1 V"' I "' ' LOCAL DISEASES. I fhall therefore confider what is the proper mode of treatment in the feveral fpecies of amaurofis. i. Amaurofis fanguinea. The indications of cure are precifely the fame as in apo- plexia fanguinea, to which I muft refer the ftudent. It is for this reafon that Hoffman,' if the pujfe admits of fuch evacua- tions, recommends bleeding, by leeches applied to the tem- ples, by the lancet from the feet, or, in preference to both, either from the frontal vein or from the temporal artery. With the fame view of diminifhing preffure in the brain, , he advifes to cleanfe the firft paffages by cooling and moft .' gentle cathartics, and the great inteftines by carminative . clyfters. With thefe remedies he enjoins ftrict temperance. 2. Amaurofis fpafmodica. The indications of cure are the fame as in palfy and ' • epilepfy, which the ftudent may confult. We muft here be particularly careful to obviate, firfl: the occaflonal, then the predifponent caufe of fpafmodic affection. If, as very often happens, there is irritation in the alimentary canal, it muft be removed by gentile cathartics and carminative clyfters. If the irritation fliould be from the hemorrhagic effort in the uterine veffels, nature muil be affifted by emmenagogues of the antifpafmodic order combined with tonics. If from a tonic gout, attention muft be paid to that difeafe. If the ftim- ulus is mental, the angry paflions muft be reftrained. If 4 the fweating of the feet has been repreffed, if exanthe- mata have been repelled, or if herpetic eruptions have been checked ; the fame treatment muft be adopted, as recommended by Hoffman in his tuffis ferina, which is to be found in my fection vi. of catarrh. Hoffman particularly recommends calomel with bal- famics and corroborants, which in many cafes obviate both the remote caufes of the difeafe. Dr. Collin of Vienna, fince the year 1773, has intro- ' duced the arnica montana to the notice of phyficians, as » - a powerful tonic in cafes of amaurofis, and fome of my friends in Spain have proved its efficacy. He gave from two drams to half an ounce infufed in boiling water, '' with an ounce of fyrup of maiden hair, (adianthum ca- pilhu >g£ LOCAL DISEASES. pillus veneris) for a dofe, and he affures us, that in nine cafes it perfected the cure. As it is a penetrating aro- matic bitter, it prOmifes to be,a valuable acquifition in a variety of fpafmodic affections. Electricity is of all antifpafmodics, the moft fpeedy in its- operation, and in cafes, of amaurofis has very frequently been found effectual. Mr. Wathen and Mr. Phipps have cured many patients by that means. A generous diet is admiflible in this difeafe, yet every . * fpecies of intemperance muft be carefully avoided. The patient muft fhun the extremes, and the fudden alterna- tions of heat with cold. ♦ 3. Amaurofis ferofa. The indications are precifely the fame as in apoplexia ferofa. Emetics, cathartics, diuretics, blifters, fetons,- and fternutatories, are highly proper, and may be fol- lowed up with fpirit. The abforbents may be excited to action by calomel, and particularly by fuperoxygenated air. Of this I have been witnefs in the practice of my friend Dr. Thornton, more efpecially in the cafe of " Patterfon. 4. Amaurofis organica admits of no relief. Genus LXXXVI. Dysopia. * Sight depraved, requiring one certain quantity of light, one particular diftance or pofition. Dr. Cullen has five fpecies. 1. Dyfopia tenebrarum. . 2. Dyfopia luminis. 3. Dyfopia diflitorum. 4. Dyfo- . * pia. proximorum. 5. Dyfopia lateralis. Thefe coincide with as many fpecies of amblyopia in Sauvage'; but as with thefe this learned profeffor has .. ^ affociated two others \vhi.ch evidently belong to different k;, genera, Dr. Cullen has remitted one of them to calico,' the other tK> amaurofis. 1. Dyfopia tenebrarum, in which objects to be feen v require tha ftrongeft light. '* This fpecies Sauvage informs us was epidemic in the vicinity of MontpeHier, chiefly near the rivers, where fold- iers in particular, who mounted guard by night, were the firft to fuffer. " • . It LOCAL DISEASES. 4S9 ^ It was cured by evacuants, fuch as emetics, cathartics. diuretics, diaphoretics, blifters, and bleeding. Boerhaave mentions a variety of this fpecies arifing from contraction and immobility of the pupil, which he confidered as incurable. 2. Dyfopia luminis, in which objects to be feen require obfcurity. . • This muft arife from extreme fenfibility of the retina, as in cafes of inflammation, with a peculiar conformation of the iris. When it arifes from inflammation, the cure is obvious. 3. Dyfopia diffitorum, near fightednefs. 4. Dyfopia proximorum, in which near objects are in- diftinctly feen. Thefe require the aid of the optician. 5. Dyfopia lateralis, in which objects to be feen re- quire an oblique,pofition. This may arife, 1. From the obliquity of the pupil. 2. From want of tranfparency in fome part of the cor- nea. 3. From obliquity of the cryftalline. 4. From want of fenfibility in a part of the retina. 5. From the habit of fquinting, in which cafe alone relief can be ex- pected. This, according to circumftances, may be ob- tained either by proper fpectacles or by a proper mafk. Genus LXXXVII. Pseudoblepsis. Sight depraved, creating imaginary objects, or repre- fenting them different from what they are. Sauvage has entered fully into this moft curious fub- ject, and in his two genera of fuffufio and diplopia, has taken notice of all the optical deceptions which arife from morbid affections of the eye. But as thefe may be regarded chiefly as fymptomatic of fome primary difeafe, I fhall not here repeat his obfervations. They moft com- monly attend either fever or fpafmodic affections, and then originate in preternatural determination to the brain. In the firft cafe the proper remedies are the tepid pedi- luvium, bleeding, carminative clyfters, refrigerant ca- thartics, and every part of the antiphlogiftic regimen. Ooo But 4g0 LOCAL DISEASES. But if the determination to the head arifes from fpaf- modic affection, the principal attention muft.be to remove the ftimulating caufe, then to invigorate the general habit. If the eyes have been fatigued by nocturnal ftudies, or diftreffed by immoderate effulgence, they muft be per- mitted to repofe, and the tonic plan muft be purfued. Genus LXXXVIII. Dysecoea. Hearing diminifhed or deftroyed. SECTION I. Of the Caufes of Deafnefs. \. The meatus auditorius externus may be clofed by —a. Infpiffated wax, which fometimes acquires the hard- nefs of a ftone.—b. Membrane formed in the meatus, which may be rendered thicker by collecting wax.-—c. A flefhy excrefcence or polypus fucceeding an ulcer.—d. Swelling of its glands.—e. Extraneous bodies. 2. The membrana tympani may be morbidly affected by —a. Relaxation, which may be occafioned by humidity, or by the difcharge of ulcers.—b. Preternatural tenfion. In this cafe the perfons hear beft in damp and foggy weather.—c. Becoming callous or even long, as happens to other membranes.—d. Rupture, occafioned either by external and mechanical violence ; by the concuffion of loud founds, or from within, through the Euftachian tube, by fneezing : or the folution of continuity may be occafioned by acrimonious pus. 3. In the tympanum.—a. The fmall bones may either lofe their power of motion by adhefive inflammation, or may be deftroyed by caries.—b. The mufcles ferving for the motion of thefe bones may be morbidly affected either by fpafm, by palfy, or by inflammation and fuppuration, which is the more readily induced becaufe of their con- nexion with the Euftachian tube.—c. Next to wax in the auditory paffage, the moft common caufe of deafnefs is obftrudtion in the Euftachian tube. When I was in Ed- inburgh, Mr. Braidwood, now of Hackney, was there, teaching the deaf and dumb to underftand and fpeak. He LOCAL diseases. 49 He had then about twenty fcholars, who were all born deaf. Upon examination, I difcovered that in the major part of thefe the Euftachian tube was clofed. In violent fevers this effect is very frequently produced by inflam- mation, as happened to the patient whofe cafe of bilious autumnal fever has been related. Sometimes the tube is clofed by vifcid mucus, as in catarrh, on the going off of which the hearing is fuddenly reftored, and the paf- fage is opened by a loud and furprifing fnap. It often happens that venereal virus either produces exoftofes in the bony part of the tube, or ulcers, with the adhefive inflammation in the mufcular part, and the paffage is ob- literated. It is fometimes clofed by polypus. 4. The internal ear may be morbidly affected—a. By redundance or deficiency of aqueous fluid in the laby- rinth—b. By inflammation and fuppuration of the peri- ofteum.—c. By caries of its bones. 5. The auditory nerves are fubject precifely to the fame affections as the optic nerves ; and for thefe, therefore, J muft refer the ftudent to what I have faid on amaurofis. SECTION II. Of the Cure of Deafnefs. 1. When we are to examine a patient, who complains of deafnefs, we muft begin with the external ear, and for this purpofe we muft contrive to throw a funbeam into the auditory paffage. Should this be obftructed by ex- traneous bodies, they muft be extracted ; if by infpif- fated wax, which is moft frequently the cafe, it muft be foftened, either by ox gall, lime water, oil of bitter al- monds, or by warm milk, with four drops of aqua kali; then wafhed, by injecting frequently either lime water or fage tea with honey. The ox gall or oil muft be put into the ear at night, and the paffage muft be fyringed the next morning. The fyringe fliould have a filver pipe with numerous perforations at the end, fome lateral, others oblique, but none direct, left the membrane of the drum fhould be mechanically injured. *After injecting this infufion, the ear muft be kept warm, and no cold liquids 4g2 LOCAL DISEASES. liquids muft be drank. This operation muft be repeated every day, even for a month, or till the wax is cleared away. If there is a fuperfluous membrane, it muft be pierced,, if a polypus, it muft be extirpated, either by ligature, by the knife, or by a cauftic, whkh may be introduced by means of a tent thruft through a canula adapted to the ear. If the glands are fwelled, a few drops of oil of al- monds with camphor, will allay the pain, and gentle ca- thartics, with fmall dofes of calomel, will reduce thern. Should they fuppurate, a decoction of barley and agri- mony will cleanfe the ulcers. 2? If the membrana tympani is relaxed, the hearing will be worft in foggy weather, and will be quickened in a time of froft. For this tonics externally and internally applied are proper ; fuch as cold bathing, cool air, ex- ercife, a generous diet, bitters, bark, and fteel, and a cold infufion of tormentil may be injected into the paffage of the ear, once every morning. Should this membrane be affected with preternatural tenfion, oil of almonds may be dropped into the ear at night. When we fufpect that deafnefs arifes from lacer- ation, or from erofion of the membrana tympani, the perfon muft be made to take a full infpiration of air into his lungs, then flop his noftrils and his mouth, and en- deavour to expire. Should air efcape by»his ears, we may be certain that we have difcovered the caufe of deaf- nefs, and need look no further. 3. To difcover whether one or both the Euftachian tubes are clofed, let the expedient mentioned in the pre- ceding fection be reforted to, and if they are open the air will be felt preffmg the membrana tympani. If noth- ing is felt, the tubes are clofed. Diemerbroeck remarks* that when thefe tubes in catarrh are clofed by mucus, if you flop both ears, and with a flick between your teeth, ftrike the firings ofamufical inftrument,you hear nofound, and that by this method he examined his patients ; but the preceding trial will be fully fufficient for our purpofe. If the Euftachian tube is clofed by mucus, it will be proper to try fialagogues, followed by cephalic fnuff, or fome LOCAL DISEASES. 493 jbme more efficacious fternutatory, which may be found in the clafs errhina of my Vade Mecum. Should thefs prove infufficient, a proper catheter may be introduced into the tube through the noftril, as Dr. Monro, of Edin- burgh, has practifed. 4. The difeafes of the internal ear are not eafily dif- tinguifhed; but thefe, it is apprehended, very feldom hap- pen, becaufe the parts are far removed from injury. When however the mufcles or the membranes partici- pate in the general affections of the fyftem, the general treatment will extend its beneficial effects to them. 5. Affections of the auditory nerve are, perhaps, as common as thofe of the optic nerve ; but unfortunately, they are not. fo readily diftinguifhed. In amaurofis we can have little room to doubt, becaufe when there is no vifible injury, when the parts are all tranfparent, and when the pupil is dilated and immoveable, it is evident, that there muft be obftruction of the nerve ; but in the ear all the internal parts are hid. If, however, either apoplexy, palfy, epilepfy, vertigo, head ach, or lofs, or even imperfection of and other fenfe has either immediately preceded, or attends the deafnefs, we may have reafon to fufpect that there is preffure on the nerve. This preffure on the auditory nerve may be produced by—a. Blood, and may arife from either pythora, and therefore require evacuants, with a vegetable diet,.and conftant exercife ; or it may be induced, as it very often is, by fpafmodic affection and determination to the head, which may be either permanent or periodical, and may return either regularly or at uncertain intervals. In thefe cafes the fame treatment precifely is required as in amauro- fis fanguinea and amaurofis fpafmodica, to which I muft re- queft particular attention.—b. Serum, with fymptoms of relaxation, debility, and torpor, as in amaurofis ferofa, and in apoplexia ferofa, under which the proper treatment will be found.—c. Steatoma—d. Exoftofis, which, if pro- duced either by fcrophula, or by the venereal virus, will require the fame remedies as have been ordered in thofe difeafes. SECTION ■"■ tlf^f-W^^p 494 LOCAL DISEASES. SECTION III. Cafes of Deafnefs., Case I. A girl who had been deaf for many months, was at the fame time palej low fpirited, and complained of deficient catamenia. After taking hyofcyamus albus daily for fix weeks, fhe perfectly lecovered her hear- ing, her colour, and her flefh. She began with one third of a grain, and gradually increafed the dofes to feven grains a day. See Sauvage, Vol. I. p. 753/ Case II. A lady, aged 60, of a ftrong conftitution, yet fubjedt, when coftive, during feafons of rain, to heavinefs and pain in her head, with fome degree of deafnefs, was fuddenly feized with total lofs of hearing in the left ear, and difficulty of hearing in the right. By the advice of Hoffman, fhe took a drtun of rhubarb with an ounce of coffee, made into an infufion, which was repeated at intervals, and fhe put a clove of garlic alternately with a few drop3 of effence of colocynth and mufk into her ear. By thefe means her hearing was reftored. Had they failed, the profeffor would have ordered a few grains of ammonia pp. with a frnall quantity of caftor, to have been put into the ear. Case III. " ^ A veteran profeffor, who for 16 years had loft the hearing of his right ear, fearing the fame misfortune for the left, applied to Hoffman, who, finding his bowels conftipated, ordered cathartic pills. Thefe, among other ingredients, were compofed of calomel, cinnabar, aloes, jalap, and fait of amber, with Peruvian balfam. But the good old man, wrapped up in the profoundeft meditations as he walked, inftead of one fcruple, confifting of fourteen pills, took the whole quantity prefcribed, being no lefs than 120 pills. In lefs than two hours he bad excruciating pain in his inteftines, with naufea and frequent fail- ings 5 yet he had only four motions : violent fpafmodic pain in the right fide of his head; more particularly of the ear, fucceeded, and ra- ged to fuch a degree as to deprive him of reft. This was however followed by a dreadful explofion, like the difcharge of a cannon, v/iiich removed the pain, and his hearing perfeaiy returned. Case IV. A military praefeft, in the vigor of youth, having taken cold during a mercurial falivation, loft his hearing altogether, and complained of a weight in his head. After two months, the Prince of Orange fent him to Hoffman, who ordered the following cathartic : Gum ammoniac, rhubarb, aloes, calomel, cinnabar, of each half a dram ; fait of amber, faffron, caftor, of each twelve grains ; Pe- ruvian balfam, fufficient to make a mafs of pills, one fcruple of wub T mt° tWenty piJIs' was taken evei7 °ther day. With this he ordered a fparing diet, abftinence from wine, and the warm pediluvium twice a day. He put a blifter to the nape of the neck, LOCAL DISEASES. 495 neck, gave him a fternutatory powder, and put cotton, with a few drops of what he called his balfam of life, into the ears. By this means his hearing was reftored. Case V. A Dutch count, aged 69, of the fanguine temperament, much dif- pofed to anger, temperate, robuft, and accuftomed from his youth to the fatigues of hunting and of war, complained of vertigo, more ef- pecially in going down flairs, with great weaknefs of head, and pain in the cervix after deep meditation, or any remarkable intenfity of thought. His mouth and lips were inflated and diftorted, his hand trembled when he wrote* and the left fide of his face was fpafmodically affefted. His left eye was inflamed, and on his tongue he had fome puftules, which diftreffed him with a burning heat. His hearing was ai- moft deftroyed, but that of the left ear was much the worft. He had been fuddenly feized with the paralytic affeftions about a year and an half before, on returning home, after having been expofed to humidity and cold. In ©ther refpe&s the count was vigorous, rode a hunting, and performed all the functions of life with ardour. Yet his alacrity was greateft after meals, and after dinner he could both write without tre- mor, and indulge intenfity of thought without any remarkable weak- nefs in his head. It muft be added, that he had been accuftomed formerly to bleed frequently in the foot, but that latterly he had loft blood by the arm. only, twice a year, at the equinoftial periods, and that he had for- merly been open in his bowels, but now complained of coftivenefs. Hoffman, attributing, as he informs us, the paralytic affection, the ver- tigo, the deafnefs, and the diflreffing weaknefs of the head after intenfity of thought, to one and the fame caufe, a fuperabundance of ferous fluids, and being perfuaded that a determination to the head was fupported by conftipation of bowels, ordered fuch cathartics as, confidering the age of his patient, he could venture to prefcribe. Thefe were rhubarb, fait of tartar, crocus of antimony, and crab's claws, given twice a week. He ordered oil of amber with aqua ammonise, and what he calls tinc- tura tartari, to be taken twice a day. The refult of this curious cafe is not communicated. Genus LXXXIX. Paracusis. Dr. Cullen has two fpecies; i. That in which founds are heard, but not with the ufual conditions. 2. That in which the fenfation is excited by internal caufes. But Sauvage of thefe makes two genera, paracufis and fyrigmus ; the firft containing four, the latter eleven fpe- cies, of which I fhall here take notice. 1. P. barycoia is the affection in whicli leva fou'.id? create confufion in the hearing. It i: attributed to rigidi- tv • 406 local diseased ty and rheumatic affection in the mufcles, which move the malleus and the ftapes. 2. P. oxycoia is confufion of hearing, arifing from extreme fenfibility and intolerance of founds, which is induced by inflammatory and fpafmodic affections. The marchionefs Parifma, labouring under cephalalgia and hyfteric cough, was fo diftreffed by the voice of her at- tendants, that not only the pain of her head increafed, but it extended to her cheft; and her cough was wonder- fully aggravated. Some patients are thrown into con- vulfions, or become delirious, even by the flighteft founds. 3. P. duplicata. Double hearing. A mufician, who excelled upon the German flute, walking in a cold rain, at night, was feized with a catarrh, in confequence of which, when playing the flute, he heard a double found, ifochronous, but not in harmo- ny, and therefore fo offenfive, that he was obliged to' r lay afide his flute. This fymptom ceafed with the catarrh. ( A fimilar cafe continued for many months. 4. P. Willifiana. This fpecies requires loud noifes to aflift the ear in diftinguifhing articulated founds. Dr. Willis records four cafes, one of which required a drum to be conftantly beating. One deaf perfon heard well in a carriage, and another when the bells were ringing near him. Sauvage, as I have ftated, enumerates eleven fpecies of fyrigmus, in which imaginary founds of different kinds are excited by internal caufes. The principal of thefe iit will be fufficient merely to enumerate : 1. S. criticus. 2. S. a debilitate. 3. S. plethoricus. 4. S. cephalalgias. 5. S. caiarrhalis. 6. S. vertiginofus, 7. S. a ventriculo. 8. S. ab oxyccea. His three other fpecies, fibilus, fufurrus, and bombus, make part of the generic character, and therefore fhould not appear as fpecies. When this difeafe is fo diftreffing as to require medical afliftance, we muft determine whether it is connected with the pyrexiae or neuroses ; whether it is a fymp- tom of the fthenic or of the afthenic diathefis, that we may know how to treat it. If local diseases-. 4C/7 If the patient is athletic or plethoric; if the pulfe is full, hard, frequent, and ftrong in the carotid arteries ; if his dittrefs increafes when he is recumbent and warm in bed ; it it is attended by vigilance, by pain in the head, and by .other inflammatory fymptoms ; if it has been relieved by hemorrhage; it is connefted with the pyrexiae, and requires evacuants, with the antiphlogiftic regimen : But if the patient is of a relaxed and irritable habit; if he has been exhaufted by previous difeafes, or by any fpecies of intemperance ; if he has fuffered by hemor- rhages or exceffive evacuations of any kind; if he is re- duced try penufy; if he has been fubjea to hyfterical, epileptic, or other nervous difeafes, it is connected with neuroses, and requires chiefly cordial ftimulants, with tonics and aftringents : If again, we find it connected with fpafmodic affedion, it will be needful, not merely to obviate, as above, the predifponent caufe, but to remove the occafional caufes, either by anthelmintics, by emmenagogues of the tonic and antifpafmodic orders ; or by cleanfing the firft paf- fages, whether with emetics or gentle cathartics, affifted by carminative clyfters, all which will relieve effectually the determination to the head, as I have fully ftated un- der mania hyfterica. Gemis XC. Anosmia. Smell diminifhed or deftroyed. The power of fmelling may be diminifhed or deftroy- ed, precifely as the fight and hearing, by preffure on their refpective nerves ; by extreme drynefs of the pitui- tary membrane, or by its being covered with mucus; by polypus, obftructing the paffage of air into the noftrils j and by deftruction of the parts, whether it be by ozcena or by caries. From thefe circumftances Sauvage has de- rived his fpecies, which it will be fufficient to enumerate: i. A. catarrhalis. 2. A., ab ozcena. 3. A. a polvpo. 4. A. fyphilitica. 5. A. verminofa. 6. A. a ficcitate. 7. A. paralytica. The treatment muft be taken from the primary difeafe. P P p Gsnus. 498 LOCAL DISEASES. Genus XCI. Ageustia. Xafte diminifhed or deftroyed. The pathology of this affection appears to me to have been univerfally mifunderftood. That the tongue is not the organ of tafte will appear from hence : that if the noftrils are clofed, or if the velum pendulum palati is drawn up, fo as to prevent the free current of air by that paffage, the tafte of whatever is taken into the mouth will be prevented ; or if the tongue is protruded, and a fheet of pafte board is interpofed between the part protruded and the noftrils, fapid fubftances may be placed upon the tongue without exciting any tafte. Hence it is that the fmell and tafte are fo intimately connected, as they are univerfally obferved to be; and hence it follows, that whatever affects the former will equally affect the latter, and that the difeafes are the fame in both. «fe Genus XCII. Anesthesia*; Lofs of Feeling. Sauvage enumerates four fpecies: i. Anaefthefia ab fpind bifida. Of this he faw fix cafes, in the fpace of ten years, at MontpeHier. To fuch an authority I bow down with reverence : but certainly it is not a common fymptom of the difeafe, nor, unlefs I am much miftaken, is it mentioned as fuch by either Morgagni or by Haller. 2. Anaefthefia plethorica. This he takes from Ludo- vici, and upon the authority of that author it muft reft ; but I can fcarcely conceive how a few drops of blood taken from the ranula fhould obviate plethora, and re- ftore univerfal feeling to the nerves. 3. Anaefthefia nafcentium. This feems to be afphyxia. 4. Anaefthefia melancholica. The fingular cafe here recorded by Sauvage is moft remarkable, both for its fymptoms and its cure : but as no reafon is afligned for inoculating this patient with the itch, it feems to be im- perfectly related. Clafs LOCAL DISEASES. 499 Clafs IV. LOCALES. Order II. Dysorexie. The Appetites deficient or depraved. In this order we have eight genera : i. Bulimia. 2. Pica. 3. Polydipfia. 4. Satyriafis. 5. Nymphomania. 6. Noftalgia. 7. Anorexia. 