$*mr£. **C?\ > ** %-^r- ** *■*•■ ~* ->*"** - ♦rfL v-i-A ^^■vi. **■&&- -rfOOOuC^ ].2<0'Q<0& '^ sM1 Surgeon General's Office W?^ ft *V JrXSS fA "*».vC*V. >*. ff N« zs~~ 'O"'/jG-0G!)C iQOQOQCy? It •■«%: fei:,;! ""* i.'' >3 XT" ~S* *&J*k** Af%%. THE STUDY OF MEDICINE, BV JOHN MASON GOOD, M.D. F.E.S. MEM. AM. PHIL. SOC. AWD F.L.S. OF PHILADELPHIA. IN FOUR VOLUMES. / sisv BOSTON : WELLS AND LILLY—COURT-STREET. 1823. *• W0 •» 1 "--•"^V. V ^ CLASS V. 4 CLASS V. GENETICA. DISEASES OF THE SEXUAL FUNCTION. ORDER I. CENOTICA. AFFECTING THE FJLV1DS II. ORGASTICA. AFFECTING THE ORGASM III. , CARPOTICA. AFFECTING THE IMPREGNATIOJV r __£•■___ CLASS V. PHYSIOLOGICAL PROEM. e now enter upon the maladies of that important function by which animal life is extended beyond the individual that possesses it, and propagated from generation to generation. To this division of diseases the author has given the classic name of genetica, from ywtfcxi, " gignor," whence genesis (yme-tg), " origo," " ortus." In almost every preceding system of nosology the diseases of this function are scattered through every division of the classification^ and are rather to be found by accident, an index, or the aid of the memory, than by any clear methodical clue. Dr. Macbride's clas- sification forms the only exception I am acquainted with ; which, however, is rather an attempt at what may be accomplished, than the accomplishment itself. His division is into four orders ; gene- ra!, and local as proper to men, and general, and local as proper to women ; thus giving us in the ordinal name little or no leading ide« of the nature of the diseases which each subdivision is to include, or any strict line of division between them; for it must be obvious that many diseases commencing locally very soon become general, and affect the entire system, as obstructed menstruation; while oth- ers, as abortion, or morbid pregnancy, may be both general and local. Under the present system, therefore, a different arrangement is chosen, and one which will perhaps be found not only more strict to the limits of the respective orders, but more explanatory of the leading features, of the various genera or species that are included under them. These orders are three: the first embracing those diseases that affect the sexual fluids ; the second those that affect the orgasm ; and the third those that affect the impregnation. To the first order is applied the term cenotica (xiwnx*) from xtvmnt " eva- cuatio," " exinanitio," to the second orgastica (egyar™.a_) from •{y*£* " irrito,11 " incito," and especially libidinose; and to the third carfotica (*«{*«■<*«) from xx^tog, " fructus." Before we enter upon these divisions, it will perhaps prove ad- vantageous to pursue the plan we have hitherto followed upon W 6 PHYSIOLOGICAL PROEM. [CL. V. commencing the preceding classes, and take a brief survey of the general nature of the function before us, under the following heads: I. THE MACHINERY BY WHICH IT OPERATES. II. THE PROCESS BY WHICH IT ACCOMPLISHES ITS ULTIMATE END. III. THE DIFFICULTIES ACCOMPANYING THIS FROCESS WHICH STILL RE- MAIN TO BE EXPLAINED. I. One of the chief characters by which animals and vegetables are distinguished from minerals, is to be found in the mode of their formation or origin. While minerals are produced fortuitously or by the casual juxta-position of the different particles that enter into their make, animals and vegetables can only be produced by gene- ration, by a system of organs contrived for this express purpose, and regulated by laws peculiar to itself. Generation is effected in two ways: by the medium of seeds or eggs, and by that of offsets: and it has been supposed that there may be a third way, to which we shall advert hereafter; that of the union of seminal molecules, furnished equally by the male and the female, without the intervention of eggs, which constitutes the leading principle of what has been called the theory of epi- genesis. Many plants are propagable by offsets, and all plants are suppos- ed to be so by eggs or seeds. As we descend in the scale of animal life, we meet in the lowest class, consisting of the worm tribes, with examples of both these modes of propagation also. For while a production by ova is more commonly adhered to, the hydra or po- lype is well known to multiply by bulbs or knobs thrown forth from different parts of the body, and the hirudo viridis, or green leech, by longitudinal sections, which correspond with the slips or suck- ers of plants. In these cases we meet with no distinction of sex; the same in- dividual being capable of continuing its own kind by a power of spontaneous generation. In other animals of the worm class we trace examples of the organs of both sexes united in the same in- dividual, making a near approach to the class of monoicous plants, or those which bear male and female flowers distinct from each other but on the same stock, as the cucumber: thus constituting proper hermaphrodites, evincing a complexity of sexual structure which is not to be found in any class of animals above that of worms. Some of the intestinal worms are of this description, as the fasciola or fluke, which is at the same time oviparous, the ovaries being placed laterally. The helix hortensis, or garden-snail, is hermaphrodite, but incapa- ble of breeding singly. In order to accomplish this, it is necessary that one individual should copulate with another, the male organ of each uniting with the female, and the female with the male, when both become impregnated. The manner in which this amour is OL. V.] PHYSIOLOGICAL PROEM. 7 conducted is singular and highly curous. They make their ap- proach by discharging several small darts at each other, which are of a sharp form, and of a horny substance. The quher is contain- ed within a cavity on the right side of the neck, and the darts are launched with some degree of force, at about the distance of two inches, till the whole are exhausted; when the war of love is over and its consummation succeeds. The increase is by eggs which are perfectly round and about the size of small peas. There are some animals in which a single impregnation is capa- ble of producing several generations in succession: we have a fami- liar example of this in the common cock and hen; for a single co- pulation is here sufficient to give fecundity to as many eggs as will constitute a whole brood. But the same curious fact is still more obvious in various species of insects, and especially in the aphis (puceron or green-plant louse) through all its division, and the Daphnia Pulex of Miiller and Latreille (the monoculus Pulex of Linn^us.) In both these a single impregnation will suffice for at least six or seven generations; in both which, likewise, we have another curious deviation from the common laws of propagation, which is that in the warmer summer months the young are produc- ed viviparously, and in the cooler autumnal months oviparously. It is also very extraordinary that, in the aphis, and particularly in the viviparous broods, the offspring are many of them winged, and ninny of them without wings or distinction ot sex: in this respect making an approach to the working-bees, and still more nearly to the working-ants, known, till of late, by the name of neuters. For the generative process which lakes place in these two last kinds we are almost entirely indebted to the nice and persevering labours of the elder and the younger Hiiber ; who have decidedly proved that what have hitherto been called neuters are females with undeveloped female organs, and therefore non-breeders; but whose organs, at least in the case of bees, are capable of develope- ment by a more stimulating or richer honey, with which one of them, selected from the rest, is actually treated for this purpose by the general consent of the hive on the accidental loss of a queen- bee, or common bearer of the whole, and in order to supply her place. It is these alone that are armed with stings; for the males, or drones, as we commonly call them, are without stings; they are much larger than the non-breeders or workers, of a darker colour, and make a great buz in flying. They are always less numerous in a hive than the workers, and only serve to insure the impregnation of the few young queens that may be produced in the course of the season, and are regularly massacred by the stings of the workers in flic beginning of the autumn. The impregnation of the queen-bee is produced by a process too curious to bo passed over. It was con- jectured by Swamnierdam that this was effected by an aura seminalis thrown forth from the body of the whole of the drones or males collectively. By other naturalists it has been said, but erroneously, to take place from an intermixture of a male milt or sperm with tf PHYSIOLOGICAL PROEM. [cl. y. the eggs or spawn of the queen-bee, as in the case of fishes. M. Hiiber, however, has sufficiently proved that the queen-bee for- thi« purpose forms an actual coition, and this never in the hive, but during a tour into the air, which she takes for this purpose, a few- days only after her birth, and in the course of which she is sure to meet with some one or other of her numerous seraglio of males. As soon as copulation has been effected, she returns to the hive, which is usually in the space of about half an hour, and often bears home with her the full proofs of a connexion in the ipsa verenda of the drone; who thus wounded and deprived of his virility by the violence of his embrace, dies almost immediately afterwards. This single impregnation will serve to fecundate all the eggs the queen will lay for two years at least; Hiiber believes for the whole of her life ; bu: ii«: has had repeated proofs of the former. She begins to lay her eggs, for the bee is unquestionably oviparous, forty-sir hours after impregnation, and will commonly lay about three thous- and in two months, or, at the rate of fifty eggs daily. For the first eleven months she lays none but the eggs of workers; after which she commences a second laying which consists of drones' eggs alone. Of the mode of procreation among fishes, inconsequence of their living in a different element from our own, we know but little. A few of them, as the squalus. or shark genus, some of the skates, and other cartilaginous fishes, have manifest organs of generation, and unquestionably copulate. The male shark, indeed, is furnished with a peculiar sort of holders for the purpose of maintaining his grasp upon the female amidst the utmost violence of the waves, and his penis is cartilaginous or horny. The female produces her young by eggs, which, in several species of this genus, are hatched in her own body, so that the young, when cast forth, are viviparous. The blenny produces its young in the same manner; in most spe- cies by spawn or eggs hatched externally, but in one or two vivi- parously, three or four hundred young being thus brought forth at a time. The blenny, however, and by far the greater number of fishes, have no external organ of generation, and appear to have no sexual connexion. The females, in a particular season of the year, seem merely to throw forth their ova, which we call hard roe or spawn, in immense multitudes, in some shallow part of the water in which they reside, where it may be best exposed to the vivific action of the sun's rays; when the male shortly afterwards passes over the spawn or hard roe, and discharges upon it his sperm, which we call soft roe or milt. These substances are contained in the respective sexes in two bags that unite near the podex, and at spawning time are very much distended. The spawn and milt thus discharged intermix ; and, influenced by the vital warmth of the sun, commence a new action, the result of which is a shoal of young fishes of a definite species. , Yet though no actual connexionfcan be traced among the greater number of the class of fistfes, 'Something like pairing is often dis CL. V.] PHYSIOLOGICAL PROEM. 9 cernible among many of those that have no visible organs of copu- lation : for if we watch attentively the motions of such as are kept in ponds, we shall find the sexes in great tumult, and apparently struggling together among the grass or rushes at the brink of the water, about spawning-time , while the male and female salmon, after having ascended a fresh stream to a sufficient height and shal- lowness for the purpose, are well known to unite in digging a nest or pit in the sand, of about eighteen inches in depth, into which the female casts her spawn, and the male immediately afterward ejects his milt; when the nest is covered over with fresh sand by a joint exertion of their tails. The salmon, the sturgeon, and many other marine fishes, seek out a fresh-water stream for this purpose : and their navigations are often of very considerable length before they can satisfy them- selves, or obtain a proper gravelly bed. The salmon tribe some- times make a voyage of several hundred miles, cutting their way against the most rapid currents, leaping over floodgates, or up cata- racts of an astonishing height: in their endeavour to surmount which they often fail, and tumble back into the water; and, in some places are, in consequence, caught in baskets placed in the current for this purpose. The power of fecundity in fishes surpasses all calculation, and appears almost incredible. A single herring, if suffered to multiply unmolested, and undiminished for twenty years, would show a pro- geny greater in bulk than the globe itself. This species, as also the pilchard, and some others of the genus clupea, as a proof of their great fertility, migrate annually from the Arctic regions in shoals of such vast extent, that for miles they are seen to darken the surface of the water. The mode of procreating among frogs does not much vary from that of fishes. Early in the spring the male is found upon the back of the female in close contact with her, but there is no discoverable communication, although this contact continues for several days; nor can we trace in the male any extern..1 genital organ. After the animals quit each other, the female seeks out some secure and shal- low water, in which, like the race of fishes, she deposits her spawn, which consists of small specks held together in a sort of chain or string by a whitish glutinous liquor that envelopes them; and over this the male passes and deposits his sperm, which soon constitutes a part of the glutinous matter itself. The result is a fry of minute tadpoles, whose evolution into the very different fo.m and organi- zation of frogs, is one of the most striking curiosities of natural his- tory. In the Surinam toad (rana Pipa), this process is varied. The female here deposits her eggs or spawn without any attention to or- der; the male takes up the amorphous mass vvUn his feet and smears it over her back, driving many of the eggs hereby into a variety of cells that open upon it; and afterwards ejecting over them his spermous fluid. These cells are so many nests in which the eggs are hatched VOL. IV. abis.J The peculiar character of the memhrane must necessarily be governed by the character of the organ in which it is formed. Upon the whole, it does not seem to afford much support to the argument in whose favour it is appealed to, and the subject requires further in- vestigation. The third difficulty attendant upon the common doctrine of the day, which supposes the fetus to hold its entire communication with, and to derive its blood, nutriment, and oxygen from the mother by means of the placenta and umbilical chord, is founded upon the oc- casional instances of fetuses of large and even full growth being found in the womb, and even brought forth at the proper period without any placenta, or at least of any utility, without any um- bilical chord, or even the trace of an umbilicus. Admitting the course just glanced at to be the ordinary provision of Nature, what is the substitute she employs on these occasions ? the means by which the bereft fetus is supplied with air and nourishment ? The advocates of the doctrine of epigenesis, as new modelled by the hands of Buffon and Darwin, triumphantly appeal to these curi- ous deviations from the established order of nature, as effecting a direct overthrow of the doctrine of evolution by an impregnated ovum: while the supporters of the latter doctrine have too general- ly cut the question short by a flat denial of such monstrous aberra tions. There is little of the true spirit of philosophy in either conduct Admitting the existence of such cases, they just as much cripple the one doctrine as the other, for, granting the explanation which is usually offered by the former, the ordinary machinery of a placenta and an umbilical chord, become immediately a work of supereroga- tion : a bulky and complicated piece of furniture to which no im- portant use can be assigned, and which the overloaded uterus might be well rid of. * De Sed. ct Caus. Morb. Ep. t Med. Trans. Vol. vi. Art. xvi. -j: Vol. I. p. lt»2 24 PHYSIOLOGICAL PROEM. [CL« v • But, on the contrary, to deny the existence of well established and accumulated facts merelv because we cannot bend th^m to our own speculation, is still weaker and more reprehensible. The kangaroo, opossum, and wombat, all breed their youns: without either placenta or navel-string. The embryons are inclosed in one or more membranes, which are not attached to the coats of the Uterus, and are supplied with nourishment, and apparently with air from a gelatinous matter by which they are surrounded. Hoffman gives us the case of a fetus born in full health and vigour with the funis sphacelated and divided into two parts.* Vauder Wiel gives the history of a living child exhibited without any umbilicus, as a pub- lic spectacle ;t and in a foreign collection of literary curiosities is the case of a hare which was found, on being opened, to contain three leverets, two of them without a placenta or umbilical vessels: and the other with both.J Ploucquet has collected a list of several other instances in his lnitia:§ but, perhaps, the most striking ex- ample on record is one which occurred to the present author in December 1791, an account of which he gave to the public in 1795.|| The labour was natural, the child, scarcely less than of the ordinary size, was born alive, cried feebly once or twice after birth, and died in about ten minutes. The organization, as well external as internal, was imperfect in many parts. There was no sexual character whatever, neither penis nor pudendum, nor any interior organ of generation : there was no anus or rectum, no funis, no umbilicus ; the minutest investigation could not discover the least trace of any. With the use of a little force, a small, shrivelled pla- centa, or rather the rudiment of a placenta followed soon after the birth of the child, without a funis or umbilical vessels of any kind, or any other appendage by which it appeared to have been at- tached to the child. No hemorrhage or even discoloration follow- ed its removal from the uterus. In a quarter of an hour afterwards a second living child was protruded into the vagina and delivered with ease, being a perfect boy attached to its proper placenta by a proper funis. The author dissected the first of these shortly after its birth in the presence of two medical friends of distinguished reputation, Dr. Drake of Hadleigh, and Mr Anderson of Sudbury, both of whom are still able to vouch for the correctness of this statement. On the present occasion, however, it is not necessary to follow up the amorphous appearances any further, as they are already before the public, except to state that the stomach which was natural, was half filled with a liquid resembling that of the amnios. * Op. de Pinguediiie. t Observ. Cent. post. £ Cominerc. Literar. Norimberg. t> Initia Bibliotheca:, Medico-Pract. et Chirui3. Tom. m. p. 554. 4to. Tubing, 1794. || Case of Picter-natural Fetation, with observations: read before the Medical Society of London, Oct. 20, 1794. GL. V.] PHYSIOLOGICAL PROEM. 25 This subject has been brought forward, and will be found ably discussed in the earlier volumes of the Edinburgh Medical Essays, by Professor Monro, and Mr. Gibson.* The latter giving full credit to the few histories of the case then before the world, endeavours very ingeniously to account for the nutriment of the fetus by the liquor amnii, which he conjectures to be the ordinary source of supply and not the placenta. The chief arguments are, that the embryon is at all times found at an earlier period in the uterus than the placenta itself; which does not appear to be perfected till two or three months after conception; and consequently that the em- bryon must, thus far, at least, be supported from some other source than the placenta; and if thus far, why not through the whole term of paturition ? That extra-uterine fetuses have no placenta, and yet obtain the means of growth and evolution from the surrounding- parts. That the liquor amnii is analogous in its appearance to the albumen of a hen's egg, which forms the proper nourishment of the young chick : that it is found in the stomach and mouths of vi- viparous animals when first born ; and that it diminishes in its vo- lume in proportion to the growth of the fetus. To these arguments it was replied by Professor Monro, that we have no satisfactory proof that the liquor amnii is a nutritive fluid at all, and that in the case of amorphous fetuses produced without the vestige of a mouth or of any other kind of passage leading to the stomach, it cannot possibly be of any such use : that if the office of the placenta be not that of affording food to the embryon, it be- comes those who maintain the contrary to determine what other office can be allotted to it; and that till this is satisfactorily done, it is more consistent with reason to doubt the few and unsatisfac- tory cases at that time brought forward, than to perplex ourselves with facts directly contradictory of each other. For the full scope of the argument the reader must turn to the Edinburgh Medical Essays themselves, or for a close summary to the present author's observations appended to his own case. It must be admitted that the instances adverted to in the course of the discussion are but few, and most of them stamped with something unsatisfactory. Others, however, might have been advanced even at that time on authorities that would have settled the matter of fact at once, how much soever they might have confounded all ex- planation. But after the history just given, and the references to other cases by which it may be confirmed, this is not necessary on the present occasion. It is singular that the subject of aeration, which forms another difficulty, in discussing the question, is not dwelt upon on either side, notwithstanding the ingenious conjecture of Sir Edward Hulse, that the placenta might be an organ of respiration as well as of nutrition, had at this time been before the public for nearly half a * Vol. i. Art. xm. Vol. ii. Art. ix, x, XI. See also Dr. Fleming's paper. Phil. Trans. Vol. xwx. 1775-6. p. 254. VOL. V- 4 26 PHYSIOLOGICAL PROEM. [CL.V. century: and it shows us how slow the hest founded theories not unfrequently are in obtaining the meed of public assent to which they are entitled from the first. These, however, are only a few of the peculiar difficulties that still accompany the subject of generation, to whatever doctrine we attach ourselves. There are others that are more general, but epually inexplicable. The whole range of extra-uterine fetuses is of this character; often formed and nourished and developed with- out either placenta or an amnios, and yet sometimes advancing, even in the remote cavity of the ovarium, and perfect in every or- gan, to the age of, at least, four months, of which we have already offered an example. A great part of the range of amorphous births defy equally all mental solution; particularly the production of monsters without heads or hearts, some of whom have lived for several days after birth ;* of others consisting of a head alone, wholly destitute of a trunk, and yet possessing a full developement, a specimen of which was lately in the possession of Dr. Elfes, of Neuss, on the Rhine :| and of others again, the whole of whose ab- dominal and thoraric viscera has been found transposed.^ Nor less inexplicable is the generative power of transmitting pe- culiarities of talents, of form, or of defects in a long line of heredi- tary descent, and occasionally of suspending the peculiarity through a link or two, or an individual or two, with an apparent capricious- ness, and then of exhibiting them once more in full vigour. The vast influence which this recondite, but active power possesses, as well over the mind and the body, cannot, at all times, escape the notice of the most inattentive. Not only are wit, beauty, and genius propagable in this manner, but dulness, madness, and deformity of svery kind. Even where accident, or a cause we cannot discern, has produced a preternatural conformation or singularity in a particular organ, it is astonishing to behold how readily it is often copied by the gener- ative power, and how tenaciously it adheres to the future lineage. A preternatural defect in the hand or foot, has, in many cases, been so common to the succeeding members of a family, as to lay a foun- dation in every age and country for the family name, as in that of Varro, Valgius, Flaccus and Plautus of Rome. Seleucus had the mark of an anchor on his thigh, and is said to have transmitted it to his posterity: and supernumerary fingers and toes have descended in a direct line for many generations in various countries. Hence hornless sheep and hornless oxen produce an equally hornless off- spring, and the broad-tailed Asiatic sheep yields a progeny with a tail equally monstrous, often of not less than half a hundred pounds weight. And hence, too, those enormous prominences in the hind- er parts of one or two of the nations at the back of the Cape of * See for examples and authorities the author's volume of Nosology. t Hufeland, Journal der Practischen Heilkunde. Apr. 1816. £ Sampson, Phil. Trans. 1674. CL. V.] PHYSIOLOGICAL PROEM. 27 Good Hope, of which examples have been furnished to us in our own island. How, are we moreover to account for that fearful host of diseases, gout, consumption, scrophula, leprosy and madness, which, originat- ing, perhaps, in the first sufferer accidentally, are propagated so deeply and so extensively that it is difficult to meet with a family whose blood is totally free from all hereditary taint ? By what means this predisposition may be best resisted it is not easy to determine. But as there can be no question that intermarriages among the col- lateral branches of the same family tend more than any thing else to fix and multiply and aggravate it, there is reason to believe that unions between total strangers, and, perhaps, inhabitants of different countries, form the surest antidote. For admitting that such stran- gers to each other may be tainted on either side with some morbid predisposition peculiar to their respective lineages, each must lose something of its influence by the mixture of a new soil; 'and we are not without analogies to render it probable that in their mutual encounter the one may even destroy the other by a specific power. And, hence, nothing can be wiser, on physical as well as on moral grounds, than the restraints which divine and human laws have con- curred in laying on marriages between relations: and though there is something quaint and extravagant, there is something sound at the bottom, in the following remark of the sententious Burton upon this subject: " And surely," says he, " I think it has been ordered by God's especial providence, that, in all ages, there should be, once in six hundred years, a transmigration of nations to amend and purify their blood, as we alter seed upon our land, and that there should be, as it were, an inundation of those northern Goths and Vandals and many such like people, which came out of that continent of Scandia and Sarmatia, as some suppose, and over-ran, as a deluge, most part of Europe and Africa, to alter, for our good, our complexions that were much defaced with hereditary infirmi- ties, which by our lust and intemperance we had contracted."* Boethius informs us of a different and still severer mode of disci- pline at one time established in Scotland for4he same purpose, but which, however successful, would make, I am afraid, sad havoc in our own day, were it ever to be carried into execution. " If any one," says he, " were visited with the falling sickness, madness, gout, leprosy, or any such dangerous disease, which was likely to be propagated from father to son, he was instantly castrated; if it were a woman she was debarred all intercourse with men ; and if she were found pregnant with such complaint upon her, she and her unborn child were buried alive."t * Anatomy of Melancholy, Vol. i. Part i. Sect. n. p. 89. 8vo. t De Veterum Scotorum Moribus, Lib. i CLASS V. GENETICA. ORDER I. C EXOTICA. Utscases affecting the iFlufts. MORBID DISCHARGES ; OR EXCESS, DEFICIENCY OR IRREGULARITY OF StTH AS ARE NATURAL. This order, the name of which is derived from Galen, and has been explained already, is designed to include a considerable number of diseases which have hitherto been scattered over every part of a nosological classification, but which are related to each other as be- ing morbid discharges dependent upon a morbid condition of one or more of the sexual organs. The genera are five, and they may be thus expressed: I. PARAMENIA. MISMENSTRUATION. II. LEUCORRHUSA. WHITES. III. BLENNORRHEA. GONORRHOEA. IV. SPERMORRHUT.A. SEMINAL FLUX. V. GALACTIA. MISLACTATION. GENUS I. PARAMENIA Stttsmrnstruatfon. MORBID EVACUATION OR DEFICIENCY OF THE CATAMENIAL FLUX. Paramenia is a Greek term derived from -xxfct" male" and uw " men- sis." The genus is here limited to such diseases as relate to the 3U GENETICA. [CL. V.-OR. I. menstrual flux, or the vessels from which it issues. This fluid is incorrectly regarded as blood, by Cullen, Leake, Richerand, and other physiologists: for, in truth, it has hardly any common pro- perty with blood, except that of being a liquid of a red colour. It is chiefly distinguished by its not being coagulable ; and hence, when coagula are found in it, as in laborious and profuse menstrua- tion, serum or blood is intermixed with it, and extruded either from atonic relaxation or entonic action of the menstrual vessels. " It is," observes Mr. John Hunter, "neither similar to blood taken from a vein of the same person, nor to that which is extravasated by accident in any other part of the body; but is a species of blood, changed, separated, or thrown off from the common mass by an ac- tion of the vessels of the uterus similar to that of secretion; by which action the blood loses the principle of coagulation, and, I suppose, life." Mr. Cruikshank supposes it to be thrown from the mouths of the exhaling arteries of the uterus, enlarged periodically for this purpose ; and his view of the subject seems to be confirmed by a singular case of prolapse, both of the uterus and vagina, given by Mr. Hill, of Dumfries, in the Edinburgh Medical Commentaries. In this case, the os tincae appeared like a nipple projecting below the retroverted vagina, which assumed the form of a bag. The patient, at times, laboured under leucorrhcea : but it was observed that, when she menstruated, the discharge flowed entirely from the projecting nipple of the prolapse ; while the leucorrhoea proceeded from the surrounding bag alone.* As this distinction has not been sufficiently attended to either by nosologists or physiologists, many of the diseases occurring in the present arrangement under paramenia, have been placed by other writers under a genus named menorrhagia, which, properly speak- ing, should import hemorrhage (a morbid flow of blood alone) from the menstrual vessels. And we have here, therefore, not only a wrong doctrine, but the formation of an improper genus; for menorrhagia or uterine hemorrhage is, correctly speaking, only a species of the genus hemorrhagic, and will be so found in the present system, in which it occurs in Class hi. Order rv. This remark applies directly to Sauvages ; and quite as much so to Cullen, who, in his attempt to simplify, has carried the confusion even further than Sauvages. Few diseases, perhaps, of the uterus, or uterine passage, can be more distinct from each other than vicarious menstruation, lochial discharge, and sanious ichor; yet all these, with several others equally unallied, are arranged by Sau- vages under the genus menorrhagia, though not one of them belongs to it. While Cullen not only copies nearly the whole of these maladies with the names Sauvages has assigned them, but adds to the generic list leucorrhcea or whites, abortion, and the mucous fluid, secreted in the beginning of labour from the glandula Nabothi at the orifice of the womb, and hence vulgarly denominated its show, or appearance. * Vol. iv. p. 91. GE. I.-SP. I.] SEXUAL, FUNCTION. 31 Menstruation may be diseased from obstruction, severe pain in its secretion, excess of discharge, transfer to some other organ, or cessation: thus offering us the five following species, accompanied with distinct symptoms: I. paramenia obstructionis. 2. --------- DIFFICILIS. 3.---------SUPERFLUA. 4.---------ERRORIS. 5- --" CESSATION!-. OBSTRUCTED MENSTRUATION. LABORIOUS MENSTRUATION. EXCESSIVE MENSTRUATION. VICARIOUS MENSTRUATION. IRREGULAR CESSATION OF MENSES. THE SPECIES I. PARAMENIA OBSTRUCTIONIS. ©bstructe* Menstruation. CATAMENIAL SECRETION OBSTRUCTED IN ITS COURSE ; SENSE OF OPPRESSION J LANGUOR J DYSPEPSY. This species by many writers called menostatio, appears under the two following: varieties :— Amis gpcucs uy uiauy nun two following varieties :— m Emansio. Retention of the menses. S Suppressio. Suppression of the mense: The secretion obstructed on its accession or first appearance. The feet and ancles edematous at night; the eyes and face in the morning. The secretion obstructed in its regular periods of recurrence. Head-ache, dyspnoea, palpitation of the heart. In order to explain the first of these varieties, or retention of the mi nses, it i< necessary to observe, that when the growth of the anim.ii frame is completed, or nearly so, the quantity of blood and sensorial power which have hitherto been employed in providing for such growth, constitutes an excess, and must produce plethora by being diffused generally, or congestion by being accumulated locally. Professor Monro contended for the former effect; Dr. Cullen, with apparently more reason, for the latter. And thi* last turn it seems to take lor the wisest of purposes; 1 mean in order to prepare for a future rice by perfecting that system of organs which is immediately coocerned in the process of generation; and which, during the general growth of the body, has remained dor- mant and inert, to be developed and perfected alone when every other part of the frame has made a considerable advance towards 32 GENETICA. [CL. V.-OR. I. maturity, and there is, so to speak, more leisure and materials for so important a work. We shall have occasion to touch upon this subject more at large when we come to treat of the genus chlorosis : for the present it will be sufficient to observe, that this accumula- tion of nervous and sanguineous fluid seems first to show itself among men in the testes and among women in the ovaria, and that from the ovaria it spreads to all those organs that are connected with them either by sympathy or unity of intention, chiefly to the uterus and the mammae ; exciting in the uterus a new action and secretion, which secretion, in order to relieve the organ from the congestion it is hereby undergoing, is thrown off periodically, and by lunar intervals in the form of a blood-like discharge, although when minutely examined, the discharge, as already stated, is found to consist not of genuine blood, but of a fluid possessing peculiar properties. These properties we have already enlarged upon, and have shown in what they differ from those of proper blood : and it is upon this point that the physiology of Dr. Cullen is strikingly erroneous, for not only in his First Lines, but long afterwards in his Materia Medica, he regards the discharge as pure blood, and, conse- quently, the economy of menstruation as a periodical hemorrhage. " I suppose," says he, " that in consequence of the gradual evolution of the system, at a certain period of life, the vessels of the uterus are dilated and filled: and that by this congestion these vessels are stimulated to a stronger action by which their extremities are forced open and pour out blood. According to this idea it will appear that, I suppose, the menstrual discharge to be upon the footing of an active hemorrhagy, which, by the laws of economy, is disposed to return after a certain interval."* From the sympathy prevailing between the uterus and most other organs of the system, we meet not unfrequently with some concomi- tant affection in various remote parts ; as an appearance of spots on the hands or forehead antecedently to the efflux ;t or, which is more common, a peculiar sensation or emotion in the breasts.| We cannot explain the reason why this fluid should be thrown oft once a month or by lunar periods, rather than after intervals of any other duration. But the same remark might have been made if the periods had been of any other kind : and will equally apply to the recurrence of intermittent fevers. It is enough tnat we trace in this action the marks .of design and regularity : and after the establishment of a habit by a few repetitions, there is no difficulty in accounting for the jntervals being of equal length. The time in which the secretion, and consequently the discharge, commences, varies from many circumstances, chiefly, however^ from those of climate, and of peculiarity of constitution. In warm climates menstruation appears often as early as at eight or nine * Mat. Med. Vol. n. p. 587. 4to. t Salmuth, Cent. ill. Obs. 18. t Act. Nat. Cr. Vol. n. in verb. p. 5i4. 40 GENETICA. [CL. V.-OR. L colour it has been supposed to be a powerful diuretic, but even this quality it has been incapable of supporting: and yet in the opinion of Dr. Cullen this seems to be its only pretension to the character of an emmenagogue* Given freely to brute animals Dr. Cuilen tells us, that it always disorders them very considerably, and appears hurtful to the system. Its direct virtues do not there- fore seem to have been in any degree ascertained ; but let them be what they may, it has deservedly fallen into disrepute as a remedy for any misaffection of the uterus. The athamanta Menm, or spignel, which once rivalled the repu- tation of madder, and has long sunk with it into desuetude, is better entitled to notice, and ought not' to be abandoned. It seems to have a peculiar influence in stimulating the lower viscera, and especially the uterus and bladder; and is no indifferent sudorific. On this last account it was at one time highly in favour also in intermittents, and was afterwards employed in hysteria, and humoral asthma. This part of the subject must net be quitted without glancing at a medicine that has lately acquired great popularity in North America, as an emmenagogue, and is said to have been emplo3red with unques- tionable success. This is spurred rye, or rye vitiated by being infested with the clavus or ergot, a parasitic plant which we have already had occasion to notice as producing a powerful effect on the whole system, and especially on the nervous part of it, and the abdominal viscera in general. When taken in such a quantity as to be poisonous, it first excites a sense of tingling or formication, and fiery heat in the extremities, where the action of the system is weakest; to this succeed cardialgia, and griping pains in the bowels ; and then vertigo, an alternation of clonic and entonic spasms in different parts of the body, and mania, or loss of intellect. If the quantity be something smaller than this, it excites that pestilent fever, which the French denominate mal des ardens, and in the present work is described under the name of pestis erythematica :| while in a quantity still smaller it seems to spend itself almost entirely on the extremities as being the weakest part of the body, and to produce that species of gangrjena, which is here denominated ustilaginea, or mildew mortification.^ It is hence a very acrid irritant, and from its peculiar tendency to stimulate the hypogastric viscera, seems often, in small quanti- ties, to prove a powerful emmenagogue. For this purpose an ounce of spurred rye is boiled down in a quart of water to a pint: half of which is usually taken in the course of the day, both in obstructed and difficult menstruation, and continued for three or four days. The symptoms said to be produced are head-ache, increased heat, and occasional pain in the hypogastrium, succeeded by a free and * Mat. Med. Vol. u. p. 553. 4to. edit. comp. with p. 38, of the same. t Vol. n. p. 427. 428. f. Vol. n. p. 608. GE. I.-SP. II.] SEXUAL FUNCTION. 41 easy flow of the men>frual fluid. Advantage has been taken of this effect on another occasion, for the same medicine has been prescribed in lingering labours, and we are told by Dr. Bigelow, with the best success, as good forcing pains are hereby very generally produced speedily.* In this case Dr. Bigelow, instead of a decoc- tion of spurred rye, prefers giving the crude powder, to the amount of ten grains to a dose. Wo hive hitherto regarded the spur in spurred rye, and other grain, as a clavus or species of ustilago. It was formerly, however. conceived to be a disease of the grain itself. M. Decandolle has ^ince described it as a variety of champignon, under the name of sclerotium, from its rendering the grain hard and horny. And M. Virey in a work reported upon by M. Desfontrtines, to the Acade- my of Sciences of the French Institute in 1817, ha- still more lately endeavoured to revive the obsolete opinion, by contending that it is a specific disease of the plant under which the grain is render- ed not properly speaking hard and horny, as is actually the case when infested with the sclerotium, but rather friable and easily detached. I here is something highly plausible and ingenious in the plan that was at one time tried rather extensively, of compressing the crural arteries by a tourniquet, and thus gorging the organs that lie above and are supplied from collateral branches. By compressing the jugular veins we can easily gorge the head and endanger extra- vasation and apoplexy. But it appears upon trial that the tide thus dammed up in the case before us, is thrown back upon too many or- gans to produce any very sensible effect upon the uterus. Indepen- dently of which the uterus is not like the brain, exactly inclosed in a bony box that prohibits a general and equable dilatation of its ves- sels. In six cases in which Dr. Home made experiment of this re- medy, he succeeded but once ; and others have been less success- ful still.t Impeded menstruation is sometimes, however, a disease strict- ly local, and proceeds from the obstruction of the passage by a polypous or other tumour or an imperforate hymen. In all these cases it is obvious that the cure must depend upon a removal of the local cause. Emetics have often been recommended; they rouse the system generally, but have not often been found useful in retention of the menses: though when employed in cases of suppression, and espe- cially at the regular periods of return, or so as to anticipate such return by a few days, they frequently prove a valuable adjunct. If this period be passed by without any salutary effect, and particular- ly, if, at the same time, the system labour under symptoms of op- * New Ergland Journ. of Med. and Surg. Vol. v. No. n. t Hamilton, Edin. Com. Vol. 11. Art. 31. Ww. ad Fabric, iv. 98. VOL. >' * 42 GENETICA. [CL. V.