8. An- aphrodifia. Genus XCIII. Bulimia. Appetite for Food voracious or canine. A voracious appetite may be occafioned by inani- tion, as happens to thofe who are exhaufted either by long faffing or by difeafe. It may arife alfo from an acid in the ftomach ; from a fuperabundance of gaftric juice ; and from indigefted fordes. Or it may be produced by worms. ,^And when there is more than common irrita- bility in* the nerves of the ftomach, the food maybe fpeedily rejected. Thefe fymptoms are commonly in- creafed by external cold, when it is not extreme. The proper remedies, according to the nature of the caufe, may be abforbents; fat meats, oils, butter, wine, brandy, tobacco, opium, fpices, iron, emetics, anthel- mintics, bitters, and Peruvian bark. Genus XCIV. Pica. Appetite depraved, with ftrong Defire for unnatural Food. Of this Sauvage enumerated fix fpecies, five of which Dr. Cullen has mentioned, without however giving them his fanction. The longings of pregnant women are whim- fical, capricious, and not in the leaft to be accounted for; but the depraved appetite of children for abforbents, of chlorotic virgins for the fame, for fpices, and for the moft fapid fubftances, may be confidered as the voice of na- ture. The fame may be faid of the cravings we frequent- ly, obferve in fick people, which Dr. Why*t was always ready to indulge. Every practitioner muft have met with «po LOCAL DlSEASLo. with inftances of thefe. They are indeed innumerable. Such defires are inftinctive, like thofe of brutes, which always guide them right. In children and chlorotic virgins, the caufe of pica muft be fought for in the alimentary canal, and the cure will be found in emetics and gentle cathartics, followed by bitters, bark, and fteel, with a generous diet, frefh air, and con- ftant exercife. To relieve this difeafe, no medicine can excel the cachectic Powder of Hartmann, recommended by Sauvage. It is compofed of crab's claws, fteel filings, cinnamon and fugar. Genus XCV. Polydipsia. Exceflive Thirft. Polydipsia is feldom feen as an original difeafe. Yet one inftance I have met with, in the filter of Mrs. Tudor, at the Crown Inn, Reading, who is otherwife in perfect health. r Thirft is commonly fymptomatic of fevers, fluxes, dropfy. It attends every kind of evacuation, when exceflive, being the voice of nature calling loudly for liquids, to fupply the deficiency caufed by this difcharge. When the fluids are thickened, fo as not to pafs freely through their proper veffels, nature becomes impatient for a frefh fupply of diluents; and when acrid fubftances have either been received into the ftomach, or generated in the firft paffages, fhe pleads powerfully for aqueous fluids to wafh them fpeedily away. Thus it is common- ly, when fpices, fpirits, 'alcaline fubftances, falted meats, or rancid oils in confiderable quantities, have been taken into the ftomach, and thus more particularly hi cafe of poifons. The moft common caufe of thirft is heat, to diminifh which, if exceflive, as happens after ftrong exercife and in fevers a copious perfpiration is required, and a plenti- ful fupply ol aqueous fluids to fupport that difcharge. Nature then calls for cold liquids, rather than for warm, and for acefcent drinks, rather than for fuch as contain ardent 8?^ LOCA7, DISEASES. $3' ardent fpirits. In fuch circumftances, as Dr. Brown has molt judicioufly obferved, wine increafes thirft, and excit.es both naufea and vomiting; whereas in hyfteria, typhus, and all cafes of debility, water augments the thirft which is thereby hurriedjion to naufea and to vomiting, but effectually relieved by wine or fpirits. The reafon for thefe diftinctions I have already fuflE- ciently explained. The pathology of polydipfia, as an original difeafe, has never been explained ; nor, as far; as my recollection goes, has it ever been removed by medicine. Exceflive thirft, when fymptomatic, muft be cured by- curing the primary difeafe. f Genus XCVI. Satyriasis. Exceflive and violent Defire for Coition in Men. If the ftudent recollects what I have delivered on irri- tability, ftimuli, and habits, he will fully comprehend the nature of the difeafe in quefticn, and will quickly underftand why it is feldom if ever feen among the labo- rious peafants of country villages; whilft it is the fcourge of indolence, intemperance, and vice, in cities. Morbid irritability is the predifponent caufe of fatyri- afis, and this we know is founded in debility, which is increafed,by every fpecies of intemperance ;, but more particularly, and to a moft aftonifhing degree by that, to which the difeafe itfelf is conftantly inciting. The occafional caufes are to be fought for in mental and material ftimuli, in wine, too great an abundance of animal food with fpices ; but, above all, a difeafed im- agination, heated by vicious company and converfation, or by improper books. If the ftudent will confult what has been faid on the vefanie, particularly on dreaming and delirium, he will fee that mental ftimuli are both more permanent and vio- lent than the material. When therefore the imagination kjtfelf is become the feat of this difeafe, the fymptoms will Wbe rendered moft diftreffing. As to the method of cure, we cannot do better thaa to ro2 LOCAL DISEASES. to adopt nearly the plan referred to by Sauvage, which proved fuccefsful in two cafes. It began by moderate emetics; then the patients took milk, fulphur, aethiops mineral, and cinnabar of antimony, with benzoine and ammonia. The diet was moderate, being confined to four ounces of animal food, and a fmall quantity of wine per day. But the moft effential part of the cure, as it fhould feem, Was that which followed ; viz. bark, orange peel, and vitriolated iron, with the cold bath, and gentle exercife. The fubfequent prefcription comes recommended, with the authority of Sir John Pringle, as a powerful antiaph- rodifiac. ]$, Lign. G-uaiac. un. 3. Lig. Junip. un. 2. Rad. Chinse, un. 1. Argent. Viv. in linteo humido ligati, Antimon. Crud. in linteo ligat. ana, un. 1. poft debitam cum aqua font, infufionem co- quantur ad fly 6. Sub finem codtionis addendo Rad. Glycyr. un 2. Colat. Capiat, un. 30—60. omnia quotidie per 30 ad 50 dies. Yet, in addition to this alfo, it muft be obferved, that tonics are certainly required to obviate the predifponent caufe, and that gentle exercife in the open air is a pow- erful tonic. Violent exertions would exhauft the vita! energy, and increafe debility : but neverthelefs, it will be found expedient to pufh the exercife as far as poffible without producing this effect, becaufe in this cafe the quantity of animal food may be increafed, and then muf- cular exertion will continue to be a powerful tonic. Be- fides, by experience, it is found, that when a due quan- tity of vital energy is expended in this way, nature is not folicitous tdTeek relief from any other quarter, but qui- etly finks into refrefhing flumbers : Nofte fatigatum fomnus, non cura puellae, Excipit ; et pingui membra quiete levat. The patient muft likewife endeavour to procure fome agreeable employment for his mind, in order to obviate the mental ftimulus, at the fame time moft carefully avoiding fuch places, fuch fociety, and fuch books as have been accuftomed" to inil me his imagination, and to exite his paflions. If by thefe means he acquires fome degree of fortitude * 4 and refolution, a cure may be expected, becaufe by de- grees LOCAL DISEASES, S°3 grees evil habits may be broken ; whereas by indulgence every evil habit is confirmed. It is the property of a ftimulus, either to produce ac- tion, or to exhauft the irritability of the part to which it is applied. If action is produced, and any kind of drain •from the fyftem is' eftablifhed, nature provides a regular fupply, and becomes impatient whenever that evacuation ceafes. This may be obferved in the haemorrhoidal and in the menftrual difcharge, in periodical haemorrhages, fuch as epiftaxis, and in thofe perfons who at ftated fea- fons have been accuftomed to be blooded. It is from this principle alone that plethora is increafed by venae- fection. Again, when nature has been taught to act on the flighteft irrigation, fhe becomes impatient under the com- mon ftimuli, and is thrown into convulfive or fpafmodic action by thofe which would have otherwife been endur ed without commotion. In the extreme debility of typhus, in hyfteric affections, when fevere, or when a perfon has long been fecluded from the light, how irritable is the retina ! how impa- tient under the ftimulus of light ! After long confine- ment, with filence and folitude, how readily are fuch patients convulfed by the ftimulus of founds ! the fame may be faid of every other ftimulus, even of blood in the arteries of one who is exhaufted and dying of an haem- orrhage. If, from fortitude and refolution, the ftimulus is en- dured, the irritability of the part to which it was applied will be exhaufted, and, according to circumftances, it may be hours, weeks, or months, before the irritation is renewed. This may be obferved with refpect to hunger, to parturient pain, and particularly to the appetite before us, in thofe animals, with which we are belt acquainted, of the domeftic tribe. Genus XCVII. Nymphomania. This difeafe, which is the fame with the preceding, is mmon in warm climates. The effeds, as defcribed by luviinai r04 LOCAL DISEASED. Juvenal in his fixth fatire, are moft humiliating to hu- man nature. It acknowledges the fame caufes with fatyriafis ; but as females, more efpecially in warm cli- mates, have a more irritable fibre, they are apt to fuffer more feverely than the males. As a natural difeafe, it requires tonics and aftringents -f as moral, it calls for moral arguments : in both cafes the prudential cautions recommended in fatyriafis are expe- dient. But, from what I have had an opportunity to ob- ferve in Spain, I muft further add, that young perfons of delicate fentiments and tender confciences muft be careful not to miftake a mere natural defire for moral turpitude, left diftrefs of mind fhould increafe the pre- difponent caufe of this morbid affection, which is debility, attended by irritability, and left, by rivetting this too vivid idea in the mind, it fhould there prove a conftant ftimulus to excite defire, and aggravate that diftrefs which. they are impatient to relieve. Genus XCVIII. Nostalgia. Impatience when abfent from one's Native Home, and Vehement Defire to return, attended by Melancholy, lofs of Appetite, and want of Sleep. This difeafe is equally familiar to the Swifs and to the peafants of the Afturias, who have quitted their native mountains, and in many cafes has proved fatal. It com- monly deranges the digeftive functions, and commits the greateft ravages in the alimentary canal, inducing flatu- lence, coftivenefs, atrophy, and death. Dr. Hamilton, of Ipfvvich, records a curious cafe, in a Welfh recruit, A. D. 1781. This young man was of a gloomy countenance, and complained of weaknefs. His puife was frequent and fmall ; he had little appetite ; his fleep was difturbed by ftarting, he was atrophic, and his ftrength was fo reduced, that he could not leave his bed ; yet he had no pain, no thirft, no cough. Neither wine, cordial ftimulants, nor other tonics had the leaft effect, for his pulfe daily became quicker and fmaller. Evening exacerbations and morning fweats fucceeded. LOCAL DISEASES. 5©5 His nails became mcurvated, and the tunica adnata of his eyes pellucid, attended by debility and emaciation in the extreme. In this fituation his fagacious phyfician obtained from the commanding officer, and communicated to his pa- tient a promife of a furlough for fix weeks. On this promife his appetite and ftrength returned; in a few days he was able to get up, and in two months he left the hofpital, being then perfectly reftored to health. Genus XCIX. Anorexia. Appetite impaired. Dr. Cullen very properly confiders anorexia as fymp- tomatic of other difeafes, but chiefly of dyfpepfia ; yet, for the benefit of ftudents, he takes it as a genus, and reduces nine out of the thirteen fpecies, enumerated by Sauvage, to two. The other four he confiders as un- certain. His two fpecies are, 1. Anorexia humoralis; and 1. Anorexia atonica : but, in my apprehenfion, he might have reduced them. both to the atonica, becaufe anorexia pituitofa, anorexia* biliofa, and the anorexia a faburra, which are the three fpecies of Sauvage included in the anorexia humoralis of Cullen, all arife from atony, either of the mucous glands, or of thofe which fecrete the gaftric juice. 1. When the mucous glands are relaxed, the ftomach will be lined with vifcid mucus ; digeftion will be im- peded, and bile may regurgitate ; in confequence of all which, the appetite for food, as well obferved by Boer- haave in his aphorifms 70, 71, will be impaired. The proper remedies in thefe cafes are emetics, rhubarb, fteel,- and aromatics, temperance, exercife, and air; but par- ticularly vital air. The anorexia melancholica of Sauvage, arranged by Cullen under his atonica, is ftated to arife from fear and grief, which relax the mucous glands, load the firft paf- fages' with flime, and thereby feparate between the living fibre and the gaftric juice. «... 2 When the glands, which iVcrete the gaftric juice, O n a become e0S LOCAL DISEASES, become atonic, this folvent will be deficient either in quantity or quality ; and in either cafe the appetite for food will be impaired. This affection of the glands may be a fymptom of pal- fy, and of comatofe affections, or it may be induced by violent and exhaufting ftimuli topically applied, fuch as opium and ardent fpirits in excefs. This conftitutes the anorexia paralytica of Sauvage. It is however probable that the fame caufes which de- range one fet of glands in the ftomach difturb at the fame time the action of the other, more efpecially in cafes of anorexia paralytica ; and for this reafon it was that Sauvage recommends emetics and cathartics. Yet, if the emetics fhould not bring to light a quantity of vifcid mu- cus, we may be certain that thofe glands only, which fecrete the gaftric juice, are injured. In this cafe not .emetics and cathartics, but cordial ftimulants and tonics, fuch as opium and ether, with bitters and aromatics, will be expedient. This obfervation more particularly applies to the ano- rexia arthritica and to the anorexia exhauftorum of Sau- . vage, both very properly arranged by Cullen under his . anorexia atonica. In cafes of fever, lofs of appetite arifes from two caufes, , i. From vifcid mucus lining the ftomach, and feparating, as I have ftated, between the living fibre and the gaftric juice. 2. From the fever itfelf, if of the ardent or in- flammatory kind; becaufe nature then requires and loudly calls for, not fuch fubftances as abound with hy- drogen, but cooling diluents, with acids and acefcent fruits, as I have fully explained in my obfervations on ref- piration and vital air, when treating of continued fever, which, that I may avoid repetition, I muft requeft the ftudent to confult. Indeed the young practitioner fhould always have it deeply impreffed upon his mind, that when the fyftem is fupplied by the lungs with oxygen, heat, by decompofition of the vital air, is generated in propor- tion to the quantity of oxygen abforbed in refpiration by the blood: but that when the fyftem is faturated with oxygen by the ftomach, and receives it, not from an elaftic fluid LOCAL DISEASES. 507 fluid abounding with caloric, but from either folids or from non elaftic fluids, no fuch fupply of vital heat enfues, and that the quantity of heat muft therefore fen- fibly diminifh. It is probable that nature, in her efforts to relieve her- felf, may, in ardent fever and in extremity of heat, fup- ply a lefs than ufual quantity of gaftric juice, and then in both thefe cafes lofs of appetite will follow, and will be properly arranged under anorexia atonica. The anorexia neophytorum of Sauvage arifes, like his pituitofa, from mucus accumulated in the alimentary ca- nal, and may be cured by rhubarb and magnefia, to which half a grain of calomel may be added to advantage. That the young practitioner may not miftake inability to fuck in new born infants for anorexia, I may here tran- iiently obferve, that when the tongue is tied, they feize the teat and try to fuck, but inftantly manifeft difap- pointment and diftrefs. Genus C. Anaphrodisia. Impotence. Dr. Cullen enumerates two fpecies. i. Anaphro- difia paralytica. 2. Anaphrodifia gonorrhoica ; .the form- er a paralytic affection of the mufcles, and the latter the confequence of extreme debility. When impotence appears, as the dregs of fatyriafis, there can be little expectation of relief from medicine; but when it is merely the confequence of general debility, a generous diet, with tonics and aftringents, affifted in their operation by exercife and air, particularly by fuper- oxygenated air, will fpeedily effect a cure. I had, whilft I was in Spain, a patient, a moft refpecta- ble and virtuous young man, who, from ficknefs and de- bility, had anaphrodifia gonorrhoica, and for this com- plaint had been, moft prepofteroufly, reduced to,a vegeta- ble diet. When he confulted me his pulfe was very fre- quent, but fo fmall as fcarcely to be felt ; and fuch was the irritability of his fyftem, that he could not fufter the irritation, either of a ra zor on his beard, or of a comb to £08 LOCAL DISEASES. to his head, without fpafmodic affection producing gonor- rhea. . I ordered him animal food, with plenty of wine and Peruvian bark, and made him undertake a journey, in confequence of which he was fpeedily reftored to health, with perfect ability to perform his functions, and has fince had a numerous family. Clafs IV. LOCALES. Order III. Dyscinesije. Motion impeded or depraved, from an imperfection of the Organ. In this order we have fix genera. i. Aphonia, i. Mutitas. 3. Paraphonia. 4. Pfellif- mus. 5. Strabifmus. 6. Contractura. Genus CI. Aphonia. Inability to utter Sounds, without either Syncope or Coma* Sauvage, has nine fpecies of aphonia, which Dr* Cullen has reduced to three : I. Aphonia gutturalis, arifing from tumefaction of the fauces, and particularly of the glottis, which is the ' aphonia catarrhalis of Sauvage. This may be produced by either angina or catarrh, and muft be treated accord- ingly. ^ ' II. Aphonia trachealis, from compreflion of the tra- chea, by aneurifm of the carotids, or of the bronchia, by either aneurifms of the aorta and of the heart, or by tu- mours in the lungs, fuch as abfcefs, vomica, fteatoma, fcirrhus. III. Aphonia atonica, arifing, 1. From divifion, whether by erofion or by mechanical violence of the re- current nerves, as happens fometimes in the extirpation of glands in the neck, whether ftrumous, cancerous, or fteatomatous. 2. From Paralyfis of the recurrent nerves induced by fpafm, and occafioned by affections of the ftomach. The nervous communication between this organ of digeftion LOCAL DISEASES. 509 digeftion and the larynx is maintained by the par vagum, which, defcending along the oefophagus, as it enters the thorax, fends back the recurrent nerves to be diftributed wholly in the larynx, and is itfelf loft in the pharynx, lungs, and heart, but chiefly in the ftomach. . Dr. Cullen very properly obferves, that the aphonia melancholica, aphonia paralytica, aphonia temulento- rum, aphonia hyfterica, and aphonia ab antipathia, are fymptomatic. The treatment therefore is the fame in each as that cf the primary difeafe. Genus CII. Mutitas. Inability to utter articulate Sounds. SECTION I. Of the Species of Dumbnefs. 1. Mutitas paralytica is a paralytic affection, induced either by mechanical injury, or by preffure. It frequent- ly precedes or follows apoplexies, whether ferous, fanguine, or fpafmodic. The treatment in fuch cafes therefore muft be fought for under apoplexy. The mutitas traumatica of Sauvage, denominated mutitas atonica by Cullen, is apho- xnia, and not mutitas. • 2. Mutitas fpafmodica. Hoffman mentions feveral cafes of mutitas, which he calls aphonia, arifing from the ftimulus of worms in the firft paffages. He attributes the effect produced to fpafmodic contraction of nervous parts in the lower belly, by which the blood is impelled with force into the tongue, and, there ftagnating, preffes upon the nerves. This pathology may certainly be juft, or the determination of blood to the fuperior region may be caufed by fpafmodic conftridtion of the diaphragm in the manner I have explained in mania hyfterica. But I am rather inclined to account for this effect by referring at once to fympathy of parts. This confent between the ftomach and the tongue may be maintained either by means of the firft cervical, or by means of the intercoftal, which fends branches to the ftomach, and the ninth pair, vhich diftributes branches to the tongue. Such Xio LOCAL DISEASES. Such cafes may be readily diftinguifhed by the com- mon fymptoms of worms, and eafily cured by anthel- mintics. 3. Mutitas narcotica. Lofs of fpeech may arife from the action of narcotics of opium, of atropabelladona, of hyofcyamus, &c.; or it may be induced by ardent fpirits. Highway robbers, in the vicinity of MontpeHier, ac- cording to Sauvage, are faid to have compelled the per- fons whom they plundered to drink infufion of thorn apple (datura ftrammoniwn), which rendered them fpeechlefs for two days. 4. Mutitas aficcitate. Lofs of fpeech may be caufed by drynefs, foulnefs, and inflexibility of tongue, as fome- times occurs in malignant fevers. 5. Mutitas furdorum. Want of fpeech in thofe who are born deaf. Thefe perfons may eafily be taught to underftand what is faid by watching the motion of the lips of any one who fpeaks to them, and without much difficulty may learn to fpeak. The firft who taught this art was a Span- ifh Monk. Ammanus of Amfterdam, and Wallis in London, followed in the fame line. My old friend Hen- ry Baker made fome improvements, and Pereira was eminent at Paris ; but the two gentlemen, who may be faid to have perfected this art, were the Abbe l'Epee in France, and Mr. Braid wood of North Britain, the latter now eftablifhed at Hackney. ^ The Abbe, I underftand, publifhed an admirable-trea- tife on this fubject, and it is to be hoped that Mr. Braid- wood will not fuffer his own obfervations and improve- ments to be loft. SECTION II. Cafes of Mutitas. Case I. A young lady, aged 18, of a relaxed habit, florid counttr.p.nce, and plethoric, having expofed herfelf to cold whilft her courfes were upon her, thefe were fuddenly obftrudted, fhe was feized with violent head ach, and all the blood veffels in her face became diftended. She paff- ed a reftlefs night, and in the morning fhe was fpeechlefs. For foiir days LOCAL DISEASES. 5" days fhe fcarcely eat or drank, and had little reft at night. A phyfician ordered a clyfter to relieve her coftivenefs, and took three ounces of blood from the foot. As however fhe continued fpeechlefs, Hoffman ■was confulted. Finding the pulfe frequent and full, he took away feven ounces of blood, and adminiftered effence of caftor, with aqua ammonias, and hiff mineral anodyne. Of this mixture he gave thirty drops every fifteen minutes in fome infufion of lilies of the valley. A ftrong perfpiration foon broke out all over her body, the fwelling of face fubfided, her fleep was refrefhing ; and, after continuing the medicine through the day, her voice was perfectly reftored. Case II. A man, aged 80, of a fpare habit, accuftomed to lofe blood three times a year, but always healthy, was perfuaded, on account of the long continuance of exceflive heat, to omit his ufual evacuation, till In was fuddenly deprived of fpeech, and of all fenfation. Hoffman obferving that his eyes were much inflamed, and that his Brteries bea£ ftrong, ordered him to be bled immediately, to have an emolient clyfter, to take nitre in fmall dofes at fhort intervals, and to drink infufion of balm, carduus, betony, with flowers of fage and rofe- mary. Thefe medicines procured relief, and, after fome continuance, per- fected a cure. Case III. A healthy boy, aged 11, loft fuddenly the ufe of fpeech, and was affected with fpafmodic conftriction in the mufcles of his neck and back. For thefe complaints he took anthelmintics, antifpafmodics, and tonics, which brought away fifteen worms, but for five weeks left him fpeechlefs. Hoffman being confulted, ordered * IJ, Afae foetid. Myrrh, elect. Extract. Tanaceti, Rhei, Aloes, Calo- mel, aa. 5j. Extract. Croci, gr. vj. Effent. Caftorei, q. s. ut f. Maff. Pilul. cujus ex fcrupulo, f. Pill. xx. Quarum feptem bis in feptimana fumendas funt interjectis fequentibus. §, Sal. Carthart. Amar. gr. xv. Nitri purific. Corallinae, aa. gr. vj. M. f. Pulv. mane fummend : That is Afafcetida, myrrh, extract of tanfy, rhubarb, aloes, calomel, of each one dram ; extract of faffron fix grains ; effence of caftor fuffi- cient to make pills ; of which take feven grains twice a w .-!:, interpofing the following powders : Take bitter purging fait fifteen grains, nitre and coralline of each fix grains, for one powder. Thefe medicines, with a ftrengthening plafter to his neck, foon re- ftored the ufe of fpeech. Case IV. Sauvage mentions a boy, who having paffed, by the ufe of anthel- mintics, thirty worms in twenty days, recovered his fpeech, which he had loft. _ Genus 512 LOCAL r>ISEASES> Genus CHI. Paraphonia. Depravation of Voice. Dr. Cullen has fix fpecies, which are well diftin- guifhed : i. Paraphonia puberum, in which the voice, about the time of puberty, becomes harfh and diffonant. It is cu- rious to obferve the provifion made by nature to an- nounce this internal change in the fyftem by external characters, for no fooner does virility take place, than a beard begins to grow, and the tone of the voice finks four or five notes lower than it was before. 2. Paraphonia rauca, in which, from drynefs or flaccid tumour of the fauces, the voice becomes deep, hoarfe, and diffonant. In both thefe cafes the vocal chords, extended from the arytasnoide to the thyroide and cricoide' cartillages, may be perhaps unequally relaxed, and the mufcles, whofe office it is to ftretch them, may have . loft their tone. This opinion feems -to- be rendered probable from hoarfenefs following exceflive exertions of the voice, and being cured by tonics. When hoarfenefs is a fymptom of catarrh, it muft be relieved by attention to the primary difeafe. £. Paraphonia refonans, in which the noftrils being clofed, the voice is harfli and fibilant. This varies according as the noftrils are clofed by the velum pendulum palati j by mucus in coryza, and ca- tarrh, or by a polypus, as happens fometimes in vene- real cafes. 4. Paraphonia palatina, in which the uvula is either wanting or divided, either naturally, or by erofion of venereal virus. The voice is hoarfe, and in fpeaking the countenance is much diftorted. It may be relieved by a filver palate. 5. Paraphonia clangens, in which the voice is harfli, acute, and clangent, as in hectic and confumptive pa- tients, when ulcerous inflammation extends to the larynx, producing tenfion and immobility of the vocal chords. 6. Paraphonia comatofa, fnoring, produced by infpir- ing LOCAL DISEASES. 513 mg with the mouth wide open. The larynx defcends, the tongue forms a deep channel longitudinally, its bafis. is depreffed, and the velum pendulum, relaxed, bends downward. When the perfon fnores with his noftrils clofed, the tongue expands, and makes a wider channel. When the mouth is fhut, he cannot fnore ; nor can he fnore with eafe when the tongue is forcibly depreffed and the noftrils are clofed. Genus CIV. Psellismus. Vitious Articulation refpecting Sounds. Dr. Cullen enumerates feven fpecies, Sauvage eleven. I fhall however pay little attention to the fpecific names, and content myfelf with defcribing fuch defects as are moft common, with their cure. 1. Hefitation is a trick, a contracted habit of attempt- ing to fpeak without clear and diftinct ideas. The befl remedy for this defect is to ftudy the math- ematics, to watch againft diftraction of thought, and never to fpeak upon any fubject: without having firft thor- oughly digefted the arguments and facts to be adduced, with a connected method of arrangement. When the blackfmith is at a lofs where to direct his hammer he fmites upon the anvil. 