-OR. I. pression in the head or chest, venesection to the extent of from four to six ounces of blood will be found a very useful palliative, and will have a tendency to keep up that periodical habit of deple- tion which will probably prove advantageous against the ensuing lunations. Venesection will also be found useful and often absolute- ly necessary where the suspension has suddenly taken place during the flow of the catamenia, from cold, depressing passions, fright, or, indeed, any other cause. In treating the second species of paramenia, or difficult menstrua- tion, the stimulant part of the process we have thus far recommend- ed must be sedulously abstained from, but the rest may be followed with advantage. Every thing, indeed, that has a tendency to pro- duce local excitement, and in this respect the conjugal embrace it- self, where the patient is married, must be systematically abstained from. The diet must be plain and inirritant, and the bowels be kept cautiously open with neutral salts or other cooling aperients. And, to allay the strong spasmodic action on which the severe pains in the lumbar and hypogastric regions depend, it will be found high- ly advantageous, a short time before the expected return of men- struation, to employ relaxants, and especially local relaxants ; and of these, one of the best and pleasantest is the hip-bath, which ope- rates directly upon the diseased quarter, and has a tendency to pro- duce the desired effect without weakening the system generally. The ease and comfort of this valuable contrivance is acknowledged by almost all who have had recourse to it. Martini and various other writers recommend the cold bath in preference to the hot, and Tissot represents the latter as injurious. But this is to speak without due discrimination. That the cold-bath has been found of use in some instances is unquestionable: but only where there has been such a degree of energy in the constitution as to produce a reaction correspondent to the antecedent rigor. The direct effect of the cold bath is to constringe, and consequently where a spastic contraction exists already, as is mostly the case from local or con- stitutional debility, to increase the evil. But where the constitution is naturally robust, and but little inroad has hitherto been made up- on its strength, the latent energy of the system is capable of resist- ing the sudden shudder: an increased action and consequently an increased and glowing heat ensue; the repelled fluids are forced forward; the blood flows more briskly ; the mouths of the capillary vessels give way in every direction; the muscular fibres lose their rigidity, and the suppressed secretions, of whatever kind, recom- mence. And, hence it is, that cohl bathing may sometimes be serviceable in the disease before us, and warm bathing less use- ful ; but these cases are rare, and warm bathing is mostly to be preferred. Even the hip-bath, however, though it mitigates the pain, occa- sionally does nothing more ; there is the same paucity of discharge, the same intermixture of coagula, and the same tendency to a re- GE. I.-SP. II. j -F.XUAL FUNCTION. 43 turn of the disease. In such cases, it has been common to abstract eight or ten ounces of blood from the loins by cupping, antecedent- ly to the use of the bath : and this, by diminishing the spastic con- striction, has, at times, diminished in a still greater degree the dis- tressing pain. But I do not think the hip-bath is in general had re- course to early enough to give it all the beneficial effect it may be made to possess. Instead of waiting till the periodical pains return, as is the common practice, I have found it more advantageous to anticipate this period, and to relax the vessels by employing it for two or three nights before the pains are expected. And where in this and every other way it has failed, or the patient from great de- licacy of constitution has appeared too much exhausted by its use, I have availed myself of the same relaxant power in another way, and, with a like anticipation, have prescribed the use of a broad folded swathe of flannel wrung out in hot water, to be applied round the loins and belly at the time of going to rest, and bound over with a linen swathe of .equal width, as already recommended in peritoni- tis, and hepatitis. The whole should be suffered to remain till the morning, by which time the warmth of the body will be usually found to have evaporated all the moisture, though the skin will still be dewy with perspiration from so powerful a sudorific. I have often found this plan succeed still better than the hip-bath; and have never known the patient catch cold, or complain of any chilly sensation from the use of the epithem. SPECIES III. PARAMENIA SUPERFLUA. Superfluous Jttcnstruatfon. CATAMENIA excessive, and accompanied with hemorrhage from the MENSTRUAL VESSELS. This species offers us a disease precisely the reverse of the last, not less in the facility with which the mouths of the vessels give way, than in the quantity of the discharge. It exhibits the two following varieties: » Reduplicata. Excessive from a too frequent re- Reduplicate menstruation. currence. C Profusa. Excessive from too large a flow at Profuse menstruation. the proper periods. The second variety, or profuse menstruation, is often technically distinguished by the name of menorrhagia. It is, in effect, the 44 GENETICA. [CL. V.-OR. I« menorrhagia rubra of Cullen, who makes it a distinct affection from metrorrhagia or hemorrhagia uteri, by confining the latter term to a signification of hemorrhage from other vessels of the uterus than those concerned in separating and discharging the catamenial flux. We have already observed that we cannot lay down any general rule to determine the exact quantity of fluid that ought to be thrown forth at each lunation, some individuals secreting more and others less ; and the measure varies from four to eight or ten ounces. We can only, therefore, decide that the quantity is immoderate and morbid when it exceeds what is usually discharged by the individual, or when it is associated with unquestionable symptoms of debility, as paleness of the face, feebleness of the pulse, unwonted fatigue on exercise; coldness in the extremities, accompanied with an edema- tous swelling of the ancles towards the night, pain in the back in an erect posture ; and various dyspeptic affections. Either of the varieties may be entonic or atonic, or, in common language, active or passive : but in the first there is usually a greater degree of local irritability than in the second, so that the secernents are excited, or the extremities of the minute blood- vessels open upon very slight occasions. As the disease may occur under these two different states of body, it may proceed, as Dr. Gulbrand has observed, from an increased impetus in the circulation, a relaxed state of the solids, or an attenuate state of the fluids :* to which he might have added uterine congestion. Increased impetus usually indicates great robustness of consti- tution, or an entonic habit, and is not unfrequently connected with uterine gestation ; and the accidental causes are, in many cases, cold, a violent shock or jar, or an accidental blow. Under this form the disease commonly yields to venesection, cooling laxatives, and quiet. Superfluous menstruation from atony, or in other words, a relaxed state of the solids, and an attenuate state of the fluids, frequently arises from repeated miscarriages or labours, poverty of diet, and an immoderate indulgence in sexual pleasure. It often proceeds, also, and especially in the higher ranks, from a life of indolent ease, and enervating luxury, producing what we have denominated atonic plethora, lax vessels easily distended by a current of blood super- fluous in quantity but loose and unelaborate in crasis, and which is reproduced, and perhaps still more abuudautly but at the same time still more loosely, as soon as the excess is attempted to be removed by bleeding. Here, therefore, venesection is almost sure to do mischief; we must restrain every luxurious excess as far as it may be in our power, and we may have authority enough to insure a compliance. which is not always the case ; we must employ, at the same time the milder tonics with astringents, as kino, catechu, or sulphate of zinc, and carefully guard against costiveness by cool unirritating "■ De Sanguine Uterino. 8vo. Harn. 1778. *E. I.-SP. HI.] SEXUAL FUNCTION. 45 laxatives. If the di«charge be very considerable, astringent injec- tions of cold water, or which will commonly be found better, of a solution of alum or zinc, or cold water with a third part of new port wine, should be had recourse to without fail ; or the vagina may be closely plugged up w'th a sponge, confined with a proper bandage. Early hour* are of especial importance, with a due inter- mixture of moderate exerc se, and the use of cold sea-bathing. 1 he Cheltenham waters, as those also of many other chalybeate springs, have often proved serviceable, partly from their own medicinal powers, and partly from the greater purity of air and increase of exercise with which a temporary residence at a watering-place is usually accompanied. It is a common observation, iD moral as well as in physical philosophy that extremes meet in their effects, or produce like results. ' here is, perhaps, no part of natural history in which this is more frequently exemplified than in the sphere of medicine. In the case of apoplexies and palsies, as well as various other diseases, we have had particular occasion to make this remark * and in the genus immediately before us, as well as others closely connected with it, we have another striking instance of its truth. " The proportion of the diseases peculiar to the female sex in the hospital," says Sir Gilbert Blane, speaking from tables accurately kept by himself for this purpose, u is the same as in private cases; from which it would appear that the unfavourable influence of indolent habits, excessive delicacy, and sensibility of mind and body in the upper ranks, compensate for the bad effects of hard labour and various privations in the lower orders" SPECIES IV. PARAMENIA ERRORIS. Etfcartous Menstruation. catamenia transferred to, and excreted at remote organs. We have already observed upon the extensive sympathy which the sexual organs maintain with every other part of the system. With the exception of the stomach, whicli is the grand centre of sympa- thetic action, there is no organ, or set of organs, possessed of any thing like so wide an influence. And hence, where, from any particular circumstance, as sudden fright or cold, the mouths of the menstrual vessels become spasmodically constricted at the period of menstruation, and the fluid is not thrown forth, almost every organ seems ready to offer it a vicarious outlet. We have accounts, therefore, of its having been discharged, by substitution, from the 46 GENETICA. [CL# v'*~OR' L eyes, the nostrils, the sockets of the teeth, the ears, the nipples, jhe stomach, the rectum, the bladder, the navel, and the skin ^?e™u* as noticed more fully in the volume of Nosology to which tne reader may turn at his leisure. , In effect, there is scarcely an organ of the body from which it has not been discharged under different circumstances.* In tn« ^m- burgh Medical Essays is a very singular case of "tefi^ thrown forth from an ulcer in the ancle of a young woman little more than twenty years of age, and which continued to flow at monthly periods, for two of 'three days at a time, for about five years after which, some part of the bone having separated in acanous state, the ulcer assuming a more healthy appearance, and the body becoming plumper and stronger, the vicarious outlet was no longer needed, and the menstrual tide returned to its proper channeLT In all these cases there is a considerable degree of uterine torpi- tude, and commonly of general debility : while the part forming the temporary outlet is in a state of high irritability or other diseased action. And hence the remedial process should consist in allaying the remote irritation, strengthening the system generally, and gradually stimulating the uterus to a state of healthy excitement by the means already recommended. SPECIES V. PARAMENIA CESSATIONS. Krresulatr ©cssatum of the flenses. catamenial flux irregular at the term of its natural cessation ; occasionally accompanied with svmptoms of dropsy, glandular TUMOURS, or spurious pregnanoy. The set of organs that are most tardily completed and soonest ex- hausted are those of the sexual system. They arrive latest at per- fection and are the first to become worn out and decrepit. In this early progress to superannuation the secretory vessels of the uterus grow torpid, and, by degrees, the catamenial rlux ceases. This cessation, however, has sometimes been protracted to a very late period, and, in a few rare instances, the menses have continued * Eph. Nat. Cur. passim. Act. Nat. Cur. Act. Med. Berol. Bertholin. Obs. passim. Cent, passim. Pechlin, Lib. I. passim. Bierling. Thes. Pract. Sennertus, Pract. et Paralip. Lib. iv. t Art, by Mr. James Calder, Vol. III. Art. xxix. p. 341. GE. I.-SP. V.j SEXUAL FUNCTION. 4/ nearly, or altogether, through the whole term of life : we have ex- amples of it, noticed in the volume of Nosology, at seventy, eighty, and even ninety years of age ; but the usual term is between forty and fifty, except where women marry late in life, in which case, from the postponement of the generative orgasm, they will, occa- sionally, breed beyond their fiftieth year. On approaching the na- tural term of the cessation of the menses, the sexual organs do not always appear to act in perfect harmony with each other, and per- haps, at times, not even every part of the same organ with every other part. In proof of the first remark, we seem, occasionally, to meet with a lingering excitement in the ovaria, after all ex- citement has ceased in the uterus: and we have hence a kind of conceptive stimulation, a physcony of the abdomen, accompanied with peculiar feelings, and peculiar cravings, which mimic those of pregnancy, and give the individual room to believe she is really pregnant, and the more so in consequence of the cessation of her lunar discharge, while the uterus takes no part in the process, or merely that of sympathetic irritation, without any change in size or structure. On the contrary, we may chance to find the uterus itself chiefly, if not solely affected with irregular action at this period : evincing, sometimes a suppression of menstruation for several months, some- times a profuse discharge at the proper period, and sometimes a smaller discharge returning every ten or twelve days, often suc- ceeded by leucorrhcea. And not unfrequently the system associates generally in the misaffection, and suffers from oppression, head- ache, nausea, or universal languor. All these are cases that require rather to be carefully watched, than vigorously practised upon ; and the character of an expectant physician, as the French denominate it, is the whole that is called for. The prime object should be to quiet irregular local irritation wherever necessary, by gentle laxatives, moderate opiates, or other narcotics, and to prevent any incidental stimulus, mental emotion, or any other cause, from interfering with the natural inertness into which the sexual system is progressively sinking. Hence the diet should be nutritive but plain ; the exercise moderate ; and costive- ness prevented by lenient, but not cold eccoproctics: aloes, though most usually had recourse to, from its pungency, in earlier life, is one of the worst medicines we can employ at this period, as the Epsom salts, warmed with any pleasant aromatic, is, perhaps, one of the best. if the constitution be vigorous and plethoric, and particularly if the head feel oppressed and vertiginous, six or seven ounces of blood may, at first, be taken from the arm; but it is a practice we should avoid if possible, from the danger of its being necessarily resorted to again, and at length running into an inconvenient and debilitating habit. The mammae that constantly associate in the changes of the ute- rus and constitute a direct part of the sexual system, are at this 48 GENETICA. [CL. V.-OR. I. time, also, not unfrequently in a state of considerable irritation ; and if a cancerous diathesis be lurking in the constitution, such irritation is often found sufficient to excite it into action. And hence, the pe- riod before us is that in which cancers of the breast most frequently show themselves. From the natural paresis into which this important and active system is hereby thrown, a certain surplus of sensorial power seems to be let loose upon the system, which operates in various ways. The ordinary and most favourable mode is that of expending itself upon the adipose membrane generally, in consequence of which a larger portion of animal oil is poured forth, and the body becomes plump and corpulent. The most unfavourable, next to the excite- ment of a cancerous diathesis into action, is that of irritating some neighbouring organ, as the spleen, or liver, and thus working up a distressing parabysma or visceral turgescence; or deranging the order of the stomach, and laying a foundation for dyspepsy. GENUS II. LEUCORRHCEA. Wnftes. MUCOUS DISCHARGE FROM THE VAGINA, COMMONLY WITHOUT INFECTION ' DISAPPEARING DURING MENSTRUATION. The term leucorrhoea from xtvuctt " white," and pur, " to flow," is apparently of modern origin ; as it is not to be found in either the Greek or Roman writers; and seems first to have been met with in Bonet or Castellus. This is the menorrhagia alba of Dr. Cullen, so denominated be- cause he conceives the evacuation to flow from the same vessels as the catamenia ; as also that it is often joined with menorrhagia or succeeds to it. Its source, however, is yet a point of dispute :* Stolljt Pinasus, and various other distinguished writers have ascribed it, like Cullen, to the uterus. But as it occurs often in great abundance in pregnant women, in girls of seven, eight, and nine years of age,J and even in infants, it has been supposed by Wedel 6 and mdst writers of the present day, to flow from the internal sur- * Rat. Med. P. vn. p. 155. ^ t De Notis Virginitatis. Lib. i. Prob. 3. $ Heister, Wahrnemungen, B. n. N. 128. Hoechstatter, Obs. Med. Dec. iv. Cas. i. Schol. »fl t ) Diss. De Fluore albo. Jen. 1743. WE. II.-SP. I.J SEXUAL FUNCTION. 49 face of the vagina, or at the utmost, from the vagina jointly with the cervix of the uterus. Morgagni is, perhaps, most correct, who conceives, and appears, indeed, to have proved by dissections, that, in different cases, the morbid secretion issues from both organs; for he has sometimes found the uterus exhibiting in its internal surface whitish tubercles, tumid vessels, or some other diseased indication, and sometimes the vagina, during the prevalence of this malady.* In the case narrated by Mr. Hill, of Dumfries, and noticed under (he preceding genus, it was evidently confined to the vagina aione.t From its frequency in Sweden, Riedlin conjectures it to be en- demic there :J but this can hardly be allowed, and there are more obvious causes to which such frequency may be referred. When first secreted it is bland and whitish, but differs in colour and quality under different circumstances, and hence affords the three following species: 1. LEUCORRHffiA COMMUNIS. COMMON WHITES. 2. NABOTHI. LABOUrt-SHOW. 3. -----------SF.NESCENTIUM. WHITES OF ADVANCED LIFE. SPECIES I. LEUCORRHCEA COMMUNIS. <£ommou «E©httrs. THE DISCHARGE OF A YELLOWISH-WHITE COLOUR, VERGING TO GREEN. This species is the fluor albus of most writers. It is found in girls antecedently to menstruation, or on any simple local irritation in the middle of life, and hence also, as just observed, during preg- nancy. It is said in the Berlin Transactions to be occasionally con- tagious :§ and I have met with various cases which seem to justify this remark. It has occurred as the result of suppressed menstruation: as it is said also to have done on a suppressed catarrh ;|| and dullness or sup- pressed perspiration of the feet.lF Local irritations moreover are * De Sed. et Caus. Morb. Ep. xi.vii. Art. 12. 14. 16, 17, 18, 19. 27. Ep. i.xvil. Art. 14. t Edinb. Med. Comment, iv. p. 91. $ Lin. Med. 1695. p. 164. ♦ Act. Med. Berol. Dec. i. Vol. v. p. 85. || Act. Erud. Lips. 1709, p. 376. Raulin, Sur les Fleurs blanches, p. 329. If Act. Nat. Cur. V,.'. vjii. Obs. 38. VOL. IV. 7 50 GENETICA. [CL. V.—OR. 1. frequent cause. And hence one reason of its being an occasional concomitant of pregnancy; as also of its being produced by pes- saries injudiciously employed, by voluptuous excitements, and un- cleanliness. It is said at times to exist as a metastasis, and particu- larly to appear on a sudden failure of milk during the period of lac- tation ; a failure which may be set down to the list of suppressed discharges.* Jensen gives a singular case of leucorrhcea that al- ternated with a pituitous cough.f It is usually accompanied with a sense of languor, and a weak- ness or pain in the back. And if it become chronic, or of long con- tinuance, the countenance looks pale and unhealthy, the stomach is troubled with symptoms of indigestion, the skin is dry and feverish, and the feet edematous. The discharge, in its mildest form, is slimy, nearly colourless, or of an opaline hue, and unaccompanied with local irritation. It af- terwards becomes more opake and muculent, and is accompanied with a sense of heat, and itching or smarting; in this stage it is of a yellowish-white. But as the disease advances in degree it ap- pears greenish, thinner, more acrid, and highly offensive, and is apt to excoriate the whole surface of the vagina: while there is often a considerable degree of pain in the uterus itself and even in the loins. Among novices there is some difficulty in distinguishing the dis-. charge of whites from that of blenorrhcea, which we shall describe presently. But though the appearance of the two fluids is often similar, they may easily be known by their accompanying signs. In blenorrhcea there is local irritation from the first, and this irrita- tion extends through a considerable part of the meatus urinarius, so as to produce a considerable pain in making water; symptoms which are not found in leucorrhcea. There is also from the first in the former a swelling of the labia, a more regular though a smaller secretion, and of a more purulent appearance. When the disease is violent, or of long continuance, it leads to great general as well as local debility, so as in some instances to make sad inroads on the strength of the constitution. It has some- times been followed by a prolapse of the uterus or vagina ;t by abortion or miscarriage, where there is pregnancy; and by barren- ness, where no pregnancy has occurred. When it acts on the sys- tem at large, it has given rise to cutaneous eruptions of various kinds ;§ and is said to have introduced tabes and hectic fever,, scirrhus, and cancer.IT The cure.is often difficult: but it is of no small importance to be, * Astiuc, De Morb. Mulier. Lib. i. cap. 10. t Prod. Act. Havn. p. 160. $ Boehman, Diss, de Prolapsu et Inversione Uteri. Hal. 1745. G Klein, Interpres Clinicus. p. 112. || Hippocr. Aph. Sect. v. "M Raulin, Sur les Fleurs blanches. Tom. I. passim. GE. U.-rSP. I.] SEXUAL FUNCTION. 51 from the first fully acquainted with the nature of its cause and cha- racter, for the proper means to be pursued will mainly depend upon this. And hence it will often be necessary to examine the or- gans themselves, or to entrust the examination to a nurse on whose judgment we can fully depend. If the cause be uncleanliness, a lodgment of some portion of a late menstrual flux, or any other acuating material in the vagina, nothing more may be necessary than frequent injections of warm water: or if the vagina itself be much irritated, injections of the diluted solution of the acetate of lead : which last will often indeed be found highly serviceable where the discharge proceeds from de- bility and relaxation produced by a severe labour or miscarriage, forming no uncommon causes : as they are also no uncommon ef- fects. Other astringent injections have often been tried, as green tea, a solution of alum, or sulphate of zinc, a decoction of pomegranate' bark, or a solution of catechu. All these are sure to be of service as tending to wash away the discharge, and keep the parts clean ; and in many cases they will also succeed as astringents : nor is it always easy to determine which is to be preferred, for in some cases one answers the purpose best, and in others another. Sir Kenelm Digby recommended a local application of the fume of sulphur,* which may be communicated in various ways; and so far as this has a tendency to change the nature of the morbid ac- tion, by originating a new excitement, it is worthy of attention ; but perhaps the diluted aqua-regia bath, of which we have spoken under spasmodic jaundice,! may prove more advantageous. The disease, however, is often highly troublesome and obstinate, and hence it has been necessary to employ constitutional as well as local means. The general remedies that have been had recourse to are almost innumerable. Acids have been taken internally in as concentrated a state as possible, but rarely with much success. The sulphuric- acid has been chiefly depended upon: and, in the form of the eau de Rabel, which is that of digesting one part to three of spirit of wine, it was at one period supposed to be almost a specific. The compound, however, has not been able to maintain its reputation, and has long sunk into disuse. Emetics have been found more useful, as operating by revulsion and stimulating the system generally: and on this ground a sea- voyage accompanied with sea-sickness has often effected a cure. Stimulating the bowels, and particularly in the commencement of the disease, and where the general strength has not been much encroached upon, has for the same reason been frequently found useful, as transferring the irritation to a neighbouring organ, and under a more manageable form. And one of the best stimulants for * Medic. Experiment, p. 65. t Medic. Experiment, Vol. I. p. 380. 52 GENETICA. [CL. V.-OR. I. this purpose is sulphate of magnesia. Small doses of calomel n^v^ been given daily with the same view, but they have not succeeded in general. Heister, however, recommended mercury in this dis- ease even to the extent of salivation ;* yet this is a very doubtful remedy, and even under the best issue purchases success at a very dear rate. A spontaneous salivation has sometimes indeed effected a cure ;t but this is a very different affair, for here the blood is not broken down into a dilute state, nor the general strength interfered with. Mr. John Hunter, with a view of changing the nature of the morbid action in its own field, advised mercurial inunctions in the vagina itself. Other stimulants have been recommended that operate more generally, and have a peculiar tendency to influence the secretion of mucous membranes, as the terebinthinate preparations, particu- larly camphor, balsam of copaiva, and turpentine itself: and there is reason to believe that the second of these has often been useful. It has sometimes been employed in combination with tincture of cantharides: but the latter is, in most instances, too irritating, whether made use of alone, or with any other medicine. As the acids have not succeeded, neither have other astringents to any great extent. The argentina or wild tansy (Potentilla anserina, Linn.) was at one time in high favour; it was particularly recommended by M. Tour efoot, and, upon his recommendation, very generally adopted. Alum has been supported by a still greater number of advocates for its use; and kino has, perhaps, been employed quite as extensively. Dr. Cullen asserts that he has tried all these alone without success, but that by uniting kino and alum, as in the pulvis stypticus of the Edinburgh College, he obtained not only a most powerful astringent, but one that had occasionally proved serviceable in the present disease. The anserina has justly sunk into oblivion. Upon the whole, the best general treatment we can recommend is a use of the metallic tonics, and especially zinc and iron, in conjunction with a generous but temperate diet, exercise that produces no fatigue, pure air, and change of air, cold bathing. regular and early hours, and especially a course of the mineral waters of Tunbridge or Cheltenham. * Wahrnemungen. Band. 11. t Eph. Nat. Cur. Dec. w. Ann. ix. x. Obs. 140. CE. II.-SP. II.] SEXUAL FUNCTION. 53 SPECIES II. LEUCORRHCEA NABOTHI. aaoour-siioto. THE DISCHARGE SLIMY, AND MOSTLY TINGED WITH BLOOD. In this species the fluid is secreted by the glandulae Nabothi situate on the mouth of the uterus, whence the specific name. It is the leucorrhoea Nabothi of Sauvages, and the hsemorrhagia Nabothi of Cullen. It is most usually found as the harbinger of labour: and indicates that the irritation which stimulates the uterus to spas- modic and expulsory contractions, when the full term of pregnancy has been completed, or some aCcident has hurried forward the process, has now commenced, and that the pains of child-birth may be expected soon. It is probably nothing more than the usual fluid secreted by the glands from which it flows, augmented in quantity in consequence of temporary excitement, and mixed with a small quantity of blood thrown forth at the same time, and from the same cause, by the mouths of the exhalants which gives it, soon after its first appearance, a sanguineous hue. It is hardly entitled to the name of a haemorrhage, as given by Dr. Cullen, though blood from the uterus often succeeds to it, apparently thrown forth by anasto- mosis, in consequence of the violence of the pains. In its ordinary occurrence it is only worthy of notice, as a deviation from the common secretions of health, and is rather to be hailed than to become a subject of cure or removal. But there is a state of irritation to which these glands are sometimes subject that produces the same discharge, and in considerable abundance, for many weeks or months before labour, and which, for the comfort of the patient, requires a little medical advice and attention. The irritation may proceed from plethora and distension, or from a weak or relaxed state of the constitution. If from the former, venesection and gentle laxatives will prove the best course we can pursue : if from the latter, a reclined position, easy intestinal evacuations, and such sedatives as may sit most pleasantly on the stomach, and produce least disturbance to the head. 54 GENETICA. [CL. V.-OR I. SPECIES III. LEUCORRHCEA SENESCENTIUM. OTftttcs of afcoanccU 2U'fc. THE DISCHARGE THIN, ACRID, FREQUENTLY EXCORIATING AND FETID. This is usually, but not always, connected with a morbid state of the uterus. It commonly shows itself on the cessation of the menses : and is often chronic and obstinate. The more common diseases of the uterus with which the discharge is combined are an incipient cancer, or a polypous fungus. But I have occasionally met with it unconnected with either, and appa- rently dependent upon a peculiar and chronic irritability of the uterus, or rather perhaps of those glands which secrete the fluid that is poured forth during the act of sexual intercourse. A lady about forty years of age, not long ago applied to me, who had for more than a twelvemonth been labouring under a very distressing case of this kind. She had been married from an early period of life, but had never been pregnant. Her general health was good, her temper easy, her imagination peculiarly warm and vivid. She had no local pain, and had ceased to menstruate at the age of about thirty-eight. The discharge at the time I first saw her consisted of at least from a quarter to half-a-pint daily ;—thick, slimy, brownish, and highly offensive. Every external and internal remedy that could be thought of appeared to be of only temporary avail, and sometimes of no avail whatever, though she certainly derived relief from injections of the punica Granatum, with a fourth part port wine, which for some time checked the discharge, and diminished the fetor. In the mean time, the general strength was preyed upon, the loins became full of pain, the appetite failed, and the sleep was disturbed. Accidental circumstances compelled her, even in this debilitated state, to undertake a voyage to India. During its progress she suffered severely from sea-sickness; but the change hereby produced, or effected by the warmth of the climate, proved peculiarly salutary : for she gradually lost the complaint, and reco- vered her usual health. Emetics, change of climate, and the tonic plan already recom- mended under the first species, seem, hence, to be the best course we can pursue in the species before us. 6E. HI.] SEXUAL FUNCTION. 5.3 GENUS III. BLENORRHCEA. CKonorrfioca. ML'CCLKNT DISCHARGE FROM THE URETHRA, OR VAGINA ; GENERALLY WITH LOCAL IRRITATION AND DYSURY; NOT DISAPPEARING DURING MENSTRU- ATION. Blenorrhosa is a Greek compound of modern writers, derived from Cae»v«, " mucus," and ft*, " to flow." Sauvages, and after him Cul- len, have employed gonorrhoea from y«»««, u semen," and ft*, as a common term for this and spermorrhoza constituting the ensuing genus, and consisting in an evacuation of semen. Cullen, indeed, has extended the term still further in his First Lines, and hence morbid secretion of mucus, all kinds of venereal contagion, and se- minal flux, are equally arranged as species of the same generic dis- ease ; and this too under a word which imports the last alone. While, to add to the confusion, this very word, in its vulgar sense, is restrained to venereal contagion, which, in its strict meaning, that of seminal flux, it signifies just as much as it does abortion or stone in the bladder. It is high time to make a distinction, and to di- vide the list of Sauvages into two genera. Blenorrhoea has, indeed, been already employed of late by various writers to de- note the first of these genera, and there is no necessity for chang- ing the term. The genus under Miiller,* is subdivided into numerous spe- cies : but the three following include the whole that fairly belong to it: 1. BLENORRHCEA SIMPLEX. SIMPLE URETHRAL RUNNING. 2. ----------- LUODES. CLAP. 3.-----------CHRONICA. GLEET. * Miiller, Medic. Wochenblatt, 1734. N. 51, plures species. 56 GENETICA. [CL. V.-OR. I- SPECIES I. BLENORRHCEA SIMPLEX. Simple WLvtthval Stunning. SIMPLE INCREASED SECRETION FROM THE MUCOUS GLANDS OF THE URE- THRA. This definition is given in the words of Dr. Fordyce, and is suffi- ciently clear and expressive. In effect, the efflux proceeds from mere local irritation, unaccompanied by contagion, or virulence of any kind, and is chiefly found in persons in whom the affected or- gan is in a state of debility ; the occasional causes of irritation be- ing venereal excess, too large an indulgence in spirituous liquors, cold, topical inflammation, too frequent purging, violent exercise on horseback, to which various authors add transferred rheumatic action ;* and occasionally, according to Mr. John Hunter, transfer- red irritation of the teeth.f The matter discharged is whitish and mild, producing no exco- riation, pain in micturition, or other disquiet. It is the mild go- norrhoea of many writers, the gonorrhoea pura of Dr. Cullen; and usually yields without difficulty to rest, emollient injections, and very gentle and cooling purgatives. SPECIES II. BLENORRHCEA LUODES. E\l AL FUNCTION. 73 SPECIES V. GALACTIA YIRORUM. *HtUt=floto in ,$tf alea. MILK SECRETED l.\ MALES AND IH^CHAROED FROM THE PROPER EMIWC- TORY. A milky scrum, and sometimes genuine milk has been found to distil from the nipples of new-born infants, of both sexes, and sometimes from boys of a later age. But various authors, as Schb'lk, P. Borelli, and Lauremberg have given cases of genuine milk discharged in like maimer by adult males ; occasionally continuing for a long time : and, in some instances, enabling them to perform the office of nurses. In the Commentaries of the St. Petersburg Academy,* a flow of milk from the breasts of males, is said to be very common in Russia: and Blumenbach has noticed the same peculiarity in the males of various other mammals.! Among men, indeed, the dis- charge appears occasionally to have occurred even in advanced life ; for Paullini gives the case of a man, who was able to suckle at the age of sixty.J Why man should, in every instance, possess the same organiza- tion as woman for secreting and conveying milk, is among the many mysteries of physiology that yet remain to be solved. But as there is little or no sympathy between the mammae in man and any of the proper organs of generation, as in women, we are at no loss to ac- count for their general sterility and want of action. Occasionally, however, the lacteal glands in man, or the minute tubes which emerge from them are more than ordinarily irritable, and throw forth some portion of their proper fluid. And if this irritation be encouraged and supported, there is no reason why such persons may not become wet-nurses as well as females. And hence, Dr. Parr inquires, with some degree of quaintness, whether this organization is allotted to both sexes, in order that " in cases of necessity men should be able to supply the office of the woman ?" Under these circumstances, the discharge, though unquestionably a deviation from the ordinary law of nature, can scarcely be regarded as a dis- ease. * Tom. in. p. 278. + Hanoversich Magazin, 1707 % Cent. II. Obs. 93. Schacker, Diss, de lacte Virorum et Virginum. VOL. iv. 10 CLASS V. GENETICA, ORDER 11. ORGASTICA mmamn averting the #rsasm. ORGANIC OR CONSTITUTIONAL INFIRMITi, DISORDERING THE POWER, OR THE DESIRE OF PROCREATING. The ordinal term orgastica, is derived from ofyxv i; appeto impa- tienter; proprie de animantibus dicitur, quae turgent libidine. Sca- pul. Orgasmus is, hence, used by most writers for salacity in gene- ral ; though by Linneus it is employed in a very different sense, being restrained to subsultus arteriarum. The following are the genera which appertain to this order: 1. CHLOROSIS. II. PROSOTIA. III. LAGNESIS. IV. AGENESIA. V. APHORIA. VI. .EDOPTOSIS. GREEN-SICKNEf-S. GENITAL PRECOCITY. LUST. MALE STERILITY. FEMALE STERILITY. GENITAL PROLAPSE. BARRENNESS GENUS I. CHLOROSIS. CKreen=Sicnne»8 PALE, CHLORID COMPLEXION ; LANGUOR ; LISTLESSNESS ; DEPRAVED APPETITE AND DIGESTION : THE SEXUAL SECRETIONS DEPRAVED OR INERT, ESPECIALLY AT THEIR COMMENCEMENT. Chlorosis is a derivative from ^Ao* or ^a«» " herba virens;" whence, among the Greeks, y^utxw^x and xA*>£/«r<$ " viror," " pal- GE. I.] SEXUAL FUNCTION /«') lor;" evidently applied to the disease, like our own term green- sickness, from the pale, lurid, and greenish cast of the skin. The causes of this disorder are numerous: one of the most frequent is menostration, retained or suppressed catamenia ; another is excessive menstruation; a third, inability of obtaining the object of desire, in popular terms love-sickness : a fourth is dyspepsy, or any other source of general debility about the age of puberty, by which the natural developement of the sexual system and the energy of its secretions is at this time interfered with. Dr. Parr makes it a question whether love-sickness or an ungrafified longing for an object of desire is ever a cause ; but the examples are too mmerous to give countenance to any doubts upon the subject;* and pining, eager, unratified desire for any object whatever, in a particular state of constitution, whether for an individual or for a particular circle of society, for home or for country, is well known in many cases to break down the general health, and to lay a foun- dation for chlorosis, as well as many other complaints even of a severer kind. We have already noticed it as producing suppressed menstruation; as we have also the opposite state of disappointment overcome, renewed hope, and a prospect of connubial happiness, as one of the best and speediest means of cure. Perhaps retained menses, and dyspepsy at the period of puberty, are the most common causes ; and hence chlorosis makes so near an approach to both these complaint?, that some nosologists have merg- ed it altogether in the first, and' others in the second. Dr. Cullen so far as relates to his opinion, is an example of the former. Dr. Young, so far as relates to his arrangement, of the latter. It is necessary to attend to this limitation : for while Dr. Cullen, in the later editions of his Synopsis, asserts " nullam chlorosis speciem veram, praeter illam quae retentionem menstruorum comitatur, ag- noscere vellem"—he still continues chlorosis in all the editions of this work as a distinct genus from amenorrhoea, or paramenia obstructionis, of which upon this view of the subject it should be only a species or variety. In the same manner, Dr. Young, while he makes chlorosis a mere species of dyspepsia in his classification, observes, as though dissatisfied with its arrangement, " I have followed a prevalent opinion, but there are various reasons for thinking it is quite as naturally connected with amenorrhoea." Chlorosis is often, indeed, not only connected with amenorrhoea, but a consequence of it. Yet few writers have felt themselves able to adopt Dr Cullen's views upon the subject, and to believe it in every instance a modification of this disease. Sauvages asserts that there are daily cases of chlorosis occurring among children from their cradles; and he has hence, among his chloroses verm., set down one species under the name of chlorosis infantum. This, however, is to generalize the term too widely, and to make it * PanareL Jatrolog. Pentech. in. Obs. 14. Ephem. JVat. Cur. Dec. n. Aun. IX. Obs. 114. 76 GENETICA. [CL. V.-OR. II. include all cases marked by indigestion, and a chlorid countenance. Yet I cannot but concur with those authors who contend that chlorosis is by no means uncommon among females who have no interruption of the menstrual flux ; though a derangement of some kind or other in quantity, quality, or constituent principles appears to be always connected with it; and is for the most part the cause or leading symptom. There is even ground for carrying the term, with other authors, still further, and applying it to green-sick boys as well as green-sick girls, for reasons which will be offered in their proper place. For the present, it is sufficient to characterize chlorosis as a dysthesis or cachexy, produced by a diseased condition of the sexual functions operating upon the system at large, and hence most com- mon to the age of puberty, in which this function is first called forth by the complete elaboration of organs that have hitherto been inert and undeveloped. "A certain state of the genitals," says Dr. Cullen, " and the remark will apply to both sexes equally, is neces- sary to give tone and tension to the whole system; and, therefore, that if the stimulus arising from the genitals be wanting, the whole system may fall into a torpid and flaccid state, and from thence chlorosis may arise." The genus chlorosis offers the two following species: 1. CHLOROSIS ENTONICA. ENTONIC GREEN-SICKNE?^. 2.---------ATONICA. ATONIC GREFN-SICKNE-" SPECIES L CHLOROSIS ENTONICA. 25ntonic ®freen=Sicftnej8s HABIT PLETHORIC ; PAIN IN THE HEAD, BACK, OR LOINS ; FREQUENT PALPITATIONS AT THE HEART ; FLUSHES IN THE FACE ; PULSE FULL, TENSE, AND FREQUENT. Chlorosis has been commonly confined to the second or atonic species. But the symptoms and mode of treatment of the disease, as it appears in a vigorous, florid, and full-bosomed country-girl overflowing with health and hilarity; and in a delicate, pale-faced, emaciated town-girl, debilitated by an indulgence in a course of luxurious indolence from her infancy, seem to justify and even demand a distinction. In both cases there is a want of energy of mind, great irregularity in the mental functions, and often a high degree of irritability in the nervous system, clearly proving a very extensive disturbance of the GE. I.-SP. I.] >EXUAL 11 NOTION. 