2. Stuttering, or ftammering. This likewife is a contracted habit. The tongue has for its motion four pair of mufcles, befide thofe which belong to the os huoides, and innu- merable mufcular fibres, by which it is contracted, ex- panded, elevated, or depreffed, protruded forwards, or retracted in a multiplicity of ways. Thefe, among other offices, afii'ft in forming letters, fyllables, and words. For the fame purpofe it is amply furnifhed with nerves, having two confiderable branches from the fifth pair, and the fame number from the ninth, befides fome fila- ments from the par vagum. Thefe, with their numerous papillae, when the epidermis has been removed, are dif- covered on the upper furface of the tongue, where the. office affiVned them is to direct its motions. R r r AX rj^ LOCAL DISEASES. At this ample fupply of mufcles and of nerves we can- not be furprifed, when we confider that, independently of directing the food in the acts of maftication and de- glutition, it is the principal modeller of founds in fpeech. For although fome of the letters only have been called Unguals, whilft others are denominated dentals, guttu- rals, and palatines, yet in every one of thefe the tongue is the prime agent, and muft, by determinate motions, aflift to form them all. Yet, when once the habit is acquired, no fooner is a determinate motion of the tongue required, than it in- ftantly obeys, and even feems to prevent volition, as the fingers of the mufician, without confcioufnefs, find the firings. All this now depends on habit; but let thefe affociated motions be thrown into confufion by fome nervous affection, producing difeordant action, and the habit, inftantly difturbed, is no longer ufeful; the chain is broken, and calls for ftrong mental efforts to renew it. In the mufician, who has learnt his art by rules, it may require a little recollection only to join the broken threads ; or, by taking up the piece from the beginning, if his confidence does not fail fo as to produce nervous affection and frefh confufion in his affociations, he will get rid of his perplexity. But the ftammerer, not hav- ing learnt to fpeak by rule, cannot with the fame facility extricate himfelf. With him all depends on habit; and as it is probable that fhame, difappointment, and diftrefs will produce the fame effect more readily a fecond time, it will be in vain for him to recommence a chain of thought and expreflion, which, without tranquillity of mind, he wiil never be able to purfue. For this reafon Mr. Henry Baker, who taught flam- merers to fpeak plainly, always began with teaching them the alphabet by rule ; then led them on to fyllables, and from fyllables to fentences. When his pupils, whilft reading or fpeaking, began to Hammer, he took notice by what letter they were thrown into confufion, and flopped them inftantly ; he gave them time to recollect themfelves ; and then made them practife fingle w ords, or fhort fentences, abounding with that letter. After this he LOCAL DISEASES. 51S he made them repeat the fentence often which had cre- ated their perplexity, but flowly at firft, and with much deliberation, as muficians practife, when they find their fingers at a lofs to execute new and difficult combinations in a piece of mufic. By this method, employing three hours in a week, he cured the ftammerer in the fpace of a few months ; and as, from its fimplicity, he was apprehenfive that other teachers might adopt his plan, he exacted an oath from all his pupils that they never would reveal his fecret. In moft cafes of ftammering the nerves are affected, and the fyftem is too irritable. It is then truly a difeafe ; belongs to the neurofes ; and, like all other fpafmodic affections, calls for medical afliftance. To effect a cure in fuch cafes requires tonics, ftrict temperance, with a generous diet, cool air, exercife, bit- ters, bark, fteel, and the cold bath. 3. Literal omijfions and miftakes. Some people have acquired a habit of omitting par- ticular letters wherever they occur. The moft common defect is to omit the R. Many drop both R and L ; yet, by a little attention, they might recover both. For the R they need only raife their tongue to the roof of their mouth, and, breathing ftrong, make its point vi- brate ; and by practifing frequently fuch tremulous motion of the tongue they will acquire the habit of pro- nouncing this letter with facility. In the fame method, by inquiring how other perfons move the tongue, they will learn to form every letter. It is for want of this knowledge and attention that many people fubftitute one letter for another, B for P, D for T, and F for V, or frequently L for R, and fome- times even T for C, 16, P. mercurialis, to be relieved by liver .of fulphufc f as ■ P. gravidarum, attending the firft months of preg-, local diseases. 523 as firft practifed by the ingenious Dr. Garnet of Har- rowgate, and defcribed in his letter to Dr. Beddoes. . if. P. a calculo. Several inftances have tyeen record- t cd of falivation arifing from calculi in the duct of the Li fublingual gland, and ceafing when thefe cretaceous con- •^ cretions have been extracted. ' ,, 18. P. purulentus. In this fingular diforder the p* T- tient for more than three years difcharged purulent fanies '* 'ffrom the maxillary finus, which were carious, yet in other \f% refpects he enjoyed perfect health. • 19. P.. urinofus, recorded by fome writers of author- ity. * 20. P. lappotiicus. It is a fymptom of Lapland colic, which when moft fevere is terminated by fpontaneous 'falivation. Genus CXI. Enuresis. Involuntary Difcharge of Urine without Pain. Sauvage has nine fpecies. ■ 1. Enurefis infantum. Children of a weak and irrita- ble fibre are moft fubject to involuntary difcharge of nrine, and particularly whilft they fleep. Such children from debility fleep found, yet from irritation or diften- tion in their bladder, are apt to dream that they are in a convenient place for this evacuation; The proper reme- dies are, 1. Tonics and aftringents. 2. To drink lit- tle after dinner and nothing in the evening. 3. To , make them empty the bladder before they go to bed. 4. To threaten and even punifh them, when they tranf- grefs, for although the difcharge is involuntary, yet ftrong impreflions made upon the mind when they are ^awake, will retain fome influence on their actions when **they are afleep. fc- 2. Enurefis paralyticorum arifes from relaxation of the fphincters, caufed by compreflion of the nerves. It is relieved by curing the primary difeafe. 3. Enurefis herniofetum, occafioned only when, by the aaion of the hernia, the fphincters are prevented from f'Attracting. * W . 4. Enurefis t$* LOCAL DISEASES. Jj 4. Enurefis puerperarum, arifing from ulceration of the bladder in hard labour. This effect is produced by compreflion of the neck of the bladder ^againft the pubis , "' by the head of the child, which brings on mortification of the part, and feparation by the ulcerative procefs. This alfo has been frequently produced by unfkilful ufe of the forceps, when the operator has not only taken the pubis for his fulcrum, but has injudicioufly continued his preffure too long upon one fpot. 5. Enurefis calculofa, is caufed either by a calculus in the neck of the bladder, by founding, or by dividing the fpinctre when cutting for the ftone* 6, -Enurefis fiftula. This fometimes arifes from viru- lent gonorrhoea, when venereal ulcers in the urethra ad-. mit urine into the cellular fubftance, where it produces abfcefs and fiftula. If this communicates with the blad-.. der, the difcharge, of urine is inceffant. In this cafe the. **^ opening by the knife muft be extenfive. 7. Enurefis gravidarum. This difeafe attends not on* ly pregnant women in the laft months of pregnancy, but thofe alfo who have borne many children. In the firft cafe a proper fufpenfary bandage will give relief; in the latter tonics external and internal, general and topical, ' 4 are called for. ' *W 8. Enurefis catamenialis. This cafe is curious ; and1 fhews that, in obftructed catamenia, the haemorrhage .*/- ^ effort, renewed monthly, although infufficient to produce V» the defined effect, excited action in the bladder by con- fent of parts. The young lady in queftion had been troubled with enurefis to the age of puberty ; but when fhe became a woman, fhe remained for three years free from this complaint,* till her courfes were fuppreffed by waffl- ing her feet in cold water. From this time every month for three nights fhe had enurefis, with total want of fleep, and eight days before this monthly period, and for as many after it, fhe had head ach, tumour in the hypo- chondria, and cedematous fwelling of her feet, or even haemoptyfis. But if at any period the flux of urine fail-. ed, then all thefe fymptoms were much aggravated, and continued till enurefis was reftored. _ 9. Enurefis LOCAL DISEASES. r . 5^$"^ 9. Enurefis .afparganofi. From the fuppreflion of tnilk after childbirth. It is cured by ftrong cathartics. Genus CXII. Gonorrhosa'. A preternatural Flux from the Urethra in Men.^ ,v Sauvage enumerates feven fpecies, which Cullen nair reduced very properly to four. '.' 1. Gonorrhoea dprmientium, in which the feminal flird Is emitted during fleep, with erection and lib i aous ..Yearns. tf ' To underftand the nature of this affection, let the ftu- k dent confult what has been delivered on fleep, vigila^c , X dreaming, and delirium. He will jhen be able to trace the effect produced, to mental and material ftimuli, to * fpices and fpirits, or to wanton imaginations cherilhed in the day. For the remedy ©f this difeafe, I muft refer him to what I have faid on fatyriafis. 2. Gonorrhoea laxorum, in which the feminal fluid is i emitted during vigilance, with libidinous defire, but without erection. m •♦ «■_ 3. Gonorrhoea pur a, in which the feminal fluid is "emitted without erection or libidinous defire, and when Slhere has been no impure connection. *"■•■ This debilitating difcharge produces, among other diftreffing fymptoms, lofs of appetite, indigeftion, flatu- lence, and coftivenefs ; palenefs, proftration of ftrength and atrophy; lofc'of fleep, head ach, and defeaive mem- n-<>ory ; blindnefs, epilepfy, and palfy, with a depreffion of fpirits bordering on defpair. ' ' (l Patients may be reduced to this deplorable condition in %. confequence of exhaufting difeafes, when thefe have pro-' " educed relaxation, debility, and irritability, in the extreme. as in the cafe of anaphrodifia gonorrhoica already men- i "tioned ; but it is commonly the punifhment of vicious § babits, whether of the fecial or of thefolitary kmd^The fc ^treatment muft be tfie fame as in fatyriafis,, \L'"' 4 Gonorrhoea impura, in which, after improper con- ' icftion a purulent difcharge, attended,by dyfuna, pro- * ceeds r26f*' LOCAL DISEASES. ceeds from the urethra. This afterwards is followed by ■$ increafed fecretion and the flux of mucus. For the cure I muft refer to fyphilis. * Hoffman has Recorded eleven very interefting cafes of • gonorrhcea, from which I fhall feledt the following : , **- A young man, infirm from his infancy, and atrophic at the age off feven, recoveringiiealth and ftrength, at the age of fifteen, learnt from a vicious companion^an evil practice, in which, when alone, he daily in^ dulged himfelf for many years, without fufpecting, till it was too late, that he had offered violence to Nature, and that fhe never pardons ■ the offender. "* The firft notice he received of her difpleafure was by fuch excruci- ating pain as rendered him unable to walk. His underftanding, memory, and fight, were the next to fuffer lofs ; his pupils were won- derfully dilated, his eyes were diftreffed with pain, and their lids were daily clofed with gluten; fo that for a length of time, although flu- dious, he was compelled to lay afide his books, for he could neither write nor read. He became again atrophic to fuch a degree that he was a fkeleton ; and although for two years he had the refolution to * * abftain from the practice which had made life a burthen, yet his refor- mation was followed immediately by nocturnal pollutions, and his fuf- ferings continued without the leaft relief. In this fituation, at the age of 25, he confulted Hoffman, by whofe * advice Ke purfued the following plan. ,, Every morning he drank affeV milk with Seltzer water, and the fub- fequent medicines as directed : §> Cornu Cervi, pp. Os Sepice vel Chel. Cancr. aa. §fs. Succini cum inftillatione, Ol. Tart, per deliq. ppt. 3ij Eleutheriae Cort- 5j. M. f. PuL c. c. 3j- ex aq. Cerafor. nigr. Cyatho 3$, Rhei. 3j. Mannas, ^j. Nitri. Antimoniati, gr. 15. Coque et Solve leni Calore in Aquae Selteranae, gvj. Colaturse, adde OL de Cedro, gtt. iij. M. f. H. qua vis quinta die fumend. !£, Ligni Santali Rub. Citrini, Rad. Chinas, ^Scorzonerae, aa. !|iv. Rad. Cichorei, 5J. Cinnamom. §fs. Maftiches, 3'j- M. f. Spe- cies, Quarum, ^ij. Ex tr,ibus aquae menfuris addito paffularum •'^ir.inoruir^manipulo Uno, per ties horae quadrantes decoquendae et eap. pro potu.ordinario. Ke was ordered to abftain from faked meats, fpices, and highly feafoned dimes, and from warm liquids. He drank infufion of mint and balm in the morning, by way of tea, ,and, continuing for fome time 10 the ufe of Hoffman's vifceral balfamic elixir, he was within fit \ sreeks reftored to perfect health. Clafs LOCAL DISEASES^ . V%^7 j -* -V **. Clafs IV. LO'CALES. Order V. Epischeses. Suppreflion of ExcretionsJ* ? f '•f In this ordeT we fiave five genera. » * ■* "*y i. Obftipatio. 2. Ifchuria. 3. Dyfuria. 4. Dyf- permatifmus. 5. Amenorrhoea. Genus CXIII. Obstipatio. Coftivenefs. '* . Sauvage who, to increafe the number of his genera, B too often multiplies diftinctions without a difference and confiders fymptoms as difeafes, has omitted obftipatio, from a perfuafion that we never meet with it as a prima- ry affection : but in this he is miftaken, as will immedi- ately appear. .1 Linnaeus, Vogel, Sagar, and Cullen, differ with him in opinion, and the fatter very properly not only con- fiders coftivenefs as a primary difeafe, but divides it into I' fpecies. I. Obftipatio rigidorunu* In perfons of a robuft and fanguine temperament, who' enjoy high health, and take much exercife, the lacteals and abforbents are extremely active. Hence it is that their alvine faeces are commonly dry, hard, corrlpact, and that they are inclined*1 to coftivenefs. Their pulfe is - full and firm, their heat is high. It is this fpecies of coftivenefs which prevails in fynocha. The proper remedy for them is to keep their bovyels foluble, by cathartics of the refrigerant and emollient ', \f daffies, fuch as caflia, tamarinds; fulphur, and tartarifed ".. tartar, with prunes, manna, and, ,in urgent occafions, caftor oil. , Obftipatio obftruclorum, with fymptoms of fpafmodic af- feclion in the bowels. Pulfe weak, fmall, frequent, heat variable. J . "-1 a. It appears 'by* the experiments and obfervations of ^ Wepfer and Van Swieten that, 1. If. even ^fter death, acrid fubftances, or any kind * of 52$ LOCAL DISEASES. of ftimulus, is applied to the inteftines, they contract :* fpafmodically, not merely in the ftimulated parts, but often in the adjoining parts, to a confiderable extent, fo a* completely to obftruct the paffage. Van Swieten,^ ^ with the: point of his difledting knife, ftimulated the**, ftomach of a dog fome minutes after the animal was. dead, when \t immediatefy and forcibly contracted to" one fixth of its antecedent capacity. 2.* In living animals, acrid fubftances, fuch as arfenic, exhibited internally, or corrofives externally, applied to, the coats of the inteftines, caufe them to contract forci- bly, permanently, and clofely, as if they were tied with cords. And whilft they are contracted in fome parts, they are violently inflated in others, which being much dif- tended become paralytic, and lofe their power of con- tracting. Wepfer obferved, that as long as the acrimonious fub- ftance continued in the bowels its morbid effects were ' permanent, and that as often as 0atus was forcibly ex- pelled it was reproduced immediately. When he had given half a fcruple of corrofive fublimate to a dog, which operated with violence both up and down, on opening the abdomen the inflated ftomach came out, and being preffed, difcharged flatus by the mouth, but was foon again diftended by frefh flatus. He had occafion likewife to obferve, that if, whilft any part remained conftricted, a fimilar irritation is produced* in fome frefh place, this part contracts, and the precede ing conftri&ion is relieved. 3. This conftridtion, with the confequent inflatation and diftention in other parts, is fo permanent when ftrong y$ ftimulants, fuch as arfenic, or any virulent corrofive, has \ been applied to the inteftines, that in fuch perfons as have died of colic, and in animals on whom thefe experiments were tried, Wepfer found it difficult to propel either the flatus or the aliments contained* between any two con- firmed parts, .; The occasional caufes of fpafmodic conftrictjon in the inteftines nfay be, 1. Inflammation, for which I,muft refer ro enteritis and gaftritis. - a. Irritation of acrid fubftances, * as LOCAL DISEASES!? - 529 £■ as in ^//r, either taken into the alimentary canal or gen- 1, erated there, fuch as bile or worms. 3. Sympathetic af- fection with other ftimulated parts, as with the kidneys in nephritis. •'The cure may be performed by fuch remedies as have been already recommended in thofe difeafes. III. Obftipatio debilium, in weakly and relaxed pa- tients, with pulfe flow and feeble; heat very low. Bile is the natural cathartic. When this therefore is cither defective or depraved, conftipation of bowels will enfue. This we have obferved in jaundice ; and we have > ^ in the Philofophical Tranfactions, for the year 1730,3 ►* curious cafe of a foldier wounded in the gall bladder, who died of conftipation. But though the bile fhould not be deficient, yet if we have^ vifcid mucus interpofed between it and the living fibre^ we fhall have coftivenefs produced, as in hypochon- Ajdriqfis and melancholia^. The nature of the food muft likewife be confidered ; t for if, inftead of animal food, which ftimulates the intef- ' tines, the patient fhould have only rice, wheaten bread or milk, his bowels will be coftive. Sauvage remarks on tenefmus afcybalis, that the effortsfto evacuate the faeces *. in patients who live on milk, fometimes refembles thofe of a parturient woman. „ \Xne proper remedy is to change the diet, and to give calomel at night, to be followed by either foluble tartar or infufion of fenna in the morning. But for particulars i let the ftudent confult jaundice, hypochondriafis, and mel- Aiancholia. & IV. Obftipatio paralytica. Lr- Dr. Cullen has taken no notice of this fpecies; but it ' appears to me well founded, and needful to complete our ^catalogue. * [t In the paraplexia traumatica of Sauvage, a dileaie not J uncommon 'about MontpeHier, and often met with in i vValentia and other countries, in which mulberry leaves > muft be daily gathered'as the food of filk worms, the If miferable object, who, by his fall, has injured the fpinal IT marrow in the lumbar vertebrae', lofes inftantly all fenfe k*. T t - ana 530 LOCAL DISEASES. and power of motion in the lower extremeties, his urine flows fpontaneoufly, and he has conftipation in his bowels. This cafe admits no remedy. In tympanites, we have coftivenefs arifing from paralyt- ic affection, with lofs of tone in fome part of the inteftines; the cure of which is to be fought for in the ufe of aromat- ics and antifpafmodics, combined with gentle tonics and aftringents, as recommended in that difeafe. Genus CXIV. Ischuria. Suppreflion of Urine. Sauvage in his ineftimable nofology has, when treat- ing of ifchuria, left us one perfect example of methodical arrangement; and Dr. Cullen, treading exactly in his footfteps, has judicioufly divided this Genus into four fpecies, each including numerous varieties. I. Ifchuria renalis, preceded by diforders of the kid- neys, and attended by diftreffing weight, or pain in the region of the kidneys, but without either fwelling of the hypogaftrium or fenfe of ftimulus exciting to the dif- charge of urine from the bladder. This fpecies contains the fubfequent varieties : a. Nephritica, from inflammation of the kidneys. The fymptoms and the cure may be feen under Nephritis. b. Nephrolithica, from calculi, has fimilar fymptoms with the preceding variety, but not the pyrexia. It is pre- ceded commonly by a difcharge of gravel, of mucus, or of blood, and immediately by pale and ftimulating urine in fmall quantities. The treatment muft be the fame as in the preceding ; and, to prevent relapfe, the lithontriptics mentioned in my Vade Mecum, particularly the aqua mephitica alcali- na, muft be reforted to. Sir John Pringle was accuftomed to prefcribe the fol- lowing. !§> Terebinth. Venet. v. o. s. dr. 4. Decoft. comm pro Clyft. un. 4. 01. Olivar. Syr. e Spin. Cervin. aa. un. 1. M. f. Enem. 1$) Sem. Lini, un. 1. Pulv. Glycyr. dr. 6. Aq. bul. q. s. infunde prope ignem, per horas 12. Cola }fc2. Cap. un. 3. fepius. & Rad. LOCAL DISEASES. 53 I IJ, Rad. Pareira brav. un. 3. Aq. Font, ft, i\. Coque ad. 1 Colat. c. un. 2. ter in die. c. Nephroplethorica, from plethora, without either pain or pyrexia, and not preceded by any fymptoms of mor- bid affeaion in the kidneys. In the cafe recorded by Riverius it was occafioned by a long journey during die hotteft days of fummer, and was perfectly relieved in lefs than one hour after a copious bleeding. d. Lunatica, returning periodically at the full of the moon and vanifhing in five days, unlefs previoufly cured, as it never failed to be by venaefection. In the cafe re- ferred to by Sauvage, the pelvis of the left kidney was found to be as large as the urinary bladder. e. Nephrofpaftica, from fpafmodic affections, as in hyf- terical patients and in young people of an irritable fi- bre, when cutting teeth, menftruating, or fuffering by other morbid ftimuli in the fyftem. For the treatment confult what has been faid on fpaf- mi and fpafmodic diforders. f. Nephrelmintica, from worms in the kidneys. g.Nephrothromboides, from clotted blood, preceded by bloody urine, and occafioned by mechanical injury or by violent exertions. It is attended by palenefs, fmall pulfe fcarcely to be felt, extreme debility, rigour, nau- fea, and flight fever, with cold fweats. h. Nephropyica, to be known by the hiftory of the cafe, and by a purulent difcharge through the urinary paf- fages. De Haen recommends uva urfi. i. Nephrophlegmatica, in cold phlegmatic habits, difcover- ed by the difcharge of mucus, and cured by diuretics of the ftimulant order, by emetics, by cathartics of the cale- facient and aftringent orders, affifted by horfe exercife. k. Nephroplegica, from Palfy. 1. Supplcta, from diarrhoea, or exceflive perfpiration, preventing determination to the kidneys. Many cafes are recorded, by authors of the moft refpectable authority, of patients who for years had no evacuation either by urine or by ftool, whilft their perfpiration was enormoufly increafed; and Platerus mentions a who for many days had S32 LOCAL DISEASES. a difcharge of water from her ear, which fupplied the place of urine. II. Ifchuria ureterica is in many cafes fcarcely to be diftinguifhed from the former. Dr. Cullen has adopted fix varieties from Sauvage^ coinciding in occafional caufes with as many of the preceding fpecies. But the moft common is the calculofa, caufed by calculi in their paf- fage through the ureters. The fymptoms are pain, naufea, vomiting, coftivenefs, coldnefs of the extremities, numbnefs of the thigh, re- traction of the tefticle, followed fometimes by convulfions or by fyncope. The proper treatment is by warm bathing, clyfters, which carry a warm fomentation to the part, demulcents and opium in repeated dofes, till the fpafm is relieved. Electric fhocks fent through the loins have feldom failed to expedite the paffage of calculi into the bladder. The following demulcent mucilage may be ufeful in this fpecies of ifchuria. I£> Gum. Arab. Tragacanth. aa. 3ij. Aq. Font. ftj. Syr. ex. Alth. S;j. M. Cap. Cochl. iij. Saspius. Take gum arabic and gum tragacanth, of each two drams ; water, a pint; fyrup of althaea, an ounce. The dofe may be three fpoonfuls often in the day. If the patient is plethoric, he muft lofe blood ; and if the heat is high he muft take ten grains of nitre two or three times a day. If the heat is moderate, 20 or 30 drops of balfam of copaiva may be given twice a day. III. Ifchuria veficalis, with fwelling of the hypogaftri- um, pain at the neck of the bladder, and frequent vefical tenefmus. This fpecies contains the fubfequent varieties : a. Cyftitica, from inflammation of the bladder. See Cyftitis, b. Cyftolithica, from ftone in the bladder. The fymp- toms are wandering pain and tkillation about the pu~ bis and the perineum, with a fenfe of weight in the perinaeum, erections, tenefmus, dyfury, bloody urine, more efpecially after riding, with its frequent yet inter- rupted difcharge. But the moft certain fymptom is obtained by founding. Rdief LOCAL DISEASES. 533 Relief may be obtained by uva urfi, two fcruples giv- tn twice a day, or this may be mixed up with conferve of rofes, as recommended in my Phyfician's Vade Me- Camph.gr. xv. Amygd. Dulc. Decort. n. iij. Simul tritis, adde paulatim Aq. Font. q. s. Colat. Solve Salis Rupell. 