77 general balance. But they differ in the symptoms enumerated in the definitions, than which no two sets can well be more at variance. They differ also in the remote and proximate causes, and conse- quently in the mode of treatment. In the species before us, characterized by a rich and oppilated habit, with a full and tense pulse, and pressive pains in the head or loins, the ordinary causes are catching cold in the feet at the period of the catamenial discharge, by which the constitutional plethora is considerably aggravated, and the plethoric excess itself even where no cold has been received. The pains so common and often so severe in the back and loins, and from sympathy, not unfrequently in other parts, evince local irritability with entastic spasm in the organs which form the seat of the disease. There is here a mor- bid accumulation of living power: the fabric is satiated or over- loaded ; and for the very reason that in dyspermia entonica or super-erection, as we shall have occasion to observe presently, there is no seminal emission, or as in double-flowering parts there is no efficient devclopement of the sexual distinctions, in the present case there is no efficient secretion of the genital fluids. And as we have shown in the Physiological Proem to the present order, that the ma- turity of the system in females as well as in males, depends upon a developemcnt of the sexual organization in all its powers, and a cer- tain degree of resorption of its secreted materials, the general frame, how rich soever and even oppressed with juices of other kinds, must remain incomplete and unripened, and sicken at the time of matu- rity for want of this appropriate stimulus. And if such an effect may occur where there is no concomitant source of excitement, we can easily conceive how much more readily it may take place upon catching cold in the feet, or on a sudden and violent mental emotion, or any other cause that may accidentally add to the pressive irrita- tion of the organs immediately affected, and increase their tendency to spasmodic action. Yet there can be no doubt that the species before us, though the offspring of a redundancy of living power, if neglected, or obstinate, and of long continuance, may, and often does, by debilitating the constitution, terminate in the atonic species we shall presently enter upon. Before such a change, however, takes place, and particularly in the commencement of the disease, we are loudly called upon for general depletion. Copious, and not unfrequently repeated vene- sections will be found necessary : cooling, rather than beating and irritant purgatives should be interposed ; and where pain about the lumbar region, or any other local irritation, is very troublesome, the hip-bath, or a general warm-bath should be used steadily. And when, by this plan, the sanguiferous entony is suLdued, a plain diet, regular exercise, and sober hours, will easily accomplish the rest. 78 GENETICA. [CL. V.-OR. II. SPECIES II. CHLOROSIS ATONICA. atonic ^frecn^Sicfeness. HABIT DEBIIITATED; GREAT INACTIVITY AND LOVE OF INDULGENCE; DYS- PNOEA ON MOVING ; LOWER LIMBS COLD AND EDEMATOUS, ESPECIALLY AT NIGHT ; FULSE QUICK AND FEEBLE. In conjunction with the above specific symptoms, there is. in this division of the disease, the same want of energy of mind, and fickle- ness of temper, and corporeal irritability which we have already noticed in the preceding, and this too in a much greater degree; abundantly proving a very extensive disturbance of the general balance. For examples of this species we are to look not into the quiet and sober retreats of rural life, marked by simple meals, healthful acti- vity, and early hours; but to the gay and glittering routine of town indulgences, and midnight parties, and hot unventilated atmospheres; the havoc of all which is to be seen in the pale, but bloated counte- nance, the withering form, emaciated muscles, and departing sym- metry of those who are the victims of a life of pleasure ; and who, in consequence of their turning night into day, are exhausted, and drowsy, and spiritless, and perhaps confined to their beds all the morning; thus carrying on the inversion of nature, and turning in like manner, the day into night. , Under a life of this kind, it is impossible for a growing girl to acquire a healthy maturity : and most happy is it for her that the caprice of fashion, which calls upon her to make this heavy sacri- fice of her person for one half of the year, drives her, in most cases. into the freshening shades and soberer manners of the country for the other half. There are other girls, however, who without these peculiar sources of exhaustion, have so much constitutional debility and rer laxation, as to be incapable of bearing the double load of growth and sexual developement without manifesting a considerable degree of sickliness in all their functions. In both these cases, the disease is probably produced by a che- mical imperfection or want of elaboration in the blood itself, so as not to keep pace with the expansion and irritability of the ^e\ual organs ; and consequently so as not to afford them a pabulum suffi- ciently rich and ripe for secretion. Here, therefore, bleeding and purgatives would only add/to the evil; and it behoves us even from the first to employ a strengthen- ing and tonic plan, and to extend it through all the departments of diet, exercise, and medicine : the whole of which, however, mav be GE. I.-SP. II.] SEXUAL FUNCTION. 79 collected from what has already been observed on the genus para- menia. The same kind of debility which prevents the full developement of the sexual organization and a secretion of the sexual juices in growing girls, prevails, not unfrequently, in growing boys, and espe- cially when about the age of puberty the growth is rapid, and out- runs the general strength of the system. And it is to this state I alluded when observing a page or two back, that the term chlorosis has occasionally been applied to males as well as to females at this unsettled period of life. In the volume of Nosology I have remark- ed that it is frequently so applied in the East, and especially among Persian writers, who accordingly express one subdivision of the disease by the name of bimariy kodek or morbus puerorum. Bonet has followed the oriental extension of the term, and has given in- stances of its occurring not only in pubescent but even adult males: and, in like manner, Sir Gilbert Blane in his table of diseases, under the article chlorosis, observes that one of his patients affected with this complaint " was a male of seventeen, who had all the charac- ters of this malady except that which is peculiar to the female sex. He was treated like the others, and recovered under the use of carbonated iron and aloes."* It is on this account that the defini- tion of chlorosis will be found, in the present work, to vary in some degree from all that have preceded it, so as to render its characters capable of embracing the male as well as the female form of the disease, which unquestionably ought to be included under it: and is to be attacked by the same remedial plan. GENUS II. PRCEOTIA. (Kenital ftrerotitg. t REMATURE DEVELOPEMENT OF SEXUAL ORGANIZATION OR POWER. The generic term proeotia or proeotes is copied from Theophras- tus, and derived from *■{*<, " premature." It is, however, pecu- liarly applied to premature semination. The genus, us embracing both sexes, comprises the two follow- ing species: 1. PROEOTIA MASCULINA. MALE PRECOCITY. 2. ———— FEM1WINA. FEMALE PRECOCITY. * Medico-Chir. Trans. Vol. IV. p. 140. 8U • iE.N'ETICA. [CL. V.-OR. II. SPECIES I. PRCEOTIA MASCULINA. $lzir $reeocitg. PREMATURE DEVELOPEMENT OF SEXUAL ORGANIZATION IN MALES. Both the mind and body advance in their ordinary career, by slow and almost imperceptible steps to maturity; faculty after faculty, and function after function puts forth, acquires strength, and be- comes perfected. But it occasionally happens that this ordinary course is departed from, and that the whole system as well mental as corporeal, or, which is still more frequent, that particular powers or organs, push forward with incredible rapidity. The admirable Crichton, as he is commonly called, and others pre-eminently gifted in the same extensive way, afford instances of the first of these re- marks : and those who, in early and even in infant life, have shown a peculiar aptitude for an acquisition of languages, or of music, or numerical arithmetic, give examples of the last kind. It is not hence much to be wondered at that a like extraordinary precocity should sometimes exhibit itself in the developement of sexual organization and power: and that from a peculiar degree of local irritation or erethism, the pubes should be found covered with hair, the testes be formed and capable of secreting a seminal fluid, and the penis be susceptible of a concupiscent turgescence and erec- tion. It is not necessary to dwell upon instances of exemplification, which may be traced in great numbers in the writings of physiologists who have been curious upon the subject. Those who are desirous of doing so, may turn to the Journal des Scavans for 1688, and the Philosophical Transactions for 1745. In the formerBioset, gives an instance of this disgusting anticipation in a boy of three years old ; in the latter, the subject in the case recorded was two years and eleven months. A similar example at a similar age is well known to have occurred, only a few years since, in a boy who was exhibit- ed by his friends for money to medical practitioners in this metro- polis ; and may be found, together with various others, minutely described in the first volume of the Medico-Chirurgical Transac- tions. With respect to moral, or even medical treatment, nothing can be worse than this very common practice of a public exposure whenever the case occurs among the poor, who are so strongly tempted to make a profit of it. The orgasm is fed by a repetition of examinations, and the polluting tide that exhausts and debases the body, is at length accompanied, even though it should not be so ■M first, with a polluting pleasure, that in a still greater degree ex- • GE. 11.-SP. I.] SEXUAL FUNCTION. ttl hausts and debases the mind. An occasional application of leeches to the seat of affection, cooling aperients, a cool, loose, and unirri- tating lower dress, with the daily use of a bidet of cold water, or iced water, will form the best plan that can be pursued on such oc- casions : and, by producing a healthful repression, may enable the unhappy infant to grow up with gradual vigour to the possession of a hearty manhood, instead of sinking, as has been sometimes the case, into a premature and tabid old age at the early period of pu- bertv. SPECIES II. PRCEOTIA FEMININA iFemale $recocitg. PREMATURE DEVELOPEMENT OF SEXUAL ORGANIZATION IN FEMALES. Under the species of obstructed menstruation, we have observed that this secretion which commonly affords a proof that the sex- ual organization is developed, and its function completed, takes place at very different periods of life under different circumstances, chiefly those of climate and peculiarity of constitution: and that though its ordinary epoch is that of thirteen or fourteen, it has sometimes, under the influence of a tropical sun, or a warm and forward temperament, shown itself as early as eight or nine years of age.* There is hence no difficulty in conceiving that, under the influ- ence of the same kind of local erethism we have noticed in the preceding species, the sexual organization in females may acquire a similar precocity to that in males. And so complete has been the developement occasionally, that we have numerous and well authen- ticated instances of pregnancy itself occurring at the early age of nine, on which we shall have to remark more fully in the introduc- tory observations to the third Order of the present Class, when treating of morbid impregnation. This foremarch of nature should be timely checked, for it will otherwise assuredly lead to a very great debility of the system in general, and is. usually found to stint the stature, and induce a pre- mature old age. And the means of repression may be'the same as those already proposed for male precocity. The premature developement of organization before us does not always seem to be connected with any cupidinous orgasm, or at least it has occurred under circumstances that render it extremelv * Walthcr, Tlics. Obs. 40. VOL. iv. 11 «2 GENETICA. [CL. V.-OR. II. difficult to entertain any such idea. One of the most singular in- stances of this kind is a case of extra-uterine fetation communicated by Dr. Baillie to the Royal Society, and published in their Trans- actions for 1789. It consisted of a suetty substance, hair, and the rudiments of four teeth, found in the ovarium of a child of not more than twelve or thirteen years of age, with an infantine uterus, and perfect hymen.* In this case there can be little doubt that an ovulum by some pe- culiar irritation had been excited to the rudimental process of an imperfect conception, and that it had, in consequence, been separat- ed from its niche, and a corpus luteum taken its place. In the Physiological Proem to the present Class, we have observed that such changes are occasionally met with in mature virgins whose organs have afforded ample proof of freedom from sexual com- merce, the ordinary mode of accounting for which, is by supposing that although they have never cohabited with the male sex, they have at times felt a very high degree of orgasm or inordinate de- sire, and that such feeling has been a sufficient excitement to pro- duce such an effect. The author has already expressed himself not satisfied with this explanation; and the case before us can hardly be resolved into any such causation. GENUS III. LAGNESIS. aust. INORDINATE DESIRE OF SEXUAL COMMERCE, WITH ORGANIC TURGESCENCE AND ERECTION. Lagnesis is a derivative from yxyitx, " libidinosus;" " praceps in venerem;" and, as a genus, is intended to include the satyriasis and nymphomania of Sauvages, and later authors ; which, chiefly, if not entirely, differ from each other only as appertaining to the male or female sex, and in their symptoms do not, like the preced- ing genus, offer ground for two distinct species. The proper spe- cies belonging to this genus are the following: 1. LAGNESIS SALACITAS. SALACITY. 2......—--- FUROR. LASCIVIOUS MADNESS. "■ i , ________________________________________^___________________________________________________ * Phil. Trans. Vol. lxxix. p. 71. GE. IH.-SP. I.] SEXUAL FUNCTION. 83 N SPECIES I. LAGNESIS SALACITAS. Salacits THE APPETENCY CAPABLE OF RESTRAINT ; THE EXCITEMENT CHIEFLY CON- FINED TO THE SEXUAL SYSTEM. In a state of health and civilized society there are two reasons why mankind are easily capable of restraining within due bounds the animal desire that exists in their frame from the period of puberty till the infirmity of age : the one is of a physical and the other of a moral kind. The natural orgasm of men differs from that of brutes in being permanent instead of being periodical, or dependent upon the return of particular seasons; and on this very account is less violent, more uniform, and kept with comparative facility within proper limits. This is a cause derived from the physical constitution of man. But the power of habit and the early inculca- tion of a principle of abstinence and chastity in civilized life, form a moral cause of temperance that operates with a still stronger in- fluence than the preceding, and lays down a barrier, which, though too often stealthily broken into, yet in the main, makes good its post and serves as a general check upon society. As man rises in education and moral feeling, he proportionally rises in the power of self-restraint; and consequently, as he be- comes deprived of this wholesome law of discipline, he sinks into self-indulgence and the brutality of savage life. And were it not that the very permanency of the desire, as we have already ob- served, torpefies and wears out its goad, the savage, destitute of moral discipline, would be at all times as ferocious in bis libidinous career as brutes are in the season of returning heat; when, stung with the periodical ardour, and worked up almost to fury, the whole frame of the animal is actuated with an unbridled force, his motions are quick and rapid, his eyes glisten, and his nerves seem to circulate fire. Food is neglected ; fences are broken down ; he darts wild through fields and forests, plunges into the deepest rivers, or scales the loftiest rocks and mountains, to meet the object that is ordained by nature to quell the pungent impulse by which he is "urged forward :* Nonnc vides ut tota tremor pertentet equorum Corpora, si tantuin notas odor attulit auras ? Ac neque eos jam frsena vhum, neque verbera s»va, "■ See Crichton on Mental Derangement, u. p. 301. 84 GENETICA. [CL. V.-OR. H. Non scopuli, rubesque cavae, atque objecta retardant Flumina, correptos unda torquentia montes.* The power of restraint, however, does not operate alike on all persons even in the same state of society, and under a common discipline. Period of life, constitution, and habit, produce a con- siderable difference in this respect, and lay a foundation tor tne four following varieties of morbid salacity : x Pubertatis. Salacity of youth. 6 Senilis. -------of age. y Entonica. -------of full habit. 5 Assueta. -------of a debauched life. The first variety proceeds not so much from organic turges- cence, as from local irritability : for it is chiefly found in relaxed and delicate frames, weakened by overgrowth, or a life of indolence and in- dulgence. The action is new, and where, from whatever cause the irritability is more than ordinary, a degree of excitement is pro- duced which shows itself constitutionally or topically. It in the former way, hysteria or chorea, or some other nervous affection, i> a very frequent effect: if in the latter, a high-wrought and distress- ing decree of appetency. It is under this state that females are said to be capable of separating ovula from their ovaries, and to form corpora lutea without copulative perculsion, in the same man- ner as the ovaries of quadrupeds that are only capable of breeding in a certain season of the year, exhibit during their heat, manifest proofs of excitement and especially of florid redness, when exami- ned by dissection. I do not think the assertion concerning women is altogether established : but in the case of young men when en- tering upon, or emerging from pubescence, and of the relaxed and delicate frame just noticed, nothing is more common than involun- tary erection and seminal emission during sleep, often connected with a train of amorous ideas excited by the local stimulus, as we have already observed under paron ria salax.J It is possible that this affection may occasionally be a result of entony or plethoric vigour as well as of atony or delicacy of health: but the last is by far the most common cause. In the first case we have nothing more to do than to reduce the excess of living power by copious venesections and purgatives, active labour, or other exercise and a low diet. In the second, it will be expedient in a very considerable degree to reverse the plan. We may, indeed, palliate the topical irritation by the use of leeches and cooling laxatives; but in conjunction with this, we should employ the unirritant tonics as the salts of bismuth, zinc. and silver, or the sedative tonics as the mineral acids, most of the bitters, and the cold bath. By taking off the debility we take off the * Virg. Georg. Lib. m. 250. t Vol. in. p. 120. GE. III.-SP. I.J SEXUAL FUNCTION. 85 irritation, and, by taking off the irritation, we overpower the dis- ease. • The salacity of age is a very afflictive malady, and often wears away the hoary form to the last stage of a tabid decline by the fre- quency of the orgastic paroxysms, and the drain of seminal emis- sions without enjoyment. It is usually a result of some accidental cause of irritation in the ovaria, the uterus, the testes, or the'prostate gland ; and has sometimes followed upon a stone in the kidneys or bladder; and is hence be«t relieved by removing or palliating the local irritation by a warm hip-bath, anodyne injections, or cataplasms of hemlock, or the other umbellate or lurid plants in common use. Where these do not succeed, our only resource is opium, and the warmer tonics. . In the first volume of the Transactions of the Medical Society of London, Mr. Norris has given a very curious and striking case of this variety, produced by a blow received a few months before near the prostate gland, followed by a small, but nearly indolent tumour on the part affected. The patient was a married man of sixty-seven, and during the violence of the ereth'sm occasioned by this local irritation, which had now continued for two months, was reduced to a state of the most wretched and squalid emaciation. He could not restrain the libidinous propensity, though he confined himself to his wife, with whom he copulated from fifteen to twenty times nightly, receiving nevertheless, pain rather than pleasure from the indulgence The wife, a matronly woman of great modesty, was hereby rendered extremely ill from local inflammation. By supporting the system with tonics, and hnnging the tumour to suppu- ration, the man completely recovered. Entonic salacity, or that of a robust and sanguine temperament, is not always so easily remed.ed as might at first be supposed. Co- pious venesections, purgatives, and a reducent diet, and this suc- ceeded by a regular use of neutral salts, and especially of nitre, will often, indeed, be found highly beneficial. But the erethism occasionally becomes chronic, and defies the effects of all medicines whatever: and, where there is an excess of irritability in the constitution, and the patient, from a principle of chastity, has sedulously restrained himself from all immoral indulgences, the nervous system, and even the mind itself, has sometimes suffered in a very distressing degree, tine or two examples of this we have already noticed undij.r ecphronia Mania, or madness;* and it is hardly worth while to dwell further upon the subject. The natural cure is a suitable marriage wherever this can be accomplished : but unless the union be of this character, it will often be attempted in vain. Professor Frank of Vienna, in his System of Medical Polity, relates the case of a lady of his acquaintance, of a warm and amorous constitution, who was unfortunately married to a very debilitated and impotent man; and who, although she often betrayed unawares, Vol. in. p. 66. 86 GENETICA. [CL. V.-OR. II. by her looks and gestures, the secret fire that consumed her, yet from a strong moral principle resisted all criminal gratification. After a long struggle her health at last gave way: a slow fever seized her, and released her from her sufferings. The salacity of a debauched life, or lechery produced and confirmed by habit, can only be cured by a total change of habit: which is a discipline that the established debauchee has rarely the courage to attempt. Fx^rcise, chinge of place and pursuits, cooling laxatives, and a less stimulant diet than he will commonly be found accustomed to, may assist him in the attempt: but in general the mind is as corrupt as the body, and the case is hopeless. He perse- veres, however, at his peril, for with increasing weakness, he will at length sink into all the miserable train of symptoms which characterize that species or marasmus, which is usually expressed by the name of tabes dorsalis, and which we have described al- ready.* SPECIES II. LAGNESIS FUROR. JlmtMoxw iHau'ness. APPETENCY UNBRIDLED, AND BREAKING THE BOUNDS OF MODEST DEMEANOUR AND CONVERSATION : MORBID AGITATION OF BODY AND MIND. Most of the causes of the preceding species are causes of the present, though it shows itself less frequently at the age of puberty. It is in fact very nearly related to the species sv \citas, though the local irritation is more violent, and the mind participates more generally and in a very different manner. Under the first, the patient has a sufficiency of self-command to conduct himself at all times with decorum and not to offend the laws and usages of public morals ; and, if, as is rarely the case however, the mind should at length become affected, it is rather by a transfer of the morbid irritation than an extension of it, so that patients thus afflicted very generally lose the venereal erethism, and show no reference to it in the train of their maniacal ideas. In lascivious madness, on the contrary, this last symptom continues in its utmost urgency, all self-command is bro- ken down, the judgment is overpowered, the imagination enkindled and predominant, and the patient is hurried forward by the concu- piscent fury like the brute creation in the season of beat, regardless equally of all company and all moral feeling. As it occurs in males it is the satyriasis furens of Cullen: as it occurs in females it is the nymphomania furibunda of Sauvages. * Vol. ii.p. 488. GE. III.-SP. II.] SEXUAL FUNCTION. 87 The pulse is quick, the breathing short, the patient is sleepless, thirsty, and loathes his food ; the urine is evacuated with difficulty, and there is a continual fever. In women the disease is often connected with an hysterical temperament, and even commences with a semblance of melancholy ;* and I once had an instance of it, from local irritation, shortly after child-birth. The child having suddenly died and there being no more denrnnd for a flow of milk, the fluid was repelled from the breasts wi;h too little caution, and the uterine region, from the deb.lity it was yet labouring under, became the seat of a transferred irritation. Among females the disease is strikingly marked by the movements of the body and the salacious appearance of the countenance, and even the language that proceeds from the lips. There is often, indeed, at first some de- gree of melancholy, with frequent sighings; but the eyes roll in wanton glances, the cheeks are flushed, the bosom heaves, and every gesture exhibits the lurking desire, and is enkindled by the distressing flame that burns within. In some cases it has unquestionably proceeded from the perpetual friction of an enormous clitoris, making an approach, from its erec- tion, to what Galen calls a female priapism. Buchner, Schurig,t and Zacutus LusitanusJ gives numerous examples of this: and Bar- tholin has the case of a Venetian woman of pleasure, whose clitoris was rendered bony by frequent use, and consequently became a source of constant irritation. In hot climates this kind of enlargement and elongation is by no means uncommon, and, as it becomes a source of uncleanliness, as well as of undue excitement, circumcision or a reduction of the clitoris to its proper size, has been often performed with advantage. The same operation has been proposed for the case before us, and, in some instances, it has succeeded completely. kt A young woman," says M. Richerand, " was so violently affected with this disease, as to have recourse to masturbation, which was always accompanied with profuse emissions; and which she repeated so frequently as to reduce herself to the last stage of marasmus. Though sensible of the danger of her situation, she was not possessed of self-command enough to resist the orgastic urgency. Her parents took her to Professor Dubois, who, upon the authority of Levret, proposed an amputation of the clitoris, which was readily assented to. The or- gan was removed by a single stroke qf the bistoury, and all hemor- rhage prevented by an application of the cautery. •• The wound healed easily, and the patient obtained a radical cure of her dis- tressing affection.§ Where the cause cannot be easily ascertained we must employ a * Delius, Advers. Fascic. i. Belol, furor uurinus, Melancholicus Effectus, Paris, 1021. i Gynacolog, p. 2. 17. | Prax. Admir. Lib. ii. Obs. 91. •< Richerand, Nosographic Chirurgicale, \'< 88 GENETICA. LCL* V'-OR- "' general plan of cure. If there be plethora or constitutional fulness, venesection should never be omitted; and, in most case-, cooling laxatives, a spare diet, with acid fruits and vegetables, cold bathing, local and general, will be found useful. Nitre, by attenuating the crasis of the blood, and diminishing its impetus, has often proved beneficial; and to this may be added conium, aconite and other nar- cotics. Camphor, which acts upon another principle, is a favourite medicine with many, and is also well worth a trial. From the infuriate state of the mind in most cases of this malady, Vogel has arranged both satyriasis and nymphomania as species of mania. But this is incorrect; the fury of the mind is merely symp- tomatic. Parr, on the contrary, has ranked, under lagnesis, to which, with great perversion, he applies the term hallucinatio, erotomania or love-sickness, more properly a variety of empathema desiderii, and which, in the present, and most other systems, is, therefore, regarded as a mental malady. Love-sickness, however, may sometimes be an occasional or ex- citing cause, and its symptoms may be united with the complaint, and even add to the general effect, of which the History of the Academy of Sciences affords an instance :* but in itself, it is, as we have already shown, altogether a disease of a different kind, and even nature ; and where it becomes blended with concupiscent fury, it must be from a concurrence of some of the special causes of the latter, either general or local, which we have just pointed out. In males the disease has led to quite as much exhaustion as in females: Bartholin gives an example of a hundred pollutions daily. GENUS IV. AGENESIA. JHale E. IV.-SP. H.J SEXUAL FUNCTION. 93 above period, was the morbid entony we are now discussing. Time, that, by degrees, broke the vigour of the encounter, effected at length a radical cure, and gave him an offspring he had almost des- paired of. Mr. J. Hunter recommends opium in this case, as the best allayer of the undue stimulus. The second variety, or misemission from the incursion of an epileptic fit, it is not difficult to account for. Persons who are predisposed to epilepsy, are, for the most part, of a highly irrita- ble habit; and wherever the predisposition exists, any accidental excitement, as we have already shown in discussing this affection,* is sufficient to produce a fresh paroxysm : and hence it is seldom more likely to occur than from the perculsion of a sexual em- brace. Even death itself has sometimes ensued in consequence of the violence of the venereal paroxysm. Examples of epilepsy from this cause, as collected in the public medical records, are numerous. Among men, one of the most famous instances is that of the celebrated Hunnish chief Attila.t Morgag- nij and Sinbaldus§ have given examples among women. Hence a life of matrimony had better be relinquished by those who are thus afflicted, as well on their own accounts, as on that of their descendants. And where marriage is actually effected, sexual commerce should be sedulously abstained from at the periods in which the disease is accustomed to recur, or during the continuance of those signs by which a paroxysm is usually preceded. The third and fourth varieties, or anticipating and retarding misemission, are put together by Ploucquet under the name of eja- culatio intempestiva,\\ and are equally entitled to this character: while the former is, by Schenck, denominated ejaculatio prcema- fura.1T The anticipating or premature variety evinces great nervous ir- ritability in a delicate or relaxed habit; the plethora of the first or entonic variety would produce the best and most effectual cure ; but as this is rarely to be accomplished in a constitution of this kind, tonics, a plain but nutritious diet, especially light suppers, and, more especially still, a bidet of cold water before retiring to bed, form the most effectual means of subduing this precession of generative power. In some cases, the afflux has been so quick as to take place even before the vagina has been fairly entered. The fourth or retarding variety forms a perfect contrast to the preceding. It imports a sluggishness either of constitution or of local erethism, in consequence of which the seminal flow does not * Vol. in. Syspasia, Epilepsia, p. 353. t Borelli, Amalth. Med. Hist. p. 161. | De sed. et Caus. Morb. Ep. XXVI. Art. 13. i Geneanthropia, p. 794. || Init. Biblioth. Torn. iv. p. 61. 4to. Tubing, 1795. 1 Observ. Lib. iv. Obs. 46. 94 GENETICA. [CL. V.-OR. in- take place till the orgasm of the female has subsided, and fatigue, perh.ips disgust, has succeeded to desire. Here too, general tonics and local stimulants offer the fairest chance of success; and both sting-nettles* and flagellations.t as in some cases of organic impo- tency, are said to have worked wonders. The variety is generally described under the name of bradyspermatismus. The refluent variety is chiefly introduced upon the authority of M. Petit,+ whose description has been copied by Sauvages. " It consists," he tells us, " in a reflux of the semen into the bladder or vesicular seminales, on account of the narrowness of the urethra, in consequence of which there is no semination during the mter- union, and the semen is afterwards discharged with the urine. This narrowness is common to those who have suffered from fre- quent blenorrhoeas, and have hence contracted strictures or scirrhous indurations in the course of the urethral passage, or have the pas- sage blocked up with indurated mucus. Deidier gives a case not very unlike, consisting of a patient who laboured under a fistula opening from the vesiculae seminales into the rectum: in conse- quence Of which, though sound in every other respect, whenever he embraced his wife scarcely any of the semen escaped from the penis, nearly the whole passing into the intestine, intermixed with a small quantity of urine; and hence his marriage was sterile.§ In all these cases the cure of the impotency must depend upon a cure of the local cause of constriction. The dyspermatismus, urethralisy nodosus and mucosus of Sauvages and Cullen, who has copied from him, are all resolvable into this variety, as proceeding from like causes, and producing a like effect. SPECIES III. AGENESIA INCONGRUA. &o)mlatfte Xncongniits- the seminal fluid inaccordant in its constituent principles, with the constitutional demand of the respective female. All the species of this genus are closely connected; yet it is only the first two that have hitherto been noticed by nosologists; nor is there any preceding system that I am aware of, under which * Eph. Nat. Cur. Dec. n. Ann. v." App. p. 55. t Meibom, and Riedlin, loc. chat. f Memoires de l'Acadcnuc dc Chirurgie, I. p. 434. & Tom. m. Consult, i, GE. IV.-SP. III.] SEXUAL FUNCTION. 95 even these two have been introduced into the same subdivision. In almost every instance, indeed, they have been regarded as dis- tinct genera belonging to distant orders or even classes, and ar- ranged with diseases that have little or no relation to them. Thus, in Sauvages impotentia, by him called anaphrodisia, occurs in the second order of his sixth class, united with such diseases as " loss of thirst" and " desire of eating;" while dysspermia, or dyssperma- tismus is carried forward to, the third order of his ninth class. In Cullen these diseases occur, indeed, in the same class, a very im- proper one, that of locales, but under different orders of this class ; impotentia being arranged under the second order, with the mor- bid cravings of the alimentary canal, and some of those of the mind, as nostalgia; and dysspermia being placed under the fifth order, en- titled epischeses or suppressions. The present species is, for the first time, so far as the author knows, introduced into a nosological system; and is derived from personal observation in full accordance with the scattered remarks of several other writers and practitioners. The principle upon which the species is founded belongs, strictly, to the general doc- trine of conception, and has been already explained in the Physio- logical Proem to the present class. It will hence be sufficient to throw out a few additional hints for the purpose of bringing the principle more immediately home to the disease before us, and supporting the propriety of its introduction into the general register. Every one must have noticed occasional instances in which a husband and wife, apparently in sound health and vigour of life, have no increase while together; either of whom, nevertheless, upon the death of the other, has become the parent of a numerous family; and both of whom, in one or two curious instances of divorce, upon a second marriage. In various instances, indeed, the latent cause of sterility, whatever it consist in, seems gradually to diminish, and the pair that for years was childless, is at length endowed with a progeny. In all this there seems to be an incon- gruity, inaccordancy, or want of adaptation in the constituent principles of the seminal fluid of the male to the sexual organization of the respective female ; or, upon the hypothesis of the epigenesis, which we have already illustrated, to the seminal fluid of the female. Writers, strictly medical, have not often adverted to this subject, though it is appealed to, and for the most part with appro- bation, by physiologists of all ages and countries. Sauvages, how- ever, evidently alludes to and admils such a cause in his definition of dysspermatismus serosus, which is as follows : u Ejaculatio seminis aquosioris, adeoque ad genesim inepti, quae species est frequentis- simum sterilitatis virilis principium." He illustrates his definition by a case which occurred to Haguenot and Chaptal, who attributed it to the cause in question, and refers for other examples to Etniulter. Cullen expresses himself doubtfully upon this species, '• De dysspei- matismo seroso SauvagesU," says he, u mihi non satis constat." Yet his own gonorrhoea laxorum. in the present system spermorrhoca 96 GENETICA. [CL. V.—OR. II. atonica, and which he explains " humor plerumque pellucidus, sine penis erectione, sed cum libidine, in vigilante, ex urethra fluit," makes so near an approach to it, that the physiologist who admits the one can find little difficulty in admitting the other. The resem- blance is, indeed, close and striking; in the latter disease the indi- vidual labouring under it, emits involuntarily, and without coition, or even erection, but with a libidinous sensation, a pellucid fluid, apparently of a seminal character, affirmed positively by Sauvages, from whom Cullen derives his species, and to whom he refers, to « be an " effluxus seminis ;" while, in the former, the same dilute and effete semen, with difficult, and imperfect erection, is poured forth during coition. In like manner, Forestus speaks of a proper gonorrhoea, or invo- luntary emission of seminal fluid, produced ex aquositate,* from too watery a condition of the secretiou : Timaeus, of fhe same disease occasioned ex semine acn',T by a secretion of an acrimonious semen : Rnd Hornung, of hysterics occasioned in married women, who are sterile from an " imm'issio frigidi seminis .-"J an expression adopted from, or at least employed by, Ballonius,§ and supported by Schurig,|| and Ab Heer.H The explanation, however, now offered, takes a more compre- hensive view of the subject, by supposing that the seminal fluid may be secreted, not merely in a state of morbid diloteness, but, under various modifications, even in a stale of health, of such a condition as to render it inadequate to the purposes of generation in female idiosyncrasies of certain kinds, while it may be perfectly adequate in those of other kinds. In agricultural language, it supposes that the respective seed may not be adapted to the respective soil, how- ever sound in itself. So, Parr tells us, on another occasion that, « In some instances the semen itself seems defective in its essential qualities."** Here again, the mode of treatment must be regulated by a close attention to the nature of the cause. In most cases, whatever will tend to invigorate the system generally will best tend to cure the sterility: as a generous diet, exercise, the cold-bath, and particu- larly the use of the bidet or local cold-bath. With these may be combined the warm and stimulant resins and balsams, as guiacum, turpentine, copaiba; and the oxydes of iron, zinc, and silver Abstinence by consent, for many months, has, however, proved a * Lib. xxvi. Obs. 12. t Cas. p. 188. | Cista. p. 487. * Opp. i. p. 120. || Spermatologia, p. 21. TT Observ. Rar. N. 10. *'* Diss. Art. Anaphrodisia. GE. IV.-SP. III.] SEXUAL FUNCTION. 97 more frequent remedy than any other, and especially where the intercourse has been so incessantly repeated as to break down the stamina! strength : and hence the separation produced by a voyage (o India has often proved successful. GENUS V. APHORIA. Jpemale Steriliti?. Barrenness. INABILITY to conceive offspring. Aphoria («0flg««) " sterilitas" " infecunditas" from « negative, Qt$* li fero," " pario," is the term in common use among the Greek writers. It is singular that the morbid condition it imports has no distinct place in any of our most esteemed nosologists. It may possibly be intended under the anaphrodisia of several of them, though in none of them hau the genus any one species, that expressly applies to female barrenness. The proper species belonging to it are the following :— 1. aphoria impotens. barrenness of impotency. 2. ------ paramenica. barrenness of mismenstruation. 3. ------ impercita. barrenness of 1rrespondbnce. 4- ------ incongrua. barrenness of incongruity. SPECIES 1. APHORIA IMPOTENS. Barrenness of Xntpoteneg. IMFERFECTION OR ABOLITION OF CONCEPTIVE POWER. This species runs precisely parallel with the same disease in males already described under agenesia impotens, and consequently offers us the two following varieties: «. Atonica. Atonic barrenness. 6 Organica. Organic barrenness. Tv atonic barrenness there is a direct imbecility or want of tone. VOL. IV. 13 98 GENETICA. [CL. V.-OK. II. rather than a want of desire: and the ordinary causes are a life of intemperance of any kind, and especially of intemperate indulgence in sexual pleasures, a chronic leucorrhcea, or paralytic affection ot the generative organs. It has also been occasioned by violent con- tusions in the loins, or the hypogastric region, and by over-exer- tion in walking. The plan of freatment is to be the same as already laid down un- der atonic sterility or impotency in males, yet it is seldom that any treatment has afforded success under this variety. Organic barrenness is produced by some structural hindrance or defect, whether natural or accidental. And this may be of various kinds: for the vagina may be imperforate, and prohibit not only all intermission of semen, but an entrance of the penis itself. The ovaria may be defective, or even altogether wanting, or not duly developed, or destitute of ovula; or the fimbriae may be defective, and incapable of grasping the uterus ; or the Fallopian tube may be obstructed, or impervious, or wanting; in all which cases barren- ness must necessarily ensue. In the case of an impervious vagina, however, unless there be a total occlusion, conception will some- times follow: for it has occurred where the passage has been so narrow as not to admit the penis; and occasionally indeed, when, with the same impediment, a rigid and unbroken hymen has offered an additional obstacle, of which the medical records contain abundant examples. Ruyset gives us a singular case of a hymen found un- broken at the time of labour. In all these instances the hymen seems to have been placed high up in the passage, so as to allow the penis to obtain a curtailed en- trance, and to produce its shock; when the occlusion not being complete, a part of the semen has passed through the aperture, and effected its ordinary result. These, however, are rare instances: for the impediment before us is, in common cases, a sufficient bar not only to conception, but to copulation. The author was lately consulted by a very amiable young couple in an instance of this kind, to whom the want of a family was felt as a very grievous affliction. The hymen had a small aperture, but was tense and firm, and the ordinary force of an em- brace was not sufficient to break it. He explained the nature of the operation to be performed, and added that he had no doubt of a suc- cessful issue. The lady was reluctant to submit herself to the hands of a surgeon, and hence with equal courage and judgment be- came her own operator. The impediment was completely remov- ed, and she has since had several children. In a few instances, however, this will not answer, for there is a natural narrowness or stricture, sometimes found in the vagina, which cannot be overcome, at least without a severer operation than most women could be induced to submit to; that 1 mean of lay- ing it open through the whole length of the contraction. A sponge tent, however, gradually enlarged, has sometimes succeeded. Surig GE. V.-SP. II.] SEXUAL FUNCTION. 9^ gives an account of a dissolution of marriage in consequence of an impediment of this kind.* SPECIES II. APHORIA PARAMENICA. Barrenness of JHismenstruation. CATAMENIAL DISCHARGE MORBIDLY RETAINED, SECRETED WITH DIFFICUL- TY, OR IN PROFUSION. It is not always necessary to impregnation that a female should menstruate : for we have already observed! that a retention of men- ses, or rather a want of menstruation, is not always a disease ; but only where symptoms occur which indicate a disordered state of some part or other of the body, and which experience teaches us is apt to arise in consequence of such retention. In some cases, there is great torpitude or sluggishness in the growth or develope- ment, or proper erethism of the ovaries, and menstruation is delay- ed on this account, and in a few rare instances we have remarked that it has occurred for the first time after sixty years of age. It may hence easily happen, and we shall presently have occasion to show that it often has done so, that a woman becomes married who has never been subject to this periodical flux: and although it is little to be expected that she should breed till the sexual or- gans are in a condition to elaborate this secretion, yet if such con- dition take place after marriage, impregnation may instantly suc- ceed and prohibit or postpone the efflux which would otherwise take place.J But where there is a manifest retention of the catamenial flux producing the general symptoms of disorder which we noticed when describing this disease, it is rarely that conception takes place, in consequence of the morbid condition of the organs that form its seat. For the same reason it seldom occurs where the periodical flow is accompanied with great and spasmodic pain, is small in quantity, and often deteriorated in quality. And if, during any intermediate term, conception accidentalh commence, the very next paroxysm of distressing pain puts a total end to all hope by separating the germ from the uterus. * Gyiiiucolog. p. 223. T \ ol. iv. Paramenia obstructionis, p. 33. t Class v. Order in. Carpotica, Introductory remark? 100 GENETICA. [CL. V.-Oft. II. But there must be a healthy degree of tone and energy in the conceptive organs, as well as of ease and quiet, in order that they should prove fruitful: and hence, wherever the menstrual flux is more frequently repeated than in its natural course, or is thrown forth, even at its proper time, in great profusion, and, as is gene- rally the case intermixed with genuine blood, there is as little chance of conception as in difficult menstruation. The organs are too debilitated for the new process; and not unfrequently there is as little desire as there is elasticity. Having thus pointed out the general causes and physiology oi barrenness when a result of mismenstruation, it will be obvious that the cure must depend upon a cure of the- particular kind of morbid affection that operates at the time and lays a foundation for the dis- ease, of all which we have already treated under the different spe- cies of the genus paramenia, and need not repeat what is there laid, down. SPECIES III. APHORIA IMPERCITA. Barrenness of KrresjJOiUjrncr. STERILITY PRODUCED BY PERSONAL AVERSION OR WANT OF APPETENCY. It is not perhaps altogether impossible, that impregnation should take place in the case of a rape, or where there is a great repug- nancy on the part of the female, for there may be so high a tone of constitutional orgasm as to be beyond the control of the individual who is thus forced, and not to be repressed even by a virtuous recoil, and a sense of horror at the time. But this is a possible rather than an actual case, and though the remark may be sufficient to suspend a charge of criminality, the infamy can only be completely wiped away by collateral circumstances. . In ordinary instances, rude, brutal force is never found to succeed against the consent of the violated person. And for the same reason, wherever there is a personal aver.-ion, a coldness, or reserve, instead of an appetency and pleasure, an irrespondence in the feelings of the female to those of the male, we have as little reason to hope for a parturient issue. There must be an orgastic shock, or perculsion sufficient to shoot off an ovulum from its bed, and to urge the fine and irritable fimbriae of the Fallopian tube to lay hold of the uterus and grasp it tight, by which alone a communication can be opened between this last organ and the ovarium, or the seed cannot reach home to its proper soil, and produce a harvest. GE. V.-SP. III.] SEXUAL FUNCTION. 101 So observes the first didactic poet of ancient Rome, addressing himself to the Generative Power, in the language not of the volup- tuary but of the physiologist: —per maria, ac monteis, fluviosque rapareis Frnndiferasque domos avium, camposque virenteis, Omnibus incutiens blandurn per pectora amorem, Ecficis, ut cupide generatim secla propagent,* So through the seas, the mountains, and the floods, The verdant meads, and woodlands fill'd with song, Spurr'd bt desire each palpitating tribe Hastes, at thy shrine, to plant the future race. x The cause is clear, and the effect certain, but it is a disease immedicable by the healing art, and can only be attacked by a kind, assiduous, and winning attention, which, however slighted at first, will imperceptibly work into the cold and stony heart, as the drops of rain work into the pavement. It should teach us, however, the folly of forming family connexions and endeavouring to keep up a family name, where the feelings of affection are not engaged on both sides. SPECIES IV. APHORIA INCONGRUA. Barrenness of Enconsruitn. THE CONCEPTIVE POWER INACCORDANT WITH THE CONSTITUENT PRINCIPLES OF THE SEMINAL FLUID RECEIVED ON THE PART OF THE MALE. This species runs precisely parallel with the third under the preceding genus agenesia incongrua, and the physiological and therapeutic remarks there offered will equally apply to the present place. * De Rer. Nat. i. 17. 102 GENETICA. [CI» V.-OR. II. GENUS VI. iEDOPTOSIS. Genital ftroiajise. PROTRUSION OF ONE OR MORE OF THE GENITAL ORGANS, OR OF EXCRES- CENCES ISSUING FROM THEM, INTO THE GENITAL PASSAGE; IMPAIRING OR OBSTRUCTING ITS COURSE. ./Edoptosis is a compound term from xiSoiet, " inguen," pi. xiZtuc. « pudenda," whence x$*g " pudor," and nrtwtg " lapsus." In like manner Sauvages and Sagar use ./Edopsophia, applying the term to the meatus urinarius, as well as to the uterus. Sauvages, however, expresses the present disease, but less correctly, by hysteroptosis, for this, with strict propriety, can denote only one of the species that fall within its range, namely displacement of the uterus. The genus embraces the five following species :— 1. .edoptosis uteri. falling nown of the womb. 2.--------vauinjE. pri.lapse of the vagina. 3.--------vesicae, prolapse of the bladder. 4.--------complicata. compl •( ated genital prolapse 5. -------- polyposa. genital excrescence. SPECIES I. iEDOPTOSIS UTERI. if Uino fcoton of the SFomft. PROTRUSION OF THE UTERUS INTO THE VAGINA. This may take place in several ways, and hence offers the following varieties : * Simplex. Simple descent of tne womb. 5 ;letroversa. Retroverted womb. y Inversa. Inverted womb. In the first variety, or that consisting of a simple descent of the uterus, the organ retains its proper posture and figure. Different names are frequently given to different degrees of this variety. GE. VI.-SP. I.] SEXUAL FUNCTION. 103 If the descent, be only to the middle of the vagina, it is called relaxatio uteri; if to the labiae, procidentia; if lower than the labia?, prolapsus. The distinction is of trilling importance ; the causes are the same in all, which are those of debility or violence. The disease is hence most common to women who have had numerous families; but is occasionally met with in virgins after straining, using violent exercise in dancing, or running, and hence sometimes in girls of a very early age. Professor Monro gives an example of its occurring in an infant of not more than three years old, preceded by a regular menstruation, or more probably a dis- charge of blood, every three weeks or month, from the vagina, accompanied with considerable pain in the belly, loins, and thighs. The case was too long neglected as being supposed of little impor- tance ; and the uterus, which at first appeared to be a very small body just peeping out of the vagina, descended lower and lower, continually increasing in size, till at length it became as big as a hand-ball, and purely blocked up the passage of the pudendum. At this time the sanguineous discharge had ceased its returns; but a considerable secretion of leucorrhoea supervened. The ute- rus seems at last to have been strangulated, gangrene ensued, and was soon succeeded by death.* The disea?»> first shows itself by what is called a bearing down of the womb, which is a slight descent produced by a relaxed state of its ligaments, and its own weight when in an upright position. There Is, at this time, an uneasy sensation in the loins, as well as in the inguinal regions, often extending to the labia, and particularly in walking or standing. There is also an augmented flow of the natural mucous secretion in consequence of the local irritation, which by degrees becomes acrimonious, and excoriates the sur- rounding parts, and is accompanied with an obstinate leucorrhcea. The stomach sympathises with the morbid state of the womb, the appetite fa.is, the Dowels become irreguiar and flatulent, and the animal spirits are dejected. In attempting a cure we must first restore the prolapsed organ to its proper position, and then retain it there, by a support introduced into the vagina, which should be continued till the ligaments of the womb have recovered their proper tone. Various pessaries have been invented for this purpose, but that made of the caoutchouc or elastic gum, with a ligature to withdraw it at option, appears to be one of the most commodious. Astringent injections, as a solution of alum or sulphate of zinc, or even of cold-water, will generally be found useful; as will also spunging the body with cold-water, or using a hip-bath of sea-water. New and rough port-wine, diluted witl, an equal quantity of cold-water, has proved one of the most valuable injections to which the author has ever had recourse. Dr. Berchelmann in a foreign journal, has recommended a far bolder and more decisive cure, derived from the rash, but successful * Edin. Med. Lssays, Vol. m. An. svii. p. 282. 104 GENETICA. [CL. V.-OR. II- practice of a woman upon herself. This courageous sufferer having long laboured under a prolapse of the womb, and tried every method in vain, tired out with the continuance of her complaint, cut into the depending substance of the womb with a common kitchen- knife. A considerable hemorrhage ensued; after which, the ves- sels collapsing, the organ gradually contracted, and ascended into its proper site ; and she was radically cured of the disease. Having boated of her success, the writer informs us that many other women in the neighbourhood, afflicted with thfc same complaint, appi.ed for her as-istance, and derived a like cure from the same operation.* In cases where the prolapse depends upon a loose and relaxed condition of the uterus, it is highly probable that this bold practice may often be found to succeed, but it must be useless where the relaxation is seated in the ligaments: and the knife, if employed at all, should be applied to an extirpation of the entire organ, which has lately taken place with success in various cases. In the ketroverted womb, the fundus falls down, and becomes the lower part, sometimes from a morbid weight and enlargement, but more usually from a neglected distension ofthe bladder between the third and fourth month of pregnancy, at which period the fundus i- just heavy euuugl. to fall forward, whenever the cervix is pressed upon and elevated by such distension ; though after this period the cervix itself is too heavy to be affected by the bladder in thi- way, and the entire uterus too much enlarged to fall down in any way. The bladder, in this case, must be carefully evacuated, and kept evacuated by a free use of the catheter, which will give the uterus an opportunity of righting itself. But if this should not take place in two or three days, the obstetric practitioner should endeavour to 'restore the organ to its proper position by introducing the fingers of one hand into the vagina and two fingers of the other hand into the rectum. The womb is inverted when at the same time that it is displaced or has fallen down, it is turned inside out. This mischievous con- dition is most commonly produced by unskilfully and violently pulling away the placenta after delivery : and is only to be reme- died by a restoration of the uterus to its proper state before it contracts, without which perpetual barrenness must necessarily ensue, and the patient be subject for life to a difficulty of walking, leucorrhcea, ulceration, and the chance of a schirrhus "or cancer. * Acta Philosophico-Medica Soc. Acad. Scient. Princ. Hassiacae 4to. Giess\ the purpose it was assigned to answer : so that if we could believe there was a distinct intelligence existing in every part of the body, we should say it was concluded in council that this ovum can never come to perfection and shall be expelled."* The causes of abortion of a constitutional or accidental kind are more obvious. They may be internal and depend upon a relaxed or debilitated state of the system generally, and consequently of the uterus as a part of it; or external, and depend on adventitious circumstances. Violent pressure, as that of tight stays, by preventing the uterus from duly enlarging, is an obvious cause, as is also that of a sudden shock by a fall, or a blow on the abdomen: violent ex- ertion of every kind is a cause not less obvious, as that of immoderate exercise in dancing, riding, or even walking ; lifting heavy weights ; great straining to evacuate the feces, or too frequent evacuations from a powerful purgative. Violent excitement of the passions, as of terror, anxiety, sorrow or joy. Violent excitement of the external senses by objects of disgust—whether of sight, sound, taste, or even smell; or whatever else tends to disturb or check the circulation suddenly, and hereby to produce fainting, will often prove a cause of abortion. And when once this affection has been produced, the organs with difficulty recover their elasticity, and it is extremely apt to recur upon the slightest causes. Plater gives us an account of fourteen miscarriages in succession;! Werlhoff, of five within two years;| an0* Werloschnig, of not less than eight in a single year.§ Wolfius relates the history of a woman, who, in the whole course of her life, suffered twenty-two distinct abortions :|| and Schultz, that of another, who, in spite of every remedy, miscarried twenty- three times, and uniformly in the third month, probably from an indisposition in the uterus to become distended further, as suggested * Denman, ubi supra, p. SOS. t Observationes, Lib. n. p. 467. ! Opp. m. p. 718. J De Curationibus Verno-autumn, p. 496. || Lection. Memorab. p. 41S. GE. I.-SP. III.] SEXUAL FUNCTION. 125 in similar cases by Dr. Denman in the passage just quoted from him. Another, and a very frequent cause, is plethora, and this, whether it be from entony or atony. " The uterus," observes Mr. Burns, " being a large vascular organ, is obedient to the laws of vascular action, whilst the ovum is more influenced by those regulating new formed parts ; with this difference, however, that new formed parts or tumours are united firmly to the part from which they grow by all kinds of vessels, and generally by fibrous or cellular substance, whilst the ovum is connected to the uterus only by very tender and fragile arteries and veins. If, therefore, more blood be sent to the maternal part of the ovum than it can easily receive, and circulate and act under, a rupture of the vessels will take place, and an extravasation and consequent separation be produced: or even where no rupture is occasioned, the action of the ovum may be so oppressed and disordered as to unfit it for continuing the process of gestation."* Now in atonic plethora, or that commonly existing in high and fashionable life, among those who use little exercise, live luxurious- ly, and sleep in soft warm beds, alt hough the action that accom- panies the pre^ure is feeble compared with what occurs in the op- posite state, the vessels themselves are feeble also, and their mouths and tunics are exceedingly apt to give way to even a slight im- petus : and hence plethora becomes a frequent cause of abortion in women of a delicate habit and unrestrained indulgence. Among the robust and the vigorous, however, its mode of opera- tion is still more obvious and direct. An increased flow of blood is here forced urgently on the uterus, which participates irresistibly in the vehemence of the action; so that if the vessels do not sud- denly give way, and hemorrhage instantly occur, the patient feels a tensive weight in the region of the uterus, and shooting pains about the pelvis. "This cause,1' observes Mr. Burns, "is especial- ly apt to operate in those who are newly married, and who are of a salacious disposition, as the action of the uterus is thus much in- creased, and the existence of plethora rendered doubly dangerous. In these cases, whenever the menses have become obstructed, all causes tending to increase the circulation must be avoided, and often ;i temporary separation from the husband is indispensable."! The general treatment of abortion consists of two intentions, that of preventing it when it threatens ; and that of safely leading the patient through it when there is little doubt that it has taken place. The chief symptoms menacing abortion are transitory pains in the back or hypogastric region, or a sudden hemorrhage from the vagina. In all these cases the first step to be taken is a recumbent position, and when the patient is once placed in this state we should deliberately examine into the nature of the cause. If there be * Principles of Midwifery, 3d Edit. 8vo. p. 191. + Burns, ut supra, p. 1^2. 126 GENETICA. [CL. V.-OR. III. symptoms of plethora, or oppression, if an accident, or a sudden emotion of the mind, or severe exercise, as of dancing, riding, or even walking, have produced them by disturbing the equilibrium of the circulating system, blood should be immediately taken from the arm, and all irritation removed from the bowels by a gentle laxative or injection. In plethora, indeed, we may go beyond this, and empty the bowels more freely; yet even here our object should be to reduce without weakening. In every instance, except where plethora prevails, after abstracting blood, the next best remedy is a full dose of opium consisting of thirty or forty drops of laudanum, or more if the symptoms be urgent, and repeated every three or four hours till the object is obtained.* And where the system is so feeble or emaciated that bleeding is counterindicat- ed, we must content ourselves, with giving sulphuric acid with small doses of digitalis, unless, indeed, there be much tendency to sinking at the stomach, and, in this case, we must limit our practise to the mineral acid and opium, and gently relieving the bowels. By this plan the pains originating from incidental causes are often checked, and the partial separation of the ovum that has commenc- ed is put a stop to. But the remedial process is thus far merely begun : the patient, for some weeks, must be peculiarly attentive to her diet, which should be light and sparing, and if exercise of any kind be allowed, it should be that of swinging, or of an easy carriage. Cold bathing, and especially cold sea-bathing, is of great importance; and where these cannot conveniently be had, a cold hip or shower-bath may be employed in their stead ; and if there should still be the slightest issue of blood from the vagina, injections of cold water, or of a solution of alum, or sulphate of zinc, should be thrown up the passage two or three times a-day : or an icicle or a snow ball be employed as a pessary. If the habit be peculiarly vigorous and robust, stimulants and soft- ness of bed-clothes must be carefully avoided, and the downy couch be exchanged for a hard mattrass. But if the constitution be delicate and emaciated, two or three glasses of wine may be allowed daily, and a course of angustura, columbo, or some other bitter tonic should be entered upon. In either case, however, it is absolutely necessary that sexual connexion should be abstained from for ten days or a fortnight. It has of late been very much the custom to confine women of a very delicate frame, and especially after they have once miscar- ried, to a recumbent position from the first symptom of conception through the whole term of gestation. In a few cases this may be a right and advantageous practice, but in the present day it is em- ployed far too indiscriminately. Among the causes of abortion we have just enumerated there are many it can never touch, as where the ovum itself is at fault, or there is a natural indisposition in the uterus to expand beyond a certain diameter. In this last case, ii * Aaskow, Act. Soc. Med. Hafn. Tom. I. OE. I.-SP. III.] SEXUAL FUNCTION. 127 we could be sure of it, a tepid hip-bath employed every evening about the time the abortion is expected would be a far more likely means of preventing it: for we should act here as in all other affec- tions where our object is to relax and take off tension, in which States we uniformly employ warmth and moisture, commonly, in- deed, a bread and water poultice. And hence, in the instance before us, one of the best applications we could have recourse to would be a broad swathe of flannel moistened with warm water and applied round the loins and lower belly every night on going to bed, surrounded externally with a dry swathe of folded linen. This should be worn through the whole night, and continued for a fort- night about the time we have reason to expect a periodical return of abortion from the cause now alluded to. I was lately requested to join in consultation with an obstetric physician upon the state of a young married lady of a highly ner- vous and irritable frame united with great energy and activity both of mind and body, who had hitherto miscarried about the third month of gestation, by braving all risks, taking walks of many miles at a stretch, or riding on horseback for half the day at a time. She was now once more in the family way, and had just commenced the discipline of only quitting her bed for the sofa to which she was carried, and on which she was ordered to repose with her head quite flat and in a line with her body, and without moving her arms otherwise than to feed herself: and to continue in this motionless state for the ensuing eight months. Without entering into the im- mediate cause of her former miscarriages, I ventured to express my doubts whether so sudden and extreme a change would not rather hurry on than prevent abortion, by accumulating such a degree of sensorial power as should produce an insupportable dys- phoria or restlessness, which would peculiarly vent itself on the organ of greatest irritation. But 1 recommended that all exertion of body and mind should be moderated, that the diet should be plain, the hours regular, that the position should be generally recumbent, and strictly so for a fortnight about the time in which abortion might be expected. It was overruled, however, to persevere in the plan already adopted from the moment, and every sedentary relief and amusement that could be devised was put in requisition to support the patient's spirits. She went on well for a week, but at the end of this period became irritable, fatigued, and dispirited; and miscarried at about six weeks from conception, instead of ad- vancing to three months as she had hitherto done. Even in the case of a delicate and relaxed frame, and of a mind that has no objection to confinement, it is well worth consideration whether the ordinary means of augmenting the general strength and elasticity by such tonics as are found best to agree with the system, and such exercises as may be taken without fatigue ; par- ticularly any of those kinds of motion which the Greeks denominat- ed aeora, as swinging or sailing, riding in a palanquin, or in a car- riage with a sofa-bed or hammock, which, as we observed on a 128 GENETICA. [CL. \ .-OR. III. former occasion,* instead of exhausting, tranquillize and prove se- dative, retard the pulse, produce sleep, and calm the irregularities of every irritable organ,—may not be far more likely to carry the patient forward than a life of unchanging indolence, and undisturbed rest, which cannot fail to add to the general weakness, how much soever the posture it inculcates may favour the quiet of the uterus itself. We have thus far supposed that there is a mere danger of abor- tion, and that the symptoms are capable of being suppressed. But if the pains, instead of being local and irregular, should have be- come regular and contractile before medical assistance is sought for, or should have extended round the body, and been accompanied with strong expulsory efforts, and particularly if, in conjunction with those, there should have been a considerable degree of he- morrhage, our preventive plan will be in vain, a separation has un- questionably taken place, and to check the descent of the detached ovum would be useless if not mischievous. Even though the pains should have ceased we can give no encouragement, for such a ces- sation only affords a stronger proof that the effect is concluded. If the discharge continue but in small quantity, it is best to let it take its course ; to confine the patient to a bed lightly covered with clothing, and give her five and twenty or thirty drops of laudanum. Bleeding is often had recourse to with a view of effecting a revul- sion : it is uncalled for, however, and may do mischief by augment- ing the weakness. But the practitioner often arrives when the discharge is in great abundance and amounts to a flooding; and the patient is faint and sinking, and appears ready to expire. To the inexperienced these symptoms are truly alarming, and, in a few instances, sudden death appears to have ensued from the exhaustion that accompanies them. But these are very uncommon cases, for it rarely happens that the patient does not recover in an hour or two from the deliquium : and even the syncope itself is one of the most effectual means of putting a check to the discharge by the sudden interruption it gives to all vascular action. Cold, both external and internal, is here of the utmost importance ; the bed-curtains should be undrawn, the windows thrown open, and a sheet alone flung over the patient ; while linen wrung out in cold water, or ice-water should be applied to the lower parts of the body and renewed as its temperature becomes warm: holding the appli- cation, however, as soon as the hemorrhage ceases. Injections should, in this case, be desisted from; for the formation of clots of blood around the bleeding vessels should be encouraged as much as possible, instead of being washed away. Aud for this reason it is now a common practice to plug the vagina as tight as possible with sponge or folds of linen, or what is better, a silk * Marasmus Phthisis, Vol. n. p. 519. GE. I.-SP. III.J SEXUAL FUNCTION. 129 handkerchief, smeared over with oil that they may be introduced the more easily, and afterwards to confine the plug with a T ban- dage. This plan has been long recommended by Dr. Hamilton, and has been extensively followed with considerable success. Here, •ilso, Dr. Hamilton prescribes large doses of opium as an auxiliary, beginning with five grains, and continuing it in doses of three grains every three hours, till the hemorrhage has entirely ceased. Opium, however, is given with most advantage where the flooding takes place after the expulsion of the ovum; for if this have not occurred its advantage may be questioned, since it has a direct ten- dency to interrupt that muscular contraction without which the ovum cannot be expelled. And it should be farther observed that where opium is had recourse to in such large doses as are above produced, it must not be dropped suddenly, for the most mischievous consequences would ensue; but must be continued in doses gra- dually diminishing till it can at length be omitted with prudence. If the flooding occur after the sixth or seventh month, and the debility be extreme, the hand should be introduced into the uterus as soon as its mouth is sufficiently dilated, and the child turned and brought away. And if, before this time, a considerable degree of irritation he kept up in the womb from a retention of the fetus or any considerable part of the ovum after its separation, one or two fingers should also be introduced for the purpose of hooking hold of what remains, and bringing it away at once. Such a retention is often exceedingly distressing, the dead parts continuing to drop away in membranous or filmy patches for several weeks intermix- ed with a bloody and offensive mucus. And not unfrequently some danger of a typhous fever is incurred from the corrupt state of the unexpelled mass. In this case, the strength must be supported with a nutritious diet, a liberal allowance of wine, and the use of the warm bitters, with mineral acids. It is also of great importance that the uterus itself be well and frequently washed with stimulant and antiseptic injections, as a solution of alum or sulphate of zinc, a decoction of cinchona or pomegranate bark, a solution of myrrh or benzoin, or, what is better than any of them, negus made with rough port wine. The injection must not be wasted in the vagina, but pass directly into the uterus; and, on this account, the syringe must be armed with a pipe made for the purpose and of sufficient length. The application of cold then, plugging the vagina, opium, and perfect quiet, and, where the pulse is full, venesection, are the chief remedies to be employed in abortions, or threatenings of abortion, accompanied with profuse hemorrhage ; and where these do not succeed, and especially after the sixth month, immediate de- livery should be resorted to. The process, however, of applying cold should not be continued longer than the hemorrhage demands; for cold itself, when in extreme, is one of the most powerful sources of sensorial exhaustion we are acquainted with. And hence, where the system is constitutionally weak, and particularly where VOL. iv. 17 130 GENETICA. [CL. V.-OR. III. it has been weakened by recurrence of the same discharge it may be a question well worth weighing whether any thing below a moderately cool temperature be allowable even on the first attack ? as also whether the application of warm cloths to the stomach and ex- tremities might not be of more advantage ? for unless the extremi- ties of the ruptured vessels possess some degree of power they cannot possibly contract, and the flow of blood must continue. And it is in these cases that benefit has sometimes been found by a still wider departure from the ordinary rules of practice, and the al- lowance of a little cold negus. So that the utmost degree of judg- ment is necessary on this occasion, not only how far to carry the established plan, but on peculiar emergencies how far to deviate from, and even oppose it. We hare said that the hemorrhage which takes place in abor- tions, however profuse, is rarely accompanied with serious effects. This, however, must be limited to the first time of their taking place : for if they recur frequently in the course of a single gesta- tion, or form a habit of recurrence in subsequent pregnancies, the blood, from such frequent discharges, loses its proper crasis; the strength of the constitution is broken down; the sensorial fluid is secreted in less abundance, perhaps in less energy; and all the func- tions of the system are of consequence performed with a considera- ble degree of languor. The increasing sensorial weakness pro- duces increasing irritability : and hence slighter external impres- sions occasion severer mischief and the patient becomes subject to frequent fits of hysteria, and other spasmodic affections. Nor is this all: for the stomach cannot digest its food, the intestines are sluggish, the bile is irregularly secreted, the heart acts feebly; and the whole of this miserable train of symptoms is apt to terminate in dropsy. GENUS II PARODYNIA. Jttorfcft Sabour. the progress of labour disturbeo or endangereo by irregulari- ty OF SYMPTOMS, PRESENTATION OR STRU8TURE. The generic term is a Greek compound from *-*g«. malfc, and *}» or »S<{, mo$, "dolor parturientis.11 All the different species of vivi- parous animals have a term of uterogestation peculiar to them- selves, and to which they adhere with a wonderful precision. Among women we have already said that this term is forty weeks, being nine calendar or ten lunar months. Occasionally the expulso- GE. II.] SEXUAL FUNCTION. 131 ry process commences a little within this period, and occasionally extends a little beyond it: but, upon the whole, it is so true to this exact time as clearly to show it to be under the influence of some particular agency, though the nature of such agency has never been satisfactorily pointed out. Sometimes the weight of the child has been supposed to force it downwards at this precise period, and sometimes the uterus has been supposed to contract, from its inabi- lity of expanding any farther, and hence from an irritable excite- ment produced by the pressure of the growing fetus. By other phy- siologists it has been ascribed to the increasing activity of the child, and the uneasiness occasioned by its movements. But it is a suffi- cient answer to all these hypotheses to remark that a like punctua- lity is observed whether the child be small or large, alive or dead ; unless, indeed, the death took place at a premature period of the pregnancy : for " No fact," says Dr. Denman, " is more incontesta- bly proved than that a dead child, even though it may have be- come putrid, is commonly born after a labour as regular and natural in every part of the process as a living one :"* and hence we can only resolve it into the ordinary law of instinct or of nature, like that which regulates the term of menstruation, or assert still more intelligibly with Avicenna that, " at the appointed time labour comes on by the command of God." In natural labour, which consists in a gradual enlargement of the mouth of the womb, and the diameter of the vagina, so as to suffer the child to pass away when urged from above by a repetition of expulsatory contractions of the uterus and all the surrounding mus- cles, there is little or no danger, however painful or distressing to the mother. These contractions, or labour-pains, continue with a greater or less regularity of interval and recurrence from two hours to twelve, the process rarely terminating sooner than the former period, or later than the latter: the ordinary term being about six hours. But unhappily labours do not always proceed in a natural course; for sometimes there is a feebleness or irregularity in the muscular action that greatly retards their progress; or a derangement of some remote organ that sympathizes with the actual state of the uterus, and produces the same effect; or the mouth of the uterus itself is peculiarly rigid and unyielding; or the natural presentation of the child's head may be exchanged for some other position ; or the ma- ternal pelvis may be misshapen, and not afford convenient room for the descent of the child; or there may be a plurality of children ; or even after the birth of the child the placenta may not follow with its ordinary regularity, or an alarming hemorrhage may supersede : each of which conditions becomes a distinct species of disease in the progress of morbid labour, and the whole of which may be ar- ranged as follow : * Pract. of Midwifery, 8vo. Edit* 5. p. 255. 132 GENETICA. [CL. V.-OR. III. 1. PARODYNIA ATONICA. ATQNIC LABOUR. 2. ---------IMPLASTICA. UNPLIANT LABOUR. 3. --------- SYMPATHETICA. COMPLICATED LABOUR. 4. --------- PERVERSA. PRETERNATURAL PRESENTATION. CROSS-BIRTH. 5. ---------AMORPHICA. IMPRACTICABLE LABOUR. 6. ---------PLURALIS. MULTIPLICATE LABOUR 7. --------- SECUNDARIA. SEQUENTIAL LABOUR. SPECIES I. PARODYNIA ATONICA 3tomc labour. LABOUR PROTRACTED BY GENERAL OR LOCAL DEBILITY, OR HEBETUDE Oi ACTION. It often happens in various affections of the system that a general law is incapable of being carried into effect with promptness and punctuality from weakness or indolence of the organs that are chiefly concerned in its execution. Thus, when vaccine or variolus fluid is properly inserted under the cuticle, it remains there in ma- ny cases for several days beyond its proper period, in a dormant state from inirritability or indolence in the cutaneous absorbents: and, in the case of small-pox, even where the fluid has been receiv- ed into the system, whether naturally or by inoculation, and has ex- cited febrile action, this action is, in many instances, very conside- rably augmented from a like indolence or irritability of the secer- nents of the skin which do not throw off the morbid matter suffi- ciently on the surface. A like want of harmonious action very frequently occurs in parturition. The full time has expired- the uterus feels uneasy, and the uneasiness is communicated to the adjoining organs, and there are occasional pains in the back or in the lower belly, but either from a weakness, or hebetude, or both, in the uterus itself, or in the muscles that are to co-operate with it in expelling the child, the pains are not effective and the labour makes little pro- gress. It often happens, also, in debilitated habits that while in some part of its progress the labour advances kindly and even rapidly, the little strength the patient possesses is worn out, and her pains suddenly cease ; or, what is worse, still continue, but without their expulsory or effective power, and, consequently, do nothing more than tease, her, and add to the weakness This exhaustion will GE. II.-SP. I.] SEXUAL FUNCTION. 133 sometimes occur soon after the commencement of the labour, or in its first stage, before the os uteri has dilated and while the water is slowly accumulating over it; but in this stage it is more likely to occur if the membranes should have prematurely given way, and the water have been already evacuated. Yet it occurs also, occasionally, towards the close even of the last stage, and when the head of the child has completely cleared itself of the uterus, and is so broadly resting on the perinaeum that a single effective pain or two would be sufficient to send it without any assistance into the world. In the greater number of these cases, to wait with a quiet com- mand of mind, and soothe the patient's desponding spirits by a thousand little insinuating attentions, and a confident assurance that she will do well at last, is the best if not the only duty to be per- formed. A stimulant injection, however, of dissolved soap or mu- riate of soda will often re-excite the contractions where they flag, or change the nature of the pains where they are ineffective. After this it is often useful to give thirty or five and thirty drops of laudanum, and to let the patient remain perfectly quiet. It is not certain in what way the laudanum may act, for it sometimes proves a local stimulant, and sometimes a general sedative, but in either way it will be serviceable and nearly equally so; for it will either shorten the labour by re-exciting and invigorating the pains, or increase the general strength by producing sleep and quiet. If the pulse should be quick and feeble with languor and a sense of faintness at the stomach, a little mulled wine or some other cordial may be allowed. If the mouth of the womb be lax and dilatable, and the water have accumulated largely and protrude upon it as in a bag, advantage is often gained by breaking the membranes and evacuating the fluid, for a new action is hereby given to the uterus, and while it contracts with more force it meets with less resistance, and its mouth is more rapidly expanded. But unless the labour should have advanced to this stage, the membranes should never be interfered with ; for their plasticity, and the gradual increase and pressure of their protruding sac against the edges of the os uteri, form the easiest and surest means of enlarging it, whilst the retention of the fluid in this early stage of parturition lubricates the inner surface of the womb, and tends to keep off heat and irritation. For the same reason, if the mouth of the womb be narrow and have hitherto scarcely given way, the application of the finger can be of no advantage. Every attempt to dilate it must be in vain, and only produce irritation, and an increased thickening in its edges: but"if it have opened to a diameter of two inches, and be at the same time soft and expansile, advantage should be taken of the pains to dilate it by the introduction of one or two fingers still fur- ther, which should only, however, co-operate with the pains, and be employed while they are actinsr; and by these conjoint means the 134 GENETICA. [CL. V.-OR. III. head of the child sometimes passes rapidly and completely out of the uterus into the vagina, or outer mouth as it is called on these occasions. We have said that it is sometimes apt to lodge here in conse- quence of the patient's exhaustion, and an utter cessation of all pains, or of all that are of any avail. She should again therefore be suffered to rest, and, if faint, be again recruited with some cor- dial support. Generally speaking, time alone is here wanting, and the practitioner must consent to wait: and it will be better for him to retire from his patient and to wait at a little distance. But if several hours should pass away without any return of expulsory efforts, if there should be frequent or continual pains without any benefit, if the patient's strength should sink, her'pulse become weak and frequent, if the mind should show unsteadiness, and there be a tendency to syncope, and if, at the same time, the head be lying clear on the perinasum, the vectis or forceps should be had recourse to, and the woman be delivered by artificial means. This situation forms a general warrant: but for the peculiar circumstances in which such or any other instruments should be employed, the manner of employing them and the nature of the instruments them- selves, the reader must consult such books as are expressly written upon the subject, and should sedulously attend the lectures and the introductory practice which are so usefully offered to him in this metropolis. SPECIES II. PARODYNIA IMPLASTICA. V&nplimt aabour. LABOUR DELAYED OR INJURED FROM IMPLASTICITY OR UNKINDLY DILATATION OF THE SOFT PARTS. The tediousness and difficulty of the preceding species of labour proceed chiefly from atony or hebetude of the system generally, or of the instrumental organs particularly. But it often happens that the parte dilate and the labour proceeds as slowly from an implasticity, or rigid resistance to the expansion and expulsory efforts which should take place, according to the law of nature, at the fulness of time which we are now supposing to be accomplished, and which is sometimes productive of other evils than that of protracted suffer- ing, offering us indeed the four following varieties •— ftE. II.-SP. II.] SEXUAL FUNCTION. 135 x Rigiditatis. The delay confined to a simple rigidity of the uterus or outer mouth. C Prolapsa. Accompanied with prolapse. y Haeruorrhagica. Accompanied with hemorrhage. 