3iij. M. f. Emulfioc. c. Co. iij. tertia quaque hora. That is, Camphor fifteen grains ; three fweet almonds ground together, with fufficient water to make an emulfion ; Rochelle fait three drams. Take three fpoonfuls every three hours. II. Dyfuria fpafmodica, from fpafmodic affection of the fphincter caufed by confent. The common occafional caufes of fpafm may be feen in the former part of this work. This fpecies includes the fubfequent fpecies of Sauvage, which, as being fymptomatic, may be referred to the primary difeafes. a. Dyfuria hyfterica, a fymptom well defcribed by Syden- ham in his treatife on hyfteria as fometimes miftaken for calculus. b. Dyfuria nephralgica, occafioned by irritation in the kidneys, whether from calculi or from acrimonious urine. This includes the dyfuria ab ulcere renum of Sydenham. c. Dyfuria rachialgica, from irritation in the bowels pro- ducing cholic. Citefius, from whom Sauvage has taken this difeafe, recommends emetics and cathartics, with oily preparations interpofed between them. d. Dyfuria diabetica, which feems to be the fame with hyfterica, with this diftinaion, that limpid urine is drf- charged only the inftant food has been received into the ftomach. Dr. Douglas, who defcribes this difeafe, faw it in an hyfterical patient, in whom it continued for many months without thirft, but attended by atro- phy and nocturnal feverifhnefs. e. Dyfuria herpetica, from fuppreflion of herpetic erup- tions. Dr. Cullen has taken no notice of this, but it feems to be of kin to the hyfterica, and it certainly be- longs to the fpafmodica. Ill Dyfuria compreffionis, from the preffure of the ad- U u u joking 53* LOCAL DISEASES. joining parts, as in pregnancy ; hernia of the bladder £ obliquity of the womb ; or retention of menftrual blood, occafioned by imperforation of the hymen. IV. Dyfuria phlogiftica, from inflammation of adjoin- ing parts. This may be induced by inflammation of the urethra, or by phlegmonic affection of the proftate gland, as happens frequently in fyphilis ; by hemorrhoids, when, protruded from the anus, they ftretch the nerves of the urethra ; or by hyfleritis. For all thefe the primary dif- eafe muft be confulted. V. Dyfuria irritata, with figns of ftone in the bladder. See ifchuria veficalis. VI. Dyfuria mucofa, with copious difcharge of mucus. Lieutaud calls this difeafe a catarrh of the bladder ; and Hoffman, who was confulted in one cafe, calls it a moft rare affection. In the cafe recorded by him, the haem- orrhoidal flux was converted into dyfuria mucofa. This learned profeffor recommended Spa water, cafcarilla bark, with effence of amber ; and for the common beverage, a decoaion of liquorice, farfaparilla, fcorzonera, and cichory roots, with fennel feeds. Genus CXVI. Dvspermatismus. Seminis in actu venereo tarda, impedita, et ad genera- tionem infufficiens emiflio. The ftudent, fhould he happen to be confulted in fuch cafes, muft confider what is the condition of the urethra. If that is free from difeafe and pervious, his enquiries will be directed to three points : i. To debility and deficiency of vigour. 2. To irritability and fpafmodic affeaion, 3. To excefs of vigour. In the firft cafe tonics and aftringents are required ; in the fecond, antifpafmodics, combined with tonics; in'the thiricafe, evacuants, ftria temperance, and refrigerants ;, that is, acids and acefcents muft conftitute the chief arti- cles of diet. In this way the noble young Venetian, who by his ambaffadors confulted all the moft eminent praai- tioners in Europe, was at laft relieved. Genus LOCAL DISEASES. 539 Genus CXVII. Amenorrhcca. Menfes wholly or partly obftruaed, without Pregnancy. That this excrementitious difcharge fhould be regu- lar as to quantity and quality, and that it fhould obferve the monthly period, is effential to health. When it is obftruaed, nature makes her efforts to obtain for it fome other outlet, either by the eye, the ear, the gums, even by a carious tooth, by the ftomach, the lungs, the blad- der, or^even by the tip of a finger ; and from whatever part it is evacuated, it has the fame property of not co- agulating, like living blood. Nay, fo important is this property, that if twice the ufual quantity is evacuated with the power of coagulation, even from the fame vef- fels, equal benefit is not received, much lefs when taken from other veffels by the lancet. See Hunter on the Blood. When thefe efforts of nature fail, the confequence may be, i. Pyrexia and pulmonic affeaion, which may ter- minate in phthifis. i. Spafmodic affeaions, hyfteria, epilepfia, mania, apoplexia. 3. Chlorofis ; according to the general habit and difpofition of the patient. Hence three fpecies of amenorrhoea naturally prefent themfelves to our confideration. I. Amenorrhoea plethorica, with a full ftrong pulfe. Van Swieten in his comment has the fubfequent re- mark : In the plethoric we obferve good blood and veffels pervious, yet fo diftended, that they cannot reaa on their contents. But as foon as by venaefeaion the quan- tity of blood has been diminifhed, the aaion of the vef- fels is renewed, and even whilft the blood is flowing from this vein, the menfes have been fuddenly reftored. To fuch patients ftria temperance, or even a vegetable diet, with much exercife, muft be prefcribed. II. Amenorrhoea fpafmodica, in irritable habits, and attended by other fpafmodic affeaions. The predifponent caufe is debility : the occafional caufes are either fud- den frights j or the aaion of cold at the time of men- ftruation j as happens after dancing in warm rooms, then ^4® JLOCAL DISEASES. then drinking cold liquids, wafhing in cold water, or be- ing fuddenly expofed to the natural air. This feems to induce fpafmodic aaion in the extremities of the uterine arteries. The proper emmenagegues in this fpecies feem to be antifpafmodics, fuch as afafcetida, myrrh, camphor, caftor, and the warm pediluvium, in the application of which laft, we may profit by the cautions of the judicious Hoffman. If the pulfe is full, he recommends venaefeaion, and if the feet are cold, he advifes friaion, before im- merfing them in warm or even in tepid water. But though antifpafmodics are thus indicated, the moft effeaual means of relieving conftriaion in the extreme arteries is by in- creafing their aaion, which may be accomplifhed by ftimulants and tonics. The beft flimulant in this cafe is elearicity, and the moft efficacions tonic is fteel and vi- tal air, to which muft be added exercife, and a generous diet. III. Amenorrhoea atonica, with weak pulfe and a re- laxed fibre. We have here a general flaccidity of the fyf- tem, and confequently debility, with torpor caufing weak aaion in the veflels of the uterus. In this fpecies the indications of cure are, to reftore tone to the fyftem in general, and to excite the aaion of the uterine veffels in particular. The tonics are the fame as in the preceding fpecies, and the moft efficacious form for exhibiting the fteel is in filings mixed with conferve of rofes. Five grains of the filings may be given three times a day, increafing the dofe. This wonderful and univerfal diftributer of oxygen reftores vital heat to the extremities, and colour to the cheeks, raifes the fpirits, in- creafes both the appetite and ftrength, and in a few weeks makes the catamenia flow. I have very often prefcribed the fubfequent : £, Ferr. Vitriolat. 3j. Sach. Alb. gij M. f. Pulv. c. c. 5j. Ter. in die fuperbibendo, Aq. Pulegii, jij. Take green vitriol a dram ; white fugar two ounces ; mix. The dofe is one dram three times a day in penny royal water. To be continued. For the encouragement^ the ftudent, I can venture fo affure him, that in five and thirty years experience, thefe chaiybeates have never failed to cure, even when heaic LOCAL DISEASES. 541 heaic had appeared, and fymptoms of phthifis had cre- ated much alarm for the fafety of the patient. . ^ Some praaitioners place their chief dependance on ex- citing the uterine veffels by confent with the reaum, when ftimulating emmenagogues are paffmg through the alimentary canal; but I have never had recourfe to thefe. As to the amenorrhea difficilis of Cullen, in which the catamenia flow fparingly and with much pain, we may remark from Dr. Fothergill, that the patient may take purified opium one grain every hour till the pain goes off. For further information I muft refer the ftudent to the cafes and obfervations of Dr. Whytt, in his ineftimable treatife on nervous difeafes, from page 176—182. Clafs IV. LOCALES. Order VI. Tumours. Partial Swellings without Inflammation. This order comprehends fourteen genera. 1. Aneurifma. 2. Varix. 3. Ecchymoma. 4. Schirrus. 5. Cancer. 6. Bubo. 7. Sarcoma. 8. Verruca. 9. Clavus. 10. Lupia. 11. Ganglion. 12. Hydatis. 13. Hydrarthus. 14. Exoftofis. Genus CXVIII. Aneurisma. A foft Tumour on Arteries with Pulfation. This may be either aaive or paflive, either from in- creafed aaion of the blood againft the coats of the artery, or from diminifhed refiftance of thefe coats when they have been ftrained, bruifed, or wounded. The former always happens near the heart, the latter in the extremi- ties. By an invariable law of the animal economy, pref- fure on a part produces its abforption. But here it is cu- rious to obferve the efforts of nature to relieve herfelf. When an aneurifmal fack in the aorta preffes againft the back bone, the abforption begins at the external furface of the artery, where it comes in contaa with the bone, and continues till the whole is abforbed, leaving the bone in tA2 LOCAL DISEASES. in contaa with the blood. The furrounding parts then ftrono-ly unite by the adhefive procefs, and form a chan- nel for the blood, which channel is thus preferved intire, even when the bones themfelves have been abforbed in confequence of preffure. Thus it fometimes happens where no affiftance can be derived from art. But fhould the aneurifm be near the furface, the fkilful furgeon will continue to aflift the weakened artery, and to refift the preffure of the blood, till the coats of the artery have recovered their tone. My friend Mr. Gimbernat, of Madrid, has contrived an inftrument, by which he has cured many deplorable cafes of aneurifm in the popliteal artery. It is compofed of a fteel plate perforated in the middle by a fcrew to regulate the preffure, and kept in its place by two fteel rings, the fuperior ring to grafp the thigh immediately above, and the inferior ring to embrace the leg juft be- low the knee. Each ring confifts of five pieces, with which one, rivetted to the fteel plate, is conneaed with two others by horizontal joints, to admit of bending the knee, either in fitting or in walking. From thefe proceed two other pieces, with which they are conneaed by per- pendicular joints, and which being opened, admit the limb. Thefe might clafp together in a variety of ways, but for the fake of neatnefs, and that the fame inftrument may be adapted to a leg of any fize, one piece enters in- to the other and catches by a fpring. The end of the fcrew which perforates the plate is rivetted to a fmaller plate, which fupports the pad or comprefs ; and thus the patient can give that degree of preffure which is needful to fupport the weakened part. By fimilar contrivances he relieves other cafes of aneu- rifm, even that of the carotid arteries. In recent cafes this method has made perfea cures, and in cafes of long ftanding it has prevented rupture of the artery. When this however fails, relief may be procured by double liga* iures above the aneurifm, in the manner firft praaifed by John Hunter. Genus LOCAL DISEASES. $4$ Genus CXIX. Varix. A foft Tumour on Veins without Pulfation. When varices prefs upon the bones they fhould be either relieved in the manner already defcribed in cafes of aneurifm, or when that proves ineffeaual they mult be extirpated. Of hemorrhoids I have already treated under haemor- rhages, the fourth order of the pyrexiae. For external application the Spanifh phyficians recommend their un- guentum malorum infanorum ; but as that fruit is not to be obtained in England, the ung. alb. camphorat. with a few drops of ol. buxi, may fupply its place. To this a few drops of laudanum may be added, if occafion fhould require it. To keep the body cool and open give the following to the fize of a nutmeg twice a day. §, Ele£t. e Senna, un. 2. Flor. Sulph. dr. 3. Nitri. puri, dr. 2. Magnef. Alb. dr. 1. 01. Carui, gtt. 3. Syr. ex Althae. q. s. f. Eleft. c. c. M. N. M. bis die. Lenitive electuary two ounces, fulphur three drams, nitre two drams; magnefia one dram; oil of caraways three drops ; fyrup of marfli- mallow fufficient for an electuary: take the fize of a nutmeg twice a day. Genus CXX. Ecchymoma. A black and blue Swelling either from a Bruife, or from morbid Extravafation of Blood, as in Typhus, the Plague, and Scurvy. When fuch injuries have been received as naturally produce extravafation, the part fliould inftantly be kept as warm as blood, and if it is a part which can be im- merfed, it fhould be fteeped for a confiderable time in brandy. In this way 1 have feen the worft contuficns pafs without the leaft appearance of extravafated blood. But if extravafation has taken place, and to a great extent, we muft have recourfe to venaefeaion and moder- ate cathartics with warm diluents, a cool regimen and topical applications in the form of poultice or fomenta- tions, to keep the parts warm, and gently to ftimulate the veflels. Tr 544 local diseases. If the tumours become lefs, and do not inflame, they may fafely be left to nature, for the abforbents will take up the extravafated blood. Even fhould inflammation follow, we muft ftill endeavour to promote a refolution of the tumour, which may be frequently obtained by preffure, when applied to a degree juft beyond the point of eafe, for this fets the abforbents of the part to work for the purpofe of removing, when it is removeable, the preff- ing fubftances, one of which in the prefent cafe is the extravafated blood. Should however thefe attempts be fruftrated, the in- flammation may be fafely left to fuppurate ; after which it will be treated as an ulcer. Genus CXXI. Scirrhus. A hard Tumour commonly of a Glandular Part, Indo- lent, and not readily Suppurating. The proximate caufe feems to be want of aaidn in the veffels of the part affeaed. This we collea from a con- fideration of the remote caufes, which are fuch as either debilitate the fyftem in general, or deftroy the tone of the veffels in parts fubjea to their aaion. The fame ap- pears from hence, that weakly, relaxed, and fcrophulous patients, with women at the change of life, are moft lia- ble to have indurated glands. The indications of cure, naturally deduced from this view of the difeafe, will be, to excite the aaion of the abforbents. This may be accomplifhed by evacuants, which excite their aaion by confent, accompanied by topical applica- tions, and followed by general tonics. For an evacuant we cannot have one more efficacious in this cafe than calomel, which may be taken at nioht, and carried off in the morning by a gentle cathartic of rhubarb, fenna, and cream of tartar. Many, for the external application, ufe mercurial oint- ment. Van Swieten recommends acetous fomentations, and a liniment compofed of gum ammoniac with vinegar of fquills, which he adopts from Hildanus, and the form of which I find preferved by Hoffman. I£> Gum LOCAL DISEASES. 545 Tp (iura Ammon. un. 1. Olei Amygdalar, et Olei Liliorum Alb. Pinguedinis Gallinae anna un. 2. Succi Cicutae, un. 4. Aceti Scil'- ht. un. 2. M. et digere per 24 horas, et fpiffum fiat linimentum. Dr. Simmons, in a cafe of fcirrhous tefticle, gave hemlock (conium maculatum) in powder, beginning with^ a fcruple, and increafing the dofe to a dram a day, and at the fame time corrofive fublimate a quarter of a grain per day, and in fourteen days the fcirrhus began to mend. In the fouth of Spain the phyficians affured me, that they found the conium maculatum very efficacious in curing the fcirrhous tumours, more efpecially when affifted by mercurials. Certain it is that the conium in warm climates is a more aaive medicine than it is in our more temperate and humid ifiand. All this muft be underftood of recent cafes; for when the inveterate fcirrhus is much enlarged, and becomes hard like ftone, the preceding remedies would come too late, and nothing remains but either patience or the knife. This however is not the cafe in one fpecies of fcirrhus, the bronchocele, for that, when even inveterate, may be carried off by the abforbents. Sauvage, who makes bronchocele a genus, includes in it four fpecies. 1. Bronchocele botium, which I fhould rather call bron- chocele fteatomatofa. 2. Bronchocele ventofa, which belongs to pneumatofis. 3. Bronchocele far coma, which I fufpea to be fteato- matous. 4. Bronchocele aquofa, the only fpecies noticed by Boerhaave, and which belongs to anafarca. The fcirrhous bronchocele is clearly fteatomatous, and as fuch may be fpeedily cured by foda. It is very fre- quent in the vale of Pewfey, and during five and thirty years I have never failed to cure it in all who have appli- ed to me for my advice. I formerly gave lozenges of burnt cork, burnt fponge, and pummice ftone, in equal parts, and always found this fufficitnt without any other medicine or application, but lately, confidering that it is the alkali of thefe lozen- ges which combines with the fat colleaed in the thyro- W w w ide C46 LOCAL ©ISEASES. ide gland, and makes a foap, I have confined myfelf wholly to burnt fponge, which abounds with foda. This is made into lozenges, one of which, weighing half a dram, is put under the tongue every night. ]$> Spongiae exuftae, giij. Syr. ex Altheae, q. s. f. Trochifci 60 ho- rum unus h. s. lingua fuppofitus ibi per noctem lente deliquefcat. Genus CXXII. Cancer. A hard Tumour of a glandular part, painful and obfti- nate, which terminates in the fouleft Ulcer. What I have faid refpeaing fcirrhus in the preced- ing genus is applicable to cancer, that deplorable difeafe to which all the glands of our machine are fubjea. The eyes, the nofe, the tongue, the palate, the cheeksj the lips, the groin, the axillae, the uterus, and the breafts of women, are the parts moft frequently infeaed, and thofe in which it ravages are moft fevere. In women it commonly appears about the time when menftruation ceafes, and the firft alarming fymptom is perceived when they move their arms backward, fo as to put the fibres of the peaoral mufcle on the ftretch. On examination, they then difcover a fmall lump, perhaps not bigger than a hazel nut. On recolleaion they com- monly remark, that two or three months prior to this period, they had a fmall difcharge of blood from the nip- ple, which ftained their linen. This fymptom proves that fome alteration is taking place in the ftruaure of the breaft. The tumour goes on enlarging, fometimes rapid- ly, till the whole glandular fubftance becomes fcirrhous. The fuperficial veins then become confpicuous, tortuofe, enlarged, and very black. When the tumour is much increafed, one part of it appears fofter than the r-Si, and when ulcerated dif- charges a faneous ichor, but no pus. Pain then-becomes conftant, the ulcer fpreads, and a luxuriant fungus arifes, which it is not eafy to reftrain. The difcharge, ufually copious, excoriates the fkin, and produces excruciating pain, which gradually de- ftroys the patient. Before LOCAL DISEASES. 547 Before ulceration takes place in the external furface, the axillary glands are much enlarged, which arifes prob- ably from an abforption of the cancerous virus, and the tumour, at firft moveable, becomes fixed to the peaoral mufcle. In the beginning of this difeafe the fwelling may be re- tarded by the antiphlogiftic regimen in its full extent, and by external applications. In this ftate elearicity with the exhibition of hemlock have done great things, partic- ularly in Germany and Spain, where it is of a fuperior quality, and mercurials, both internally and externally, may be fafely tried. But in England the flores martiales (ferrum ammoniacale) have been the moft fuccefsful medicine. This preparation of iron may be given in any kind of mucilage, and not only alleviates pain, but di- minifhes the tumour. Mr. Cline, in his leaures, par- ticularly mentioned the cafe of a lady in which the flores martiales conftantly produced thefe effeas, after other medicines had been tried in vain. From his account of this lady there is much room to hope he will be able to perfea a cure. The famous cancer powder of Plunket, exhibited by Martin of Pennfylvania, and given by both thefe quacks with no contemptible fuccefs, has been deteaed to be arfenical. This medicine is perhaps the moft aaive tonic in the materia medica, and deferves to be fairly tried in all defperate cafes, where a powerful tonic is required. A good preparation of it by Dr. Fowler has been already mentioned, as ufed with great fuccefs in intermittents. When, notwithftanding thefe endeavours to check the progrefs of the tumour, it continues to increafe, there is at leaft one fource of hope remaining for a cure, which is by fpeedy extirpation. But fhould this be thought in- expedient, and fhould the ulcer continue to extend its limits, even then pain and all offenfive fmell may be pre- vented by the external application of carbonic acid air, in the manner firft praaifed by Dr. Ewart, and defcribed in his publication. At Bath he had a lady under his care, whom I vifited. As the ulcer was covered, I could form no idea of its condition or of its difpofition to heal j jj4* LOCAL DISEASES. but fhe was perfeaiy freed from pain, and there was not the leaft offenfive fmell. The application here defcribed can never be injurious, nor is it attended with difficulty; for when the bladder is agglutinated to the breaft, it may eafily be filled with the carbonic acid air from another bladder, in which it has been colleaed. This fupply may be derived from the furface of fermenting liquors by a fyringe, and by the fame inftrument may be forced into the bladder, which ferves as a referyoir. Genus CXXIII. Bubo. A fuppurating Tumour of conglobate Glands. Buboes may be fymptomatic of fcrophula, of fyphilis, or of the plague ; and, as Sauvage judicioufly obferves, may be either fcirrhous, phlegmonic or oedematous. Of thefe varieties the phlegmonic are eafily refolved and quickly fuppurate; the cedematous refolve, but never fuppurate; the fcirrhous refill refolvents, yet never fup- purate. I. Schrophulous buboes call for tonics, preceded by gentle cathartics ; in them the metallic oxyds are partic- ularly ufeful. II. Peftilential buboes are critical, yet require to be opened by the lancet, and to be affifted by poultices to expedite their fuppuration. III. Syphilitic buboes, being frequently ill managed by ignorant praaitioners, demand a particular difcuffion. Thefe tumours in the lymphatic glands of the groin, arifing from impure connexion, are more or lefs painful according to the degree of inflammation, which depends on the quantity and quality of the abforbed ..virus with the irritability of the fyftem. The cure therefore might be attempted, as I have fully explained, when treating of the Phlegmasije, either i. by refolution ; or 2. by fuppuration ; but the latter fliould be carefully avoided. My reafon for this opinion is, that when a fyphilitic bubo fuppurates, it becomes a kind of fecretory organ, whofe adion is increafed by the ftimulus of oxygen in the at- mofpheric LOCAL DISEASES. 5-^ mofpheiic air, whilft thefecreted matter, which not only retains it fpecific nature, but acquires virulence by con- taa with the air, being abforbed in great abundance, produces general infeaion in the fyftem. The cure therefore by refolution fhould be preferred to fuppuration. This may in moft recent cafes be accomplifhed by ven- aefeaion, general or topical, by cathartics, and princi- pally by friaion with mercurial ointment, becaufe by this application the fmall quantity of fyphilitic virus con- tained in a bubo, although taken up by the abforbents, carries with it the proper antidote, as it circulates through- out the fyftem. Should however the bubo have acquired fuch an ex- tent of inflanimation, as not to berefolvable ; the fuppu- rative piocefs muft be then promoted by cataptafms and fomentations; and, when it arrives towards maturity, it muft be opened either by the lancet or by cauftics. In this ftate the fubfequent abforption muft be care- fully prevented by keeping the ulcer clean, and the fyf- tem muft be guarded from general infeaion by mercu- rial ointments. Genus CXXIV. Sarcoma. A foft Excrefcence refembling Flefh, not Painful. These excrefcences arife from different parts of the body. From i. The carunculce lachrymales. 2. The eyelid, either externally, or internally. 3. The Sneide- rian membrane. 4. The gums. 5. The fcalp. 6. The Jback. 7. The uterus. 8. The vagina. 9. The cre- mafter mufcle of the fcrotum. When it is derived from the Sneiderian membrac% it arifes from a very narrow bans, but grows larger as it proceeds either through the noftrils or turns back into the throat. As this kind of excrefcence, known by the name of polypus, has but few blood veffels, it may be re- moved without hazard, either by ligature or by the for- ceps accordingly as it is fituated, either near the anterior opening of the noftrils, or higher up. When this op- r ° eration <-c LOCAL DISEASES. eration has been effeaually performed, the polypus re- turns no more, and the haemorrhage, which follows, may be flopped by thrufting lint up into the noftrils. When it affeas the tefticle, it is known by the name offarcocele, and arifes commonly from contufion of that tender organ. In fome cafes the injury extends no far- ther than the tefticle ; but in others it creeps along the cremafter mufcle, fituated on the outfide of the tunica vaginalis, and ftretches away, over the fpermatic veffels, to the inguinal ring. In the firft cafe the extirpation may be performed with fafety ; but when farcoma reaches to the ring, little good can be expeaed from the operation, nor can it be prudently advifed. This will be evident if we confider, i. That the excrefcence may have penetrated the inguinal ring itfelf, and have paffed into the abdomen, where the knife cannot be ufed. 2. That to attempt a ligature of the fpermatic blood veffels fo high up as the ring, will be difficult and dangerous in the extreme, becaufe they retraa, when cut ; yet if this ligature were not feeured the patient would be loft. When farcomatous excrefcences arife from other parts of the body acceffible to ligatures, they may be extirpa- ted with eafe. Genus CXXV. Verruca. A Wart. A Tumour hard, fcabrous, and void of Senfation. Whatever produces inflammation at the root, or death in the wart itfelf, as happens by the application of a cauftic, will excite action in the abforbents to feparate not oply between the living and the dead, but between the found parts and the difeafed. For it is a general law of the animal economy, that if a part is organically injured, the found part beneath relaxes, and fhews dif- finaiy the limits of the difeafe, fo that a feparation begins to take place although the aaual death or deftruaion of the part,^ as by a cauftic for inftance, has not reached fo &r. It is upon this principle, as John Hunter has ob* ferved3 LOCAL DISEASES'. 