3 Lacerans. Accompanied with laceration of the ute- rus or perinseum. Rigidity of the uterus may extend to the entire organ, or be limited to the cervix, or os uteri as it is called after the cervix has lost its natural form, and partakes of the sphaeroidal shape of the fundus. Where the former occurs the practitioner meets with severe pains in the loins, shooting round to the lower belly and producing great contractile efforts of the muscles surrounding the uterus, so as to throw the patient from the violence of her exertions into a profuse perspiration, and induce the attendants to believe that the labour is advancing with great speed, while the practitioner himself finds, on examination, that there is no progress whatever; that the uterus itself does not unite in the expulsory force, the fluid of the amnios does not accumulate over the os uteri, nor the head of the child bear down upon it. In other cases, he finds that the general organ of the uterus does participate in the common action, and force the head of the child downward, but that the mouth of the womb does not dilate or become thinner in consequence hereof; appearing on the contrary, in some cases, from a peculiar tenderness and irritation, to grow thicker and tenser, and more intractable. And he not unfrequently finds even where both the body and mouth of the womb are sufficiently pliable and co-operative with the common intention, and the head of the child has become easily cleared of this organ, that a like rigidity and impUsticity exist in the os externum, and that the child having readily worked its way thus far, is fast locked from this circumstance, and cannot get any further. In all cases of this kind the same means of relaxation should be resorted to as in an irritable or inflammatory tenseness and rigidity of other organs. Blood should be freely abstracted, active purga- tives be given by the mouth, and copious em< llient injections be administered without much aperient virtue, so that they may for some time remain in the rectum and act as a fomentation. And here also it may be advantageous to apply round the loins and lower belly, a broad swathe of flannel wrung out in hot water, and to encircle it with an equally broad band of folded linen, in the manner already recommi'iided in paramenia difficilis. In several cases of rigidity, if no means be adopted to subdue the tension, the protrusive force of the surrounding muscles is some- times so considerable that, as it cannot expel the child by itself, it goes far to expel the child and the uterus conjointly, the latter being thrust downward into the outward passage and its mouth projecting out of the vulva, thus constituting a parturient prolapse. 136 GENETICA. [CL. V.-OR. III. While the uterus is thus forcibly descending, the attendant should support It, or the head of the child, with two fingers: if the pro- lapse be complete, the uterus should be returned into its proper place as quickly as possible ; and if this cannot be done, the child must be turned^ and delivery take place as speedily as may be. In the violence of thi« struggle, it sometimes happens moreover, and particularly where the water has escaped, that «ome of the vessels give way, or the placenta is partly detached, and there is the additional evil of a profuse hemorrhage to contend with. If this occur in the commencement of labour, venesection should generally be had recourse to, the patient be kept cool and quiet, and take thirty drops of laudanum. If the labour have advanced and is advancing rapidly, and the hemorrhage not be very consider- able, we may safely trust to nature to complete the process before any serious mischief ensues. But if the patient be debilitated, or much exhausted, or the labour advance slowly, the woman should be delivered by turning the child, or having recourse to the forceps according to the progress of the labour, and the position of the child at the time. But there is a far worse evil than any of these, which results from the implasticity we are now considering: and that is a rupture or laceration either of the vagina or of the uterus. The causes of laceration are said to be numerous, and it often occurs suddenly and without any known cause : but if we examine into their general nature, we shall find that except in the case of brutal force or want of skill, they are almost always dependent on a certain degree of implasticity in the part of the lacerated organ which prevents it from yielding with the uniformity of the other parts, or, from a peculiar degree of irritability that renders it more liable to irregular action or spasm: though there can be no question that in a very few instances the laceration has commenced from a cut produced by an occasional sharpness of the edge of the ilium. " Those women," observes Mr. Burns, " are most iiable to rupture of the uterus who are very irritable, and subject to cramp; or who have the pelvis contracted, or its brim very sharp, or who have the os uteri very rigid, or any part of the womb indurated. Schulzius relates a case where it was produced by schirrhus of the fundus: and Friedius one where it was owing to a carneo-cartilaginous state of the os uteri."* Laceration of the fundus of the womb may take place during any part of the labour when the pains are violent, and the walls of the organs do not act in unison in every part; but the mischief more commonly commences in the cervix, when the head, or the >tiouI- ders, or any other part, is passing through, and the whole of its cir- cumference does not yield equally. Where the accident occurs in the vagina or perinaeum, it must necessarily take place after the head has descended from the womb, and is pressing upon the * Principles of Midwifery, 8vo. 3d. edit. p. 361. GE. 1I.-SP. II.] bEXUAL FUNCTION. 137 substance of these organs that, like the lacerating os uteri, does not yield equally in every point. In most cases of an implastic rigidity, whether in the body of the uterus itself, or in its cervix, or in the os externum, there is a consi- derable degree of local irritation, and, in very many of them, of firm and vigorous action. The parts are not only rigid, but dry, and hot, and tender, and the pulse is generally full with restlessness, and a heated skin. And hence venesection is imperatively called for from an early period of the labour; and there are few cases in which the uterus has not acted afterwards with more freedom, and its mouth been rendered Iaxer, softer, and more compilable. In all such cases also an emollient injection several times repeated, will considerably co-operate in taking off the tension, and increasing the expansibility. Here opium should be avoided, but general relax- ants as antimony and ipecacuan, given in the neutral effervescing draught, may add to the general benefit. The operator must be abstinent till the parts have yielded and the tension and irritation subsided, for before this, every application of the fingers will only increase the morbid tendency. The only case in which the use of opium is here to be justified, is where, from the violence of the contractile pains, a considerable and an alarming hemorrhage has ensued, and the state of the os uteri will not allow of the introduction of (he hand for the purpose of turning and delivering immediately. In this instance, after vene- section and a due administration of emollient and aperient injec- tions, our last dependence must be upon a powerful opiate for the purpose of allaying the irritation and taking off the pains. And if the force of the expulsory power thrust down the uterus so as to give danger of producing a prolapse, the practitioner must support the organ during the recurrence of the pains, by introducing two fingers into the vagina for this purpose, and the patient must be kept in a recumbent position without moving from it; and must be instructed to avoid as much as possible every expulsory or bearing- down exertion, while the pain is upon her. If the uterus have actually protruded into the vagina, a reduction must be instantly attempted; and if this cannot be done, no time should be lost in passing the hand through the cervix, as soon as, without force, it can be sufficiently dilated for this purpose, and delivering the child by turning. Laceration generally takes place suddenly, though, in irritable habits, cramps or other spasmodic affections are often previously complained of in different parts of the body. Mr. Burns has well described the symptoms that succeed: " When this accident does happen the woman feels something give way within her, and usually suffers at that time an increase of pain. The presentation disappears more or less speedily, unless the head have fully entered the pelvis, or the uterus contract spasmodically on part of the child, as happen vol. iv. 18 138 GENETICA. [CL. V.-OR. III. ed in Bechling's patient.* The pains go off as soon as the child passes through the rent into the abdomen: or if the presentation be fixed in the pelvis, they become irregular and gradually decline. The passage of the child into the abdominal cavity is attended with a sensation of strong motion of the belly, and is sometimes produc- tive of convulsions."t It is not necessary to make a distinction between the parts in which the laceration takes place : for whether it be in the fundus or cervix of the womb, or in the vagina, except where, as just ob- served, the position is fixed in the pelvis, the part presented in- stantly disappears, and the child slips imperceptibly through the chasm into the hollow of the abdomen, sometimes with a hemorr- hage that threatens life instantly, but sometimes with little or even no hemorrhage whatever. This accident will not unfrequently occur towards the close of a labour that promises fair. It is not many years ago, when the pre- sent author, at that time engaged in this branch of the profession, was requested with all speed to attend, in consultation, upon a lady in Wigmore Street, who was then under the hands of a practitioner of considerable skill and eminence. She had for about eight hours been in labour of her first child, herself about thirty-eight years of age, had had natural pains, and been cheered throughout with the prospect of doing well, and even more rapidly than usual under the circumstances of the case. In fact the head had completely cleared the os uteri and was resting on the perinaeum, and the obstetric practitioner was flattering himself that in a quarter of an hour at the farthest, he should be released from his confinement, when he was surprized by a sudden retreat of the child during a pain which he expected would have afforded her great relief, accompanied with an alarming flooding: and it was in this emergency the author of this work was requested to attend. On examination, it was ascer- tained that a large laceration had taken place in the uterus com- mencing at the cervix and apparently on the passing of the shoulders, but why any part of it should have torn at this time rather than an- tecedently there were no means of determining. It is usual, under these circumstances, to follow up the child with the hand through the rupture into the abdomen, and to endeavour to lay hold of the feet, and withdraw it by turning. The hemorrhage had alarmed the practitioner, and this had not been attempted; and at the time of the author's arrival, which was about an hour and a half after- wards the attempt was too late, for the pulse was rapidly sinking, the breathing interrupted, and the countenance ghastly, yet the patient had not totally lost her self-possession, and being informed of her situation, begged earnestly to be let alone, and to be suffered to die in quiet. Where there is little or no hemorrhage, the life usually conti- * Haller, Disput. Tom. in. p. 477. t Burns, ut supra, p. 362. GE. n.-SP. II.] SEXUAL FUNCTION. 139 nues much longer, whether the child be extracted or not; mostly about twenty-four hours; though in some cases considerably longer still Dr. Garthshore attended a patient who lived till the twenty- sixth day, and the Copenhagen Transactions* contain the case of a woman, who after being delivered, lingered for three months : and a few marvellous histories are given in the public collections, of a natural healing of the uterus while the child continued as a foreign and extra-fetal substance in the cavity of the abdomen for many years. Haller has reported a case in which it continued in this state for nine years ff and others relate examples of its remaining for sixteen,| and even twenty-six years,§ or through the entire term of the mother's natural life. The only rational hope of saving both the mother and the child ' is by following up the latter through the rupture, and delivering it by the feet: but where this cannot be done from the smallness of the dilatation of the os uteri, or from a violent contraction of the uterus between the os uteri and the rent, we have nothing to pro- pose but to leave the event to nature, or to extract the child by the Cesarean operation. We have just seen that in a few rare instan- ces the vis medicatrix Naturae, or instinctive tendency to health has succeeded in healing the wound and restoring the patient with the fetus still inhabiting the belly. But this result is so little to be expected that an incision into the cavity of the abdomen has not unfrequently been tried, and in some instances unquestionably with success.!! SPECIES III. PARODYNIA SYMPATHETICA. dompltcatrtr ULafcour. LABOUR RETARDED OR HARASSED BY SYMPATHETIC DERANGEMENT OF SOME REMOTE ORGAN OR FUNCTION. We have often had occasion to observe that, with the exception of the stomach, there is no organ that holds such numerous ramifica- tions of sympathy with other organs as the womb: and we hence * Tom. n. p. 326. t Mem. de Paris. 1773. X Eph. Nat. Cur. Dec. i. Ann. m. Obs. 12. i Id. Dec. II. Ann. vm. Obs. 134. || Progres de la Medicine, 1698. 12mo. Abhandlung der Konigl. Schwed. Acad. 1744. Hist, de l'Acad. Royale des Fdences, 1714. p. 29. 1716. p. 32. 140 GENETICA. [CL. V.-OR. Ill find the progress of parturition disturbed, and what would other- wise be a natural, converted into a morbid labour by the interfer- ence of various other parts of the body or the faculties which ap- pertain to them. The whole family of varieties which issue from this source are extremely numerous: but the three following are the chief: a Pathematica. Accompanied with terror or other mental emotion. S Syncopalis. Accompanied with fainting. y Convulsiva. Accompanied with convulsions. In the pathematic varietv, the joint emotions which are usually operative upon a patient's mind, and especially on the first labour. are bashfulness on the presence of her medical attendant, and ap- prehension for her own safety. There is not a practitioner in the world but must have had numerous instances of a total suspension of pains on his first making his appearance in the chamber. And in some cases the pains have been completely driven away for four and twenty hours, or even a longer term. There is nothing extraordinary in this, for two powerful morbid actions are seldom found to proceed in the animal frame simultane- ously ; and hence pregnancy is well known to put by phthisis, and the severest pain of a decayed tooth to yield to the dread of having it extracted, while the patient is on his way to the operator's house. It is hence of great importance that the bespoken attendant should familiarise himself to his patient before his assistance is re- quired, and endeavour to obtain her entire confidence: and it is better, when he is first ushered into her presence, in his profession- al capacity, that he should say little upon the subject of his visit, direct the conversation to some other topic of general interest, and then withdraw till he is wanted. And if the idea alone of his ap- proach be peculiarly harassing, it is best for him to be in a remote part of the house in readiness, and not to see his patient, till her pains have taken so strong a hold as to be beyond the control of the fancy. If her apprehensions, however, be very active, and if there be any particular ground for them it is most reasonable to enter can- didly on the question, and to afford her all the consolation that can be administered. Syncope in labour proceeds commonly from a peculiar participa- tion of the stomach in the irritation of the womb, and is hence often connected with a sense of nausea, or with vomiting. Occa- sionally it occurs also from the exhaustion produced by the violence of the pains; and particularly in relaxed and debilitated habits, in which case the fainting fits sometimes follow up each other in very rapid succession, and require very close attention on the part of the practitioner and the patient's friends. The usual remedies should here be had recourse to in the first GE. II.-SP. HI.] SEXUAL FUNCTION. 141 instance: pungent volatiles should be applied to the nostrils, the patient be in a recumbent position, with the curtains undrawn, and, unless the season of year prohibit, with the windows open ; the face, and especially the forehead and temples, should be sprinkled with cold-water or ether; and the usual volatile fetids, aromatics, and terebintbinates, as camphor, should be given by the mouth: and to these, if necessary, and particularly where the pulse is feeble and fluttering, should be added a glass or two of Madeira, or any other cordial wine, with twenty drops of laudanum. If this plan should not answer, and especially if the fainting fits should increase in duration and approximation to each other, the patient must be delivered by the process of turning as soon as ever the os uteri is sufficiently dilated to let the hand pass without force. One of the worst and most alarming of the associated symptoms in labour, is that of convulsions, and these are often connected with fainting-fits and alternate with each other. We have already glanc- ed at them generally under svspasia convulsio,* but must dwell a little more at large upon the present modification. Convulsions may occur during any period of gestation, but we are now to consider them as an accompaniment of labour and as interrupting its progress. Their proximate cause is a peculiar ir- ritation of the nervous system as participating in the irritation of the womb: and hence it is obvious that the radical and specific cure is a termination of the labour. We cannot always trace the link of this peculiar influence of the womb upon the nervous system : though, where there is a predispo- sition to clonic spasm of any kind, we can readily account for its excitement, and may be under less -apprehension than where it occurs without any such tendency. The occasional causes of faint- ing are the occasional causes of convulsions; and hence they are apt to follow, and particularly in delicate or debilitated constitu- tions, on the fatigue and exhaustion of violent and protracted pains, great depression of the animal spirits, and profuse hemorrhage. Sometimes, however, they occur where none of these are present, and where the patient is of a strong plethoric habit of body, and especially if it be her first time of pregnancy : and are accompanied with, or even preceded by a sense of dizziness and oppression in the • head, ringing in the ears, or imperfect vision : the plethora itself thus forming the occasional cause. The attendant symptoms are peculiarly violent, sometimes re- sembling those of hysteria, sometimes those of epilepsy, but more ve- hement than in either of these. Nothing can restrain the spastic force of a woman when in parturient convulsions, whatever be her natural weakness. The distortion of the countenance is more hide- ous than the most extravagant imagination can conceive : and the rapidity with which the eyes open and shut, the sudden twirlings of the mouth, the foam that collects about the lips, the peculiar * Vol. in. n. 346. 142 GENETICA. [CL. V.-OR. III. hiss that issues from them, the stertor, the insensibility, and the jactitating struggle of the limbs, form a picture of agony that can- not be beheld without horror. The exciting cause is the irritable state of the womb; and, what- ever be the predisponent or occasional cause, whether a debilitated and mobile condition of the nervous system, or a robust and entooic fulness of the blood-vessels, it is obvious that such violence of action cannot take place under any circumstances without endangering a rupture of the vessels in the head, and consequently all the mis- chiefs of apoplexy. It is against this, indeed, that all practitioners, how much soever they may disagree upon other points, most cor- dially endeavour to guard, though it rarelv happens that effusion in the brain, and some of its results, do not take place in spite of all their exertions. The first step is to open a vein and bleed copiously, from a large orifice, till the patient faints: and if the operator be expert, the best vein to make choice of is the jugular: the hair should be im- mediately removed from the head, and lotions of cold water, pound- ed ice, or the freezing mixture, produced by dissolving three or four different sorts of neutral salts in water at the same time, be applied all over it by w» t*d napkins cianged for others as soon as they acquire the least degree of warmth. At the same time a pur- gative injection should be thrown up the rectum, and five or six grains of calomel be given by the mouth with a draught of sulphate of magnesia in infusion of senna. The paroxysms must, if possible, be put a stop to, the fatal effects they threaten must be anticipated, and not a moment is to be lost. This is the general plan ; and it is to be pursued under all cir- cumstances, though its extent, and particularly in regard to blood- letting, must be regulated by the strength and energy of the patient. The local mode of treatment seems to be somewhat less decided. It may happen that at the attack of the fits, the os uteri is merely beginning to open, or that it is of the diameter of a crown piece, but peculiarly rigid and undilatable. There are practitioners who, in this case, confine themselves to the depleting plan, and only wait for the advance of the labour: but, in the state of the uterus we are now conl^mpl iting, they may have to wait for some hours be- fore the labour is so far advanced as to render them capable of affording any manual assistance whatever, while the fits are, per- haps, recurring every quarter of an hour, and threatening fatal mischief to the brain. And in this case 1 cannot but warmly ap- prove of the bolder, or rather the more judicious advice of Dr. Bland, who, after a due degree of depletion, recommends a full dose of opium, for the purpose of allaying the nervous irritation gene- rally, and part.cularly that of the uterus, which is the punctum saliens of the whole. A few hours rest may set all to rights, if no vessel have thus far given way in the head :Vor when the next tide of pains returns, it will commence under very different circumstan- ces in consequence of the reducent course of medicine that has been GE. II.-3P. IU.] SEXUAL FUNCTION. 14.i pursued : and it will rarely be found that the whole body of the uterus is not rendered more lax and plastic, and consequently its cervix, and even the os externum, more yielding and dilatable. But this is not the common course which the uterus takes under these circumstances; for, in by far the greater number of cases, the whole of this organ, the cervix as well as the fundus, is so exhaust- ed in the general contest, as to be more than ordinarily relaxed and flaccid, and dilatable with considerable ease: insomuch that if the muscular power of the system were now concentrated in a common expulsory effort, as in natural labours, the whole process would terminate in a few minutes. But unfortunately this muscular exer- tion, instead of being concentrated, is distracted and erratic, and wandering over all the muscles and organs of the system, producing general mischief instead of local benefit: so that whatever pains there may be they are of far less use than in a state of harmonious action. This may be easily ascertained by introducing the hand on a return of the paroxysm, when the uterus will be found to contract, indeed, but with a tremulous undetermined sort of force, perfectly different from what it does at any other time The necessary practice in this case should seem to be obvious and without doubt: the medical attendant seems imperatively called upon to introduce his hand into the os uteri, as soon as it is suffi- ciently open for him to do so without force, to break the membranes if not broken already, lay hold of the child's feet, deliver by turn- ing, and thus put an end to the convulsions at once, and, consequent- ly, to the fatal effects which seemed to await the mother as well as the child. Such was the practice recommended by Mauriceau, upwards of a century since : La convulsion, says he, fait souvent perir la mere et l'enfant, si la femme n'est pas promptement secourue par Vaccouche- ment, qui est le meilleur remede, qu'on puisse apporter a l'une et a 1'autre.* This recommendation was adopted generally, and in our own country successively by Smellie, W. Hunter, and Lowder. And although, in circumstances of so much danger, it was not and could not be always successful, yet it was supposed, and with reason, to be the means of saving the life as well of the mother as of the child, in very numerous instances in which that of one or of both would otherwise have unquestionably perished. Some forty years after the publications of M. Mauriceau's work, Professor Koederer of Goettingen called this practice in question, and recommended that the patient be left to the natural course of the labour:! and we are told by Dr. Denman that in our own country Dr. Ross, toward the close of last century, " was the first person of late years, who had courage to declare his doubt of the propriety of speedy delivery in all cases of puerperal convulsions. The observation," continues Dr. Denman, " on which these doubts were founded, was merely practi- * Traite des Maladies des Fewmes grosses. Tom i. 23. 4to. Park, 1721. t Elements Artis Obstetric®. Aph. 679. Goet. 1769. €vo. 144 GENETICA. [CL. V.-OR. III. cal, and the event of very many cases has since confirmed the jus- tice of his observation, both with respect to mothers and children. The sweeping extent of this censure seems to show that the prac- tice has often been had recourse to indiscriminately, and without a correct limitation. And the apparent concurrence of Dr. Denman in Dr. Ross's opinion, together with the undecided manner in which he treats of the question in his subsequent pages, has raised up amongst the most celebrated obstetric physicians of our own day various advocates for leaving in general to nature the case of labour accompanied with convulsions, or at least till the natural efforts ot the mother are found completely to fail; and in this last case, as the child's head may be supposed to have cleared the uterus, to have recourse to the perforator or the forceps, according to the na- ture of the position. The chief grounds for this proposed delay, as far as I have been able to collect them, are, that the introduction of the hand into the os internum, in the irritable state of the organ we are now contem- plating, is more calculated to renew the convulsions than to put an end to them: that a repetition of them after due depletion has been employed is not so dangerous as is generally apprehended, and con- sequently that immediate delivery is by no means essential to the patient's safety: and lastly, that we are not sure of putting an end to the convulsions, even after delivery is effected; since it is well known that they have occasionally continued, and sometimes have not commenced till the process of labour has been long com- pleted. In reply to this, it may be observed, that if a repetition of the convulsive fits be not so dangerous as is commonly apprehended, a practitioner should feel less reluctance in introducing the hand even though he were sure of exciting a single fit by so doing: and the more so as this single fit might perhaps be the means of terminating the whole, and, consequently, would be a risk bought at a cheap rate. At the same time it should be observed that general experience does not seem to justify the remark that a cautious and scientific use of the hand, where the mouth of the womb is sufficiently dilated, be- comes a necessary or even a frequent excitement of fresh parox- ysms; and the prediction of such an effect is therefore without suf- ficient foundation. And if there be a considerable chance, as seems to be admitted, that instrumental assistance will be requisite at last, and that the forceps, or what, in the probability of the child's being still alive is ten times worse, the perforator must be called into ac- tion, how much more humane is it, as well as scientific, to employ instrumental aid at first, and thus save the pain and the peril of per- haps many hours of suffering—and particularly when the soft, and supple, and plastic instrument of the hand, may supersede the use of the ruder, and rougher, and less manageable tools of art. But the most important part of the question is as to the actual de- * Practice of Midwifery, p. 586. Svo. 3d. edit. 1816. GE. 1I.-SP. III.] SEXUAL FUNCTION. 145 gree of danger which is induced by convulsions; and to determine this, nothing more seems necessary than to put the whole upon the footing of an impending apoplexy. It is possible that no effusion in (he brain may have taken place at the time when the depleting plan has been carried into execution, but if the paroxysms should still re- cur, surely few men can look at the violence of the struggle which they induce, at the bloated and distended state of the vessels of the face and of the temples, at the force with which the current of blood is determined to the head, at the stertor and comatose state of the pa- tient during the continuance of the fit, without feeling the greatest alarm at every return. And that he does not feel in vain is clear, because in various instances the insensibility continues after the pa- roxysm is over, accompanies her through the remainder of her la- bour, and, is the harbinger of her death. Regarding puerperal convulsions then as a case of impending apoplexy produced by an exciting cause which it is often in our power to remove, it should seem to follow as a necessary and in- contestable result, that in this, as in every other case in which the same disease is threatened, our first and unwearied attempt should be to remove such cause as far as it may be in our power, and whenever it is so. It is not long since that the present author's opinion was request- ed upon a case of this very kind; but it was by the connexions of the patient who had already fallen a victim to her sufferings. She had been attacked with natural labour-pains and was attended by a female, who, alarmed by the sudden incursion of a convulsion-fit, sent immediately for male assistance. The practitioner arrived, and a consultation was soon held with several others: the os uteri is admitted to have been at this time open to the size of a crown- piece, soft, lubricous, and dilatable. The depleting and refrigerant plan was, however, confided in alone, and the labour was suffer- ed to take its course. Expulsory pains followed at intervals, but the convulsions followed also, and became more frequent and more aggravated: in about six hours from the time of venesection, the patient became permanently insensible, and as the child's head, completely cleared of the uterus, had now descended into the pel- vis, it was determined to deliver her by the forceps, which was ap- plied accordingly ; and in about an hour afterwards a dead child was brought into the world, whose appearance sufficiently proved that it had not been dead long. The source of irritation had now ceased, and with it the convul- sions, but the patient continued comatose still: yet even this effect went off in seven hours afterwards, and she revived, and gave con- >iderable hopes of recovery. On the second day, however, in con- sequence of the accession of milk-fever, the convulsions returned, immediately followed with stertor and insensibility, and on the en- suing day she died apoplectic. To reason from a single instance, whether successful or unsuc- cessful, is often to reason wrong. Vet it is difficult to avoid con- vor. iv. If 146 GENETICA. [CL. V.-OR. III. jecturing that if immediate delivery had here taken place as soon as the sanguiferous system had been duly emptied, and when the state of the uterus was so favourable for a trial, two lives might have been spared, both of which were lost under the course pursued. It is true the fits returned with the milk-fever, but had the brain been less injured, there would have been far less danger of such return. The cases of Dr. Smellie and of Dr. Perfect concur in justifying such a conjecture : and the following- passage of Mr. Burns should be committed to memory by every student, and every practitioner. " But this is not all," adverting to the necessity of a free depletion, " for the patient is suffering from a disease connected with the state of the uterus, and the state is got rid of by terminating the labour. Even when convulsions take place very early in labour, the os ute- ri is generally opened to a certain degree, and the detraction of blood which has been resorted to on the first attack of the disease, renders the os uteri usually lax and dilatable. In this case, al- though we have no distinct labour-pains, we must introduce the hand, and slowly dilate it, and deliver the child. I entirely agree with those who are against forcibly opening the os uteri: but I also agree with those who advise the woman to be delivered as soon as we can possibly do it without violence. There is, 1 am convinced, no rule of practice more plain or beneficial. Delivery does not, indeed, always save the patient, or even prevent the re- currence of the fits, but it does not thence folLow that it ought not to be adopted."* SPECIES IV. PARODYNIA PERVERSA. . 4.C3. GE. H.-SP. V.J .SEXU-VL function. 159 veral weeks before their due time. But the first account of any ar- tificial method of bringing on premature labour was given to me by Dr. C. Kelly. He informed me that about the year 1756, there was a consultation of the most eminent men at that time in London to consider of the moral rectitude of, and advantages which might be expected from, this practice; which met with their general ap- probation. The first case in which it was deemed necessary and proper fell under the care of the late Dr. Macaulay, and it termi- nated successfully. The patient was the wife of a linen-draper in the Strand. Dr. Kelly informed me that he himself had practis- ed it; and, among other instances, mentioned that he had perform- ed this operation three times upon the same woman, and twice the children had been born living. "A lady of rank," continues the same writer, "who had been married many years, was soon after her marriage delivered of a living child in the beginning of the eighth month of her pregnancy. She had afterwards four children at the full time, all of which were, after very difficult labours, born dead. She applied in her next pregnancy to Dr. Savage, whom I met in consultation. By some ac- counts she had received she was prepared for this operation, to which she submitted with great resolution. The membranes were accordingly ruptured, and the waters discharged, early in the eighth month of her pregnancy. On the following day she had a rigor, succeeded by heat and other symptoms of fever which very much alarmed us for the event. On the third day, however, the pains of labour came on, and she was, after a short time, delivered, to the great comfort and satisfaction of herself and friends, of a small but perfectly healthy child, which is at this time nearly of the same size it would have been had it been born at the full period of utero-gestation ; and it has lived to the state of manhood. In a sub- sequent pregnancy the same method was pursued, but whether the child was of larger size, or the pelvis was become smaller, whether there was any mistake in the reckoning, or whether the child fell into any untoward position, I could not discover, but it was still- born though the labour did not continue longer than six hours. Yet in a third trial the child was born living and healthy, and she reco- vered without any unusual inconvenience or trouble."* It is only necessary to add, that the time in which labour-pains will come on alter thus rupturing the membranes and discharging the waters, is uncertain, and appears to depend much on the irrita- bility of the uterus. It is sometimes delayed, as in the first trial in the case just noticed, for three days, but the labour has sometimes, also, been found to commence within a few hours. ' Fpist. Anp. ad Stfauss de form. Muskipont. p. 293. Jt)0 GENETICA. [CL. V.-OR. SPECIES VI. PARODYNIA PLURALIS. SUttltfjilCcatc aabour. LABOUR COMPLICATED BY A PLURALITY OF CHILDREN. The fertility of women seems to depend upon various circumstan- ces, partly, perhaps, the extent or resources of the ovaria, partly constitutional warmth of orgasm, and partly the adaptation of the male semen to the organization of the respective female. Eisen- raenger gives us the history of a woman who produced fifty-one children :* and sometimes the fertility seems to pass from genera- tion to generation, in both sexes, though it must be always liable to some variation from the constitution of the family that is mar- ried into. I have in my own family at the time of writing, a young female servant whose mother bore twenty-three children, and brought them up with so much success, that at the time of her mother's death, she was the youngest of nineteen then living: and her eldest brother has fourteen children at present, all of whom I believe are in health. But while some women produce thus rapidly in single succession, there are others that are multiparient, and bring forth occasionally two or even three at a time, more than one ovum being detached by the orgastic shock. Three at a time is not common : I have met with but one instance of it in which the children were all alive and likely to live ; and one instance only occurred to Dr. Denman in the course of upwards of thirty years practice. Four have oc- casionally but very rarely been brought forth together, and there are a few wonderful stories of five, but which rest on no well-au- thenticated testimony. Twins are mostly produced at a common birth, but, owing to the incidental death of one of them while the other continues alive, there is sometimes a material difference in the time of their expul- sion, and consequently, therefore, in their bulk or degree of maturi- ty, giving us the two following varieties: x Congruens. Of equal or nearly equal growth, Congruous twinning. and produced at a common birth. S Incongruens. Of unequal growth, and produc- Incongruous twinning. ed at different births. In congruous twinning or ordinary twin cases, in which there is * Epist. App. ad Sjrauss de fcetu. Mussipont. p. 228. UE. H.-SP. VI.J SEXUAL KLiNCTlO.N. 161 no great disparity of size between the two, on the birth of the one, it can be pretty easily ascertained that another is still in the womb by applying the hand to the abdr men; for the limbs, and, if the child be alive, its movements, may generally be felt very distinctly. except, indeed, when an ascites is present, and the practitioner must then have recourse to other tokens. There are no precise signs by which a woman or her attendant can determine whether she be pregnant of twins or not. Inequali- ties in the prominence of the abdomen, peculiarities of internal sen- sation or motion, slowness in the progress of a labour, have .been advanced as signs ; but they belong as frequently to the uniparient as to the multiparient, and hence are not entitled to attention. The claim to priority of birth in a twin case is dependent, not on superiority of strength, or any other endowment, but on a closer proximity to the mouth of the uterus alone, and, consequently, on a greater convenience of position. Though when, on the birth of twins, one is found small and emaciated, and the other plump and strong, we have some ground for apprehending that the vigorous child has absorbed the greater part of the nutriment afforded by the mother, as we find not unfrequently in plants shooting from the same spot of earth. The general rules that govern in morbid labour of individual children, govern equally in morbid labour of twins. The second child is usually delivered with comparatively few pains and little inconvenience, as the parts have been sufficiently dilated by-the passage of the first; and, although there is commonly some interval between the termination of the one and the commencement of the other struggle, it is not often that this interval exceeds half an hour or an hour. It has, indeed, in a few instances extended to whole days; in one instance to ten,* and in another to seventeen days.? But these are very uncommon cases: and as mischief may possibly happen to the womb, and to the system at large from a long pro- traction of uterine irritation, it is now the practice to deliver the second child by art, after having waited four or five hours in vain for a return of expulsory exertions. In incongruous twinning we meet in different cases with every possible diversity in perfection of form, and term of expulsion between the co-offspring. Nor is this to be wondered at in either respect. We have already seen that a single fetus may die during any period of parturition from a variety of causes : and hence we may readily conjecture that one of the twins may die at any period, while the other still thrives and remains unaffected, i his twin may remain in the womb, and both be expelled together at the full time. But it may happen, also, from the peculiar irritation of the uterus generally, or the peculiar position of the dead fetus near the cervix, that this organ may be so far stimulated by the death, * ilisr. d' 'vcad. de? Sciences, 1751, p. !A~ ' £'c: Bc.'ftia vWhendelingen ^an E:*:>rr, mi A;t; x."c. * /or.. / 21 162 GENETICA. [CL. T.-OR. 111. and corrupt state of the fetal corse and its membranes, as to expel it from the body, while the living child receives no injury, and continues to thrive, and is maturely delivered at its proper time. ^ In the latter case, where the dead fetus has been discharged in the second or third month of pregnancy, the mother, not knowing herself to have been pregnant with twins, has been erroneously conceived, on the arrival of the second birth, to have produced a perfect child within the short term of six or seven months. In the former case, or that in which the dead fetus remains quiet in the womb through the remaining term of pregnancy and both are discharged at a common birth, an opinion equally erroneous was formerly entertained in order to account for the apparent dif- ference of the two in growth and size : for it was supposed that the dead and puny, and apparently premature fetus, was conceived some months subsequently to the perfect and vigorous child, and hence had not time to reach it in size and perfection: and to this supposed subsequent conception was given the name of superfeta- tion. We have reason to believe that such a process does occasionally take place in some quadrupeds whose wombs are so formed as to allow of it: but we have already observed in the preliminary Proem to the present Class, as also in the introductory observations to the present Order, that, in women, from the moment of conception, an efflorescent membrane is formed which lines the whole cavity of the uterus, and acts as a septum to the ascent of any subsequent tide of male semen; not to say further that the os uteri itself is so plug- ged up by the secretion of a viscid mucus at the time as to prevent any communication between this organ and the vagina till the period of pregnancy is completed. And hence the doctrine of superfeta- tion in women has deservedly sunk into general disrepute.* The cases of this kind, and formerly ascribed to this cause, are by no means uncommon. Dr. Maton has given a very decided one in the Medical Transactions, containing the history of a lady de- livered at Palermo of a male child in November 1807, and again, scarcely three months afterwards, in February 1808, of another male infant, " completely formed."f The proportion or powers of the first child are not sufficiently noticed : but we are told that both were born alive ; that the elder died when nine days old " without any apparent cause;" and that the younger died also, but after a longer term. In Henchel we have an account of a minutej and a mature fetus born at the same time: and in the Transactions of the Medico- Chirurgical Society, a similar account by Mr. Chapman with the ex- ception of the time which varied considerably : the dead and mi- nute fetus, apparently not more than three or four months old, hav- * Waldschmied, Dissert, de Superfoetatione falso praetens & Hanb. 1727. t Vol. iv. Art. xn. $ Neue Medicinische und Chirurgische Anmerkungen, B. II. GE. II.-SP. VI.] SEXUAL FUNCTION. 163 ing in this case been born in October 1816, and the twin, a full- grown child, not till December, just two months afterwards.* In this last instance, however, there can be no doubt that the aborted fetus had remained quiet in the uterus for some months af- ter its death before it was expelled ; which in truth is the only way of reconciling its apparent age and size of not more than three or four months at the time of its expulsion, with the full time or nine months of the mother, completed only two months afterwards. Nor is a quiet and undisturbing continuance in the uterus after the death of the fetus by any means uncommon, whether the off- spring be single or double. «:We have already given examples of an interval of ten, and even seventeen days, in the case of twins born equally of full size. But where the growth has been discre- pant, and the dead fetus has remained behind unsuspected, it has sometimes been several months before expulsion has taken place. Ruyset gives a case in which it was delayed a twelvemonth, after the apparent term of its death, and even then discharged without corruption :t and some of the foreign collections have instances that more than double this time.f The present author was lately engaged in consultation upon the case of a lady in Bedford Row, who had miscarried of a fetus under three months old, which there was every reason to believe died four months antecedently; as at that time the mother had been at- tacked with a flooding and rigors, had had various subsequent ute- rine hemorrhages, and had never been able to quit a recumbent position without producing some return of the bleeding. SPECIES VII. PARODYNIA SECUNDARIA. Sequential Hafcour. DISEASED ACTION, OR DISTURBANCE SUCCEEDING DELIVERY. In ordinary child-birth the pains of labour may be said to cease with the expulsion of the fetus : since though sequential, or after-pains, as they are ordinarily called, are not uncommon for a day or two, and are useful in expelling the placenta and its membranes, and a few large coagula of blood that have formed in the uterus, these * Vol. ix. p. 195. t Thesaur. omnium max. t jVene Satnml. Wahrnekmungen. Band. IV. p. 241. 16-1 GENETICA. [CL. V.-OR. III. last are neither violent nor by any means frequent. It sometimes happens, however, that there is almost as much trouble, and as much pain, and as much danger after the birth of the child as an- tecedently, so that the labour itself may be fairly said to be pro- tracted into this secondary stage, which offers the following va- rieties of morbid affection: x Retentiva. Retention of the secundines. S Dolorosa. Violent after-pains. y Hemorrhagica. Violent hemorrhage or flooding. 2 Lochialis. Profuse lochial discharge. In about ten minutes or a quarter of an hour after the birth of the child the uterus recovers its action, and again exerts itself, though with less force, and consequently slighter pain, to expel what is commonly called the after-birth, consisting of the placenta and its membranes; which in common cases are easily separated and thrown off from the sides of the organ. The instinctive or re- medial power of nature is just as competent of itself to do this as to expel the child; but, as unquestionable benefit is found from as- sisting in the expulsion in the latter case, a like degree of benefit is also found in the former; and the practitioner by taking hold of the funis, and gently pulling it during the action of a pain, will in most cases, be sure of expediting the passage of the placenta, with- out running the least risk of rudely tearing it from the sides of the uterus, and exciting a hemorrhage. It will sometimes however be found that the funis, instead of being fully inserted at its upper extremity into the body of the placenta, originates alone from a few of its vessels, and that from an incautious tug it gives way, and is diawn down by itself, leaving the placenta behind; and consequently putting it entirely out of the practitioner's power to render any collateral assistance. It also happens, not unfrequently, from the general exhaustion of the system, or the local exhaustion and torpitude of the uterus, that no expulsory pains of any kind follow at the ordinary time, or even for a long period afterwards, and consequently that the placenta i; still lying unseparated in the uterus. On a trial instituted by Dr W. Hunter, and Dr. Sandys in the Middlesex Hospital, it was found in one case, that the placenta left to the action of the uterus alone, was not rejected till twenty-four hours after delivery : and as no ill consequences followed on this experiment, it became soon afterwards a practice with many in this metropolis, as it had long before been with still more on the Conti- nent, to pay no attention to the placenta, and to leave it to take its course. Great mischief however, has been, in many cases found to ensue from this kind of quietism : for, where there is great ex- haustion, a sufficiency of natural exertion does not in numerous in- stances return for three or four days afterwards, and sometimes even longer: while the placenta, by remaining in the uterus, keeps up a febrile irritation and, what is infinitely worse, by being in many instances partly though not wholly detached, and rendered a dead GE. II.-SP. VII.] ^EXIAL FUNCTION. 1»J as well as a foreign substance, the detached part putrifies, and pro- duces a fetor through the whole atmosphere of the chamber suffi- cient of itself to render the patient sick, and fa.nt, and feverish, if it do not occasion a genuine typhus. 1 was lately reque-ted to attend in consultation upon a case of this kind. The patient had had a verv difficult labour, and after two or three days of severe suffering w-<« del vered by the use of the crotchet. Mie was afterwards for a longtime in a state of syncope, and the placenta was suffered to remain without any attempt to re- move it. She had no expulsory pains for three days, but very great soreness and some degree of laceration in the soft parts, with such a torpitude of the bladder that the water wa« obliged to be drawn off daily. In about eight and forty hours, she had a hot dry skin, brown furred tongue, with a quick, small pul-e. and slight de- lirium, and occasional shiverings. It was in this state I was re- quested to see her. The room which was small, was insupportable from its stench, notwithstanding all the pains taken to maintain cleanliness, and to cover the fetor by pungent odours. I strenuously advised that the placenta should be instantly removed, but was an- swered that gangrene had already begun, the patient would cer- tainly die, and as certainly sink under the very attempt to bring it away, so that the operator would fall under the charge of having killed her. My reply was, that she would assuredly die if it were not removed, but I was not so certain that she would if it were; that in my judgment the fetor rather proceeded from the placenta itself than from the ichorous discharge about the vagina, and gave a token of a very extensive separation, though the patient wanted power to expel it from her body. And 1 could not avoid adding that if none of the gentlemen present (we made four in all) would venture upon the task I would take the risk upon myself, though I had long declined the practice, and give the patient this only chance of a recovery. This declaration inspirited the rest: the operation was determined upon, the placenta, as I suspected, was found nearly separated throughout, and half advanced into the vagina, and was removed without difficulty. By the use of cinchona and the miner- al acids, with a nutritive regimen, the patient gradually recovered, and is now in a state of perfect health. The modern practice, therefore, of not trusting the placenta to the mere powers of nature, when those powers are exhausted or inoperative, is founded upon a principle of the soundest observa- tion. Four or five hours is the utmost time now usually allowed, and if it be retained beyond this period, the operator interferes, brings it away by the funis, if the uterus will hereby become sufficient- ly stimulated, and if not, or the funis be broken, by cautiously intro- ducing his hand into the uterus, and peeling the placenta gradually from its walls by the action of his fingers. If the uterus, instead of contracting at all at its fundus, should contract irregularly and transversely so as to form what has been called an hour-glass contraction, the removal of the placenta should take place before this time. 166 GENETICA. [CL. V.-OR. III. In some irritable habits it is sometimes found, on the contrary, that after-pains, instead of ceasing gradually, continue almost with- out ceasing, and with nearly as great violence as the pains of la- bour itself; and this for many hours after the extraction of the pla- centa. If such after-pains follow close upon the labour, they proceed from a morbid irritation and spasmodic tendency of the uterus alone ; and the best remedy is an anodyne liniment applied to the abdomen, with an active dose of laudanum, which last must be re- peated as soon as the first dose has lost its effect, the bowels in the mean while being kept regularly open. If such violent pains do not take place till some hours after the evacuation of the placenta, or even the next day, it is highly probable that some large cake of coagulated blood has formed in the uterus, and become a source of irritation. This may often be hooked out by a finger or two intro- duced for such purpose, and the organ be rendered easy : if not, an opiate will here be as necessary as in the preceding case. Haemorrhage or flooding after delivery is another evil which the practitioner in the obstetric art is not unfrequently called upon to combat. This is sometimes produced by pulling too forcibly at the umbilical chord, and separating the placenta from the walls of the uterus before its vessels have sufficiently contracted : but the most common cause is an exhausted state of the uterine vessels them- selves, and a consequent inability to contract their mouths; so that the blood flows through them without resistance. The uterus is, at this time, so stored with blood of its own, that a prodigious rush will often flow from it without producing syncope or any serious ev.l upon the general system : for it is only till it has lost its own proper supply, and begins to draw upon the corporeal vessels for a recruit, that any alarming impression is perceived. Yet from the first moment the attendant should be on his guard, and should have recourse to the means already laid down under flooding occurring in the latter months of pregnancy.* From the very open state in the present case of the mouths of all the uterine vessels that have anastomosed with the vagina, the flooding is here, how- ever, upon some occasions, far more profuse and dangerous than at any. other period, so that a woman has sometimes been carried off in the course of ten minutes, with a sudden faintness, sinking of the pulse, and wildness of the eyes that is most heart-rending. And, in such a situation, as the living powers are failing apace, and must be supported at all adventures, while cold and astringent applica- tions are still applied to the affected region, we must have recourse to the warmest, the most active, and most diffusible cordials, as Ma- deira wine or brandy itself in an undiluted state : and if we succeed in rousing the frame from its deadly apathy, we must drop them by * Vol. iv. p. 121. Gen. i. Spec. n. Paracvesis uterina hemorrhagica; and compare with Vol, n. pp. 468. 469. GE. II.—SP. VII.j SEXUAL FLM/HON. 167 degrees, or exchange them for food of a rich and nutritive, but less stimulant description. When the discharge of blood from the uterus ceases, it is suc- ceeded by a fluid of a different appearance which is commonly call- ed lochia (x»%uc,) a term employed by Dioscorides in the sense of secundsr, or the materials evacuated by a lying-in woman after the birth of the child. The nature of this discharge do. •« not seem to have been very fully explained by pathologists. The numerous and expanded blood-vessels of the uterus contract gradually, and particularly in their mouths or outlets; by which means the fluid they contain, and which is not entirely evacuated by the vagina, is thrown back on the system with so much moderation as to produce no serious evil, and its stimulus is chiefly directed to the breasts. As the mouths of these vessels progressively collapse, the finer part of the blood only, or at least with not more than a small proportion of the red particles, issues from them, and in smaller abundance, and hence the discharge appears less in quantity and of a more diluted redness. By intermixing with the oxygene of the air, which has a free admission to the sexual organs, this red, as in the case of ve- nous blood, assumes a purple or Modena hue : and as this hue be- comes blended with the yellowish tinge of the serum, it necessarily changes to greenish which is the colour of the lochial discharge before its cessation. While this discharge issues in a due proportion to the demand of the idiosyncracy, for the quantity differs considerably in diffe- rent women, there is little fever or irritation, and we have no ill consequences to apprehend : but the mouths of these vessels may be irritated by various causes, as catching cold, violent emotions of the mind, the use of too stimulant a diet, or the want of a sympathetic action in the breasts; and the result, under different circumstances, is of a directly opposite kind. If there be no spasm hereby induced on the mouths of the closing vessels, they will throw forth a morbid superabundance of serous fluid, without running perhaps into a he- morrhage, or opening sufficiently to discharge red blood, and the patient will become greatly exhausted and weakened, have a sense of a prolapse of the uterus, and be pecul arly dispirited in her mind. If, on the contrary, which is more frequently the case, the mouths of the uterine vessels become suddeuly and spasmodically closed in consequence of the superinduced irritation, there will be a total and abrupt suppression of the lochia, a sense of great weight and pain will be perceived in the uterus and the whole region of the pubes, a considerable degree of fever will ensue, and the pa- tient will be in danger of a puerperal typhus. These are the evils which result from a disturbance of the ba- lance of the lochial discharge. In attempting to remedy them the exciting cause should, in the first place, be removed as far as this is capable of being accomplished. After which, in the former case, the strength is to be sustained by unirritant tonics, astringents, and a plain nutritive diet: and in the latter, the spasmodic pain, and 168 GENETICA. [CL. V.-OR. III. heat, and other febrile symptoms are to be subdued by antispasmo- dics and relaxants, particularly camphor, with small doses of ipeca- cuan or antimony. The neutral salts have also in this case proved serviceable, which have the farther advantage of opening and cooling the bowels. It will likewise be found highly useful to fo- ment the abdomen with flannels wrung out in hot water, or, which is far better, to bind a flannel swathe wrung out in hot water in the same manner round the whole of the abdomen and the back, and to encircle it with a band of folded linen to prevent it from wetting the sheets, and to let it remain on like a cataplasm, till it becomes dry by evaporation. GENUS 111. ECCYESIS. 23j:tva=ttterMe Jpetatfon. IMPERFECT FETATION IN SOME ORGAN EXTERIOR TO THE UTERUS. We have shown in the Physiological Proem to the present class. that the sexual fluid of the male passes, at the time of the embrace or soon afterwards, into the uterus, and from the uterus into the Fallopian tube, or even the ovarium, where it impregnates an ovulum detached from its proper niche by the force of the orgastic perculsion. It sometimes happens, however, that the Fallopian tubes, or the openings from the uterus leading into them are ?-o im- pacted with fat or some other material, or so straitened in their diameter that the detached and impregnated ovum is incapable of obtaining a passage into the cavity of the uterus, and is arrested in its course: in which case it must either remain in the tube itself, into which it has thus far proceeded, or drop, at the origin of the fimbriae, into the hollow of the abdomen. And it has also some- times occurred that the ovulum or vesicle that has been detached in the ovarium has been incapable of making its way out of the ovarium itself, and has become impregnated in its original seat without a possibility of stirring farther. In all these cases, the progress of impregnation still goes forward though in an imperfect manner, and with an imperfect develope- ment of organs, and we are hence, furnished with the three follow- ing distinct species of extra-uterine gestation. 1. ECCYESIS OVARIA. OVARIAN EXFETATION. 2. ------- TUBALIS. TUBAL EXFETATION. 3. ------- ABDOMINALIS. ABDOMI.NA! K\itTA>TO\ GE. III.] SEXUAL FUNCTION. 169 It is a very remarkable fact, that the uterus still sympathises in every one of these species with the imprisoned and impregnated ovum, in whatever part of the body it may happen to be lodged, pro- duces ordinarily the same efflorescent membrane or decidua, which we have already observed it secretes in the commencement of utero- gestation for the reception of the ovum upon its arrival m the uterus, enlarges its capacity and thickens its walls as though the fetus were really present in its interior; exhibits the same symp- toms and excite the same caprices of the stomach as those by which utero-gestation is usually distinguished : and at the expiration ot the regular period of nine months, and sometimes, as in ordinary preg- nancy, even before this, is attacked with spasmodic or expulsory pains, which often continue for some hours and seldom altogether subside till the organized and extra-uterine substance loses its living power, and becomes of the nature of a foreign material to the or- gans by which it is surrounded. After which menstruation again returns regularly, as it has hitherto been suspended. The extra-uterine ovum, in the mean while, endowed in conse- quence of its impregnation with a principle of life, continues to grow, whatever be the place of its aberration, in some instances becomes surrounded with an imperfect kind of placenta, developes the general structure of its kind, and exhibits an organized corn- pages of bones, membranes, vessels, viscera, and limbs; the whole figure being more or less perfect according to circumstances that lie beyond our power of penetration. After the death of the extra-uterine fetus, the uterus, and conse- quently the general frame, frequently becomes quiet; and the bulky substance, enveloped in a covering of coagulable lymph, remains for years, or perhaps through the whole of life, with no other in- convenience than that of a heavy weight and tumour in the part in which the dead fetus is lodged. But, in many instances, like any other intrusive or foreign material, it produces great irritation, which is succeeded by the ordinary process of ulcerative inflamma- tion, and an opening is hereby made into the intestines, or the vagina, or externally through the integuments of the abdomen, and the indissoluble parts of the fetus are discharged piece-meal; some- times the patient sinking during the tedious process under the ex- haustion of a hectic, but more generally evincing strength enough to sustain the progressive expulsion, and at length restored to the enjoyment of former health. vol.. iv. 170 GENETICA. [CL. V.-OR. III. SPECIES I. ECCYESIS OVARIA. ©bariau Epfetatton. IMPERFECT FETATION OCCURRING IN THE RIGHT OR LEFT OVARIUM. The physiology and general pathology have been already given so much at large in the paragraphs immediately preceding that it is only necessary to observe further that this form of extra-uterine fetation is very common, as well as very distressing. Vater relates a singular case of this kind producing a general intumescence of the abdomen on the right side, the right ovarium being the seat of the disease, that continued with little variation through a period of three years and a half with an equal degree of distress and danger to the patient :* and other instances are adverted to in the volume of Nosology. It is in this organ more especially that rudimental attempts at fetal organization, the mere sports of nature, are frequently found produced without impregnation, or any contact with the male sex, and sometimes in very young subjects. One of the most singular cases of this kind is that communicated by Dr. Baillie to the Royal Society in the year 1788.t The young subject of the case was not more than twelve or thirteen years old, with an infantine uterus and perfect hymen : and the fetation con- sisted of a suetty substance, hair, and the rudiments of four teeth. The same kind of formative ludibria are found, also, in mature life in women of the most correct rives, and whose chastity has never been impeached, of which we have an instance in a late volume of the Transactions of the Medico-Chirurgical Society. The subject, an unmarried female, was about thirty years of age, at the time of her death, which took place after a long series of suffering, accompanied with great pain in the region of the bladder. and a considerable swelling of the abdomen. On examining the body, a large tuft of hair of about the size of a hen's egg was found inclosed in a tumour of the left ovarium, surrounded with a fluid of the thickness of cream. In the bladder was traced a similar tuft of hair surrounded with a like fluid which distended and plugged up the organ.| Such rudiments of organised form have been resolved by the disciples of Buffon into the peculiar activity of his molecules organ- ises, concerning which we have already spoken in the Physiological * Dissert, de Graviditate apparcnte ex tumore ovarii dextri enormi, kc. i Phil. Trans. 1789. £ Vol. IX. p. 427. E. IV.-SP. I.] SEXUAL FUNCTION. 177 Hewson—" from the blood's being without motion in the cavity of the uterus;" and consequently coagulating : u and hence," continues he, " the origin of those large clots which sometimes come from the cavity: and which, when more condensed by the oozing out of the serum, and of the red globules, assume a flesh-like appearance, and have been called moles."* The concretion, indeed, has be- come sometimes so close and indurated as to resemble the consoli- dation of a stone; and hence Mr. Bromfield describes a mole expel- led from the uterus as consisting of a stony mass of the size of a child's head.t And Hancroft has related a similar case.J Living blood, however, has a strong tendency at all times, and es- pecially when aided by rest and the warmth of the body, to fabri- cate vessels and assume a membranous structure. " I have reason to believe," says Mr. J. Hunter, " that the coagulum has the power under necessary circumstances, to form vessels in and of itself: for although not organic, it is still of a peculiar form, structure or ar- rangement. I think I have been able to inject what I suspected to be the beginning of a vascular formation in a coagulum when it could not derive any vessels from the surrounding parts."§ It is probably on this account that we sometimes find the discharged mass or mole evincing something of a fibrous or membranous ap- pearance, and mimicking the structure of an organized substance. Fragments of a placenta, or of its membranes have also some- times remained unexpelled from the uterus, and have become blended with coagula of blood,|| and probably of blood aiming, as above, at a vascular developement, and hence the mole has been of a still more complicated character, and has often puzzled practi- tioners of great judgment and experience. And occasionally hydatids have found the means of forming a ni- dus in some one of the sulci of the womb, and, by swelling into a considerable tumour or various clusters of tumours, have very con- siderably added to the enlargement.1T Many writers have described, by the name of moles, the frag- ments of a fetus, which have long remained in the uterus after its death, and have sometimes been surrounded with an adscititious in- volucrum, or some part of its placenta or membranes, but so chang- ed by some subsequent chemical or animal operation, as to have little resemblance to their original structure. These, however, are rath- er miscarriages, or remnants of miscarriages, than moles. They manifestly bespeak an impregnation and organic growth in the pro- per organ, but, owing to torpitude or some other diseased condition * Inquiries, &c. Part i. p. 27. t Observ. II. p. 156. X Dits. de Mola, occasione molse osseae in vetula inventa. Goet. 174£ ♦ On Blood, &c. p. 92. 4to. Edit. 1794. || Ruysch, Thesaurus, in. vi. "i Lph. Nat. Cur. Dec. n. Ann. n. 157. Ann. vni. 50. et alibi. Morga^ni, De Sed. et Caus. Morb. Ep. xlviii. 12, ire. VOL. IV. 23 178 GENETICA. [CL. V.-OR. III. of the womb, were not expelled at the period of the death of the fetus. We have already observed, in treating of miscarriage, para- cyesis abortus, and more particularly still under paracyesis plu- ralis, that such retention, and almost to an unlimited period, is by no means uncommon, and have illustrated the remark by nume- rous examples. . . „ Simulating pregnancy, from molar concretions, assumes in many cases so much of the character of genuine impregnation as to be distinguished with considerable difficulty. In general, however, the abdominal swelling increases in the spurious kind far more rapidly than in the real for the first three months; after which it keeps nearly at a stand : the tumour, moreover, is considerab y more equable, the breasts are flat and do not participate in the action, and there is no sense of quickening. There is almost always a reten- tion of the menses. If we suspect the disease, the state of the uterus should be exa- mined, and it will often be in the examiner's power to ascertain the fact, and by a skilful introduction of the finger to hook down a part of the mass through the cervix, and hence, by a little dexterity, to remove the whole; but he should be careful not to break the mole into fragments. Moles, wholly or in fractions, are thrown out by the action of the uterus at different periods: often at three months ; more frequently by something like a regular accession of labour-pains, at nine : but they occasionally remain much longer: in a case of Riedlin's, for three years ;* and in one described by Zuingen for not less than seventeen.! SPECIES II. PSEUDOCYESIS INANIS. jFalse Conception. THE UTERUS VOID OF INTERNAL SUBSTANCE ; AND IRRITATED BY SOME UN- KNOWN MORBID ACTION. There are two periods during the active power of the womb in which it is peculiarly irritable ; and these are at the commence- ment, and at the final termination of the catamenial flux. And hence it sometimes happens at the last period, from some unknown •■xcitement, though generally, perhaps, the increased erethism * Lin. Med. 1695. p. 297. t Theatrum vitse humans, p. 331, 357. GE. IV.-SP. H.J SEXUAL FUNCTION. 1/J which, in consequence of such irritation, accompanies the conjugal embrace, that it becomes sensible of feelings and communicates them to the stomach, not unlike what it has formerly sustained in an early stage of impregnation ; and, a catenation of actions having thus commenced, every link in the chain that accompanied the whole range of former pregnancies, is passed through and as ac- curately imitated as if there were a real foundation for it. This illusory feeling, however, sometimes dies away gradually at the end of three months, but more usually runs on to the end of the ninth, when there is occasionally a feeble attempt at labour- pains, but they come to nothing: and the farce is gradually, and in a few instances suddenly concluded by a rapid diminution of the ab- dominal swelling, and a return of the uterus to its proper size. The distinctive signs which indicate real from spurious pregnan- cy under the last species, and which we have already noticed, are equally applicable to the present, and the practitioner should avail himself of them. A CLASS VI. CLASS VI. ECCRITICA. DISEASES OF THE EXCERNENT FUNCTION- ORDER I. MESOTICA. AFFECTING THE PARENCHYMA. II. CATOTICA. AFFECTING INTERNAL SURFACES. 111. ACROTICA. AFFECTING THE EXTERNAL SURFACE. CLASS VI. PHYSIOLOGICAL PROEM. J. he structure of the solid parts of the body consists of three dis- tinct substances—a fibrous, a parenchymatous, and a cellular or web-like. The fibrous is chiefly to be traced in the bony, mus-. cular, and membranous parts; the parenchyma, a term first em- ployed by Erasistratus, and, as we shall show hereafter, in a very different sense from that in which it is used at present, in what are commonly called visceral organs; and the cellular in both. The cellular, is in truth as it was first denominated by Bordeu, a mucous web ;* and, while it serves the purpose of giving support to the vessels and nerves of the fibrous parts, of separating them from each other where necessary, and where necessary of connecting them ; it is the repository or receptacle of the gelatinous material, which constitutes the general substance of the parenchymatous parts, and has peculiar qualities superadded to it according to the nature of the organ which it embodies, and the peculiarity of the texture which runs through it:—whence the structure of the liver differs from that of the pancreas the structure of the pancreas from that of the kidneys: and the structure of the lungs, or of the placen- ta, from all the rest. All these parts are perpetually wearing out by their own action— the most firm and solid as well as the most spongy and attenuate. They are supplied with new materials from the general current of the blood, and have their waste and recrement carried off by a cor- respondent process. It is obvious that, for this purpose, there must be two distinct sets or systems of vessels : one by which the due recruit is provided, and the other by which the refuse or rejected part is removed. These vessels are, in common language, denominated secketories and absorbents. They bear the same relation to each other as the arteries and veins: the action which commences with the former is carried forward into the latter: and we may further observe that while the socretories originate from the arteries, the absorbents * Recherchcs sur le Tissu muqueus ou organe cellulaire. Paris, 17<>7. 184 PHYSIOLOGICAL PROEM. [cL. VI. terminate in the veins. The general function sustained by these two sets or systems of vessels is, in the present work, denominated eccritical or excernent : the health of this function consists in the balance of power maintained between their respective vessels : and its diseases in the disturbance of such balance. There may be un- due secretion with healthy absorption; undue absorption with healthy secretion : or there may be undue or morbid absorption and secretion at the same time. The refuse matter, however, or that which is no longer fit for use, is not all wasted : nor in reality any of that which falls within the province of the absorbents. Nature is a judicious economist, and divides the eliminated materials into two parts—one consisting of those fluids which, by an intimate union with the newly formed chyle, and a fresh subaction in the lungs, may once more be adapted for the purposes of general circulation; and the other of those which no elaboration can revive, and whose longer retention in the body would be mischievous. It is the province of the absorb- ent system to take the charge of the whole of the first office; to collect the effete matter from every quarter, and to pour it, by means of innumerable channels that are perpetually uniting, into the thoracic duct, which forwards it progressively to the heart. The really waste and intractable matter, instead of disturbing the ac- tion of the absorbents, is at once thrown out of the general system by the mouths of the secernents themselves, as in the case of insen- sible perspiration; or, where such a perpetual efflux would be in- convenient, is deposited in separate reservoirs, and suffered to ac- cumulate, till the individual has a commodious opportunity of eva- cuating them, as in the case of the urine and the feces. Thus far we see into the general economy: but when we come to examine minutely into the nature of either of these sets of ves- sels, we find that there is much yet to be learned both as to their structure, and the means by which they operate. The subject is of great importance, and may, perhaps, be best considered under the three following divisions : I. THE GENERAL NATURE OF THE SECERNENT SYSTEM. II. THE GENERAL NATURE OF THE ABSORBENT SYSTEM. III. THE GENERAL EFFECTS PRODUCED BY THE ACTION OF THESE TWO SYSTEMS ON EACH OTHER. I. It was at one time the common doctrine among physiologists, as well chemical as mechanical, that all the vast variety of animal productions which are traced in the different secretory organs, whether wax, or tears, or milk, or bile, or saliva, were formerly contained in the circulating mass; and that the only office of these organs was to separate them respectively from the other materials that entered into the very complex crasis of the blood ; whence, indeed, the name of secernents or secretories, which mean nothing more than separating powers. This action was by the chemists sup- CL. VI.] PHYSIOLOGICAL PROEM. 185 posed to depend on peculiar attractions, or the play of affinities which was the explanation advanced by some ; or on peculiar fer- ments, conveyed by the blood to the secernent organ, or pre-exist- ing in it, which was the opinion of others. The mechanical phy- siologists, on the contrary, ascribed the separation to the peculiar figure or diameter of the secretory vessels, which, by their make, were only fitted to receive particles of a given form, as prisms where the vessels were triangular, and cubes where they were square. Such was the explanation of Des Cartes: while Boerhaave, not essentially wandering from the same view, supposed the more attenuate secretions to depend upon vessels of a finer bore, and the more viscid upon those of a larger diameter. Modern chemistry, however, has completely exploded all these and many other hypotheses founded upon the same common princi- ple, by proving that most of the secerned materials are not formally existent in the blood, and, consequently, that it is not, strictly speak- ing, by an act of separation, but of new arrangement or recomposi- tion that they produced out of its elements. And hence, physiolo- gists have been led to a critical inquiry into the fabric of the secern- ing organ, but hitherto without much satisfaction. In its simplest state it seems, as far as it can be traced, to consist of nothing more than single vessels possessing a capillary orifice, as in the Schneide- rian membrane. In a somewhat more compound form we find this orifice opening into a follicle, or minute cavity of an elliptic shape ; and, in a still more complicated make, we meet with a glandular nppacitus more or less glomerate, consisting of a congeries of se- cernent vessels, with or without follicles, and occasionally accom- panied with a basin or reservoir for a safe deposit of the secreted or elaborated matter against the time of its being wanted, of which the gall-bladder furnishes us with a well-known example. But in none of these instances are we able to discover any peculiar effect produced by this complication of machinery beyond that of affording the means of accumulation: for large as is the organ of the liver it i1? in the penicilli, or the pori biliarii alone that the bile is formed and completely elaborated : the liver is a vast bundle or combina- tion of these, and hence affords an opportunity for a free formation of bile in a collective state, but it has not been ascertained that it affords any thing more. And although in the gall-bladder we find this fluid a little varied after its deposite, and rendered thicker, yellower, and bitterer, the change is nothing more than what must necessarily follow from absorption, or the removal of a part of the finer particles of the bile. The conglomerate glands of the mam- mae offer us the same results, for the milk here secreted is as per- fect milk in every separate lactiferous tube, as when it flows in an accumulated form from the nipple. And hence, follicles themselves may be nothing more than miuute reservoirs for the convenient ac- cumlation of such fluids as are deposited in them till they are re- quired for use. Mucus and -ebum are inspissated by retention, but they rarely undergo any other change. We are obliged, therefore, n>L. IV. i?) 1JJ6 PHYSIOLOGICAL PROEM, [CL. YI. to conclude with Sir Everard Home, that " the organs of secretion are principally made up of arteries and veins; but there is nothing in the different modes in which these vessels ramify that can in any way account for the changes in the blood, out of which secretions arise."* These organs, however, are largely supplied with twigs of small nerves, and it has been an idea long entertained by physiologists that secretion is chiefly effected through their instrumentality. Sir Everard Home, in his paper inserted in the volume of the Philoso- phical Transactions just refered to, has " observed that in fishes which are capable of secreting the electric fluid the nerves connec- ted with the electrical organs exceed those that go to all the other parts of the fish, in the proportion of twenty to one :'"t and in con- firmation of this view of the subject, it may be remarked that there are no parts of the body more manifestly affected, and few so much so, us the secretory organs, by mental emotion. The whole sur- face of the skin is sometimes bedewed with drops of sweat and even of blood by a sudden paroxysm of agony of mind; grief fills the eyes with tears: fear is well known to be a powerful stimulant to the kidnevs, and very generally to the alvine canal; anger gives an additional flow, perhaps an additional acrimony, to the bile; and. if urged to violence, renders the saliva poisonous, as we have al- ready observed under the genus lyssa :j and disappointed hope destroys the digestion, and turns the secreted fluids of the stomach acid. All this should seem to prove that the secretory organs are. chief- ly influenced by the sensorial system; yet Haller has long ago ob- served that the larger branches of the nerves seldom enter into them, and seem purposely to avoid them i§ the secernent glands have little sensibility ; and the secretions of plants, which have no ner- vous system, areas abundant, and diversified, and as wonderful in every respect, as those of animals. The means, therefore, by which the very extensive and impor- tant economy of secretion are affected, seem hitherto, in a very considerable degree, to have eluded all investigation. We behold, nevertheless, the important work proceeding before us, and are in some degree acquainted with its machinery. The most simple, and at the same time, perhaps, the most copi- ous of the fluids, which are in this manner separated from the blood, is that discharged by very minute secernent vessels, supposed to be terminal or exhalant arteries, which open into all the cavities of the body, and pour forth a fine, breathing vapour, or halitu< as it is called, which keeps their surfaces moist, and makes motion eas\ —an effluvium which must have been noticed by every one who * Pl.il. Trans. 1S09, p. 387. t Id. p. 386. X Vol. in. p. 232. f Physiolog. Tom. ix. passim. t L. Vl.] PHYSIOLOGICAL PROEM. I"' has over attended the cutting up of a bullock in a slaughter-house. We have formerly had occasion to observe that arteries terminate iu two ways—in minute veins—and in exhalant vessels. The for- mer termination can often be followed up by injection? and occa- sionally traced by the microscope ; but no microscopic experiment ha« hitherto enabled the anatomist to discover the orifices of Ihe exhalant branches of arteries. Their existence, however, is prov- ed, as Mr. Cruikshank has observed, by their sometimes, and es- pecially when enlarged in diameter or acted upon by a more than ordinary vis a tergo, pouring forth blood instead of vapour, ot which we have a striking instance in bloody sweat; as also in the menstrual flux, which though not blood itself, proceeds, as Dr. Hun- ter has sufficiently shown, from the mouths of the exhalant arteries of the uterus, periodically altered in their diameter and secernent power. . .. II. The fluid thus thrown forth to luhricatr- internal surfaces would necessarily accumulate and become inconvenient, it there were not a correspondent set of vessels perpetually at work to carry off the surplus. But such a set of vessels is every where distribu- ted over the entire range of the body, as well within as without, to answer this express purpose : and they are hence called absorsext.* ; and, from the limpidity of their contained fluid, lymphatics. Their course has been progressively followed up and developed from the time of Asellius,* who, in the year 1622, " reaped the first laurels in this field by his discovery ot those vessels on the mesentery which, from their carrying a milk-white fluid, he de- nominated lacteals,"! and whose researches were confirmed and extended by the valuable works of Pecquet, Rudbeck, Jollyfie, Bartholinc, Glisson, Nuck, and Ruysch, till by the concurrent ami finishing demonstrations of Hoffman and Mekel, and more especially of our own illustrious countrymen Hewson, the elder Monro, both the Hunters, and Cruikshank, the whole of this curious and elabo- rate economy was completely explained and illustrated towards the close of the preceding century, and the opposition of i>aron Haller was abandoned. . The vessels of the absorbent system anastomose more .frequently than either the veins or the arteries ; for it is a general law oi nature that the smaller the vessels of every kind, the more freely they communicate and unite with each other. We can no more trace their orifices, excepting, indeed, those of the lacteals, than we can the orifices of the exhalants ; but we can trace their united branches from an early function, and can follow them up sin-ly, or in the confederated form of conglobate glands, till, with the excep- tion of a few that enter the right subclavian vein, they all terminate in the common trunk of the thoracic duct; which, as we have for- merly observed, receives also the tributary stream of the anasto- * F.pistola ad Haller. : II'. w^on, Of ihe Lymphatic System, p. '2 188 PHYSIOLOGICAL PROEM. [CL. VI. mosing lacteals or the absorbents which drink up the subacted food from the alvine canal, whose orifices are capable of being traced— and pours the whole of this complicated fluid, steadily and slowly by means of a valve placed for this purpose at its opening, into the subclavian vein of the left side. By this contrivance there is a prodigious saving of animalized fluids, which, however they may differ from each other in several properties, are far more easily reducible to genuine blood, than new and unassimilated matter obtained from without. Yet, this is not all: for many of the secretions, whose surplus is thus thrown back upon the system, essentially contribute to its greater vigour and perfection. We have a striking example of this in absorbed semen, which, as observed on a late occasion,* gives force and firmness to the voice, and changes the downy hair of the cheeks into a bristly beard : insomuch that those who are castrated in early life are uniformly deprived of these peculiar features of manhood. The absorption of the surplus matter secreted by the ovaria at the same age of puberty produces an equal influence upon the mammary glands, and finishes the character of the female sex, as the preceding absorption completes that of the male. So, absorption of fat from the colon, where, in the opinion of Sir Eve- rard Home, it is formed in great abundance, carries on the growth of the body in youth.t Absorbents accompany every part of the general frame so closely, and with so much minuteness of structure, that Mr. Cruikshank has proved them to exist very numerously in the coats of small arteries and veins, and suspects them to be attendants on the vasa vasorum, and equally to enter into their fabric. Wherever they exist they are peculiarly distinguished by their very numerous valves, with which they are enriched far more than any other sets of ves- sels whatever. "A'fymphatic valve is a semicircular membrane, or rather of a parabolic shape, attached to the inside of the lym- phatic vessels by its circular edge, having its straight edge, corres- ponding to the diameter, loose or floating in the cavity: in conse- quence of this contrivance fluids passiug in one direction make the valve lie close to the side of the vessel, and leave the passage free ; but attempting to pass in the opposite direction, raise the valve from the side of the vessel, and push its loose edge towards the centre of the cavity. But, as this would shut up little more than one half of the cavity, the valves are disposed in pairs exactly opposite to each other, by which means the whole cavity is accurately closed."