55* ferved, that arfenic, fuperficially applied, removes tu- mours. From what has been faid, it will appear to be nearly a matter of indifference, as to the effea, what kind of cauftic, aaual or potential, is applied. Some remove their warts by the juice of celandine (chelidmium ma- jus), fome by fpurge (euphorbia heliofcopia), others by juice of houfeleek (fempervivum teclorum). Some prefer the aaual cautery, others are better pleafed with either burnt alum, with blue vitriol, with vitriolic acid, or with the lunar cauftic, and others again are fatisfied with ligatures, when they can be applied. The verruca fyphilitica belongs to fyphilis. After cur- ing the primary difeafe, the tops of thefe warts may be cut off, and then a little powder of favine may be appli- ed to them. Genus CXXVI. Clavus. A Corn. A thickening of the Cuticle, hard, lamellated. The beft inftrument for cutting corns is a pair of fcif- fars, fhort in the blades and fharp in the points, becaufe by thefe there is no danger of going fuddenly fo far as to make them bleed, provided the perfon operates on his own corns. A radical cure may be obtained by fuffering them to grow freely without preffure, and this effea may be ob- tained by flicking plafters, accumulated in proportion as the corn grows up, if each plafter has a hole in the middle for the corn to penetrate. This however re- quires more attention than moft people can command, Genus CXXVII. Lupia. A Cyft under the Skin, foft, moveable, indolent. This might have been confidered as a fpecies of fcir- rhus, becaufe the matter contained in the cyft is fteatoma- tous. When this matter is liquid and foft as honey, Sau- v?gc r-2 LOCAL DISEASES. vage calls the tumour lupia meliceris ; when it refembies fuet, he gives it the name of lupia fteatoma. Extirpation by the knife is fafe, eafy, and effeaual, provided no part of it is left behind. Genus CXXVIII. Ganglion. A hard Tumour, moveable on the Tendons. Ganglions, upon the tendons, are inclofed in the fame cellular membrane which forms their vagina, to facilitate their motion. They occupy their ftation alfo on the annular ligaments and capfulas mucofae, through which they pafs. Thefe tumours, although indolent, being yet very troublefome by preffing on the tendons, it becomes needful to remove them. This may in com- mon be effeaed by exciting the abforbents, the beft way of doing which is by preffure, for this, when applied to. a degree juft beyond the point of eafe, calls forth their aaivity to remove, when it is immoveable, the preffing fubftance, and that fubftance is the ganglion. I need fcarcely add, that the preffure muft be uniform and long continued. Another method of cure is, to give repeated and hard blows with a hammer, for this, by bruifing, difturbs the organic ftruaure of the part, and thereby, according to a beautiful law of the animal economy, excites the ab- forbents into aaion for the purpofe of conveying it away. When the ganglion, by neglea, has been fuffered to enlarge itfelf, it may be vain to attempt its refolution in thefe ways. Nothing then remains but to remove it, either by the knife or by a cauftic. The latter in fkilful hands may have the preference; but, confidering the irritability of tendons, with the danger attending anv vi- olence offered to them, and the greater hazard of de- ftroying the. coats of fome artery, it muft be evident, that much patience and the moft watchful attention are required ; when in fuch a delicate fituation we advife the application of a cauitic. My friend M. Gimbernat, being required to remove a large ganglion on the wrift of the princefs royal of Spain, which LOCAL DISEASES. 553 which was clofe to the radial artery, after having tried in vain what could be done by preffure, had recourfe to cauftics, which were fo flowly and fo cautioufly applied as to require more than twelve months for perfecting a cure. Genus CXXIX. Hydatis. A cuticular veficle filled with an aqueous fUrid, refem- bling that which arifes from combuftion, but not pain- ful, unlefs when broken. - Although thefe cuticular veficles are called hydatides, it is not meant by this appellation to imply, that they contain tenie hydatigene, which are found in cafes of encyfted dropfy, nor, as I apprehend, do they require medical afliftance. Genus CXXX. Hydarthus. rf A white fwelling on the joints, chiefly in the knees, fmall at firft, not difcoloured, very painful, and deftroying the mobility of the joint. It is a difeafe of the lymphatics in the part affeaed ; for either the exhalants are relaxed, or the abforbents become atonic, in confequence of which there is an ac- cumulation in the fynovial glands, which by preffure caufes irritation and in the end ulceration of the parts. The predifponent caufe feems to be laxity of the folids, and the occafional caufe commonly is fome contufion. The indications of cure are to excite the aaion of the abforbents and to brace the folids ; the former by emet- ics and cathartics, but particularly by fetons, by burning moxa on the part, and by repeated blifters round the joint ; the latter by tonics and aftringents, particularly by bark and fteel. m Let the ftudent confult further what nas been faid on fcrophula. Xxx Genus 554 LOCAL DISEASES. Genus CXXXI. Exostosis. A hard Tumour on a Bone. The bones are fubjea to the fame difeafes as othe?r parts of the animal machine, for they equally abound with nerves, arteries, veins, cellular membranes and lymph- atics. The interftitial parts of this contexture we fee occupied by phofphorated lime and gluten. This appears by injeaions, when accurately made, for the calcareous earth may be carried off by marine acid diluted much with water, and the animal gluten may be wafhed away, after which the preparation being placed in oil of turpentine, the vafcularity of the texture will be beautifully diftina. Bones are not for any given period unalterably the fame, but are inceffantly wafting and renewed. Nay fuch is their renovating power, that in cafe of fraaure they foon form a callus ; and in cafes of necrofis, whilft the abforbents carry off the dead portion, proper veffels go to work to furround it with new bone, which at the two extremities conneas itfelf to the living portions of the old. In this operation we admire the efforts of nature to relieve herfelf; but as in every thing beneath the fun, good and evil are intimately blended \ and as it fome- times happens, that the laws provided for the health and well being of the animal may give occafion to difeafe ; fo is it here ; for this offific faculty, to which we are in- debted for health, ftrength, locomotive power, nay for the fupport of our animal exiftence, in certain circum- ftances, produces morbid oflifications and exoftofes, which may either deftroy us if they are the caufe of ap- oplexy, or render life a burthen, when they occafion ei- ther epileptic fits or palfy. It is commonly aaive inflammation in a bone, which lays the foundation of the difeafe in queftion, and this may be occafioned either by topical violence or by con- ftitutional affeaions. The topical violence may be from either wounds or contufions, LOCAL DISEASES. 555 contufions, and the conftitutional affeaion may be ra- chitis, fyphilis, fcorbutus, fcrophula. Hence Sauvage enumerates the fubfequent fpecies of exoftofis. I. Exoftofis benigna, occafioned merely by wounds, preffure, or contufions, and attended by the mildeft fymptoms ; yet incurable, unlefs by extirpation. II. Exoftofis rachitica. This fpecies attacks rickety children, and fuch adults as have been formerly fubje& to rickets. It is incurable ; for amputation cannot re- move the caufe. III. Exoftofis cancrofa. In this the tumour is brownx and the veins are varicofe ; but the moft certain fymptom is cancer in any other part. IV. Exoftofis ferophulofa. It is diftinguifhed by the common fymptoms of fcrophula in the glands, the upper lip, and the eyes. V. Exoftofis feorbutica. For the fymptoms, the gums, the teeth, the fkin, muft be examined, and the treatment muft be the fame as in the primary difeafe. VI. Exoftofis fyphilitica. It is the confequence of im- pure connexion, and the fpecies may, from that circum- ftance, be afcertained, provided other fymptoms of invet- erate lues are not wanting. Thefe are ulcers, buboes, puftules, noaurnal pains, &c. This fcourge of illicit intercourfe is moft unfriendly. to the bones. In them the fyphilitic virus fpreads, and in them its ravages are moft fevere. My friend Wathen has preferved a fkull, which is like a honey comb ; and in the cabinets of the chirurgeons I have feen ribs, the fternum, clavicles, and vertebrae, perforated in a thoufand places. . Yet deplorable as are the effeas of this difeale, its progrefs may be flopped by mercurial fridions long continued ; after which, if there is external canes, it mufl be deftroyed either by burning or by potential cauf- tics • if there is fpina ventofa, or internal caries, an open- ing muft be made by a trepan into the cavity of the bone, and the ulcer muft be cleanfed. Sauvage mentions three other fpecies ; but as they require no fpecial attention, I omit them. 55<5 LOCAL DISEASES, Clafs IV. LOCALES. Order VI. Ectopia. Parts difplaced. In this order we have three genera. i. Hernia. 2. Prolapfus. 3. Luxatio. Genus CXXXII. Hernia. . * A Rupture. The protufion of a foft part, which yet remains cov* ered by the common integuments. SECTION I. Introduction with Enumeration of the Species. It is evident that hernia may be either aaive or paf- five ; it may be produced either by violent exertions expelling the part ; or it may happen from preternatural debility, relaxation, and diminifhed power of retention. In the former cafe we have a ftrong pulfe with pain, heat, and tenfion : in the latter the pulfe is weak, pain not fevere, and heat is moderate. In one cafe it is difficult to reftore the part ; but when reftored, it is retained : in the other to reftore is eafy, but not fo to make the part continue in its place. When hernia is the effea of violence; lubricants, laxatives, anodynes, and venasfeaion are required : but when it is the confequence of relaxation and debility, the tonic plan muft be adopted, with air, exercife, a gen- erous diet, aromatics, bitters, bark, and fteel. Sauvage under this genus has introduced the fubfe- quent fpecies arranged by the learned and moft labori- ous D. Cuffon of MontpeHier, 1. Enterocele. 2. Ep- iplocele. 3. Gaftrocele. 4. Hepatocele. 5. Spleno- cele. 6. Hyfterocele. 7. Cyftocele. 8. Encephalo- •oele. SECTION LOCAL DISEASES. 557 SECTION II. Of Enterocele. Enterocele is an hernia of the inteftines. Sauvage, "who has made this one of his genera, arranges under it no lefs than five and twenty fpecies : but as thefe lead to diftinaions which are foreign to my purpofe, I fhall here omit them. It is fufficient to obferve, that the in- teftine may pafs either through the inguinal rings, the crural arches, the oval foramina, the ifchiatic femilunes, the umbilical ring ; or after wounds through the muf- cles of the abdomen, according to which circumftances the hernia is called, a. Inguinalis. b. Cruralis, or femo- ralis. c. Ovalaris. d. Ifchiatica. e. Umbilicalis. f. Ventralis ; or, from the place to which the hernia in- guinalis defcends, it is denominatedy2rota//.r and vagina- lis. It may likewife be obferved, that hernia appears in three conditions ; either A, fimple and incyfted, which is, when the inteftine alone is protruded with a portion of the peritonaeum. B, compound and incyfted, when the omentum is protruded with the inteftine, but the peritonaeum is not ruptured. C, not incyfted, When the peritonaeum itfelf is ruptured. And in addition to thefe diftinaions, it muft be yet remarked, that the hernia may be ftrangulated or not, as I fhall immediately hate occafion to explain. Of the above mentioned varieties of hernia, the in- guinalis and the femoralis are the moft important, as be- ing moft common, and requiring moft knowledge and attention. In the hernia inguinalis the inteftine paffes through the fame ring with the fpermatic veffels ; and in the her- nia femoralis it efcapes under the crural arch with the crural artery and vein. The circumftance which ren- ders thefe two fpecies peculiarly hazardous is, that they are more fubjea than the other fpecies to be ftrangula- ted, which not only prevents reduction, but flops the pe- riftaltic motion of the inteftine, impedes circulation through 55* LOCAL DISEASES. through the arteries, and, producing gangrene, very fpeedily deftroys the patient. "Strangulation may be caufed either by fpafmodic ftric- ture of the aperture, through which the inteftine paffed, or bf inflammation and diftention of the parts protruded. The cure therefore muft be attempted by fpeedy and copious venaefeaio/i, by fomentations, and by manual operation. /The method of reduclion praaifed by my valuable, friend M. Gimbernat, of Madrid, is fo ingenious, and at the fame time fo fuccefsful, that I fhall give it in detail. He places the patient on his fide oppofite the hernia, with his body a little bent and lower than the pelvis, in order to relax the mufcles of the abdomen.- With the fame intention the head is brought forwards towards the cheft, and in the hernia femoralis he elevates the thigh, on which the hernia is, yet fo as not in the leaft to ob- ftrua the operation. Sitting then by the bedfide, with his hand, which is neareft to the patient, he grafps the tumour at its bafe, which is the upper part, and with his three firft fingers he compreffes it all round to diminifh its diameter, at the fame time with the fingers of the other hand he pufhes the apex, which is the lower end of the tumour, upwards and inwards, to direa it towards the crural arch, becaufe it cannot be reduced in any other direaion. He has fometimes found that more than one hour was required for this-operation. When the patient is fatigued he ceafes both to prefs and pufh, but yet never quits his hold, and when he renews thefe efforts he increafes gradually their force. Of numerous hernias treated by him in this way, and many of them defperate, thofe which have not been re- duced have been very few. It may be needlefs to add, that this method is improp- er u the tumour is inflamed and very painful, for in fuch circumftances there is no fafety for the patient unlefs in tnecruent operation, that is in the dilatation by the knife, *,. Part wmck caufes the ftrangulation. This operation in the inguinal and umbilical hernias is fare and eafy, bus, by the ufual methods, in the femoral hernia, LOCAL DISEASES. 559 hernia, it has been found both difficult and dangerous m. the extreme. Yep in the way firft praaifed by M. Gim- bernat, the reduaion of hernia femoralis may be render- ed the moft fimple and moft fafe of any cruent opeqtion praaifed in cafes of ftrangulated hernia, for neithePthe -epigaftric arteries nor the fpermatic veffels can be injur- ed by his biftoury. * For the cruent operation, in femoral hernia,- after the fac has been properly laid open, the patient muft be placed upon his bed, as. for the reduaion, and, if the in- teftine is found, the operator muft endeavour to reduce it. For this purpofe a little more of the inteftine muii be drawn out of the abdomen, becaufe fometimes the ftrangulated part is affeaed by fuch ftrong fpafmodic conftriaion, as not to allow a paffage to the faeces con- tained in the protruded portion of the inteftine. This frequently is the only impediment to reduaion, and is commonly overcome, if there is no adhefion, by bring- ing to the arch a part of the inteftine, which, not hav- ing fuffered ftrangulation, will not be conftriaed like that which has laboured under it without remifllon for hours or for days. If, as rarely happens, the reduaion cannot be obtained m the way above defcribed, it will be needful to divide the part which caufes the ftrangulation. But, previous to this operation, the patient muft evacuate his urina* that his bladder may be free from danger of being wounded by the biftoury. When therefore the patient is ftretched upon his bed, fo as to prefent the part moft commodioufly for the op- erator, a direaor or grooved probe, with a channel of fufficient depth and a blunt point, muft be introduced along the internal fide of the inteftine, that is between the inteftine and the pubis. This muft be direaed ob- liquely inwards, till it has paffed the crural arch, the en- trance to which will be perceived by increafed refiftance, -and its having paffed will be afcertained when the point of the direaor refts upon the pubis. Then with his left hand, if the hernia is on the right fide, or with his right hand if it is on the left, the operator keeping the point 56*0 LOCAL DISEASES. of his direaor firmly refting upon the branch of the off pubis, in fuch a pofition that the back of the diredtor fhall. be turned to the inteftine, and its groove towards the frmphyfis pubis, when confequently the two edges will oe turned one of them downwards, the other towards the crural arch, he muft with the other hand introduce into the groove of the direaor a biftoury, with a narrow blade and blunt point, till it enters the arch, which will be known, as before ftated, by a little increafe of refift- ance. The biftpury muft then be very cautioufly preffed forward to the end of the groove, and, employing both hands in concert, the operator muft condua both inftru- ments together clofe along the branch of the pubis to- wards its fymphyfis, fo as at the fame time to draw them out. By this eafy operation the duplicature or expanded aponeurosis of the abdominal mufcles, which is turned inwards and upwards more than an inch, arid which forms the crural arch, is divided from its internal border, to the depth of about feven lines, and within four or five lines of its angle, at its infertion along the crefl of the pubis. The remainder of this duplicature is left attach- ed to the inferior pillar, of which it is the continuation. This fimple incifion being thus accomplifhed without the fmalleft danger, the internal border of the crural arch, which alone forms the ftrangulation, is confidera- bly relaxed, and the parts are reduced with the greateft facility. Pregnant women muft be much inclined to the fide op- pofitefrom the hernia, that the uterus may not be injured. After the operation, the lips of the incifion muft be brought together and fecured by dry flitches, over thefe a fimple comprefs with unguentum cerae muft extend two inches beyond the future to prevent the introduaion or even the accefs of air. On this dry lint and other compreffes muft be fupported by convenient bandage, and the patient muft keep his bed, with the thigh eleva- ted and the body incurvated, fo as to relax the abdominal mufcles and prevent ftrt-ng preffure of the inteftines againft a weakened part. In five or fix days the dreffing may LOCAL DISEASES. 561 may be changed, and when the patient rifes from his bed he muft wear for a great length of time the fpica bandage. Temperance with quietnefs muft be , rec- ommended, and coftivenefs muft be avoided. When this falutary operation has been negleaed^all the diftreffing fymptoms become aggravated ; pain, fick- nefs, naufea, and vomiting, the fruitleif efforts of nature to relieve herfelf, enfue; and as thefe prove vain, fhe with- draws her vital energy from the ftrangulated portion of the inteftine, now rendered not only ufelefs but worfe than ufelefs, leaves that part to mortify, and then excites the needful aaion of the abforbents to make a feparation between the living and the dead. Nor do her efforts ter- minate in this feparation, for, unlefs death prevents, which is moft frequently and fpeedily the cafe, the adhe- five inflammation may take place between the external teguments, and the fuperior portion of the inteftine, fo as to form a new anus, or the two living portions may unite and remedy the evil. Van Swieten records three curious cafes, in the firft of which, after the hernia had continued eight years, it mor- tified and caft off a portion of the inteftine in length about eight fingers, yet in lefs than five weeks the economy of nature was perfeaiy and fpontaneoufly reftored. In the fecond cafe, when the length of fix fingers had perifhed by gangrene, the furgeon paffed a thread through the mefentery, and retained both the living ends of the inteftine in the aperture of the wound with a view of making this ferve the purpofe of the anus : and in a month thefe living parts were perfeaiy united. The third was ftill more remarkable, for in this the Duke of Brunfwick's furgeon cut off a confiderable por- tion of the inteftine, after which putting the fuperior ex- tremity into the inferior, heflightly fattened them togeth- er by a future, and replaced them. This patient lived afterwards in perfea health, till, at the diftance of twelve months fhe had a pleurify, and died. After death the parts were found united, and were preferved in the cabi- net of Heifter. Queralto, firft furgeon to the Spanifh army, is report- ^ Y y y e* r62 LOCAL DISEASES. ed to have performed this operation with fuccefs, by in- troducing, as above ftated, the fuperior extremity into the inferior after he had feparated the part deftroyed by gangrene. SECTION III. OfEpiplocele. Epiplocele is an hernia of the omentum, either fim- ple, compound, facca'ted, or not faccated. It is moft common in the umbilical ring, but it may be feated in the other parts, which are fubjea to enterocele. It is at- tended by much pain, more efpecially when the patient at- tempts to walk erea, but it is not affeaed by efforts to evacuate the faeces. It may fafely be extirpated by ligature. SECTION IV. Of Gaftrocele. Gastrocele is an hernia of the ftomach, caufed by violent efforts in vomiting or lifting weights, more ef- pecially after the mufcles of the abdomen have been wounded. It is fpecifically diftinguifhed by pain in the ftomach after eating, by lofs of appetite and vomiting ; but more efpecially by eafe in an horizontal pofition. The cure is to be effeaed by reduaion, by wearing a trufs, by relaxing the mufcMs of the abdomen, by ftria temperance, and by tonics. SECTION V. Of Hepatocele and Splenocele. Hepatocele is an hernia of the liver. The cafes adduced were in new born infants and in the umbilical ring. Thefe feem to have been from natur- al defea in the organization, for the liver is not a float- ing vifcus. Splenocele is an hernia of the fpleen. Two cafes are adduced by Ruyfch and Hildanus. In both the fpleen was much enlarged and fcirrhous. SECTION local diseases. 563 SECTION VI. Of Hyfterocele. Hysterocele is an hernia of the womb. It has been occafioned by violent mufcular efforts, by blows on the abdomen at the time of geftation, if preced- ed by either wounds or abfcefs; becaufe thefe in the ab- domen do not cicatrize fo well as in parts that are at reft. Ruyfch relates the cafe of a woman, who becoming preg- nant after an ulcer had been healed in the lower part of the abdomen, the tumid uterus defcended into a dilated fac of the peritonaeum in that weakened part, till it hung, with the included foetus, at her knees. Yet, when her full time was come, the midwife reduced this wonderful hernia, and, in a natural way, fhe was fafely delivered of a fon. SECTION VII. Of Cyftocele. Cystocele is an hernia of the urinary bladder. It may pafs either by the foramen ovale, the inguinal rings, or the crural arch. It is always affeaed by the prefence or abfence of urine in the bladder, and may be therefore readily diftinguifhed from other fpecies. When inflamed, it is attended by acute pain, heat, fever, vomit- ing, and hiccough. In this cafe the antiphlogiftic plan muft be purfued to prevent a gangrene. The reduaion muft be attempted in the fame way as in the hernia inteftinalis. After which, if it has been re- duced by taxis, a proper trufs muft be applied, but if by the cruent operation, then the fpica bandage muft have the preference. SECTION VIIL Of Encephalocele. Tncephalocelr is an hernia of the brain. This has been frequently feen in new born infants, arifing from defed of oflification in the cranium and in 5^4 LOCAL DISEASES. adults after part of it has been removed by fraaure, by caries, or by the trepan. In fuch cafes a portion of the brain has been protruded by the natural diftention com- municated to it at every infpiration. To prevent this, and to fecure the brain from fuch preffure, as would pro- duce deep fleep, apoplexy, death, the apertures are ufual- ly covered by metallic lamina, chiefly of lead, adapted to their fhape and fize, with fhoulders to keep them from falling through the cranium. Genus CXXXIII. Prolapsus. The Protrufion of a foft Part uncovered. Dr. Cusson, and after him Sauvage, confiders this as a fuperior order, to be diftinguifhed into genera and fpe- cies ; but we fhall be contented with noticing thefe as fo many fpecies and varieties. I. Exophthalmia is a prolapfus or protrufion of the eye, which, according to thefe nofologifts, may be, a. Exophthalmia hydropica. The bulb of the eye increaf- es, and the fight is gradually impaired. The cornea is elevated and the iris feems to be funk. The pupil becomes aimoft immoveable, pain is felt at the bottom of the eye, and there is involuntary flux of tears. It is in truth only a dropfy of the eye, known by the name of hydrophthalmia, and belongs to caligo. It is cured as dropfy, and, if need be, the paracentefis muft be reforted to. b. Exophthalmia purulenta. This follows in confequence of violent inflammation external and internal, produ- ced by the irritation and diftention in exophthalmia hydropica. This accumulation of pus in the chamber of the eye is called hypopyon, and requires the lancet. it belongs properly to caligo. c. Exophthalmia cancrofa. It is attended with intenfity of pain and total deftruaion of organic ftruaure. No relief is to be exneaed but in extirpation. d. Exophthalmi .. tica. To be treated as a wound. e. Exophthalmia a protuberantia. This, properly fpeak- ing, is the only exophthalmia. and the protuberance may local DISEASE'S. 5*5 may be exoftofis, for which fee genu's 131;fcirrhus, for which confult genus 121; hydatides, or other encyfted tumour, as in dropfy, or it may be-merely fat; but the moft common protuberanceis polypus, which may fome- times be extraaed, if not too deeply feated, and the eye may be replaced, as was performed by my friend M. Gimbernat, in a cafe which his fon communicated to me. The fubfequent letter from one of the firft oculifts in our metropolis, contains a moft interefting cafe of ex~ ophthalmia : Captain P---------, of America, on his arrival in England, applied to me with a complaint of his left eye. On examination I found a complete paralyfis of the upper eyelid, and an increafed prominence in the eye itfelf : on further inveftigation I found the prominence of t'r e eye did not proceed from any enlargement of the globe itfelf, btrt from fome fubftance occupying the pofterior part of the orbit. This fubftance or tumour alfo feemed not to be confined to.the orbit only, but to extend itfelf into the cavity of the cranium, fo as to occafion an inrreafed projection of the prominence oftheosfcontis ontthat fide. Thefe circumftances were accompanied with a confbnt dull heavy pain in the head, which fometimes increafed to a great degree of vio- lence, and with a fenfation round the eyebrow and temple, which he defcribed as fimilar to that which he experienced when the foot is faid to be afleep. He was much emaciated, and a vaft degree of de- bility was induced on the general fyftem. The firft means employed were a large blifter on the head, the in- ternal exhibition of the hydrarg, muriat. and bark, and the external application of electricity and camphorated fpirits of wine to the eye- lids, and of a drop of the tinctura thebaica to the eye itfelf when any pain was experienced in the globe. This plan, with the renewal of the blifter as frequently as poffible, was continued about two months, -during which time, though the pain was confiderably abated, the dif- eafe feemed to gain ground. The tumour in the forehead was larger, and the eye more prominent. A. mercurial courfe was now adopted, and he rubbed in the oint- ment for about three weeks, when a violent mercurial inflammation of the eye itfelf took place, attended with a confiderable opacity of the cornea. The bark with the hydr. muriat. was now given, and the rubbing in was entirely omitted. The eye, with proper local treat- ment, began foon to amend, and entirely recovered. The paralyfui difappeared, but the tumours continued much the fame. The pain in the head returned fometimes, but in a lefs degree, and was always removed by the blifter. About this period the whole plan was inter- rupted by his taking cold, and being feized with an inflammation of the bowels, which for fome days gave us fmall hopes of his recovery When his ftrength allowed an examination, I was furprifed to find +hc prominence both of the forehead and eye much diminifhed. Thr genenJ r56 LOCAL DISEASES. rcneral debility was fo much increafed as to derange his faculties at times • the bark was again given, but it always purged, and would uever agree. Having feen the good effect of fxed air in fome debili- tated conftitutions, I recommended his drinking freely of fpruce beer. This agreed moft completely, and the change in his general health, even in the fpace-of a week, was fo great as to afford the moft fanguine hopes of hi& re-eftablifhrnent. Another inflammation now attacked the eye itfelf, attended with an ulcer of the cornea. For this a variety of local remedies were ufed, and the hydrar. muriat. again. The tumours continued gradually de- creafing, the eye perfectly recovered ; and by continuing thefe means for about two months, he quitted England, not only perfectly freed- from his difeafe, but increafed in bulk, and in better health than he had been for years. He has been fince to America, and has return- ed to England ; is in perfect health, and has never experienced the Sighteft relapfe whatever. John Wathen Phipps, N. B. He continues drinking the fpruce beer to this day. Pall-Mai!, Dec. 22, 1795. II. Blepharoptofis, is either retraaion, inverfion, or elongation of the eyelids, in all which cafes the fkilful furgeon can give relief. In all difeafes of the eye the young praaitioner may confult' the works of Maitre-jan, S. Yves, Boerhaave, Heifter, Bell, and Wathen; and, fliould any operation be required, to which he feels himfelf unequal, he can- not do better than to confult the latter, or his grandfon, Wathen Phipps, in London, who have devoted their at- tention wholiy to. this fubjea, and are certainly the firft praaitioners in Europe. III. Hypoilaphyle, falling of the uvula. This may be attended by inflammation, and requires the antiphlogiftic regimen, with cooling and detergent gargles \ or it may be caufed by relaxation, and call for tonics. In the firft cafe, for a gargle : 5, Aq.. Hord. sviij. Mel. Ilofcc §j. Sal Ammon Crud. 3j. M. fiat r^ii-garifrna : Barley water feven ounces ; honey of rofes an ounce ; crude fal ammonia a dram. Mix for a gargle. For an aftringent gargle nothing can excel the de- to&ion of oak bark, with honey of roles, and a fmall quantity of alum : ]$a Cort. Querein. un. 1. Aa. Font, ft/s, fiat Dccoctio nd fti. Cm. adde Met. Ro'ac. un. x. Alum. d.. 1. M. pro earcr^. sifmatt l h & VI. Par-floffe. LOCAL DISEASES. 567 . \ Paragl°]Fc' Under this fpecies we obferve four varieties : a. Paragloffe deglutatoria, in which the fraenum linguae being either wanted or deftroyed, new born infants iwallow the tongue. b. Paragloffe gloffomegiftus, from extreme enlargement of the tongue, of which the caufe may be fought among thofe that occafion, i. Pyrexia ; 2. Neurofes ; 3, Cachexiae ; for it may either be inflammation, or the confequence of fpafmodic affeaions, or it may arife from fome derangement in the lymphatic fyftem. En-, largemen-t of the tongue from inflammation is not un- common, but from fpafmodic affeclion is feldom to be met with. One cafe I faw in a lady, of a certain age, who was of a relaxed and irritable habit, which re- turned regularly about the monthly period, after the monthly evacuation ceafed. It feemed to arife from the ftimulus of the haemorrhagic effort in the veflels of the uterus, with which the tongue was affeaed by confent. It was at laft relieved by tonics and aftrin- gents. Enlargement of the tongue from derangement of the lymphatic fyftem is too frequently obferved when mer- curial falivation is carried to excefs. c. Paragloffe exertoria, is caufed either by paralytic affec- tion of the retrahent mufcles of the tongue, or by fpaf- modic aclion of thofe mufcles by which it is protruded. d. Paragloffe retracloria is the inverfe of the former, be- ing a violent retraaion of the tongue, either by para- lytic affeaion of the protruding mufcles or fpafmodic aaion of the retrahent. ( V. Proptoma. Relaxation of the fcrotum, of the un- der lip, of breafts in females, of the praspuce, or of the ears. VI. Exania. The falling down of the reaum may be occafioned by ftraining either in childbirth or in ef- forts to evacuate hardened fasces ; by the long contin- uance of diarrhcea and dyfentery ; by the operation of violent cathartics, and by either paralyfis or divifion of the levatores ani. Thefe caufes give names to as many fpecit: cfiS LOCAL DISEASES. fpecies in Sauvage; but, independently of thefe diftinc- tions relative to the caufes which occafion this difeafe* the prolapfus may be either fimply inflamed, it may be ftrangulated, or it may be gangrened. The indications of cure muft have refpea both to the condition of the prolapfus and its caufe. The part pro- lapfed muft be reduced by hand. Inflammation muft be checked by venasfeaion, or by leeches ; by tepid fo- mentations, and by antiphlogiftics ; and whatever is the occafional caufe muft be obviated. « VII. Hyfteroptofis. Prolapfus uteri. Falling down of the womb. This may be occafioned by hard labour, or by ill management in labour, when the ignorant mid- wife extraas the placenta before the uterus is properly contraaed. The furgeon in replacing' this vifcus muft be cautious not to injure it, and fhould the part be much inflamed, topical bleedings, with the gradual application of cold, by means of linen cloths foaked in water and frequently renewed, muft be firft recommended. When the womb has been reduced, it may be kept in its place by a peffary, and tonics with aftringents muft be both internally exhibited and topically applied to brace* its ligaments. The fame may be faid of prolapfus va- ginae, which is merely a confequence of relaxation in the cellular fubftance, by which it is attached to the fur- rounding parts. Genus CXXXIV. Luxatio. A Diflocation or disjointing of a Bone. This may be difcovered by inability to move the joint, when this inability arifes neither from fear of pain nor from any known difeafe, by a change in the exter- nal form and pofition of the part ; by variable and in- terrupted pain depending on efforts to.move, and by tenfion of the mufcles oppofed to the luxation. A diflocation, when not accompanied by rupture of the capfular ligament, can be reduced by manual opera- tion. Strong contraction of the mufcles is the only ob- ftacle to the reftoration of the joint, and this fometimes is LOCAL DISEASES. 5^9 Its fo great as to refift all the mechanical powers which can be applied. M. Ginefta, profeffor of the college of furgery at Mad- rid, has however happily difcovered a lefs terrific meth- od, and has proved that opium internally taken, and externally applied in ftrong fomentations to the contraa- ed mufcles, induces fuch a degree of relaxation as great- ly facilitates reduaion. In a memoir prefented to the infant college, and which will be publifhed, he mentions feveral cafes of long Handing reftored in this way by him, after having wearied the patience and fruftrat- * ed the hopes of other praaitioners. Fear and terror have produced the fame effea ; and feveral inftances might be referred to, in which the grim vifage of a fur- * geon, who was known to be rough in his operations, en- abled him to do with eafe what others, not lefs fkilful, had in vain attempted. When the head of the diflocated bone has ruptured the capfular ligament, and paffed through the opening, the reduaion is attended with much greater difficulty, becaufe it is fcarcely poflible to make the projeaed bone return by the fame channel. This fituation of thing? being difcerned by the more limited and impeded motion of the diflocated bone, the fkilful furgeon muft lay open the parts concerned, and dilate the perforation of the f .S capfular ligament, that he may be enabled to reduce the 'joint. In this operation the difficulty and danger will arife from the high inflammation of thefe parts when ex- pofed to the accefs of atmofpheric air. M. Ginefta has devifed a new method of performing this operation, which I may perhaps hereafter have an opportunity of communicating to the Englifh iludent. When, notwithftanding all the efforts of art, the diflo- cation cannot be reduced, nature exerts her efforts tc.re- lieve herfelf, and fometimes in the fcapula and the ilwm forms a new cavity,in which the head of the diflocated bone findTa refting plale and firm fupport For here by a law to remove the part fubjeaed to its aaion j inflammation I. ZuU with aWge of offlhc -«j»^ 57° local diseases^ articulation is produced. This, with perfea reft, would form an anchylofis, but with proper motion the articula- tion gains its capfular ligament, and becomes a perfea joint. Whilft nature is thus forming a new cavity, in which the head of the diflocated bone may move fecurely, fhe proceeds to obliterate the former cavity, as no longer ufeful. Several joints, thus formed by nature, have been dif- feaed and preferved in fpirits by my friend M. Gimber- nat, and are now in the mufeum of the royal college at* Madrid. Clafs IV. LOCALES. , Order VIIL Dialyses. Solutions of Continuity. In this order we have feven genera : i. Vulnus. 2* Ulcus. 3. Herpes. 4. Tinea. 5. Pfora. 6. Fraaura--. '$ 7. Caries. •. ' Genus CXXXV. Vulnus. A Wound. v '..>* 1. Could the divided furfaces of a wound be brought? * into contaa without effufion of blood, the mouths of" the correfponding veffels would immediately unite by mofculation. But even extravafated blood, if the lips of the wound are brought together, is fo far from beina an impediment, that it becomes a bond of union • °for the fuperfluous blood and the red particles of the remain- ing blood being fpeedily abforbed, the coagulating lymph becomes vafcular, fo as to contain within itfelf nerves ' arteries veins, lymphatics, which form a juntton with the divided veflels, and renew their communication. In this cafe the parts are faid to unite by the firft intention. II. bhould however this opportunity be loft, and the mouths of the divided veffels be fuffered to contraa they will throw out now no longer blood, but coagulating lymph, local diseases. 571 p lymph, and the parts being brought into contaa, may yet unite by the adbtfive inflammation, which is the fee- end mode of union. Divided parts may be brought into contaa in all cafes, excepting the orbicular mufcles, fuch as the lips, either ,by bandage, or by dry future, that is, by narrow ftrips of flicking plafter, which may be placed about a quarter of an inch apart. This will be fully fufficient to effea the union, and, without any other application, will heal the wound by what has been called the firft intention : but in faa this includes two operations of nature which are perfeaiy diftina. Should a fcab, for want of perfea union in this way, be formed, it fhould be fuffared to remain, and fhould be covered with eggjkin, more efpecially when near a bone, as for inftance on the fkin ; for this will expedite the union of divided parts, and at worft thefe can but fuppurate at laft, as they will inevitably do if the fcab is unfeafonably removed. Even in fome compound frac- tures this praaice is recommended by John Hunter, who judicioufly obferves, that by permitting the blood to fcab upon the wound, the blood underneath will be- come vafcular, and the union will be complete, although the parts are not in contaa. Even when inflammation is increafed by the irritation of the fcab, and when pus an effea this which is at- tributed by Dr. Crawford to its hepatic air, or fulphura- ^ ted hydrogen, as I fhall explain when I proceed to diftin- py„' guifh ulcers by their fpecific charaaers. ¥ - SECTION III. Of Ulceration. Ulceration is a procefs conduaed wholly by the abforbents, of whofe importance in the animal economy I have fully treated in my introduaion to the cachexie. When it is needful, they remove whole parts ; but for this purpofe their aaion muft be excited by fomeftimulus: for all other modes of deftruaion are either mechanical or chemical. Indeed this ftimulus 'may be itfelf either mechanical or chemical, as when a dead part preffes upon a living part, or when either fecreted fluids or foreign fubftances, applied to any part of the body, difturb the balance of affinities, and unite with its component princi- ples to form new combinations, which effea is diftinaiy to be obferved in cauftics. But the moft common ftimulus ['«., arifes from difeafe, when the organic ftruaure of a part is injured or deftroyed. Preffure from without, if flight, produces thickening ; if ftrong, promotes abforption ; but it is curious to re- mark, that preffure from within creates abforption only in that part which is neareft to the external furface of the body. And it is ftill more curious to obferve, that adhefive inflammation attends the progrefs of ulceration to prevent the efcape of pus into the cellular membrane. The abforbents firft remove thofe furfaces which are immediately contiguous to the irritating caufe, but the ulcerative procefs has no power to deftroy the cuticle unlefs by mechanical preffure of diftention. A a a a Newly 578 LOCAL DISEASES. Newly formed parts are much more fufceptible of uf- cci ation than the original. Hence it is that ulcers after being healed frequently break out afrefh, and that callufes are readily abforbed. Abforption may be conduaed either with fuppuration or without, as I have had already occafion to remark, and it is on the former of thefe operatious that depend Houghing and exfoliation. The ulcerating fore is made up of little cavities, and the edge of the fkin is notched, thin, turned a little out and overhangs: but when the ulceration ftops, the edge becomes regular, fmooth, a little rounded or turned in, and of a purple colour covered with a femitranfparent white. Nature then proceeds to granulation, that, hav- ing cleared away whatever was either ufelefs or offenfive, fhe may fpeedily repair fuch loffes as have been occafion- ed by difeafe. It is thus that fpiders, when they have devoured their prey, and caft out the ufelefs becaufe in- digeftible refiduum, haften to renew the injured portions of their web. SECTION IV. Of Granulation. Granulations are formed by an exudation of the coagulating lymph from the veflels ; and in this fubftance new veffels originate in remarkable abundance. Of this there can be no doubt fince the obfervations of John Hunter, who took notice, that the white fubftance, ex- aaiy fimilar in appearance to coagulating lymph, which he left one day on the furface of a* fore, was become the next extremely vafcular. The furface of granulations has the fame difpofitions, and pours forth the fame kind of pus as the parts from which they are derived. The colour of healthy granulations is a deep florid red, precifely like that of well oxygenated blood ; but when they are of a livid red, they are unhealthy, and fhew a languid circulation. When they are healthy they arife on flat furfaces, till they are nearly level with the fkin, but when they exceed this, they are unhealthy, foft, fpongy, LOCAL DISEASES. $J? fpongy, and have no difpofition to fkin. This condition of difeafe or health depends on the healthy or difeafed condition of the pus, which, as I have noticed, depends wholly on the tone and ftruaure of the veffels by which it is produced. When a fore is difpofed to heal, the granulations con- traa, and being affifted in this operation by a contraaile power in the furrounding edge of the cicatrizing fkin, draw the mouth of the wound together. Should nature ftand in need of art to reftrain the luxuriancy of granu- lation, and make them adhere ftrongly to each other, bandages may be applied. Thefe fliould not merely prefs % upon the part, but fhould, if need be, embrace the limb. ►" Dr. Darwin has judicioufly remarked, that nothing fo much contributes to increafe abforption, for this preffure doubles the power of the arterial pulfations in promoting | the afcending current of the fluid in the valvular *. lymphatics, and abforption prevents the increafe of proud flefh. In old fores of the depending extremities this caution 1 is the more important, becaufe the capillary arteries, having by protraaed irritation loft their tone, pour forth not coagulating lymph, but ferum, and the limb becomes cedematous. SECTION V. Of the General and Special Management of Ulcers. From what has been delivered, it will appear, that to procure good granulations, it will be abfolutely needful to eftablifh healthy aaion in the folids, becaufe, as we have feen, the nature of both fuppuration and granula- tion depends on the ftate of the fecretory arteries of the part inflamed. Want of aaion in them occafions flow circulation and ichorous pus, with black and perifhable granulations. Increafed aaion, on the contrary, quickens circulation, and produces laudable pus with healthy granulations. To promote this healthy aaion when defeftive, it is required, that we fhould invigorate the fyftem by bark and 5«o LOCAL DISEASES. and fteel, affifted in their operation by the infpiration of well oxygenated air, the effeas of which have been par- ticularly feen in the cafe of Mr. Atwood, reported by Dr. Thornton and publifhed by Dr. Beddoes. Topical ap- plications however are not to be negle'aed, to excite the languid veffels. For this purpofe the metallic oxyds, particularly that of mercury, has been hitherto our chief dependance ; but I fhall have occafion to fhew, in a cafe to be related, that nothing hitherto difcovered, not ex- cepting the flowers of zink, lately and moft juftly recom- mended, can for this purpofe have higher claim to our attention than the oxalis acetofella. When vital energy is either naturally loft, as happens in leucophlegmatic and dropfical habits, or has been ex- haufted by excitement, as in violence of inflammation ; that is, in the language of the Brunonian fchool, when extreme debility, direcT: or indirea, prevails in any part, that part will die. Hence it is, that in either of thefe cafes ulcers put on a putrid appearance, and are difpofed to gangrene. This effea may be difcovered by fcetor, an offenfive fmell, by lofs of fenfation, by flaccidity, and by blacknefs, fucceeding either to whitenefs or to florid rednefs in the part; all which together indicate deficiency of oxygen, as the vital principle, and of carbon, as the bond of union between the feveral elements of which animal fubftances confift. It is in fuch circumftances that bark, fteel, wine, and opium, mufl be freely given, and that highly oxygenated air muft be infpired. At the fame time the oatmeal poul- tice, with a large portion of charcoal in fine powder, as praaifed by Mr. Sanford of Worcefter, and communi- cated by Dr. Beddoes, will have the moft benign effea. This produces good pus and healthy granulations in ul- cers, which had been foul and putrid. The cafes re- ported by this gentleman are highly interefting, and our obligations to Dr. Beddoes, for bringing forward fuch a mafs of information as we meet with in all his publica- tions on the medical ufe offactitious airs, can never be fufficiently acknowledged* Should LOCAL DISEASES. 53* Should the inflammation run too high, the fubfequent poultice will be ufeful. 13o Farin. Aven. M. iij. Ol. Oil v. Acet. Acerrimi, q. s. M. f. Cataplafma frigidum. Take three handfuls of oatmeal, olive oil and vinegar, of each fuf- ficient to make a poultice ; to be applied cold. The meal of linfeed is excellent in emollient poultices. When fores are flow in healing, particular attention muft be paid to the organs of digeftion, and to the whole of the alimentary canal, for it will be fometimes neceffa- ry, not merely to brace the animated fibre by bark and fteel, but cleanfe the firft paffages, and particularly with calomel, which in dofes of a grain or two every night promotes aaion in the abforbent fyftem, and prevents the generation of proud flefh. When the fore proceeds to cicatrize, no drefling is preferable to white diachylon fpread on lint. Fistulous ulcers require the knife. Cancerous ulcers are diftinguifhed by their ex- treme fenfibility, and the acutenefs of pain by which they are attended, by having their borders turned outwards, and by their ichorous difcharge. Ichorous pus is confidered by Jacquin to be the refidu- um of benign pus, which by putrid fermentation has dif- charged ammonia. This fubftantially agrees with an ob- fervation of Dr. Crawford, who has demonftrated, that the purulent difcharge of cancers contains ammonia and fulphurated hydrogen. We have feen that the quality of pus depends wholly on the tone and ftruaure of the parts by which it is pro- duced ; but when the tone and ftruaure of thefe parts are affeaed by the pus, whether as immediately produ- ced by them, or as changed by new combinations, which rapidly take place when the natural balance of affinities has been once deftroyed. . . Animal fubftances, as we have feen, confift principally of hydrogen, carbon, azot, with agnail proportion of fulphur and fome oxygen, all which, in favourable cn- cumftances, tend to form feparate combinations For this purpofe they muft be expofed to heat, humidity, and atmofpheric air/ When frozen they remain unchanged 5?a local diseases. for want of caloric. When furrounded by hot air, all their moifture is evaporated, and no decompofition is afterwards effeaed. In a vacuum they are unalterable. But when fubjeaed to the aaion of air and water, in the common temperature of our atmofphere, their oxygen ef- capes united with carbon, in the form of carbonic acid air, whilft their azot and fulphur each combines with hy- drogen to form ammonia and fulphurated hydrogen. In this cafe the refiduum is a concrete oil, refembling fper- macetiywhich is compofed of carbon and hydrogen. If any of the oxygen combines with hydrogen, it muft com- pofe water; but if the water itfelf is decompofed, then its oxygen muft unite both with carbon to increafe the quantity of carbonic acid air, and with part of the azot to make nitric acid, whilft its hydrogen, with another portion of azot, forms ammonia. When animal fubftances are confined in either vital or azotic air, they are quickly decompofed, the putrid fermentation foon begins, and forms in the firft carbon- ic acid air and water, in the latter ammonia ; but in both cafes we have fulphurated hydrogen. If, inftead of - taking either azot or oxygen feparately combined with caloric, or both together, as we find them blended in at- mofpheric air, we unite them chemically, as in nitric acid, and fubjea the animal fibre to the aaion of this acid ; we fhall have a rapid decompofition, and azot with pruflic acid will be emitted in abundance, which latter, a* Jacquin demonftrates, is azot, hydrogen, carbon, and combined with a fmall portion of oxygen. But if the animal fubftance is inclofed in either hydro- gen gas or in carbonic acid air, no decompofition, nor confequently any new combination, can take place. It i& upon this principle that in cancerous ulcers Dr. Ewart has been fo fuccefsful in delivering his patients from the moft diftreffing-part of the difeafe, that is, the pain and the offenfive fmell, both which are prevented by the conftant application of carbonic acid air. If any one doubts of this effea, let him put a blifter on his imjt.v, and, when the cuticle has been removed. let him capok the finger firft in a veffel inverted and filled with vna* local diseases. 