! The distance at which the pairs of valves lie vanes exceedingly. The intervals are often equal and measure an eighth or a sixteenth part of an inch. Yet the interval is at times much greater. ,; I have seen a lymphatic vessel," says Mr. Cruikshank, " run six inches * Vol. iv. p. ll.Phys. Proem, supra. t Vol. I. p. 13. of the present work, as also Phil. Tians. 1S13, p. 157. 1 Ctuikshank, Anat. of Absorb. Vessels, p. 66. 2d. Edit. CL. VI.] PHYSIOLOGICAL PROEM. 189 without a single valve appearing in its cavity. Sometimes the trunks are more crowded with valves than the branches, and some- times I have seen the reverse of this "* In the absorbents, also, we meet with glands ; their form is mostly oval, one end being turned to the thoracic duct and the other from it: but we are in the same kind of uncertainty concerning their use, and, in some measure, concerning their organization, as in respect to those of the secernent system. The vessel that conveys a fluid to one of these glands is called a vas inferens, and that which conveys it away a vas efferens. The vasa inferentia, or those that enter a gland, are sometimes numerous; they have been detected as amounting to fifteen or twenty; and are sometimes thrice or oftener as many. They are always, however, more numerous than the vasa efferentia, or those which carry on the fluid towards the thoracic duct. The last are consequently, for the most part, of a larger diameter, and sometimes consist of a single vessel alone. It is conceived by many physiologists that the conglobate mass which forms the gland consists of nothing more than convolutions of the vasa inferentia; whilst others as strenuously contend that they are a congeries of cells or acini totally distinct from the absorbent vessels that enter into them. Whatever their structure may be, they seem to the present author to be powerfully auxiliary to the valves by abating the back force they are unquestionably called at times to encounter from some morbid action, and there is reason to believe that in this way, like the conglomerate glands of the secer- nents, they become basins or receptacles. As in the case of the secernents, we are also unacquainted with the means by which the absorbents act. This, in both instances, is said to be a vis a tergo,—a term which gives us little information in either instance, and is peculiarly difficult of comprehension in the latter. In their most composite state they possess a very low degree of sensibility, and are but little supplied with branches from the larger trunks of nerves. Abstruse, however, as the process of absorption is to us at present, we have sufficient proofs of the fact. Of six pints of warm water injected into the abdomen of a living dog not more than four ounces remained at the expiration of six hours. The water accumulated in dropsy of the brain, and deposited in the ventricle?, we have every reason to believe is often absorbed from the cavities ; for the symptoms of the disease have been sometimes marked, and after having made their appearance, and been skilfully followed up by remedies, have entirely vanished : and the water in dropsy of the chest, and even at times, in ascites, has been as effectually removed. It has been doubted by some physiologists whether there be any absorbent vessels that open on the surface of the body: yet a mul- titude of facts seem sufficiently to establish the positive side of this ' Loo. ritat. 190 PHYSIOLOGICAL PROEM. [CL. Yl. question, though it is not fluids of every kind that can be carried from the skin into the circulating system, and hence their power is by no means universal. Sailors who, when in great thirst, put on shirts wetted with salt water, find considerable relief to this distressing sensation. Dr. Simpson, of St. Andrews, relates the case of a ra- pid decrease of the water in which the legs of a phrenitic patient were bathed: and De Haen finding that his dropsical patients filled equally fast whether they were permitted to drink liquids or not, did not hesitate to assert that they must absorb from the atmos- phere. Spirits and many volatile irritants seem to be absorbed more rapidly than water, and* there can be no doubt that warmth and friction are two of the means by which the power of absorption is augmented. " A patient of mine," says Mr. Cruikshank, " with a stricture in the oesophagus, received nothing, either solid or liquid, into the stomach for two months: he was exceedingly thirsty, and complained of making no water. 1 ordered him the warm-bath for an hour, morning and evening, for a month: his thirst vanished, and he made water in the same manner as when he used to drink by the mouth, and when the fluid descended readily into the sto- mach."* The aliment of nutritive clysters seems, in like manner, to be often received into the system, and it is said, though upon more questionable grounds, that cinchona, in decoction, has also been absorbed both from the intestines and the skin. Narcotic fluids rarely enter to any considerable extent and ne- ver so as to do mischief, respecting which, therefore, the power of the cutaneous absorbents is very limited : and there are few poison- ous liquids, with the exception of the venereal, that may not be ap- plied with safety to a sound skin. This double process of secretion and absorption was supposed by the ancients to be performed, not by two distinct sets of vessels expressly formed for the purpose, but by the peculiar construction of the arteries, or of the veins, or of both. These are sometimes represented as being porous, and hence, as letting loose contained fluids by transudation, and imbibing extraneous fluids by capillary attraction. There is, in fact, something extremely plausible in this view of the subject, which, in respect to dead animal matter, is al- lowed to be true, even in our own day. For, it is well known that a bladder filled with blood and suspended in the air, from a cause we shall presently advert to, is readily permeated with oxygene gas, so as to transform the deep Modena hue of the surface of the blood that touches the bladder into a bright scarlet: and thin fluids injected into the blood-vessels of a dead body transude very gene- rally ; insomuch that glue dissolved in water and thrown into the coronary veins, will permeate into the cavity of the pericardium, and by jellying even assume its figure. And hence it is that bile is often found, after death, to pass through the tunics of the gall blad- der and tinge the transverse aorta of the colon, the duodenum or the * Anat. of the 'sorb. Vessels, p. 108. CL. VI.] PHYSIOLOGICAL PROEM. 191 pylorus with a brown, yellow, or green hue, according to its colour at the time. The doctrine of porosity or transudation, was hence very gene- rally supported till the time of Mr. Hewson, by physiologists of the first reputation. Boyle, hence, speaks, as Mr. Cruikshank has just- ly observed, of the porositas animalium, and wonders that this pro- perty should have escaped the attention of Lord Bacon. Even Dr. Hunter and Professor Mekel believed it in respect to certain fluids, or certain parts of the bod}'. The experiments of Hewson, J. Hun- ter, and Cruikshank, have, however, sufficiently shown that, while vessels in losing life, lose the property of confining their fluids, they possess this property most accurately so long as the principle of life continues to actuate them. There is, moreover, another method by which the ancients some- times accounted for the inhalation and exhalation of fluids, making a much nearer approach to the modern doctrine, and that is by the mouths of vessels ; still, however, regarding these vessels as arte- ries or veins, and particularly the latter. " The soft parts of the body," observes Hippocrates, " attract matter to themselves both from within, and from without; a proof that the whole body ex- hales and inhales." Upon which passage Galen has the following- comment: " For as the veins, by mouths placed in the skin, throw out whatever is redundant of vapour or smoke, so they receive by the same mouths no small quantity from the surrounding air: and this is what Hippocrates means when he says that the whole body exhales and inhales." This hypothesis of the absorption of veins, without the interfe- rence of lymphatics, has been revived within the last eight or ten years by M. Magendie, and M. Flandrin, of Paris, who have made an appeal to experiments which appear highly plausible, and are entitled to a critical examination. The doctrines hereby attempted to be established are, indeed. varied in some degree from those of the Greek schools; and are more complex. In few words, they may be thus expressed : that the only general absorbents are the veins;—that the lacteals mere- ly absorb the food;—that the lymphatics have no absorbent power whatever;—and that the villi in the different portions of the intes- tinal canal are formed in part by venous twigs which absorb all the fluids in the intestines, with the exception of the chyle, which last is absorbed by the lacteals, and finds its way into the blood through the thoracic duct; and that these fluids are carried to the heart and lungs directly through the vena; port* whose function it is minutely to subdivide and mix with the blood the fluids thus absorbed, which subdivision and intermixture is necessary to prevent their proving detrimental. M. Magendie further supposes that the cuticle has no power of absorption in a sound state, either by veins or lymphatics; but that. if abraded or strongly urged b}' the pressure of minute substance? that enter into its perspirable pores, the mouths, of its minute veins *re thus rendered absorbent. 192 PHYSIOLOGICAL PROEM. [CL. VL He supposes the function of the lymphatics to consist in convey- ing the finer lymph of the blood directly to the heart, as the veins convey the grosser and purple part; and that they rise, as the veins, from terminal arteries. Proper lymph, in the system of M. Magendie, is that opaline, rose-coloured, sometimes madder-red, fluid which is obtained by puncturing the lymphatics or the thoracic duct after a long fast. It is every where similar to itself; and hence differs from the fluid of cavities which is perpetually varying. He supposes the mistake of confounding the two to proceed from a want of attention to this fact. One of the chief reasons urged for regarding veins as absorbents, is, that membranes which absorb actively have, in his opinion, no demonstrable lymphatics, as the arachnoid. But, according to Bi- chat, such membranes have no more demonstrable veins than lym- phatics ; veins are seen to creep on them, but never to enter. The two principal experiments on which M. Magendie seems to rely in proof that the veins, and not the lymphatics, are absorbents, are the following:—First, M. Delille and himself separated the thigh from the body of a dog that had been previously rendered in- sensible by opium. They left the limb attached by nothing but the crural artery and vein. These vessels were isolated by the most cautious dissection to an extent of nearly three inches, and their cellular coat was removed lest it might conceal some lymphatic Vessels. Two grains of the upas tiente were then forcibly thrust into the dog's paw. The effect of this poison was quite as imme- diate and intense as if the thigh had not been separated from the body: it operated before the fourth minute, and the animal was dead before the tenth. In the second experiment a small barrel of a quill was introduced into the crural artery and the vessel fixed upon it by two ligatures. The artery was immediately cut all round between the two ligatures. The same process took place with respect to the crural vein. Yet the poison introduced into the paw produced its effect in the same manner and as speedily. By compressing the crural vein between the fingers at the moment the action of the poison began to be developed, this action speedi- ly ceased: it re-appeared when the vein was left free, and once more ceased if the vein were again compressed. The experiments are very striking, and, on a cursorv view may be.supposed to carry conviction with them : but the confidence of those who have studiously followed the concurrent experiments. and the clear and cautious deductions of our distinguished connlry- men, Hewson, both the Hunters, and Cruikshank, will not so easily be shaken. We have already observed that lymphatic absorbents, in the opi- nion of the last of these writers, probably in the opinion of all of them, enter as fully into the tunics of veins and arteries, and even into those of the vasa vasorum, as into any other part of the ani- • nal frame : and hence there can be no difficulty in conceiving that CL. vu] PHYSIOLOGICAL PROEM. 193 the poison employed in these experiments might accompany the veins by means of their lymphatics. We also observed that while the lymphatic- anastomose, or run into each other more frequently than any other set of vessels, their valves, which alone prevent a retrograde course, and direct the contained fluid towards the tho- racic duct, are occasionally placed at a considerable distance from each other, in some instances not less than six inches, and that this length of interval occurs in the minute twigs as well as in the trunks. And hence, admitting that, in the veins that were cut or isolated in M. Mageedie's experiments, such a vacuity of valves in- cidentally existed, there is also no difficulty in conceiving by what course the poisons that have already entered into their lymphatics from without should, in consequence of this frequency of anastomo- sis and destitution of valves, be stimulated to a retrograde course by the violence made use of, and be thrown into the current of the blood from within, by the mouths of those lymphatics that enter into the tunics of the vein6; and particularly as the separated ves- sels were only isolated to a distance of less than three inches, while the lymphatics are occasionally void of valves to double this dis- tance. In some cases we have reason to believe that the lymphatics that enter into the tunics of the lacteals, which M. Magendie admits to be a system of absorbents altogether distinct from the veins, are equally destitute of valves in certain parts or directions, and com- municate by anastomosis some portion of the chyle and any sub- stance contained in it to the interior of the adjoining veins, and consequently to the blood itself: for the experiments of Sir Everard Home upon rhubarb introduced into the stomach of an animal, after the thoracic duct has been secured by a double ligature, show that this substance and consequently others as well, is capable of travel- ling from the stomach into the urinary bladder, notwithstanding this impediment. In the singular experiments made with prussiate of potash by Dr. Wollaston and Dr. Marcet, the blood which was drawn from the arm during the interval of the introduction of this substance into the stomach, and its detection in the urine, did not, indeed, on being tested, discover the smallest trace of the prus- siate, though it was so obvious in the fluid of the urinary bladder. The difficulty of accounting for this is considerable, but may per- haps be explained by the very diffused state of the prussiate in the entire mass of the blood, and its greater concentration when se- creted by the kidneys: by which the same test which was applied in vain, in the former instance, completely succeeded in the latter. There is, however, another mode of accounting for the result of M. Magendie's experiments without abandoning the well-established doctrine of absorption by the lymphatic system. It is a remark which ought never to be lost sight of, that experiments made upon animals in a state either of great pain or of great debility can give lis by their result, no full proof of the line of conduct pursued by nature in a stale of health. In the dead animal body the valves of vo/.. iv. 2,"> 194 PHYSIOLOGICAL PROEM. [cl. vr. the lymphatic vessels very generally lose all elasticity and power of resistance, and transmit fluids in every direction ; whence, in all probability, that porosity or transudation, which we have already observed, as manifest, occasionally in the stomach and intestines, and in various other organs, on the use of anatomical injections. And hence there can be little doubt, that as an organ makes an approach to the same state of insensibility and irritability, by the- severe if not fatal wounds inflicted on it in the course of such experiments as are here aliuded to, the valves of its lymphatic vessels make an ap- proach also to the same state of flaccidity, and allow the fluids, whose course they should resist, to pass in any direction. This altered condition of many parts of the lymphatics in the dead body, was sufficiently shown by Mr. Cruikshank, in a course of numerous experiments made at Dr. Hunter's Museum, in the spring of 1773. The organs chiefly injected were the kidney, liver, and lungs of adult human subjects. In one case, he pushed his injection from the artery to the pelvis and ureter without any rupture of the vessels. In another he injected the pelvis and ureter from ihe vein, which he thought succeeded better than from the artery. In three different kidneys he injected from the uterus the tobuli uriniferi for a considerable length along the mammillae; and in one case a number of the'veins on the external surface of the kidney were evidently filled with the injection. In all these experiments, the colouring matter of the injection was vermillion. In numerous in- stances he filled the lymphatics of the lungs and liver with quick- silver ; and from the lymphatics of the liver, he was able, twice in the adult, and once in the fetus, to fill the thoracic duct itself* Dr. Mekelt had, already shown the same facts by a similar train of experiments, instituted only a year or two before, and the con- clusion he drew from them is in perfect coincidence with the ex- planation now offered. Dr. Mekel's experiments consisted in in- jecting mercury with great care, but considerable force, into various lymphatics, and minute secreting cavities ; and he found that a di- rect communication took place between such cavities and lympha- tics, and the veins in immediate connexion with them : and hence^ he contended, that the lymphatics and the veins are both of them absorbents under particular circumstances; the lymphatics acting ordinarily, and forming the usual channel for carrying off secreted fluids; and the veins acting extraordinarily, and supplying the place of the lymphatics where these are in a state of morbid torpi- tudc or debility, or the cavity is overloaded. He traced this com- munication particularly in the breasts, in the liver, and in the blad- der: and he thus accounts for the ready passage which bile finds into the blood, when the ductus choledochus is obstructed, as in * Edin. Med. Coin. I. p. 430. t JVova Experimenta et Observationes de fibribus venarum ct vasorum lym- phaticorum in ductus, vitceratuie corporis humani, eittiiemmie structure ulir- litate.8vo. «. L. \ I.] PHYSIOLOGICAL PROEM. 19d jaundice ; and the urinous fluid which is often thrown forth from the axillae and other organs upon a suppression of the natural se- cretion. It follows therefore, that the experiments of M. Magendie, al- lowing them to be precisely narrated, are capable of explanatioa without abruptly overthrowing the established doctrines of pre- ceding physiologists in the same line of pursuit: and we have still ample reason for believing that the economy of secretion and ab- sorption is effected by two systems of vessels distinct from veins and arteries, and in a state of health continually holding a balance with each other. III. In different periods of life, many of the secretions vary con- siderably in their sensible properties, or relative quantity. Thus the bile of the fetus is sweet, and only acquires a bitter taste after birth. In infancy perspiration flows more profusely than during manhood ; and the testes which secrete nothing before the age ot puberty, at this time acquire activity, and again lose their power in old age. There are also many of the secernent organs that, in case of ne- cessity, become a substitute for each other. Thus the perspirable matter of the skin when supprest by a sudden chill or any other cause, is often discharged by the kidneys; the catamenia by the lungs; and the serum accumulated in dropsies by the intestines. The secretions are moreover very much affected and increased by any violent commotion of the system generally. In hysteria the flow of urine is greatly augmented, while the absorption of biie seems diminished ; and hence the discharge is nearly colourless. In violent agitation of the mind, we have already observed that the juices of the stomach become acid; and sometimes the secer- nents of the skin, and sometimes those of the larger intestines, are stimulated into increased action; whence colloquative per- spiration, looseness, or both. The heat and commotion of a fe- ver will sometimes produce the same effect and sometimes a con- trary ; the skin being dry, parched, and pricking. And occasion- ally the dryness has been so considerable as to produce a sudden separation of the cuticle from the cutis; of which Mr. Gooch relates a singular instance in a patient who for several years, had once or twice a year an attack of fever accompanied with a pecu- liar itching of the skin, and particularly of the hands and wrists, that ended in a total separation of the cuticle from these parts: insomuch that it could easily be turned off from the wrist down to the fingers ends so as to form a kind of cuticular glove* The same distin- guished writer gives as singular an instance of the effects of solar heat upon the skin of another patient who had no sooner exposed himself to the direct rays of the sun, than his skin began to be af- fected with a sense of tickling, became violently hot, as stiff as leather, and as red as vermillion.t In this case we have an instance Medical and Chirurgical Observations, Cvo. Op. (int. 196 PHYSIOLOGICAL PROEM. [CL* T,# of highly excited action in the cutaneous excernents of both kinds, and of the formation of new blood-vessels under the cuticle ; the more attenuate part of the fluid secreted being rapidly carried off, and hence, the cutaneous integument converted into a coriaceous substance. There are some parts of the body that waste and become renew- ed far more rapidly than others; the fat than the muscles; the mus- cles than the bones; and probably the bones than the skin ; for the dye of the madder-root with which the bones become coloured when this root has for some time formed a part of the daily food of an animal, is carried off far sooner than the coloured lines of charcoal powder, ashes, soot, and the juices of various plants, when introduc- ed into the substance of the skin by puncturing or tattooing it, a practice common among our sailors, and still more so, and carried to a far greater degree of perfection among the inhabitants of the South-sea Islands. It has been said, indeed,* that the disappearance of the madder- colour from the bones, affords no proof that the phosphate of lime in which it was seated has itself been carried off at the same time; because the serum of the blood is found to have a stronger affinity for madder than the phosphate coloured by it; and hence will gra- dually attract and remove it, when the animal is no longer fed with the coloured food. The experiment, however, upon which this latter opinion is grounded, has not been hitherto conducted in such a manner as to be directly applicable to the question; and if it had been, it would afford no proof that a perpetual, though, in that case, a slower change than the madder would exhibit, is not taking place in the bones: nor are we driven to the effects of madder dye upon their solid substance as the only foundation for this opinion; for there is scarcely a bone in the animal system which does not as- sume a different shape at one period of life compared with that at another period: a remark that peculiarly applies to the flat bones of the skeleton, and forms the chief cause of that wonderful change which the lower jaw experiences as the individual advances from middle life to old age, and which often gives a different character to the entire face.f It is from this mysterious power of reproduction appertaining to every part of the system, that we are so often able to renew the substance and function of parts that have been wasted by fevers or atrophy, or abruptly destroyed or lopped off by accident. In the progress of this general economy, every organ and part of the body secretes for itself the nutriment it requires, from the com- mon pabulum of the blood which is conveyed to it, or from secre- tions which have already been obtained from the blood, and deposit- ed in surrounding cavities, as fat, gelatin, and lymph. And it is * Bcrnouilli, Diss, de Nutritione, Groning. 1669. 4to. t Gibson, Manchester Memoirs, Vol. i. 533. CL. VL] PHYSIOLOGICAL PROEM. 197 probable that the several organs of secretion, like the eye, the ear, and the other distinct organs of sense, are peculiarly affected by pe- culiar stimulants and excited to some diversity of sensation. In Germany, this idea has been pursued so far as in some hypo- theses, and particularly that of M. Hubner,* to lay a foundation for the doctrine of a sixth sense, to which as we observed on a former occasion,! has been given the name of selbstgejiikl or geineingefuhl, " self-feeling," or u general-feeling." The sensations, however, we are at present alluding to, are not so much general on those of the whole self, as particular or limited to the organs in which they originate ; and seem rather to be a result of different modifications of the fluid that causes the common sense of touch, than produced by distinct sensorial secretions. In most parts of the system these modifications are so inconsiderable as to elude our notice, but in others we have the fullest proof of such an effect; for we see the stomach evincing a sense of hunger, the fauces of thirst, the genital organs of venereal orgasm. And in like manner we find the Mad- der stimulated by cantharides, and the intestinal canal by purga- tives ; and we may hence conjecture that every other part of the system, where any kind of secretion is going forwards, is endowed with a like peculiarity of irritability and sensibility, though not suf- ficiently keen to attract our attention. It is hence we meet with that surprising variety of secretions which are furnished not only by different, but even by the same animal in different parts of the body. Hence sugar is secreted by the stomach, and sometimes by the kidneys ; sulphur by the brain ; wax by the ears; lime by the salivary glands, the secretoriesofthe bones, and, in a state of disease, by the lungs, the kidneys, the arte- ries, and the exhalants of the skin: milk by the breasts; semen by the testes; the menstrual fluid by the uterus; urine by the kidneys ; bile by the liver; muriate of soda by the secernents of almost every organ ; and sweat from every part of the surface. Hence some animals, as the bee, secrete honey; others, as the coccus ilicis, a large store of wax; others, as the viper and scor- pion, gum which is the vehicle of their poison: others thread, as the spider and some species of slug ; and many silk, as the silk-worm and the pinna, or nacre; whence Reamur denominates the pinna the sea-silk-worm: it is common to some of the Italian coasts, and its silky beard or byssus is worked at Palermo into very beautiful silk stuffs. There are great numbers of worms, insects, and fishes that secrete a very pure, and some of them a verj' strong phospho- rescent light, so as, in some regions, to enkindle the sea, and in others the sky, into a bright blaze at night. Many animals secrete air; man himself seems to do so under certain circumstances, but fishes of various kinds more largely, as those furnished with air- * Comment, de Csenesthesi, 4794. t Vol. in. Physiol. Proem, p. 12. 198 PHYSIOLOGICAL PROEM. [CL. VI. bladders which they fill or exhaust at pleasure, and the sepia or cuttle-fish, with numerous other sea-worms ; and by this power they raise or sink themselves as they have occasion. The cuttle-fish secretes also a natural ink, which it evacuates when pursued by an enemy, and thus converts it into an instrument of defence ; for by blackening the water all around it obtaius a sufficient concealment and easily effects its escape. Other animals, and these also chiefly fishes, secrete a very large portion of electric matter, so as to convert their bodies into a powerful battery. The torpedo-ray was well known by the Romans to possess this extraordinary power: and the gymnotus electricus (electric eel,) has since been discovered to possess it in a much larger proportion. The genus tetradou in one species secretes an electric fluid, in another an irritating fluid that stings the hand that touches it, and in a third a poisonous matter diffused through the whole of its flesh.- From the same canse we meet with as great and innumerable a variety of secretions among plants, as camphors, gums, balsams, resins: and, as in animals, we often meet with very different secre- tions, in very different parts of the same plant. Thus the mimosa nilotica secerns from its roots a fluid as offensive as that of assafoe- tida; in the sap of its step an astringent acid; its glands give forth gum arabic; and its flower an odour of a very grateful fragrance. This subject is highly interesting, and might be extended to volumes, but we are already digressing too far. There is no part of the body in which the process of secretion is not going forward: we trace it, and consequently the fabric which gave rise to it, in the parenchyma or intermediate substance of organs, in their inter- nal surfaces and outlets, and on the external surface of the entire frame: thus forming three divisions of prominent distinction, both in respect to locality and to the diseases which relate to them. It is on these divisions, that the orders of the present class are founded. CLASS VI. ECCRITICA. ORDER I. MESOTICA. 29ferasra affcctttifl the 13arcncfogma. PRAVITY IN THE QUANTITY OR QUALITY OF THE INTERMEDIATE OR CON- NECTING SUBSTANCE OF ORGANS ; WITHOUT INFLAMMATION, FEVER, OR OTHER DERANGEMENT OF THE GENERAL HEALTH. The classic term eccritica is a derivative from ixx^t*, " secerno," •l exhaurio," " to secern or strain off," " to drain or exhaust," and is preferred by the author to any other derivative which x^t*, its primitive, affords, as equally applicable to the two systems of vessels that enter into the general and important economy illustrated in the preceding Proem. The ordinal term mesotica is derived from uwtg, " medius;" for which parenchymatica might have been sub- stituted, but that there are two objections to Ihe use of the latter: the first is that wxgx is here employed in a different sense from its general signification in the system before us, which is that of " male," or "• perperam,"—instead of per or penitus, its real mean- ing in parenchyma; and, consequently, the double signification would trench upon that simplicity and uniformity which it is the direct object of the present nomenclature to maintain. The second objection is, that the term parenchyma (sragey^t/pe) is formed upon a false hypothesis invented by Erasistratus, who first employed the term, and held that the common mass or interior substance of a viscus is produced by concreted blood, strained off through the pores of the blood-vessels which enter into its general structure or membranes. The order embraces the five following genera :— I. I'OLYSARCIA. corpulency. II. EMPHYMA. TUMOUR. III. PAROSTIA. MIS-OSs'.FICATION. IV. CYRTOSIS. CONTORTION OF THE BONES. V. OSTHTMA. OSTHEW. 200 ECCRITICA. [CL. VL-OR. I. GENUS I. POLYSARCIA. C&orjmleiicg. FIRM AND UNWIELDY BULKINESS OF THE BODY OR ITS MEMBERS, FROM AN ENLARGEMENT OF NATURAL PARTS. Polysarcia from jroAt/cragiMj, " carnosus," "came abundans," im- ports bulkiness from any morbid increase of natural parts, whether fleshy or adipose: and the present genus is co-extensive with this latitude of interpretation. In medical history, however, we know of no morbid increase of this kind except from an accumulation of fat: and hence the genus is at present limited to a single species, as follows: 1. ADIPOSA. OBESITY. SPECIES I. POLYSARCIA ADIPOSA. ©hesitg. BULKINESS FROM A SUPERABUNDANT ACCUMULATION OF FAT. This species admits of two varieties. For it may be x Generalis. Extending over the body and limbs. General obesity. Z Splanchnica. Confined to the organs or integu- Splanchnic obesity, ments of the trunk. In man and other animals fat is collected in the follicles of the cellular membrane, accumulated in the groin, axilla, omentum, around the kidneys, and the blood-vessels. It is likewise secreted on the surface of the skin, which it protects from acrid substances, and where it sometimes concretes, often from want of cleanliness, or being intermixed with hardened mucus, in the shape of minute worms, forming the varus punctatus, or maggot-pimple, of the third Order of the present Class. When the perspiration becomes pro- fuse in consequence of hard walking or other exercise, a certain portion of animal oil is dissolved in this fluid which makes the chief, GE. I.-SP. I.] EXCERNENT FUNCTION. 201 perhaps the only difference between the matter of perspiration and that of sweat. Fat is, hence, accumulated by diminished perspira- tion ; as it is also by the nature of the aliments fed on, and from idiosyncrasy. It is the basis of steatomatous tumours, and contains the sebacic acid which acts readily on many metals as lead, copper, and iron. In many fishes, as the salmon and herring, it is diffused over the whole body, as though the body were steeped in it. In other genera of fishes, as the ray, it is found in the liver alone. In some few, as the whale, it appears in the form of flakes, and is called blubber, which sometimes amounts to the enormous quantity of three tons in an individual. Fat is a bad conductor of heat; and hence, one of its uses is that of keeping the body warm ; on which account those who are in- cumbered with fat perspire with but a small quantity of exercise, and are almost always too hot. We may hence also see why the warmth of the body is retained by oiling the surface, or wearing oiled skin over it. Fat is also of considerable use in lubricating the solids, and facilitating their movements; in preventing exces- sive sensibility; while by equally distending the skin, it contri- butes, when not in excess, to the beauty of the person. In cases of extreme hunger, or of abstinence from food, fat is re-absorbed and carried to the blood-vessels; and from an experiment of Dr. Stark,* it appears to be more capable of supplying the waste of the body than any sort of ordinary food. And hence, there is much proba- bility in the conjecture of Lyonet that insects, destitute of blood, derive their chief nourishment from the fat in which they abound.t With the exception, however, of the earth of the bones, it is the least animalizedof all the substances that enter into the composition of the animal frame. Chemically examined pure fat contains no azote, which is the peculiar characteristic of animalization; it has also little oxygene, consisting chiefly, indeed, of hydrogene and carbone. " I do not consider," sajs Mr. John Hunter, " either the fat or the earth of bones, as a part of the animal: they are not animal matter: they have no action within themselves: they have not the principle of life."}: It is of late formation in the fetus: scarcely any trace of its existence is discoverable before the fifth month from conception. The mode of its production is still a matter of controversy. By some it has been supposed to be secreted by peculiar glands, by others merely to transude from exhataut arteries of a peculiar kind. Sir Everard Home has lately started another hypothesis, which is at least highly ingenious and plausibly supported. He has attemp- ted to prove that the fat of animals is produced in the larger in- testines, (especially the colon,) out of the recrement of the food and * Hewson, n. p. 151. I Tr. Anat. de la chenille qui rouge le bois de saule, pp. 420. 483. et seq. # X On Blood, p. 440. VOL. IV. «* ■ 202 E< CRITIC A. [CL. VI.—OR. I. the bile, and afterwards conveyed into the system generally by channels yet undiscovered to contribute towards the common growth of the system, especially in early life.* And some arguments in favour of this opinion may be drawn from the nature of that species of enterolithus, to which in the present system is given the name of scybalum, and from the observations with which it has been illus- trated.! In general obesity, or the variety of adipose polysarcia imme- diately before us, the bulk of the body has sometimes been enor- mous. It has amounted to five hundred, and nearly six hundred pounds in many instances. Bright, of Maldon, weighed seven hundred and twenty-eight pounds; Lambert of Leicester, seven hundred and thirty-nine pounds a little before his death, which was in the for- tieth year of his age. The German journals give us examples of men who weighed eight hundred pounds. Yet the Philosophical Transactions furnish perhaps a still more extraordinary example of this disease in a girl that weighed two hundred and fifty-six pounds though only four years old.J Where a powerful adipose diathesis prevails, fat i3 often produc- ed whatever be the food fed upon. Ale and porter drank to excess, are, perhaps, the most ordinary means; Akermann gives proofs of the same effect from spirits :§ and in the Ephemera of Natural Curiosities is the case of an individual who generated fat faster, and in larger quantities, upon bread than upon a meat diet.|) Indo- lence and an indulgence in sleep seem necessary, however, in every instance. In these cases the animal oil is sometimes secreted and deposited in the cellular membrane almost as rapidly as water in anasarca : on which account obesity has by some writers been called, and cor- rectly enough, a dropsy of fat. It is in fact under particular circum- stances the soonest formed and deposited, and the soonest absorbed of all the animal secretions. For its formation, however, ease of body and mind are indispensable, and perhaps a slight increase in the flow of sensorial power beyond the common standard, or what has hitherto been the standard of the individual. It is on this ac- count those are apt to become fat who suddenly relinquish a habit of hard exercise either of body or mind for a life of quiet enjoy- ment, provided the change be not sufficient to interfere with the general health. And for the same reason, as we have already ob- served, animals which are castrated, and females that do not breed, or who have just ceased to breed, grow fat and corpulent with equal ease ; the sensorial power intended for the use of the sexual organs, and to be expended at a particular outlet, being hereby thrown * Phil. Trans, for 1813. p. 153. and 1816. p. 301. t Vol. i. p. 191. X N. 185. } Baldinger N. Mag. B. vi. p. 489. || Dec. in. Ann. vit. viii. p. 138. OE. I.-feP. I.j EXCERNENT FUNCTION. 20fi back upon the system generally, and transferred to the adipose se- cernents. And hence, also, the cause of that increase of bulk which most persons experience about the middle of life, when the muscles having attained their utmost firmness, the stature its full height, and the «iexual economy its perfection, there is a less demand for the ordiuary supply of sensorial power than has hitherto been made and the surplus is expended in broadening and rounding the general frame by filling up the cells of the adipose membrane with animal oil, instead of elongating it. For all this, however, there must be an ease of body and mind approaching to cheerfulness ; on which account plumpness, and cheerfulness, or good humour, are commonly associated in our ideas: for pain and anxiety, that wear away the corporeal substance gene- rally, make their first inroad on the animal oil, and empty the cells of the adipose membrane before they produce any manifest effect on the muscular fibres, or, as these are collectively termed, the flesh; upon which subject we have already touched in discussing several of the species of the genus marasmus.* Hence the fat becomes absorbed or carried off, as it is secerned and deposited more readily than any other animal substance. By sweating, horse-riding, and a spare diet, a Newmarket jockey has not unfrequently reduced himself a stone and a half in a week or ten days :f and a plump widow has, by weeping, become a skeleton in a month or two. A moderate increase in the secretion of animal oil rather adds to the facility of motion, and improves the beauty of the person. But if it much exceed this, the play of these different organs upon each other is impeded, the pulse is oppressed, the breathing laborious, there is an accumulation of blood in the head, a general tendency to drowsiness, and a perpetual danger of apoplexy. In splanchnic obesity, the encumbered viscera are more or less buried in beds of fat, and usually accompanied with scirrhous affec- tions ; making an approach to some species or other of parabysma, as described in the first Class and second Order of the present system.| We have observed that general obesity may be regarded as a dropsy of animal oil instead of a dropsy of water. And, as the latter dis- ease is sometimes universal and runs through the whole of the cel- lular substance, and at others local, and confined to particular cavi- ties, the former also exhibits both these modifications; and in the variety before us, is confined to individual organs. It most generally overloads the omentum, and gives that project- ing rotundity to the abdomen which is vulgarly distinguished by the name of pot-belly, and is well described by Prince Henry in his * Vol. ii. p. 494. + Code of Health, by Sir John Sinclair. &c. I Vol. I. p. 273. 204 ECCKIT1CA. [CL. V1.-OR. I. address to Falstaff, as •• a huge hill of flesh,"*—" a globe of sinful continents."! Animal oil is more apt to accumulate in the abdominal viscera than on the surface, and hence while these organs always partici- pate in a general obesity, it is not to be wondered at that they should sometimes be loaded alone. As it has been stated that free- dom from pain is necessary to its accumulation, it may, perhaps be a matter of surprise that schirrosities should be a concomitant. But this morbid condition takes place so slowly as to produce little or no local disquiet; while the small degree of increased irritability that accompanies their formation, for a reason already assigned, tends rather to promote the morbid deposit than to prevent it. In attempting a cure of the general disease, the first step is to avoid all the common and more obvious causes as much as possible. Hence, as a life of indolence and indulgence in eating and drinking is highly contributory to obesity, the remedial treatment should consist in the use of severe, regular, and habitual exercise, a hard bed, little sleep, and dry and scanty food, derived from vegetables alone, except where, from a singularity of constitution, farinaceous food is found to be a chief source of obesity. And where these are insufficient, we may have recourse to frequent venesection and such medicines as freely evacuate the fluids whether by the bowels or the skin. And, for the same reason, sialogogues, as chewed tobac- co,]; and mercury, have occasionally been used with success.