5«S vital air, then in a veffel filled with carbonic acid air, and he will have fufficient conviaion of this truth. To obtain the former, green leaves may be expofed to the fun in glafs jars filled with water and inverted. The lat- ter may be readily colleaed by a fyringe from the furface of fermenting liquors. In cancerous ulcers the azot feems to be the moft del- eterious part of atmofpheric air, for the oxygen excites inflammation, produces vigorous aaion for a time in the capillary arteries, which fecrete the pus, and gives the co- agulating lymph a difpofition to form good granulations. It feems to be carbon, which in all cafes gives firmnefs and cohefion to both animal and vegetable fibres, to the bones, and even to the particles of calcareoy^ earth in limeftone, this therefore has a tendency to unite the granulations. But alasi unlefs the virus is itfelf deftroyeci, and the whole fyftem is invigorated, the ulcer may approach to- wards cicatrization, but it will become again ill con- ditioned, and all our labour will be loft. Scrophulous ulcers are produced, chiefly in the lymphatic glands, by weak and relaxed veffels, which have loft their tone, and therefore have not vital energy fufficient to produce inflammation, without which, as we have feen, there can be neither fuppuration nor granula- tion. They are diftinguifhed by their obftinacy, by their ichorous difcharge, and by having their edges irregular. fmooth, and flat. From what I have faid generally on inflammation and ulceration, it will be clear, that to heal fcrophulous ulcers we muft reftore vital energy to the veflels of the part af- feaed. This may be accomplifhed either by topical ap- plications or by invigorating the fyftem ; but, for the reafons afligned in my obfervations on Mr. AtwoodN cafe, publifhed by Dr. Beddoes, were we confined to one of thefe, I fhould prefer the latter. When united, few fcrophulous ulcers, I believe, can refill their-efficacy. For external application we may ufe the red metallic oxyds, particularly the mercurial, but to excite energetic aaion, no application can furpafs poultices of wood ior- ' rel «$4 LOCAL DISEASES. i-el (oxalis acetofella) as mentioned by Dr. Beddoes jtt his confiderations on the medical ufe of faaitious air. Since that publication 1 have had an opportunity of ufmg it in two ill conditioned ulcers with excellent effea, for both of them in three days, inftead of fanies and ichor, difcharged good pus. The forrel leaves were fimply bruifed, and at the end of four days were fucceeded by poultices made with the roots of meadow fweet (fpirea ulmaria) mixed with the four head of butter milk. In fix weeks thefe applications perfeaed a cure in a very obftinate and foul ulcer of a finger, in which the bones themfelves had been difeafed. The other cafe is fo re- markable, that I fhall give the minutes of it as drawn up by a f oun.fjf furgeon, from Madrid, who was on a vifit at my h: ufe, and attended with me from the begin- ning. A boy, aged 18, of a fcrophulous habit with tumid glands, had his face and neck covered with ulcers, and had loft a confiderable portion of his upper lip, both lips being ulcerated. October 22d, when he applied for my affiftance, we obferved, that thefe ulcers were pale, foft in their furfaces, and covered with a thin ichorous pus, which was ex- ceedingly foetid and offenfive. Want of food, of fuel, and of clothes, with the abforption of this purulent difcharge from numerous ulcers, had reduced him to aimoft the laft ftage of tabes. His pulfe was weak, fmall, and frequent; he was emaciated, his ftrength was exceedingly reduced, he was very eoftive, and was in fuch diftrefs of pain that he feldom flept by night. We immediately applied the bruifed leaves of oxalis tb all his ulcers, which occafioned much diftrefs. The next day, when we renewed the poultice, we found him in much pain, but the pus was thicker and lefs ©ffenfive. He had fcarcely flept. October 24. The oxalis poultice was renewed. Lefs pain. The u^ers look of a more florid red ; fome granulations begin to rife, the pus is increafed in quantity, is thick, and has refumed a yellowifh hue ; he breathes more freely, and fleeps well, but his pulfe is very weak. October 26. Many new granulations, firm and red. Pus yellow- iffi, very abundant and thick ; all the veffels on the furface of the ul- cers appeared to have acquired ftrong and healthy action. This day we discontinued the oxalis, and in its place we fubftituted the fpiraea pultice. Finding him coftive, 1 gave him three grains of calomel at night; and as the pulfe continued weak in the extreme, he was or- dered to take three times a day, a wine glafs full of infufion of oak Bark, with marrubium and ginger. ]$> Cort. Quercin. un. 1. Fol. Marrub. dr. 4. Zinzib. dr. 2. Aq. Font, bul fy. 2. M. f. infuf. c. c. un. 3. ter in die. Odober LOCAL DISEASES. 585 ■ Oaober28. Lefs pain. Sleeps well. Spirit* better. Appetite ?;ood. Granulations large and healthy, filling up every where to the urface of the ulcers. Suppuration of the beft quality. Pulfe weak and frequent. Continued the poultices of fpiraea. Let him have animal food and a glafs of wine every day. October 31. No pain. Little inflammation. Granulations uniting every where. Two large ulcers healed. Coftive. Let him have three grains of calomel at night. November 9. He has continued the fpiraea poultice and the oak bark. Two more confiderable ulcers have been healed for fome days. The lip is healing faft, and the nofe looks well, but the fuppuration is not abundant. His body and mind acquire ftrength. November 25; The lip has been healed thefe twelve days, but the parotid glands continue fwelled, and frefh ulcers are breaking out be- hind his ears and in the back part of his head. Continue the fpiraea poultices. November 28. The ulcer on his upper lip has broke out again ; that on the nofe increafes, and others appear about his head. Let him take two grains of calomel twice a week. Renew the poultices of oxalis on all his ulcers. November 30. The oxalis has excited a good and copious fuppu- ration. All the ulcers have acquired a healthy appearance. December 2. Ulcer of the lip is covered with good granulations, thofe of the nofe and ear have fuppuratcd well, and all which had broke out behind the head are healing. December 5. The lip and nofe, although covered with granula- tions, do not yet feem difpofed to cicatrize, but the ulcers behind the head are healed. December 6. Better in all refpedts. The nofe is the only part which does not feem yet difpofed to heal. At this time 1 left Pewfey. OBSERVATIONS ON THIS CASE. We here beyond a doubt difcover, that the oxalis ex- cites energetic aaion in the veffels, and brings on that in- flammatory difpofition in the ulcer, which is effential to the formation of good pus and of healthy granulations; tor on the fecond day after its application the ichorous fuppura- tion ceafed, the furface of the ulcers affumed a florid red, and on the third day every charaaer of fcrophulous ul- ceration vanifhed. . This high degree of excitement continued for a time after th- oxalis was changed for the fpiraea, and having ceafed, it was renewed and healthy pus produced, when we returned to it again. B b b b Ma7 5*6 LOCAL DISEASES, May we not conclude from hence, that the oxalis, as"as fpecific flimulant of vital aaion in the fecreting veflels, fhould only be difcontinued when inflammation runs too high, and be again repeated when this falls below the de- gree which is required to produce a good and abundant fuppuration, charged with coagulating lymph, and dif- pofed to form healthy granulations. It mufl be remarked, that in this cafe my chief atten- tion was direaed towards the oxalis; but When I have him under my care again, I fhall make him regularly take his oak bark infufion and calomel, both which he negleaed ; I fhall give him extraa of cicuta, and by paying more particular attention to his general habit, which is infected with fcrophula to a degree I have never met with before, I have little doubt but that I fhall effea a cure. Syphilitic ulcers are of two forts, the one produced by the external application of the venereal virus ; the other by abforption, which excites inflammation. Syphilitic ul- cers are diftinguifhed by their palenefs and peculiar hard- nefs. by their being free from pain themfelves, but attend- ed by pain in the bones, and by other concomitant fymp- toms of fyphilitic affeaion. Their cure by mercurial ointment is fpeedy and infallible. Scorbutic ulcers are very fcetid, foul, and apt to bleed. The blood is putrid. The bottom of the ulcers foft and fpongy, the margin fwelled and livid. The neighbour- ing parts are cedematous and painful. A fungus, re- fembling liver, is conftantly fprouting up as often as it is deftroyed either by the knife, or by a cauftic ; but, when- ever cut, threatens a dangerous haemorrhage : they are obflinate, yet have no difpofition to affea the bones. In thefe, mercurials are highly injurious : whilfl frefh vegetables and ripe fruits, with the juice of oranges and lemons, expedite a cure. Genus CXXXVII. Herpes. Tetters. An aflemblage of little ulcers, itching much, and not inclined to heal, but terminating in furfuraceous fcales. I LOCAL DI-SEASES. 5*7 Thave already mentioned herpetic eruptions under lep- Tofy, where they appear as a conftitutional affeaion. But the beft authors feem inclined to rank them with local difeafes, and to confider them merely as cutaneous ulcers, wholly independent of the canflitution. The obferva- tions of Dr. Garnett upon this fubjea are highly inter- efting. With Mr. Bell, he diftinguifhes four varieties, all taken from Sauvage. l. Herpes far inofus, or Tetters. 2. Herpes puflulo- fus, or fcald head. 3. Herpes miliaris, or ring worm. 4. Herpes exedens, or fhingles. The fecond variety will be feparately noticed under 4inea, which Cullen has taken for a genus, although he might perhaps with propriety have left it as a fpecies of herpes. The others, though fpecifically diftinguifhed, admit one general mode of treatment for them all. The perfons moft fubjea to herpetic eruptions are the young, the healthy, the plethoric, who either feed high- ly or drink hard. They attack chiefly thofe parts of the body which are expofed to the alternations of heat and cold, and are much affeaed by weather. Hence they appear to be inflammatory : and this idea is confirmed by a confideration of the means moft effeaual for their cure. . Thefe, as we have already feen, from the communica- tions of Dr. C. Smith, are dulcified fpirit of vitriol, (fp. 2etheris vitriolici) in fuch dofes as gently to evacuate the bowels, and diluted vitriolic acid to the quantity of fix drams three times a day, which prove diuretic and ca- thartic. My friend Dr. Haygarth cures with nitre. Sir John Pringle depended chiefly on the following prefcriptions, the firft of which is efientially the fame with Velno's Vegetable Syrup. §> Sarfae un. 3. Aq. Font. ft. 4. Macera per noiftem. Coq. leni %ne, vafe claufo ad colat. ft. 2- CaP- lb*ls-ter die* To this if we add fenna, cherville, and white rofe leaves, with car- raway feeds, of each two drams, and boil till we have reduced it to one pint, then adding honey, we have the -vegetable fyrup, of which the dofe is four fpoonfuls morning and evening. !£, Cort. intern, ulmi. recent, un. 2. Nitri dr. i*. Coccinel. gr. 12. Coque ex. Aq. pur. ft. 2. ad ft. 1. Adde Sach. alb. un. £88 LOCAL DISEASES. ]§, Summit. Junip. un. 3. Coq. ex. Aq. Font. ft. 3. ad ft. 2. Ad- dendofub. finem Cocfionis Bac. Junip. un. 1. Colat. adde Aq. Nucis Mofchat. un. i. M. Cap. ter die, un. 1. Addendo Vin. Antimon. gtt. 10. g, Gum Guaiac. Amygd. dulc. aa. gr. 6. Simul terantur dein adde Antimonii Crud. pp. gr. ie. Cinnab. Antim. pp. gr. 12. Conf. Cynofbat, & Syr. q. s. ut fiat Bol. omni nocte fumend. Plummets Pill, which is thus prepared : §, Sulph. Aurat. Antimon. gr. 4. Calomel, gr. 2. Conferv. Cy- nofbat. q. s. f. Pill. No. 2. c. Pill. j. o. n. h. s. Dr. Huxham united his antimony and mercury in this form. / E, Hydrarg. Unc. \. Antim. Crud. p. p. dr. 3. Flor. Sulph. dr. 2. terantur ad perfect, glob. Extincl. Cap. fcr. 2. bis die. Thefe cleanfe the alimentary canal; and fuch is the confent between the internal and external furfaces, that whatever operates on the one mufl affea the other. Harrowgate water has the fame effea, and all thefe unite in one intention, which is to cool the fyftem and to abate inflammation. By the analyfis of Dr. Garnett it appears, that a wine gallon of this water contains muriat of foda (common fea fait) 615 grains, muriat of magnefia 91 grains, muriat of lime 13 grains, carbonat of lime 18 grains, carbonat of magnefia 5 grains, fulphat of magnefia (Epfom fait) 1 o grains, carbonic acid air 8 cubic inches, azot 7, ful- phurated hydrogen 19. We cannot therefore wonder that it proves cathartic, and as fuch, that it fhould dimin- ifh cutaneous inflammation, and thereby prevent ulcera- tion. But the moft interefting faa related by Dr. Gar- nett is, that common waiter impregnated with fulphura- ted hydrogen produces powerful effeas in fome herpetic cafes, in which the Harrowgate water had formerly been ufed with good fuccefs. This he accounts for in a manner which appears to be confiftent with modern chemical difcoveries. He fuppofes, that in herpetic complaints there is a fu- perabundance of oxygen in the blood : and it is now well known, that both liver of fulphur and fulphurated hydro- gen, introduced into the fyftem, and uniting with this fubftance, which is the principle both of vital energy and of inflammation, forms common water. Sulphurated LOCAL DISEASES. 5$$ Sulphurated hydrogen is obtained by diffolving hepar iulphuris in water ; for thus a moft curious decompofi- tion is effeaed, whilft the fulphur and the alkali combi- ned, accomplifh what neither of them alone could do, for they take the oxygen of the water and form a vitri- olic fait. The hydrogen of the water, at the fame time uniting with the remainder of the fulphur, efcapes as hepatic air, that is, fulphurated hydrogen. According to Jacquin, i oo cubic inches of common water will abforb 60 cubic inches of this air ; but if the quantity is increafed beyond this proportion, it is de- compofed by the oxygen of the atmofpheric air, water is formed, and fulphur is precipitated. The fame praaice as in herpes is recommended in the gutta rofea, or red blotches of inebriates, and in both, the topical application of unguentum citrinum, to pro- mote digeftion, will be ufeful. Young praaitioners muft learn to diftinguifh fyphi- litic eruption, appearing near the roots of the hair, from herpes. Sauvage indeed makes this a fpecies, which he calls herpes fyphiliticus, and therefore recommends mercurials. Genus CXXXVIII. Tinea. A Scald Head. Small Ulcers at the root of the hairs, which produce a friable white cruft. It is principally the difeafe of infants and of children, who have a relaxed habit, are ill fed, or gorged with food, and whofe nurfes neglect to keep them clean. Thefe ulcers, for want of being cleanfed, become ex- tremely foul, and as the hair cannot be combed, vermin increafe to fuch a degree, as to ftimulate the part, and caufe a determination to the head ; the miferable fufferer, deprived of fleep, becomes pale and atrophic ; and, if the diforder is negleaed, is terminates in heaic. To effea a cure, it will be needful to cut the hair very ihort or even by a pitch plafter to tear them up by the ' roots. 59° LOCAL DISEASES. roots. The head muft then be cleanfed with warm wa- ter and foap, or with cream and honey, after which the ulcers may be wafhed with a folution of corrofive fubli- mate, in the proportion of ten grains to a pint of water. But from what I have had occafion to obferve in the ufe of wood forrel for fcrophulous ulcers, I fhall try it on the next fcald head I meet with, after which I fhall apply the charcoal poultice, with little doubt of fpeedily and fafely perfeaing a cure. Should the ftudent be more inclined to follow the praaice of Sir John Pringle, he may ufe this cerate. §> Emplaft. de Minio. Uung. refinae flav. aa. p. x. Liquefcant fimul et hujus portio craffe extendatur fuper lint, admoveatur capiti et bis die renovetur. Or he may anoint with Norway pitch and fulphur every night. Or he may wafh with a ftrong infufion of tanfey, wormwood, and foutherti- wood in foap leys. The ftudent muft be cautious not to dry up thefe ul- cers by aftringent applications, before they have been properly digefted, left he fhould thereby bring on more dangerous difeafes, either of the inflammatory or fpaf- modic orders. And fhould he be confulted, after fuch effeas have been thus produced, he muft without lofs of time apply a plafter fprinkled with cantharides to the head. # In Edinburgh, fome praaitioners are in the habit of giving hemlock (conium maculatum) internally, with good fuccefs. They begin with fmall dofes, and increafe gradually till they produce vertigo : then omit the medi- cine tor a few days, and after that refume it. Sauvage has diftinguifhed nine fpecies of tinea, among wh,chwe find tinea fyphilitica; but excepting this and his tinea humida, when it is fymptomatic of eitherferoph, ula or fyphihs, they all require to be treated in the manner I have above defcribed. When tinea proceeds from either venereal affeaion Safe11 fcrophu,a'attention mu{t be paid to the primary Genus LOCAL DISEASES. ^Of Genus CXXXIX. Psora. The Itch. Small puftules with watery heads, appearing firft on ther wrifts and between the fingers. It is contagious. m This filthy, this infeaious difeafe, caufed by the little infea which Linnaeus has denominated acarus exulcerans, is readily cured by mercurial ointment, by fulphur, and by the vitriolic acid. In the country, we frequently ap- ply a quickfilver girdle without the leaft apprehcnfion of any evil confequence, or in cafe of timidity in the patient, we caufe him to be anointed with brimftone and hog's lard. In cities, where the fmell of fulphur would difguft, it is more expedient to adopt the following elegant and ef- ficacious remedy. §> Acid. Vitriol, gtt. ro. Aq. Rofce gtt. 20. Axung. Porcin. gj. Effent. Citri. gtt. 15. M. f. Liniment, m. et v utend. Hog's lard one ounce ; vitriolic acid ten drops ; rofe water twenty drops ; effence of lemon fifteen drops. Make an ointment to be ufed morning and evening. The patient may likewife wafh two or three times a day with elder flower water, acidulated with vitriolic acid. This plan of cure by vitriolic acid may be forwarded by an eleauary of nitre one dram with fix drams of ful- phur mixed up in honey, of which the patient may take the fize of a nutmeg three times a day. My judicious and kind friend Dr. Nankivell has indulged me with the fubfequent, which I have feen ufed with remarkable fuccefs. $, Pulv. Hellebor. alb. 5fs. Sach. Saturn. 5j. Coq. ex Aq. q. s. ad Colaturse lb fs. M. f. Lotio. M. & v. ufurpanda. §, Eleft. e Senna ^Ethiop. Mineral, aa gj. Antim. Crud. larvig. 5ij. Pulv. Cremor. Tart. 3yj. Pulv. Jalap. 5j Syr. q. s. M. f. Eleft. c. c. M. N. M. ter in die. That is, take powder of white Hellebore half an ounce ; fugar of lead one dram ; boil in water fo as to ftrain off half a pint for a wafh to be ufed morning and evening. Take eleauary of fenna and jEthiops mineral of each one ounce.. Crude antimony two drams ; cream of tartar fix drams ; jalap one dram ; fyrup fufficient to make an ele&uary. The dofe is the fize of a nutmeg three times a day. Taking a hint from this praaice, I intend ufing a • wn fn wa £92 LOCAL DISJEASES. wafh with ointment, infufion of bear's foot, that is, helle« borus fcetidus. Bathing in Harrowgate water very fpeedily effeas a. cure. Genus CXL. Fracttjra. The Fraaure of Bones. In cafes of fraaure, the bone muft be reftored to its proper direaion, the extremities muft be in contaa, the limb muft be perfeaiy at reft, and the degree of inflam- mation muft be regulated. When thefe precautions have been negleaed, it fome- times happens, that a preternatural joint is formed. The extremities of the fraaured bone become rounded, fmooth, and covered with a cartilage, a membranous fubftance embraces them all round, and, like a capfular ligament, both limits their motion and keeps them in their place. But unfortunately, for want of proper mufcles, this new acquifition is notonly unprofitable, but a great incum- brance, for the limb itfelf is thereby rendered ufelefs. To remedy this evil the joint muft be opened, the new capfular ligament muft be deftroyed, the cartilaginous terminations muft be cut off, the extremities of the bone muft be in contaa with each other, and by reft their union muft be fuffered to take place. Genus CXLI. Caries. The Exulceration of Bones. Caries begins with a feparation of the periofteum,: attended by whitenefs and femitranfparency of the bone'. which foon turns black, and emits a moft offenfive fmell. Caries is divided into dry and humid, the for- mer flow in its progrefs, the latter rapid, and attended both by a foetid difcharge, and by confiderable pain. Incipient caries, properly fpeaking, is necrofis, and in its progrefs we have exfoliation, followed by exoftofes- • but the term necrofis is commonly confined to the mortifica- tion LOCAL DISEASES. 593 tion of a cylindrical bone, which is attended by the pro- duaion of a new bone inclofing the old one, now dead. The flat bones, owing to their peculiar ftruaure, are fubjea only to exfoliation as the confequence of caries. In faa, the only bone of the head liable to renovation is the lower jaw, and this, it mufl be obferved, has fome analogy to the cylindrical bones. Of this a curious inftance occurred in Edinburgh, in which the teeth amained, and were properly fupported in their places by the new jaw. The common fymptoms of necrofis are : i. Deep fhooting pain referred to the infide of the bone, which 'gradually, increafes in its intenfity, and is not affeaed by preffure. 2. Tumour in the direaion of the bone without change of colour. 3. Small ulcers difcharging foetid pus. 4. Slow fever, and frequent rigors. Thefe fymptoms demonftrate the prefence of inflam- mation followed by gangrene. Caries and necrofis, according to Sauvage, may be di- vided into, 1. Pure. 2. Rachitic. 3. Scrophulous. 4. Cancerous. 5. Scorbutic. 6. Syphilitic. 7. Va- riolous. But of thefe the moft common, it is conceived, is the fyphilitic, on account of its fpecific aaion on the bones. It has been imagined, that mortification of the bones is occafioned always by inflammation of the periofteum; but recent experiments and obfervations have domonftra- ,ted, that the periofte*um may be inflamed, and in part deftroyed, without producing necrofis in the bones, and that necrofis has been far advanced without any morbid affeaion of the periofteum. On the other hand, it has been proved, that when the fpinal marrow has been de- ftroyed, necrofis in the bone has been univerfally the C° M^v wenot therefore look for the caufe of necrofis in the medullary texture, which, as it abounds with arteries, muft be liable to inflammation ? % When vitality is deftroyed in any portion of a bone, Cccr *■ 594 LOCAL DISEASES. it becomes a ftimulus, like any extraneous body, to the living fibre, excites the abforbents to make a feparation between the living and the dead, whilft "the exhalant ar- teries convey offific matter to repair the injury thus oc- cafioned by difeafe. Nature then proceeds to get rid of this incumbrance ; for as the dead bone ftimulates the new produaion, ul- cerative inflammation with fuppuration follows, fiftulous openings in the new bone are formed, |pd the dead por- tions, if not extraaed, are diffolved by the pus and floated off. But as heaic is fometimes confequent on necrofis, when nature is not affifted by art, therefore the furgeon with his biftory, trepan, and chiffel, fhould cut through the new bone, divide the old onev, and extraa the frag- ments. Nature then, haftening to repair the damages fuftained, fills up the vacuities with new bone, and in this, as in all her efforts to relieve herfelf, calls upon us to admire and adore the infinite wifdom, benevolence, and power, of the great JEHOVAH. A [ 595 ] NOSOLOGICAL SYNOPSIS, ADAPTED TO THIS WORK. CLASSES. r I. Pyrexia. After cold ihivering, a frequency of pulfe, with increafe of heat and thirft. II. Neuroses. Affeaions of fenfe and motion, dif- turbed ;—without either idiopathic pyrexia, or topical difeafe. III. Cachexl/E. A depraved habit of body ;— without pyrexia, and independent of neurofis, as original difeafes. ♦ IV. J^ocales. Morbid affeaions, which are partial. ORDERS. Class I. Pyrexia. I. Febres. Pyrexia with lofs of appetite and diminu- tion of ftrength, without primary local affeaion. II. Phlegmafie. Pyrexia with topical pain and in- flammation. III. Exanthemata. Contagious difeafes, beginning with fever, and followed by an eruption on the fkin. IV. Hemorrhagie. Pyrexia, with a difcharge of blood, without any external injury. Class II. Neurosis. I. Comata. A diminution of the powers of voluntary motion, with fleep, or the fenfes impaired. II. Adynamia. A diminution of the involuntary mo- tions, of either vital or natural funaions. III. Spafmi. 596 orders. III. Spafmi. A morbid contraaion, or motion of muf- cular fibres. IV. Vefanie. The judgment impaired, without either coma, or pyrexia. Class III. Cachexia. I. Marcores. Univerfal emaciation. II. Intumefcentie.^ General fwellings. HI. Impetigines. Cachexia, deforming the external parts of the body, with tumours, eruptions, &c. Class IV. Locales. I. Dyfefihefie. The fenfes injured, or deftroyed by the imperfeaion of the organs. II. Dyforexia. The appetite deficient, or depraved. III. Dyfeinefie. Motion impeded, or depraved, from an imperfeaion of the organ. *IV. Apocenofes. A fuperabundant flux of blood or humours, without pyrexia. V. Epifchefes. A fuppreflion of excretions. VI. Tumcres. Partial fwellings, without inflamma- tion. VII. Eclopia. Parts difplaced. VIII. Dialyfes* A folution of continuity. K f GENERA, ■ C 597 ] GENERA, AND THEIR SYMPTOMS. Class I. Pyrexiae. Order I. Febres. -i. Intermittens. Cold, hot, and fweating ftages, in fucceflion, attend each paroxyfm, and are followed by an intermiflion, or remiffion. 2. Continua. No intermiflion, yet fubjea to exacer- bations twice in one day. Species. I. Synocha. Heat increafea ; pulfe frequent, ftrong, hard ; urine * high coloured ; fenfes not much unpaired. z. Typhus. Contagious. Heat moderate ; pulfe quick, weak, fmall; fenfes much impaired, proftration of ftrength. 3. HeSica. Exacerbations at noon, but chiefly in the evening, with flight retniffions in the morning, "after nocturnal fweats; the urine depofiting a furfuraceo-lateritious fediment; appetite good; thirft moderate. .... % - Glass I. Pyrexia. Order II. Phlegmafiae. 4. Phlogofis, Rednefs ;* heat; pain; and tumour on the furface of the body. Species. 1. Phlegmone. Inflammation of a bright red colour; tumour pointed, throbbing, and tending to fuppuration. 2. Erythema. Inflammation of a dull red colour, vanifhing upon preffure, fpreading unequally, with a burning pain, and tumour fcarcely perceptible, ending in defquamation, or veficles of the fcarf-fkiri. 5. Ophthalmia. Rednefs and pain of the eye; intol- erance of light; with effufion of tears. Spfecies. ... c v 1. Ophthalmia Membranarum. Inflammation in the coats of the eye, moft commonly in the tunica conjunctiva. 2. Opthalmia Tarfu Small ulcers in the febaceous glands of the tarfus, difcharging a glutinous matter. . , 6. Phrenetis. Strong fever ; violent head ach ; red- nefs efface and eyes ; impatience of light and none; watchfulnefs j and furious delirium. 7. Cynanche. 598 GENERA. 7. Cynanche. Pain, and rednefs of the fauces ; deglu- tition, and refpiration, difficult. 8. Catarrhus. Increafed excretion of mucus from the membrane of the nofe, fauces and bronchias, with pyrexia, attended by cough, thirft, laffitude, increafed fenfibility to cold, and want of appetite. 9. Pneumonia. Pyrexia ; difficult refpiration ; cough ; and pain in the thorax. 10. Carditis. Pyrexia; pain in the region of the heart; anxiety; difficult breathing; cough; irregular pulfe ; palpitation ; fainting. n. Gaftritis. Pyrexia; anxiety; heat and pain in the epigaftrium, increafed when any thing'is taken into » the ftomach ; vomiting; hiccup ; pulfe fmall and hard; * proftration of ftrength. 12. Enteritis. Pyrexia ; fixed pain in the abdomen ; coftivenefs ; vomiting. 13. Hepatitis. Pyrexia; tenfion and pain, more or lefs acute, in the right hypochondrium, ufually referred to the top of the right fhoulder, and extending to the clavicle; increafed by lying on the left fide; urine high, coloured. * 14. Splenitis. Pyrexia; tenfion, heat, tumor; and pain in the left hypochondrium, increafed by preffure. 15. Nephritis. Pyrexia; pain'in the region of the kidneys, and fhooting along the,courfe of the ureter ; drawing up of the tefticle; numbnefs of "the thigh ; vomiting; urine high coloured, and frequently dis- charged ; coftivenefs, and colic pains. 16. Cyftitis. Pyrexia; tumour and pain in the bypo- gaftrium ; frequent and painful difcharge of urine, tenefmus. if, Hyfteritis, Pyrexia; heat, tenfion, tumour, and pain in the hypogaftrium ; pain in the os uteri, when touched ; vomiting. J 8. Arthropuofis. Pain of the joints, or mufcles, of- ten after confufion, deep, blunt, of long continuance; ottie or no tumour ; no inflammation ; pyrexia flight at ferit, at laft heaic; and finally terminating in abfcefs-. 19. Rheumatifmus. Pyrexia; pains in the joints, in, creafed GENERA. 599 treafed by the aaion of the mufcles belonging to the joint ; heat on the part. The blood after venaefeaion exhibits an inflammatory cruft. This difeafe terminates in Arthrodynia, pain in the joints without pyrexia. Species. ^ i. Lumbago, affecting cmefly the loins. 2. Ifchias, the hip^joint. 20. ^Odontalgia. Toothach. 21. Podagra. Pyrexia ;• pain in the joints, chiefly of the great toe, and efpecially of the hands and feet, return- ing at intervals : previous to the attack, the fuaions of the ftomach aVe commonlv difturbed. Class I. Pyrexia. Order III. Exanthemata. 22. Variola. Synocha; eruption of red pimples the third day, which on the eighth contain pus, and drying, fall offin crufts. -« "• 23. Varicella. Moderate fynocha; pimples bearing jbme. refemblance to variola, "quickly forming puftules, \hich cpntain a fluid matter, and after three or four tiays from their firft appearance defquamate, leaving no cicatrix. " • . <••• 24. Rubeola, Synocha; hoarfenefs; dry cough ; fneezing; drowfinefs; about * tne fourth day eruption of fmall red points, di&erhible by the touch, which, af- ter three days, end in meally desquamation. Blood, after venefeaion, exhibits inflammatory cruft. 2 c. Miliaria, Synochus ; cold ftage confiderable ; hot flage attended with anxiety and frequent fighing ; fweat of a ftrong and peculiar fmell; eruption preceded by a fenfe of pricking', firft on the neck and breaft, of fmall red pimples, which in fwo days become white puf- tules, defquamate, and are fucceeded by frefli pimples. 26. Scarlatina. Contagious fynocha; fourth day face fwells, and a fcarlet eruption appears on the fcm in patches; which af.er.hree or four day, e^^de. 6oo GENERA. eruptions about the fize of almonds filled with yellowifli ferum, and in three or four days fubfide. 28. Frambefia. Fungi like mulberries growings out of the fkin, in various parts of the body, difcharging ichor. Class I. Pyrexia. Order iV. Haemorrhagise. 29. Epiftaxis. Bleeding at the nofe, with pain or ful-^ nefs of the head. 30. Hemoptyfis. Coughing up florid, or frothy blood ; heat or pain in the cheft ; irritation in the larynx : falt- ifh tafte. 31. Phthifis.t Emaciation; debility; cough; hec- tic ; purulent expeaoration; haemoptyfis ; diarrhoea.* 32. Hemorrhois. Flux of blood from the anus : pain there, and haemorrhoids ; vertigo ; pain in the floins and head ach. 33. Menorrhagia. A too copious menftrual flux.** Class II. Neuroses. Order I. Comata. 34. Apoplexia. Abolition in fome degree of the pow- ers of fenfe and motion, with fleep, and fometimes fnor- ing, the refpiration, and motion of the heart, remaining. 35. Hydrocephalus internus. Pain in the head, laffi- tude, drowfinefs, and dilated pupils. 36. Cataphora. Sudden lofs of fenfation and volition, the body and limbs retaining the pofition, which thejl had when feized, or which is given to. them during the continuance of the fit. 37. Paralyfis. A lofs of the power of voluntary motion affeaing certain parts. Class II. Neuroses. Order II. Adynamise. m 38. Syncope. The refpiration, and aaion of the heart, either ceafe, or become much weaker than ufual, with palenefs and coldnefs. 39. Dyfpepfia. Want of appetite ; naufea ; vomiting;: flatulence; heart burn; coftivenefs; and pain in the ftomach, GENERA. 601 ftomach, with other fymptoms of debility in the organ of digeftion. 40. Hypochondriafis. Dyfpepfia; languor and want of energy ; dejeftion of mind and apprehenfion of evil, more efpecially refpeaing health, without fufficient caufe; with a melancholic temperament. Class II. Neurosis. Order III. Spafmi. In the Animal Funclions. 41. Raphania} A fpafmodic contraaion of the joints, with convulfive motions and moft violent pain: periodical. 42. Epilepfia. Convulfions with fleep, and ufually froth iffuing from the mouth. 43. Convulfio, Alternate relaxations, with violent and jjivgluntary contraaions of the moving fibres, with- out fleep. 44. Chorea. Convulfive motion of the limbs or trunk. 45. Tetanus. Spafmodic rigidity of aimoft the whole body. * In the Vital Funclions. * 46. Falp'rtatio. A palpitation of the heart, either con- ftant, or frequently returning. 47- Dyfpvoia. Difficult refpiration, continual, and without fenfe of ftriaure. Cough frequent through the whole courfe of the dilpafe. * 4.8., Afthma. Difficult refpiration returning at inter- vals with a fenfe of ftriaure acrofs the1 breaft and in the lungs ; a wheezing; hard! cough at firft, but more free towards the clofe of every paroxyfm, with a difcharge of mucus, followed by a ^miflion. * 40 'Pertujfis. Convulfive, ftrangulatmg cough, with hooping/relieved by vomiting : conjagious. In the Natural Funclions. 50 Pyrofis. Heart'burn, with copious eructation, cus'fomSes mixed w'ith blood. It is commonly at- teUnSklbytenefnniS,andiscontagious. 602- GENERA. 52. Colica. Pain in the lower belly, and twilling round the navel ; vomiting, coftivenefs. 5$. Cholera. A purging and vomiting of bile ; anx- iety ; painful gripings; fpafms of the abdominal mufcles, and thofe of the thighs. 54. Diarrhoea. Frequent liquid ftools with the nat- ural excrement, but not contagious, and feldom attend- ed with pyrexia. 5$. Diabetes. A fuperabundant difcharge of urine, which is limpid, and fweetifh to the tafte. 5& Hyfteria. A grumbling noife in the belly ; the fenfation of a ball afcending to the throat, with a fenfe of fuffocation ; ftupor ; infenfibility and convulfions ; involuntary laughing and crying ; fleep interrupted by fighs; urine limpid and abundant, previous to and after the fit; great fenfibility and irritability of mind. 57' Hydrophobia. A dread of water, as inducing painful convulfions of the pharynx. Class II. Neuroses. Order IV. Vefanise. 58. Oneirodynia. Difturbed imagination during fleep. 59. Melancholia. Erroneous judgment, but not merely refpeaing health, from imaginary perceptions, or recolleaions, influencing the condua, and depreffing the mind with ill grounded fears ; not combined with either pyrexia or comatofe affeaions ; often appearing without dyfpepfia, yet attended with coftivenefs, chiefly in perfons of rigid* fibres and torpid fenfibility. 60. Mania. A conception of falfe relations, and an erroneous judgment, arifing from imaginary perceptions or recolleaions, exciting the paflions, and producing un- reasonable aaions or emotion, with a hurry of mind in purfuing a train of thought, and in running from one train of thought to another, attended with incoherent and abfurd fpeech, called raving, and violent impatience of either contradiaion or reftraint. 61. Amentia. Imbecility of intelfea, by which the relations of things are either not perceived or not recol- feaed. Class •GENERA. 603 Class III. Cachexia. Order I. Marcores. 62. Tabes. Emaciation j weaknefs ; heaic. Class III. Cachexia. Order II. Intumefcentiae. Adipofe. £3. Polyfarcia. Troublefome obefity. Flatulent. 64. Pneumatofis. Air colleaed in the cellular texture under the fkin, rendering it tenfe, elaftic, and crepitating. 65. Tympanites. Elaftic diftention of the abdomen, not readily yielding to preffure, and founding like a drum, with coftivenefs, and atrophy ; but no fluauation. 66. Phyfometra. A permanent elaftic fwelling in the hypogaftrium, from flatulent diftention of the womb: Aqueous, 6y. Anafarca. Swelling on the furface of the body ; not elaftic ; pitting by the preffure of the finger ; and rifing flowly to its former fulnefs. 68. Hydrocephahts, External fwelling of the head, foft, not elaftic. 69. Hydrorachitis. Tumour in new born infants on the lumbal vertebrae, foft and fmall. 70. Hydrothorax. Dyfpncea ; palenefs of jhe face; cedematous fwelling of the feet; fcarcity of urine ; im- patience of an horizontal pofition, with fudden ftarting from fleep, and palpitation ; fluauation of water in the Cheft. 71. Afcites. Swelling of the abdomen, tenfe, and fcarcely elaftic ; with fluauation. # 72. Hydrometra. A fwelling in the hypogaftrium of females not pregnant; with fluauation ; no fuppreflion ° ^Hydrocele. A foft tumour of the fcrotum, increaf- ing flowly, without pain, fluauating, generally pellucid. Of the Solids. 74. Phyfeonia, Tumour occupying chiefly one part 604 GENERA, of the abdomen, increafing flowly, and neither fonorous nor fluauating. 75. Rachitis. Large head ; prominent forehead ; protruded fternum ; flattened ribs ; big belly ; emacia- ted limbs, with great debility. Class III. Cachexias. Order III. Impetigines. j6. Scrophula. Swelled lymphatic glands ; thick up- per lip ; obftinate ulcers: ophthalmia tarfi ; indolent tumours on the joints ; fair complexion ; irritable habit. 77' Syphilis. A difeafe arifing from impure connec- tion, and appearing generally after a local affeaion of the organs, occasioning chanchres ; buboes ; ulcers in the mouth and nofe ; cluftered pimples of a copper col- our ending in fcabby ulcers, chiefly fituated near the hairy fcalp^; blotches on the furface of the body ; noaurnal pain in the bones ; nodes, &c. 78. Scorbutus. Extreme debility ; complexion pale and bloated ; fpungy gums ; livid fpots on the fkin ; breath offenfive; ©edematous fwellings in the legs ; haemorrhages ; foul ulcers ; urine foetid ; ftools ex- tremely offenfive. 79. Elephantiafis. Skin thick, rough, wrinkly, unc- tuous, and void of hair ; face deformed, with tubera ; voice hoarfe, and founding through the nofe; want of feeling in the extremities. 80. Lepra. The fkin rough and chapped, with white furfuraceous fcales and crufts, under which is frequently a moifture, with itching. 81. Trichoma, or Plica Polonica. The hair grows coarfe, and twifted into inextricable tangles. It is con- tagious. 82. iaerus. Yellownefs of the fkin and eyes ; faeces white ; urine of a high colour. It tinges linen yellow. 83. Chlorofis. Dyfpepfia ; livid palenefs ; great de- bility ; palpitation ; depraved appetite, with amenorrhea. Class IV. Locales. Order I. Dyfaeflhefise. 84. Caligo. Sight diminifhed, or deftroyed by the in- terpofition GENERA. 601:, terpofition of a dark body, between the objea and the retina. 85. Amaurofis, Sight diminifhed, or deftroyed, with- out any vifible injury of the eye ; the pupil dilated and immoveable. 86. Dyfopia, Sight depraved, requiring one certain quantity of light, one particular diftance, or one pofition. 87. Pfeudoblepfis. Sight depraved, creating objeas, or representing them different from what they are. 88. Dyfeccea. Hearing diminifhed, or deftroyed. 89. Paracufis. Hearing depraved. 90. Anofmia. Smell diminifhed, or deftroyed. 91. Ageuftia. Tafte diminifhed or deftroyed. 92. Anoefthefia. Touch diminifhed or deftroyed. Class IV. Locales. Order. II. Dyforexiae. 93. Bulimia. Appetite voracious or canine. 94. Pica. Appetite depraved, or a ftrong defire of unnatural food. • 95. Polydipfia. Exceflive thirft. 96. Satyriafis. 'Exceflive and violent defire in men. 97. Nymphomania. The fame in women. 98. Noftalgia. Impatience when abfent from ones native home, and vehement longing to return, attended with gloom and melancholy, lofs of appetite, and want of fleep. 99. Anorexia. Appetite impaired. 100. Anaphrodifia. Impotence. Class IV. Locales. Order III. Dyfcinefiae. 101. Aphonia. Suppreflion of the voice, without «. ther fyncope, or coma. 102. Mutitas. Dumbnefs. % 10 v Paraphonia. Depravation of voice. _ 104. Pfellifmus. Vitiated articulation of the voice. 10 c. Strabifmus. Squinting. r • • * 106. Contraclura. A rigid contraaion of a joint t^.LASS 6o6 GENERA. Class IV. Locales. Order IV. Apocenofes. 107. Profufio. Lofs of blood. 108. Ephidrofis. A violent and morbid fw eating. 109. Epiphora. A flux of tears. no. Ptyalifmus. A falivation. in. Enurefis. Involuntary difcharge of urine. 112. Gonorrhoea. A preternatural flux from the ure- thra in men. Class IV. Locales. Order V. Epifchefes. 113. Obftipatio. Coftivenefs. 114. Ifchuria. Suppreffion of urine. 115. Dyfuria. Difficulty #nd pain in difcharging water. 116. Dyfpermatifmus. Seminis in aau venereo tarda, impedita, et ad generationem infufficiens emiffio. 117. Amenorrhoea. Menfes wholly or partially ob- ftruaed without pregnancy. Class IV. Locales. Order VI. Tumores. 118. Aneurifma. A foft tumour, with pulfation, on arteries. 119. Varix. A foft tumour without pulfe, on veins. 120. Ecchymoma. A black and blue fwelling, either from a bruife, or from a morbid extravafation of blood. 121. Schirrus. A hard tumour of a glandular part, indolent, and not readily fuppurating. 122. Cancer. A hard tumour of a glandular part, painful and obftinate, which terminates in the fouleft ulcer. 123. Bubo, A fuppurating tumour of conglobate glands. 124. Sarcoma. A foft flefhy excrefcence, not painful. 125. Verruca. A wart. 126. Clavus. Corns. 12j. Lupia. A cyft under the fkin, moveable, foft, indolent. 128, Ganglion. GENERA. 607 128. Ganglion. A hard tumour moveable, on the tendon, on the cellular vagina of the tendon. 129. Hydatis. A cuticular cyft full of an aqueous fluid. 130. Hydarthus. A white fwelling on the joints. 131. Exoftofis. A hard tumour on the bone. Class IV. Locales. Order VII. Eaopke. 132. Hernia. The difplacing of a foft part, covered by the common teguments. 133. Prolapfus. The protrufion of a foft part, un- covered. 134. Luxatio, The disjointing of a bone. Class IV. Locales. Order VIIL Dialyfes. 135. Vulnus, A wound. 136. Ulcus. An ulcer difcharging pus or ichor. 137. Herpes. An aflemblage of little creeping ulcers, itching much, and not inclined to heal, but terminating in furfuraceous fcales. 138. Tinea. A fcald head. Small ulcers at the root of the hairs, which produce a friable white cruft. 139. Pfora. Small puftules with watery heads, ap- pearing firft on the wrifts, and between the fingers. Contagious. 140. Fraclura, The fraaure of bones. 141. Caries. The exulceration of bones= INDEX. INDEX. Absorbents, their ufe, page379. Abforbents, their morbid action. 3«4. Adynamia;. 185. ^Efchylushypocaftanum. 26. 28. Ageuftia. 498. Ague. Sec fever intermittent. Agrypnia. 317. Amaurofis. 483. Amenorrhoea. 539. Amentia. 377- Anaefthefia. 49s- Analeptic pill, how made. 113. Anaphrodifia, 507. Anafarca. 4'6. Aneurifm. 54t. Animal fubftances, their chemical analyfis. 492. Anodynes. 279- 4H-. Anorexia. 505. Anofmia. 497. Antimonial wine. 25. Antimonials, their ufe. 24. Antifpafmodic formulae. 54- *°9- 110. 298. 369. St. Anthony's tire. 77. Aphonia. 508. Apocenofes. 479* 5T7» . Apoplexia. 163- l87- Apoplexy, fpafmodic. 169. Appetite, voracious or canine. 499. Appetite, when deficient in melan- cholia. 339. Appetite, deficient or depraved. 499- 505- Arnica montana. 182. Arfenic, as prepared by Dr. Fowl- er. 66. Arthropuofis. 105. Articulation, vicious. 513* Afcites. 431. Afphyxia. 194. Afthma. 265. Aftringent formulae. 56. 134. 149. 150. 159. 172- 173- 205. 272- 278. 279. 294. 295. 367. 407. 425. 441. 442. 471. Atrabilis, as the caufe of melancho- lia. 337- Attractions, vital, obfervations on. "9 340. 'Azot, its combinations. 392. "" Azot, its ufe in the animal econo- my. 437- Azo'ic air, what itis. 33- Bandages, their a&ion on the ab- forbents. 390- Bile, its ufe. 38. Bleeding at the nofe. 134. Blepharoptofis. 566. Bfindnefs. 479- Blood, lofs of. 517. Blood, the colour of, how caufed. 337- Borborygmi.1 410. Brain, obfervations on. 305. Bubo. 548. Bulimia. 499. Cachexia;. 17. 379. Caligo. 479* Camphor, obfervations on. 28. Cancer. 546. Canine madnefs. 300. Carbon, its combinations. 392. Carbon, its ufe in the animal econo- my. 396. Carditis. 100. Caries. 592. Carus. 164. 168. Catalepfy. 175- Cataphora. 175. Cataract. 479. Catarrh. 85. Cathartic formulas. 53. 66. 169: 205. 278;"285. 325. 343. 344. 356. 359- 369- 37Q- 4*o. 421. 441. 468: Chalybeates. See Iron. Chicken-pox. 124. Chin cough. 272. Chlorofis. 475- Cholera. 281. Chorea. 249. Cinchona. 26. Clap. v. Syphilis. Clavus. 551. Clinton's Febrifuge. $1. Clyfters. 62. 168. 279. 280. Gold, obfervations on. 21. Coldnefs of the extremities in mel- ancholia. 339. Colic. 280. Colic of Poitou. 179. Comata. 162. Confent of parts. 221. Confumption. See Phthifis. Contraction of a joint. 516. Convulfio indica. 255. Convulfions. 248. Corns. 551. Coftivenefs, < I N D E tf. 609 Koftivenefs-. 517. t .-------how occafioned in mel- ancholia. 339. . Cough, fympathetic. 91. 142. Critical days and. crifis of fever, *9« 43- Croup. 84. Cruent operation in femoral hernia. 559- Cynanche. 8t. ------- - maligna. 83. -----. . parotidasa. 85. --------pharyngaea. 85. - .-----tonfillaris. 82. -----. . trachealis. 84. Cyrillo's ointment. 451« Cyftitis. 104. Cyftocete. 563. Dance of St. Vitus. 249- Deafnefs. 490. 491. -------cafes of. 494. Debility, direft and indirect, ob- fervations on- 384. Delirium, its distinctions. 55. 60. 336. ......incipient. 30. Determination, preternatural to the brain accounted for. 365. Diabetes. 286* Dialyfes. 479. 570. Diaphoretic formulas. 108. 360. Diarrhoea. 283. Diet, in typhus fever. 39- 4°. Digeftion, obfervations on. 35- '.98- .. .---as .epending on vital heat. 339. Dioncea mufcipula. 21. Diflocations. 568. Diuretic formulae. 421.4". Dreams, obfervations on. 29. 322. Dropfy of the abdomen. 431. ----- in the cheft. 430. .....of the fcrotum. 436« ----- univerfal. 4'7* _______of the womb. 435- Dumbnefs. 509. Dyfaefthefia. 479- Dyfcinefiae. 478. 50*. Dyfecoea. See deafnefs. Dyfenteria. *74- Dyfopia. 488. Dyforexia. 478- 499- Dyfpepfia. 19 5- Dyfpermatifmus. 53*- Dylpnoea. 256. Dyftiria. 536- Ecchymoma. 543- Ectopias. 478- SS6' .. „wf(.if Efforts of nature to relieve herfelf. Electricity, as exciting the abfor- bents. 391. Elephantiafis. 538. Emaciation. 391. Emetic formulae. 60. 171. 204. 272. 278. 443. 468. Emprofthotonos. 2.88. Encephalocele. 252. Enteritis. 101. Enterocele. 557. Enurefis. 523. Ephidrofis. 517. Epilepfy. 229. Epiplocele. 562. Epiphora. 519. Epifchefes. 478. 499. Epiftaxis. 134. Eryfipelas. 77. Erythema. 70. Ether, obfervations on. 28. Evaporation. 31. Exania. 567. Exanthemata. 115. Exercife, obfervations on. 387. Exophthalmia- 563. Exoftofis. 554. Expectorants. 90. Fainting. 185. Fatting peultry. jr. Febres. 4. See Fever. Feeling, lofs of. 498. Fern root, a cure for taenia- 68. Fever, its proximate caufe. 43. Fever, ardent, inflammatory, nerv- ous, putrid, malignant, jail, hof- pital, bilious, autumnal, yellow. '9- 59- . Fever, continued. 18. 19. Fever, eruptive. 115. Fever, hectic. 18. Fever, hedtic, induced by worm* 67. Fever, intermittent. 18. 47- 6i Fever, miliary. 126. Fever, fcarlet- 128. Fever, puerperal. 62. Fever, tertian. 18. Fever, quartan. 18. Fever, quotidian. 18. « Fiftula, the remedy for. 157. Flooding. 158. . Fluoralbus. SeeMenorrhagiaalba. Fraifture. 592. Framboefia 131. ' Fraxinus excel nor. 27. Friftions as exciting actions in the abforbents. 389. 75- E e ec Ganglion. 55*« Gangrene. 78. Gargles. 82. 83. Gaftriti? 6io I N D E X. Gaftritis. ioo. GaftrocSle. s6t- Gaftrodynia fla.ulenta. 2j8. Gazpacho. 51. Geoffraea 'nirinamenfis, as a power- ful anthelmintic. 245. Geum urbanum. 27. Gimbernat's practice in the reduc- tion of hernia femoralis. 558. Gonorrhoea. 525. Gout. in. Gout Cough. 92. Grand Gore- 449- Granulation. '578. Green ficknefs. 475. Griffith, Dr. Mofes, his treatment ofheftic. 151. Gutta Serena. 483. Habits, obfervations on. 234. Hasmoptyfis. 137. Haemorrhages. 132. Haemorrhois. 154. Hearing deftroyed. 490. Heat, obfervations on. *i. 3c Heat, animal, the generation of. 34- 87. Heat of the human body. 87. Hectic, j8. 142. 233. Hedyfarum feyrahs. 21. Hemiplegia. 198. Hemoirhagiat. 18. 132. Hepatitis. 102. Hepatocele. 562. Hernia. 556. Hernia femoralis. 558. Hernia of the Cornea. 482. Herpes- 586. Hefitation of Speech. 513. Heurmius, his powder. 160. Hooping Cough. 272. Hope a tonic. 65. Hydarthus. 553. Hydatis. 553. m Hydrocele. 436. Hydrocephalus externus. 427. Hydrocephalus internus- J73. Hydrogen, its combinations. 392. Hydrometra. 435. Hydrophobia. 300. Hydrorachitis. 427. Hydrothorax. 430. Hypocondriafis. 46. 199. 292. Hypoftaphyle. 566. Hyfteria. 41- 42. 290. Hyfteritis. 105. Hyfterocele. 563. Hyfteroptofis. 567. I6lerus. 460. Impetigines. 379. 443. fnipotence. 507. Incubus. 302. Indigeftion. 195- Inflammations. 68. 574. Inflammation of the bladder. 104. ----. .----of the bowels. 101. .....---of the eyes. 79. ....-----of the Heart. 101. . . ...----. of the Kidneys. 103. .....----of the Liver. 102. -.----...0f the Spleen. 103. ..--------of the Stomach. 100. .....- - - of the Womb. 105, Inoculation. 117. Infania. 326. Intumefcentias. 379. 408. Iron, its wonderful ufe in the ani- mal economy. 399. Irritability, obfervations on. 2Q& ---------its accumulation. 23. Ifchuria. 530. Itch. 591. James's powder. 34. Jaundice. 460. King's evil. See Scrophula. Lachrymation. 519. Lepra. 458. Leprofy. 558. Lethargy. 170. Light and heat, obfervations on. 31; Lifle's powder. 24. Locales. 17. 478. Low fpirits. See Hypochondriafis. Lues Venerea, v- Syphilis. Lumbago. 108. 109. Lupia. 5i,i. Luxatio. 568. Mania. 348. Mania Hyfterica. 364. Mania Melancholica. 352. Mania Mentalis of Dr. Cullen- 373. Mania Phrenitoides. 358. Marcores. 391. Meafles. 124. Melancholia. 326. Melancholic temperament. See temperament. Menorrhagia. 158. Menorrhagia alba. 160. Menfes, partly or wholly obftrutt- */£• -539' Miliaria. 126. Milk Porridge. 124. MimofauPudica. 21. MollitiesOfiium. 385. Motion impeded, or depraved. 508. Mumps.* 85. Mutuas. 509. Mutitas. Cafes of. 510. Nephritis. INDEX. Nephritis. 103. Nervous Difeafes. See Neurofes. Neurofes. 17. 161. Night Mare. 302. Noftalgia. 504. Nouffer, Madame, her cure of Tae- nia- 68. Nutrition, obfervations on. 392. Nymphomania. 503. Oak bark, obfervations on. 27. Obefity. 408. Obftipatio. 527. Odontalgia. 109. Oil, its chemical analyfis. 393. Oneirodynia. 302. 324. Ophthalmia. 79. Opifthotonos. 252. Opium, obfervations on. 28. Palenefs as a fymptom of Melan- cholia. 339. Palpitatio. 260. Palfy. See paralyfis. Pariclofle. 566. Paralyfis. 178. Paraphonia. 51*. Paracufis. 495. Pareira brava. 469. Pancreatic Juice. 38. Pemphigus. 130. Peripneumony. 96. Perfpiration, the ftateof, in Melan- cholia. 339. PertufTis. 272. Peruvian bark and vegetable aftrin- gents, obfervations on. 26, Peftis. 59. Petechias. 123. tblegmafiee. 17. 69. Phlegmon. 77. Phlogofis. 77. Phofphorus, its combinations. 392. 398- Phofphorus, its ufe in the animal Economy. 398. Phrenitis. 81. Phrenfy. See Phrenitis. Phthifis. 142. Phyfconia. 437. Phyfometra. 416. Pica. 499. Piles. 154. Plague. 59. Plethora, obfervations on. 135. Pleurify. See Pneumonia. Plica Polonica. 475- Plummer's pill. 588. Pneumatofis. 409. Pneumonia. 97. Podagra, no. Polydiplia. 500- Volvlarcia. 408. 611 Pox. V. Syphilis. Preffure exciting ihe acVton of the abforbents. 385. 391. Prflwuia. 161. Profufid. 517. Prolapfus. 563. Prolapfus uteri- 567. Proptoma. 567. Prunus pardus. 26. Prunus fpinofa. 27. Pfellifmus. 515. PfeuHoblepfis. 489. Pfora. 591. Ptyalifin. 522. [ Putrefactive Procefs. 396. Pulfe, obfervations on. 41. Pulfe, the nature of in Melancho- lia. 338. Pyrexia:, their definition, 17. Pyrofis. 273. Qumfey. 81.. 82. Rachialgia metallica. 179." Rachitis- 438. Raphania. 228. ( Refpiration, obfervations on. 32. 39- >93- 338. Rheumatifm- 105. Rickets. 438. Rubeola. 124. Rupture. 556. Salivation. 522. Salix alba, S. fragilis, S. triandria. 26. Sarcoma. 549. Satyriafis. 501. Scald head. See Tinea- Scarlatina. 118. Sciatica. 107. fcirrhus. 544. Scorbutus. 453. Scrophula. 443. Scurvy. See Scorbutus. Sleep, as contributing to nutrition. Sleep, obfervations on.- 312. Small-pox. 116. Smell diminifhed or deftroyed. 497. Solutions of continuity. 570. Somnambulifm. 302. 324. 376. Sounds, inability to utter. 508. Spafm, the occafional caufe oi. 324.. Spafm, the predifponent caufe of. 200. Spafmi. 206. Spica, bandage. 560. _ Spirits, depreffed from a deficiency of vital air. 34°« Splenitis. 103. Splenocele. 562. . . Squinting. ^'-*« I N E E X. Squinting. S'S- „ Stammering and Stuttering. 5*3- Staphyloma. 4&J- Steel. See Iron. Stimuli, obfervations on. 40. 214. Stomach cough. 93. Strabifmus. 515. Sugar, its chemical analyfis. 393. Sulphur, its combinations. 392. 397. Suppuration, obfervations on. 576. Syncope. 185. Synocha. 19. 42. 48. 56. Syphilis. 449- Sweating, violent and morbid. $17. Swellings. 541. Tabes. 339. *----the fpecies of. 403* Taenia, its cure. 68. Tafte, diminifhed or deftroyed. 498. Teething cough. 92. Temperament, melancholic. 199. Tetanus. 251. Tetters. 586. Thirft, its nature. 34- __._. exceflive. 500. Tinea. 589. Tonics. 469. Tooth-ach. 109. Trichoma. 459. Trifmus. 252. Tubercles. 146. Tumours. 478. 541. Tuffis arthritica- 92. Tuffis convulfiva. 95. Tuffis a dentitione. 92. Tuffis exanthematica. 91. -Tuffis ferina. 91. Tuffis ftomachalis- 93. Tuffis verminofa. 9**- Tympanites. 412. Typhus. 19. 42. 44- 52- a cafe of. 43,- indications of cure in. 5*. Ulcers and ulceration. 574. 577. Urine, involuntary difcharge of. 523- Urine, fuppreflion of. 530. .....difficulty and pain in dif- charge of. 536. Uvula, falling. 565. Varicella. 624. Variola. "5- Varix. 543- , - , Vegetable fubftances, their chemic- al anlyfis. 393. Velno's vegetable fyrup. 587; Venereal difeafe. 449* Verruca. 550. Vefaniae. 302. Vigilance, obfervations on. 317 Vires naturae medicatrices- 79- Vital air, obfervations on. 32. 2°J- 294. 345- 3*6. 3fc! Voice, depravation 01. 512. Vomicae- See tuberceles. Vulnus. 570. Water-brafh and water-pang. 273. Water, its chemical analyfis. 393. Ward's pafte for the fiftula. 157. Warts. See Verruca, Whites. See Menorrhagia alba. White fwelling. 448. 553. Wine, its chemical analyfis. 393 Worm cough. 92. Worms, fymptoms of. 66. Wounds- 570. Yeft, in typhus." 55. Yaws. 131. FINIS. Nki.r+i&t-. WZ LIO T7H?t w mm mmr. V V Ytij&.Yi* ■{«:«■; 1 ,J- ..! ■i >' .:,^^&!l#v*#S i ,' '.< '.;t:»..M>! .., , .'>';»;. .»i • ' ,'•!^;i^f!S;:y:..^i;^[!f?4,lffl( ■•».•■ ■ '■• •- ■; ';:!Vi»f /^WWHWl •i <■•.-......^•»,,l-'»tJiiJ:^.?hr^^"jjvv' , :,.:.■..M^;.;^;■;,»i1f|{m{1{»/^^fi«»j^ft *&#k;:?;:; ,.,:. .u:i»«. •V')5 .. !■.'<■< :