§ Generally speaking, however, the diet and regimen just recom- mended with a spare allowance of water will be sufficient to bring down the highest degree of adipose corpulency. Of this we have a striking example in the history of Mr. Wood, the noted miller of Billericay in Essex. Born of intemperate parents, he was accus- tomed to indulge himself in excessive eating, drinking, and indolence, till, in the forty-fourth year of his age, he became unwieldy from his bulk, was almost suffocated, laboured under very ill health from indigestion, and was subject to fits of gout and epilepsy. Fortunately a friend pointed out to him the Life of Cornaro : and he instantly de- termined to take Cornaro for his model, and if necessary to surpass his abridgments. With great prudence, however, he made his change from a highly superfluous to a very spare diet gradually : first dimi- nishing his ale to a pint a day, and using a much smaller portion of animal food; till, at length, finding the plan work wonders as well in his renewed vigour of mind as of body, he limited himself to a diet of simple pudding made of sea-biscuit, flour, and skimmed milk, of which he allowed himself a pound and a half about four or five o'clock in the morning for his breakiast, and the same quantity at * Henry iv. Part i. Act. n. t Id. Part n. Act n. X Borelli, Cent. n. Obs. 11. & Bartholin. Act. Hafn. i. Obs. 74. Bonet, Sepukhr. Lib. u. Sect. ii. Obs. 36. Appx. GE. I.-SP. I.] EXCERNENT FUNCTION. 205 noon for his dinner. Besides this he took nothing either of solids or fluids, for he had at length brought himself to abstain, even from water; and found h.mself easier without it. He went to bed about eight or nine o'clock, rarely '•lept for more than five or six hours, and hence ro«e usually at one or two in the morning, and employed him- self in laborious exercise of some kind or other, till the time of his breakfast. And by this regimen he reduced himself to the condition of a middle sized man of firm flesh, well coloured complexion and sound health.* A like plan, or rather something approaching it, the present author once recommended lo Mr. Lambert of Leices- ter on being consulted concerning the state of his health. But either he had not courage enough to enter upon it, or did not chuse to relinquish the profit obtained by making a show of himself in this metropolis He made his choice, but it was a fatal one, for he fell a sacrifice to it in less than three years afterwards. The local disease is for the most part far less manageable: but it has sometimes yielded to a steady perseverance in the above plan, in connection with active purgatives, and the application of mercu- rial ointment to the vicinity of the organ affected; or a free use of calomel in the form of pills. G E N U S II. EMPHYMA. ZTumour. ULOMERATION IN THE SUBSTANCE OF ORGANS FROM THE PRODUCTION OF NEW AND ADSC1TITIOUS MATTER : SENSATION DULL, GROWTH SLUGGISH. Phyma, in the present system, is limited to cutaneons rumours accompanied with inflammation, as already explained in Class in. Order n.t Emphyma imports, in contradistinction to phyma, a tumour originating below the integuments, and unaccompanied with inflammation, at least in its commencement: while ecphvma in Order m. of the piesent Class, imports, in contradistinction to both, mere superficial extuberances, confined to the integuments alone. The term glomeration, or " heaping into a ball," in the generic definition, is preferred to tbe more common terms protuberance or extuberance, because some tumours or emphymata lie so deeply seated below the integuments as to produce no prominence what- ever, and are only discoverable by the touch. * Med. Trans. Vol. n. Art. xvn. t Vol. II. p. 190. 206 ECCRITICA. [CL. VI.-OR. I. The species of this Order, and much of their general character and arrangement, are taken with a few variations from Mr. Aber- nethy's valuable Tract on Tumours. Ihe subject, indeed, though of a mixed description, is commonly regarded as appertaining rather to the province of surgery than of medicine, from the tendency which most tumours seated on or near the surface have to open externally, or to call for some manual operation. In a general system of the healing art, however, it is necessary to notice them, though it is not the authors intention to dwell upon them at length; but rather to refer the reader, from the few hints he is about to pursue, to Mr. Abernethy's work, as the best comment upon them which he can consult. The species embraced by the genus phyma are the following : 1. emphyma sarcoma. sarcomatous tumour. 2. -------encvstis. encysted tumour, wen 3.-------exostosis. bony tumour. SPECIES I. EMPHYMA SARCOMA. Sarcomatous ©utnour. TUMOUR IMMOVEABLE ; FLESHY AND FIRM TO THE TOUCH- The varieties of this species, modified in respect to structure and situation, are very numerous. The following, distinguished by the former quality, are chiefly worthy of notice : a Carnosum. Vascular throughout: texture simple : Fleshy tumour. when bulky mapped on the surface with arborescent veins. Found over the body and limbs generally*. Z Adiposum. Suetty throughout : inclosed in a thin Adipose tumour. capsule of condensed cellular sub- stance : connected by minute vessels. Found chiefly in the fore and back part of the trunk. v Pancreaticum. Tumour in irregular masses ; connect- Pancreatic tumour. ed by a loose fibrous substance, like the irregular masses of the pancreas. Found occasionally in the cellular substance, but more usually in con- voluted glands: chiefly in the female breast GE. II.—SP. I.] EXCERNENT Fl'NCTION. 207 Cellulosum. Cystose tumour. Derbyshire-neck. Scirrho'sum. Scirrhous tumour. Mammarium. Mammary tumour. Tuberculosum. Tuberculous tumour. 3 Cellulosum. Tumour cellulose or cystose : cells oval, currant-sized or grape-sized, containing a serous fluid ; sometimes caseous. Found generally, but most- ly, in the thyroid gland, testis, and ovarium. Hard, rigid, vascular, infarction of glandular follicles; indolent, insen- tient, glabrous; sometimes shrink- ing and becoming more indurated. Found in glandular structures, chiefly those of the secernent system. Tumour of the colour, and assuming the texture of the mammary gland : dense and whitish : sometimes softer and brownish: often producing, on extirpation, a malignant ulcer with indurated edges. Found in various parts of the body and limbs Formed of firm, round, and clustering tubercles ; pea-sized or bean-sized ; yellowish or brownish-red ; when large, disposed to ulcerate, and pro- duce a painful, malignant, and often fatal sore. Found chiefly in the lym- phatic glands of the neck : often simultaneously in other glands and organs. Of a pulpy consistence and brain-like appearance ; whitish ; sometimes reddish-brown; when large, apt to ulcerate, and produce a sloughing, bleeding, and highly dangerous, sore. Found in different parts ; chiefly in the testes: at times pro- pagating itself along the absorbent vessels to adjoining organs. All these grow occasionally to an enormous size particularly the sarcomatous, the adipose, and the scirrhous. They are all pro- duced by some increased action or irritation in the part in which they occur, the cause of which it is rarely in our power to ascer- tain. In general, they commence slowly and imperceptibly, and are seldom accompanied with much pain whatever be the ex- tent of their growth. They are all more or less organized through ihe whole of their structure, by which they are particularly distin- guished from those of the next species : and it is highly probable that most of the irritating causes which produce any one, produce all the rest, the modification depending on the difference ot site. Medullare. Medullary tumour. 208 ECCRITICA. [CL. VL-OR. I. habit, idiosyncrasy, or local misaffection. In their formation, how- ever, there seems to be a greater tendency to inflammation, and es- pecially adhesive inflammation in the fleshy tumour, or proper sar- coma, than in any of the rest; and, from the more perfect elabora- tion of its fabric, there is no other form that maintains itself so firmly, or is removed, excepting by excision, with so much difficul- ty. The origin of the adipose may, in some degree, be understood from the remark we have offered under the last genus, and particu- larly under its second variety. The scirrhous tumour, when irritated, has a general tendency to run into a cancerous ulcer : for which it is not always easy to ac- count, excepting where there happens to be an hereditary taint in the blood : for neither the tumour nor its ordinary result, as we ob- served when treating of carcinus, is by any means confined to a glandular or to any particular structure, though the secernent glands constitute its most common seat. In Mr. Abernethy's Treatise, the place of the scirrhous tumour, however, is occupied by another to which he gives the name of carcinoma, which, in the present sys- tem, is regarded as a modification of the scirrhus, degenerated, and ulcerated mostly by a cancerous diathesis; and in such case apper- taining to carcinus, already described in the fourth order of the third class ;* or where no such diathesis is present, belonging to the same class and order under the genus and species ulcus viti- osutn.X The scirrhous tumour is, in fact, the most important of the whole tribe, not only as leading, under peculiar circumstances, and in particular habits, to the most fatal result, but as being more com- mon to every organ than any other variety whatever; and, in a few instances, common to almost every organ collectively or at the same time.J The other varieties are looser and more spongy, and contain far less of living power: in consequence of which they are more easi- ly disposed to ulcerate, and, when in this condition, often spread and become sordid and malignant from debility alone. We have said that the tumours of this species will sometimes grow to a vast and preposterous bulk. This is particularly the case with the first variety or fleshy sarcoma, and more especially when it seats itself in the scrotum forming the sarcocele, or hernia carnosa of authors. Negroes are particularly subject to this affection, and in one instance the tumour weighed fifty pounds.§ It is said that among them the disease is more common to the right testicle than to the left. Stoll, however, has asserted directly the contrary so far as relates to Europeans, and his remarks are supported by the observations of Pfeffinger and Friedius. He has moreover o-eneral- * Vol. II. p. 534. t Vol. n. p. 616. X Henggen, Museum der Heilkunde, Band. ii. p. 111. ? Schotte, Phi). Trans. Vol. lxxiii, 1783. GE. Il.-^P. I.] EXCERNENT FUNCTION. 209 iscd his assertion by contending that the left ovary of women as well as the ieft testicle of men is more subject to diseases of all kinds than the right.* The adipose tumour is also frequently of a very large magnitude. Mr. Abernethy gives an instance of one on the thigh that weighed fifteen pounds after extirpation,! and M. Leske of another of the weight of nineteen pounds dissected from the face.J In the Jour- nal de Medicine, is an account of a third, that weighed not less than forty-two pounds.§ The bulk of the scirrhous tumour, however, and especially when seated on the breast, has often equalled and sometimes exceeded the largest of these. M. Leske, indeed, gives a case, in which a tu- mour of this kind was ampuiated from the breast, of the enormous weight of sixty-four pounds, that had been increasing for years, and was at last so oppressive as to endanger the patient's life.|| The most unsightly, however, of the whole is the sarcoma cellu- losum, when it fixes in the thyroid gland in which situation it is often called Botium, Bronchocele, or Goitre • and, in our own vernacular language, derbyshire-neck, from a vulgar idea, of considerable anti- quity, that the inhabitants of this county are more subject to it than those of other districts. The cells are here very numerous, the fluid often viscid, and sometimes gelatinous; so that, when the tumour bursts, as it occasionally does, spontaneously, the contained fluid is apt to drain away very slowly, and has ulcerated with a large sloughy surface without having half evacuated its contents. Most of these may be frequently repressed or resolved if disco- vered and attended to on their origin. The fleshy, which always commences with some degree of inflammatory action, should be vi- gorously attacked with leeches, repeated as often as may be neces- sary, and afterwards with astringents or alterants, as the dilute solu- tion of the superacetate of lead, for the former purpose, and the mercurial emplaster for the latter. An issue or seton in the vicinity will also frequently assist by producing a transfer of action. If this plan do not succeed the tumour should be extirpated by the knife without loss of time, or allowing it to acquire any considerable bulk. The scirrhous tumour is usually indicative of weak, instead of entonic, action in the organ in which it makes its appearance, in consequence of which the lymphatics absorb only the more attenu- ate part of the secerned fluids, and leave the grosser which thick- en and harden in the parenchyma. There is little irritation at first, but as the distension and obduration increase, the part becomes stimulated, and, as we have already observed, in a scrophulous can- * Nov. Act. Physico-Med. Acad. Nat. Cur. Tom. iv. Noam. t On Tumour*, p. 31. 8vo. 1814. X Auserlesene Abhandlungen, Ajc. Leipzig, 177 1, 8vo. j Tom. xx. p. 551. || Op. citat. 210 ECCRITICA. [CL. VI.-OR. I. cerous diathesis is apt to call the latent seminium into action, when the hardened tumour degenerates into a foul ulcer. In an early stage they have yielded to local irritants, which have a tendency to excite an increased action, and of a new kind, and hence the ad- vantage of mercurial applications, or emplasters of the gum-resins: and particularly the emplaster of ammoniac with quicksilver which unites the two, and is an admirable preparation. Where, indeed, the irritation is already considerable the more direct of these sti- mulants must be abstained from, and the inirritants and narcotics may be had recourse to with more advantage, as the preparations of lead, acids of almost every kind, and cataplasms of hemlock, henbane, bella donna, or potatoe-leaves. But here also the best and most effectual relief is to be had in extirpation, and the actual cautery as employed by M. Maunoir* will often be found more effec- tual and even produce less pain than the knife. Many of these varieties of tumours on their first appearance, may be repelled by stimulant applications in conjunction with a steady pressure wherever this can be applied; for, with the exception of the first, there is little tendency to inflammation in any of them, and, in the greater number, a decided weakness of the living power. They are often, indeed, connected with constitutional debility, and hence appear simultaneously in different parts of the body. Ex- tirpation in this case is useless; at least till the general frame is invigorated by a tonic regimen and course of medicines. And even then from the peculiar seat or size of the tumour it will not al- ways be found adviseable. This is particularly true in that variety of the cystous sarcoma which is denominated bronchocele, goitre, or derbysfike-neck ; and which usually proceeds from an enlargement of the thyroid gland. It is mostly found in females, and in its commencement the patient and her friends always turn a deaf ear to the use of the knife, under a hope that it may yield to a course of external and internal medicine : nor is the tumour, indeed, at all times suffi- ciently defined from the first for any eflective use of chirurgical means. It originates without pain or any discoloration of the skin, and presents a general prominence on the fore part of the neck, that rises so gradually as to be at first almost without an outline. As the prominence increases it becomes harder and somewhat ir- regular, commonly with a partial feeling of fluctuation, though, in some instances, the tumour appears to be firm throughout. The skin grows yellowish, and the oppressed veins of the neck become varicose; the respiration is sometimes rendered difficult, and from the same cause the patient is troubled with head-aches. The ex- pediency of removing the tumour is, at this time, highly questiona- ble, and every day increases the difficulty from the growing diame- ter of its arteries and their proximity to the carotids. • See Vol. n. p. 617. GE. 1I.-SP. I.] EXCERNENT FUNCTION. 211 The internal substance and structure of this tumour differs ex- ceedingly in different cases. It has sometimes been found steato- matous throughout but more generally, as we have already ob- served, consists of a fluid varying in viscidity, and in the number of cells, or capsules in which it is locked up. It commonly first shows itself in girls who have reached the age of puberty, though it fre- quently commences at a later period; and is an ordinary symptom of cretinism, as we shall notice when treating of th .t disease in the course of the present order. Here also we have deficient living power in the organ affected, and very generally in the entire constitution : for it usually appears in girls of relaxed and flaccid fibres, in many cases partly debilita- ted by growth, and partly by a larger flow of catamenia than the general tone of the system can sustain without yielding. On this ac- count we may see why cretinism should be a cause. Stimulants and tonics have hence been found generally useful, as have also repeated and long continued friction with the hand over the area of the tumour, alone or in conjunction with ammoniacal or terebinthinate irritants, chiefly solutions of camphor in spirits. For a reason that does not seem hitherto to have been sufficiently ex- plained, in this kind of tumour, as in those of scrophula, the most successful stimulants are the alkalies: and of these the ammoniacal were at one time believed to be far more so than any of the rest; and hence the patient was limited altogether to a course of burnt sponge or burnt hartshorn, and at one time to burnt toads. There does not seem, however, to be any particular reason for this pre- dilection, and hence in the present day the subcarbonate of ammo- nia, or the carbonate of soda have been pretty generally allowed to supply the place of all the other preparations of this kind, as the most convenient form in which the alkali can be given. It is also recommended to be applied externally, in the form of sea-water, or the bibulous sea-plants, as already described in the treatment of scrophula :* the whole of the remedial process for which may be adopted as the fittest line of conduct on the present occasion : both diseases being chiefly seated in the glandular parts of the animal frame, and accompanied with great indolence in the lymphatic system. n . The tumour has sometimes been cured spontaneously, an in- stance of which occurred not long ago to the present author, in a young lady who had for six or seven years been successively under the care of all the most skilful physicians and surgeons of this me- tropolis, and who had nevertheless the mortification of finding the protuberance grow much larger, and more unsightly in spite ot frictions, and blisters, and setons, and mercury in every form, and the alkalies, and hemlock and hyosciamus, employed jointly or al- ternately, and in almost every proportion through the whole of this period. The distended skin at length gave way in various place« *• Vol. ii. p. 530. 212 ECCRITICA. [CL. VI.-OR. V and a thin fluid issued from the foramina. This natural discbarge was encouraged, and the sac by degrees exhausting itself, the tu- mour as gradually diminished, and at length completely disappeared. SPECIES II. EMPHYMA ENCYSTIS. SSttcguteU arumour. OTeu. TUMOUR MOVEABLE ; PULPY ; OFTEN ELASTIC TO THE TOUCH. A very small change in the power or mode of action of a secerneiv vessel will often produce a very considerable change in the nature of the fluid which it secretes. Of this we have a clear proof in the thin and acrid lymph poured forth from the mucous membrane of the nostrils in a catarrh, and the bland and viscid discharge which lubricates this cavity in a state of health; limpid and mucilaginous at first, but gradually hardening into a horny substance. So the lungs, which, when sound secrete a mjld, when in a morbid condi- tion throw out a tenacious, phlegm, a watry, or whey-like sanies. or a muculent pus. And we may hence easily account for the great diversity of materials found in the species of tumour before us. which is peculiarly distinguished by being surrounded with a pro- per cyst, and hence rendered moveable to the touch. To follow up the subdivision through the whole of the varieties it offers would be almost endless. The following are chiefly worthy Encysted extuberance, containing a fatty or suetty substance, apparently secreted from the internal surface of the cyst. Found over most parts of the body, and varying in size from that of a kidney bean to that of a pump- kin. Encysted extuberance containing a mealy or curd-hke substance, sometimes intermixed with harder corpuscles : apparently secreted as the last Found of different sizes over most parts of the body. Encysted extuberance containing a honey-like fluid. Found of different sizes over most parts of the body. Encysted extuberance containing a colourless fluid: the extuberation fixed upon a tendon. of notice : x Steatoma. Steatome. Adipose Wen. £ Atheroma. Atherome. Mealy Wen. y Melliceris. Honied Wen. 3 Ganglion. Ganglion. GE. II.-SP. I I.J EXCERNENT FUNCTION. 213 t Testurfo. Encysted extuberance containing a fluid readily Horny Wen. hardening into horn or nail: and especially when protruded externally upon an ulceration of the surrounding integuments. Most of these are supposed by Sir Astley Cooper to be nothing more at first than obstructed and enlarged cutaneous follicles: the sebaceou- matter accumulating in the hollow of the follicle, which is lined with cuticle, and expanding it often to a considerable extent by pressure, in con-equence of the mouth of the follicle becoming plugged up or entirely closed.' Where it is plugged up the obstructed mouth is generally visible by a black dot, which is carbonized sebacious matter. This being picked off or otherwise removed, a probe may often be easily forced down into the cavity and the whole of the confined material be squeezed out by pressing the sides of the tumour, even when of some inches in diameter, and this with little pain and no inflammation.* Such Sir Astley regards as the general history of common encysted tumour seated on the surfaced But they will necessarily vary in their structure and contents from a 'multiplicity of adventitious circumstances, and perhaps ai*o from idiosyncrasy. The steatoine grows to a larger size than any of the rest. Rho- dius g-ivps a case in which it weighed sixty pounds :t and it has beeu dissected of the weight of twenty six pounds from the sca- pula.| The ganglion is introduced into the present list from the parity of its nature; and in so doing the author has only followed the example of Mr. Sharp. u The ganglion of the tendon," says he, " is an encysted tumour of the meliceris kind ; but its fluid is generally like the white of an egg When it is small, it sometimes disperses of itself I ressure and sudden blows do also remove it, but for the most part it continues unless it can be extirpated.1^ It is mostly produced by hard labour, or straining a tendon ; and hence is peculiarly common to the wri to be but little deficiency of phos- phoric acid, while there is an evident want of earthy matter: for we meet with no calcareous discharge by any of the emunctories, while the union which takes place between whatever portion of the earth is conveyed to the bones, and the phosphoric acid which is secreted at the same time, renders them in some degree friable though weak, and hence as liable to fracture on slight exertions as in the preceding species. A case of this kind is at this moment under the joint care of the author and Mr. How>hip. The patient is a lady, hitherto in good health, of about eight and twenty: both the thigh-bones were broken without any violence about a twelvemoth ago, and all the other bones showed a strong tendency to *oftne*s and compressibility. There was great general debility in all the functions, with a feeble and quickened pulse. By perfect quiet, a recumbent posture on a hard and level couch, and the steady use of a tonic regimen and diet, she is now evidently recovering. Her general health is improved, the extremities of both bones appear to be united and buried in an irregular mass of callus that has clustered around them: and it is probable that in a few months she may be able to be removed by an easy conveyance to the sea-coast A somewhat similar case, but of greater severity, communicated by Sir John Pringle to the Royal Society, is contained in its forty- eighth volume.t The patient was an unmarried female servant of good character. A parostic diathesis seems, from some cause or other, to have existed, and to have been brought into action by a tedious and troublesome chlorosis. One of the legs first gave way and snapped as she was walking from the bed to her chair, and soon afterwards both the thigh bones from a little exertion. From this time her general health suffered, her habit became cachectic, and there being an increasing inability to a supply of compact calca- reous earth, all the bones became soft and pliable, and bent in every direction without breaking, while those which were broken never united. Her head, however, throughout was scarcely affected, and her mental faculties continued clear to the last. She died in less than nine months from the commencement of the disease : and on examining her body all the bones were capable of being cut through without turning the edge of the knife. In one or two of the [(receding cases mercury was emploj'ed, and carried to the extent of producing salivation, yet without any benefit whatever. It is not easy, indeed, to conceive what benefit could be expected from such a pian. The deficiency of one or all the constituents of perfect and healthy earth of bones, is evidently * Medical Observations and Inquiries by a Soci^tv 'of Physician? in London, Vol. v. 8vo. i Phil. Trans, year 1~^S. 222 ECCRITICA. [CL. VI.-OR. I. dependent upon local or general debility, though we cannot always discover the cause of this debility, nor the peculiar circumstances connected with it which give rise to this rather than any other effect of diminished energy. nd hence, the only line of treatment we can engage in with any hope of success is that of perfect quiet, and a recumbent posture to prevent distortion and fracture, a plain but nutritive and somewhat generous diet, and a course of tonic medicines. In the case of the lady just adverted to, and who is now in a train of recovery, the medicines chiefly employed were various preparations of cinchona and iron, chiefly the pilulae ferri composite. with an allowance of ale instead of wine with her dinner. GEN U S IV. CYRTOSIS. Goutortton of tfte i&tmsn. HEAD EULKY, ESPECIALLY ANTERIORLY : STATURE SHORT. AND INCURVATED ; FLESH FLABBY, PALE AND WRINKLED. The term cyrtosis is derived from the Greek xvgreg, " curvus. incurvus, gibbosus," and, among the ancients, particularly imported recurvation of the spine, or posterior crookedness, as lordosis (a»{39 226 ECCRITICA. f [CL. VI.-OR. 1. judge that it originates more frequently from mothers than from fathers. So far as I can refer the disease of the children to the state of the parents, it has appeared to me most commonly to arise from some weakness, and pretty frequently from a scrophulous habit in the mother."—" I must remark, however," continues Dr. Cullen, " that in many cases I have not been able to discern the condition of the parents to which I could refer it."* Rickets seldom appears earlier than the ninth month of infancy, and not often later than the second year, being preceded, according to Dr. Strack, by a paleness and swelling of the countenance, and a yellow, sulphur hue in that part of the cheeks which should natur- ally be red.t In some instances it seems to have originated later; in every stage, indeed, of a child's growth, till the bones have ac- quired their full size and firmness ;f and it is said to have occurred even after this. But in these late appearances we are generally capable of tracing the disease to some local injury, which acts as an exciting cause, and, for the most part, unites it with parostia flexilis. Rhachia, in its ordinary course, commences imperceptibly and advances slowly : the body becomes gradually emaciated, the flesh flaccid, and the cheeks wan or sallow, with a slight degree of tume- faction. As the flesh diminishes in bulk, the head is found to in- crease, the sutures gape, and the forehead grows prominent. The spine bends and is incapable of supporting the weight it has to car- ry : the ribs and sternum partake of the distortion, the former lose their convexity, and the latter projects into a ridge. The same deficiency of bony earth runs through the entire ske- leton, and affects not only those parts that are composed chiefly of lime and phosphoric acid, as the flat bones and the middle of the long bones, but the extreme knobs or epiphyses, in which lime is combined as largely with carbonic as with phosphoric acid. And hence, the joints are loose and spongy, and in swelling keep pace with the head. In many instances the lime appears to be elabo- rated but without its correspondent acids, and consequently, with- out compactness, and to no purpose : for we can occasionally trace it loose in the urine, in which it forms a calcareous deposite, as though carried off from the blood as a recrement. All the assimilating powers participate in the debility in a great- er or less degree : the process of dentition is slow and imperfect, and, while the cellular membrane is without animal oil, the muscu- lar fibres are tabid, without energy, and almost inirritable. It does not seem, however, that the secretion of sensorial power is so much interfered with as the other secretions of the system. Some part, indeed, of what should be sent over the frame at large, appears to * Pract. of Phys. Vol. iv. Rook n. Ch. iv. } aidccxx.ii. t Act. Philosophico-Medico Soc. Acad. Priuc. Hassiie, &c. 4to. Giessx. Catho- i inn. X Thomasin, Journ. de Med. Tom. xliii. p. 222. •-.E. 1V.-SP. I.] EXCERNENT FUNCTION. 22/ be concentrated in the sensorium : so that its equipoise is disturbed, but the general average is not perhaps much diminished. And we are hence able to account for the curious and interesting fact that while the body is generally failing, the mind in many instances ad- vances in its faculties, insomuch that a very slight recapitulation of the names of those who have been pre-eminently gifted with mental talents in every age and nation, and have immortahzed them- selves as poets, philosophers, and even leaders in the held, will put before the eye of those who have not much attended to this sub- ject, a far greater proportion of the hump-backed, and the ncketty, than they may hitherto have had any conception of. \\ e had occa- sion to make a like remark when treating of scrophula, and the same fact occurs almost as strikingly in hectic fever. The progress of the mind does not necessarily depend upon the general progress of the body: in the ordinary course of things the one runs parallel with the other; but, in the great field of pathology, where this course is departed from, we are perpetually called to behold proofs that these powers are by no means one and indivisible, and that, even before the hour of death, the spirit gives token of an advance towards perfection, while the body in its general crasis is imbecile, or, perhaps, sinking gradually into ruins. At the commencement of rickets there is rarely any degree ot fever, but, as the disease advances, irritability, as in scrophula, suc- ceeds to inirritability, and a hectic is produced. Or it may happen that the sensorium at last participates in a greater degree with the disease of the rest of the frame, and the mind itself becomes en- feebled? and torpid, or fatuous. In the treatment of rickets, the eye should be directed to the two following intentions: that of strengthening the system general- ly : and that of facilitating a supply of phosphate ot lime to the or- gans that form the chief seat of disease. For the former purpose, a pure, dry, and temperate atmosphere, a wholesome and somewhat generous diet, regular exercise, ot such kind as can be indulged in with the least inconvenience, clean- liness, and cold-bathing are of essential importance, and have often worked a cure alone. And it is possibly owing to a more general conviction of the advantage of such a regimen in the present en- lightened age, that rickets is a complaint far less common now than it was a century or even half a century ago. A tonic plan of medicines, however, ought to be interposed, and will effectually co-operate with a tonic, regimen. As in infancy we can employ those remedies only which are neither very bulky nor very disgustful, we should, for the purpose immediately before us, make choice of the metallic salts. Mr. Boyle is said to have em- ployed, long ago, with very great success, some kind of ens veneris; and various preparations of copper have since been made use of, and been highly extolled for their virtues in the present disease, especially by Benevoli, and Biichner. Dr. Cullen, however, is per- suaded that the ens veneris of Boyle was a preparation not of cop- 228 ECCRITICA. [CL. VI.-OR. I. per, but of iron, in fact the flares martiales of the old dispensatories, and there is no doubt that this conjecture is right. From the ge- neral irritability of the system, iron, indeed, seems to be more ad- viseable on the present occasion than any other metal. And its stimulant property is a recommendation to its use, rather than a dissuasive. If the appetite fail, which is not common, and the stomach evince acidity and other dyspeptic symptoms, an occasional emetic will be highly serviceable. The bowels must be kept open with rhubarb, or neutral salts; and, if the abdomen be tumid, or there be any other symptoms of an affection of the mesenteric glands, mercury in small doses may be advantageously had recourse to, and combined with the tonic plan. The means of carrying into execution the second intention, or that of producing a direct supply of osseous matter, is accompanied with more difficulty, nor is it certain that we are in possession of any remedy whatever by which this can be accomplished, though it has often been attempted Bone may be regarded as a cancellated fabric of gluten whose cells are filled up with the earth of lime and a combination of car- bonic and phosphoric acid, of which the former bears the larger proportion. In all cases of rhachia, there seems to be a deficiency of these acids, but particularly of the phosphoric, and, in many cases, a deficiency of the earth as well as of the acids. Acids, however, of every kind, when in excess, have a tendency to dissolve calcareous earth instead of concreting it into a solid mass: and hence one of the most effectual means of preventing that tendency to the separation or production of a morbid superabund- ance of calcareous earth in osthexia and lithia, is a free use of acids as a solvent. A hint has been taken from this effect, and, as the disease before us is of an opposite kind, and evinces a deficiency of lime, and es- pecially of phosphate of lime, instead of an excess it has been in- geniously proposed to pursue an opposite practice, and to have re- course to a free use of alkalies and alkalescent earths, especially lime united with phosphoric acid, with a view of obtaining the de- ficient materials. Baron Haller and De Haen employed, for this purpose, prepared oyster-shells ; but these consist of lime with car- bonic acid, and do not, therefore, offer a proper supply for the basis of bones. M. Bonhomme h;is of late improved upon this prac- tice by substituting the phosphate of lime, or the powder of bones for its carbonate, and uniting it in equal parts with phosphate of soda: of which compound the dose is a scruple for an infant given twice a day. And he recommends that the body should also be bathed morning and night with an alkaline solution, consisting of half an ounce of common potass in a pound of spring water. Abil- iraard has carried the alkaline plan still farther, and has employed GE. IV.-SP. I.] EXCERNENT FUNCTION. 229 the fixed alkali internally* And, as acidity of the stomach in in- fants seems to be one cause of the disease, and a principal cause, as conjectured by Cappelt and Zeviani,}: where the digestion is evi- dently at fault, we may, in such circumstances, reasonably expect benefit from alkaline preparations or magnesia. How far any preparation of lime introduced into the stomach may be able to find its way without decomposition through the sanguiferous system to the assimilat.ng vessels, and be secerned in the parts affected, has not been exactly determined. Vauquelin made various experiments upon fowls, to decide the question, and M. Bonhomme has since attempted others. To themselves these experiments appeared satisfactory ; but they are open to some ob- jections which have not been entirely removed. Yet we see every dav, in a thousand instances, with what facility substances, of almost every kind, introduced into the stomach, are diffused with little other change than that of minute division over every part of the system. Emetics do not act till they reach the circulating system: the colouring matter of the madder-root is conveyed to and tinges the most solid bones: prussiate of potash, turpentine and various other balsams enter without change into the bladder. It is hence that rape-seed communicates an intolerable taste to hares that feed upon it, and that the flesh of sheep feeding upon wormwood ac- quires the bitter flavour of this plant. So, the buck-thorn gives a cathartic property to the flesh of thrushes that have swallowed it, and scammony to goat's milk. Partridges that have feasted harm- lessly on hellebore, often occasion sickness when employed as food ; and wheti oxen have grazed in a pasture abounding with alliaceous plants the beef they produce possesses the same taste and smell. And hence, phosphate of lime may, in like manner, be conveyed from the stomach to the secernents of the bones, and reach them without chemical decomposition. As rhachia is peculiarly distinguished by a great inirritability and want of action, rubefacients and other cutaneous stimulants have often been employed, and proved serviceable, as well from the friction that accompanies their use as their own acuating pow- er. These have sometimes been so far heightened as purposely to excite some degree of fever, with a view of carrying off the dis- ease by this means, as dyspepsy, cephalaea, and chronic rheumatism have often been carried off by a smart attack of a tertian intermit- tent. We are told that a practice of this kind prevails very gene- rally in the Western Isles, and is productive of great success. The heating oil of the skate-fish is rubbed every evening first upon the wrists and ancles of the patient, which raises, a fever of several hours1 duration : and when the inunction upon these parts has lost * Collect. Soc. Med. Havn. i. Art. I. i Versuch cinen vollorstaudigen Abhandlung iibcr die Englische krankheit, &c. f Delia cura di Bambini, attacati della Rhachitidc. Cap. n. p. 80. 230 ECCRITICA. [CL. Vl.-OR. I. its effect, it is then applied, in like manner, to the knees and el- bows ; and afterwards, in like manner, to the spine; so that a cer- tain degree of pyrexy may be daily maintained And when fric- tion, on all these organs, is found to fail, as fail it will by degrees, a flannel shirt dipped in the oil is finally had recourse to, and worn on the body, which produces a higher degree of fever than has yet existed; and continues to be worn, after fresh illinations, till a cure is obtained, which is said to be pretty certain, and usually in a short time. Many ingenious devices have been executed by surgical instru- ment makers for giving support to the limbs that seem mostly to suffer, and for removing the weight of the body from one part to another. In infancy, however, all these are of little avail, and where the disease pervades the entire skeleton, they will al- ways do as much mischief as good, by aiding one part at the ex- pense of another. The best mechanical instruments are a hard in- compressible couch, and a level floor on which the infant may lie at full length, and stretch his limbs as he pleases. The conch should be made light and moveable, so that he may be carried upon it in the open air for exercise. Moderate warmth is of great service, but a downy bed that gives way to the pressure of the body and sinks into unequal hollows cannot fail to increase the incurvation. SPECIES II. CYRTOSIS CRETINISMUS. (tvttinism. CHIEFLY AFFECTING THE HEAD AND NECK J COUNTENANCE VACANT AND STUPID ; MENTAL FACULTIES FEEBLE OR IDIOTIC : SENSIBILITY OBTUSE : MOSTLY WITH ENLARGEMENT OF THE THYROID GLAND. Cretinism makes a very close approach to rickets in its general symptoms. It differs principally in the tendency to the peculiar enlargement of the thyroid gland, which, in France, is denominated goitre, and with us, Derbyshire-neck, and in the mental imbecility which accompanies it from the first. In treating of rhachitis we observed, that, while all the func- tions of the general frame are here in a state of great debility, with the exception of the mental, these last exhibited, in many in- stances, a precocity and a vigour rarely found in firm health. And we endeavoured to account for it by supposing that the flow of sen- sorial fluid instead of being in deficiency, like all the other secre- tions, is only disturbed in its balance ; and that much of the pro- OE. IV.-SP. H.] EXCERNENT FUNCTION. 231 portion of this, which should be distributed among the motory fibres of the frame, and prevent that inirritability and muscular inertness by which rickets is so peculiarly distinguished, is transferred, under a different modification, to the sensorium, and gives to the mental faculties a more than ordinary degree of quickness. In cretinism the organ of the brain seems to follow the fate of the rest of the body, and, in many cases, even to take the lead, so that the chief imbecility is to be found in this region. For the peculiar symptom of goitre it is not so easy to account. We know so little of the purpose, and even of the fabric of this gland, as to be incapable of assigning its use in the animal economy, and hence, it is not much to be wondered at that its peculiar tendency to asso- ciate, in the present disease, with the morbid condition of the bones and of the intellect, should not hitherto have been ascertained. It does not always, however, accompany the other symptoms, though it is, for the most part, an associate. We have already observed that cretinism was first distinctly noticed and described by Plater about the middle of the seventeenth century, as occurring among the poor in Carinthia and the Valais ; and that it was afterwards found in a still severer degree in other vallies of Switzerland and the Alps generally ; as it has since been detected in very distant regions where the country exhibits a simi- larity of features, as among a miserable race called Caggets, inha- biting the hollows of the Pyrennees, whose district and history have been given us by M. Raymond, and as far off as Chinese Tartary, where it is represented as existing by Sir George Staunton. On the first discovery of cretinism it was ascribed by some to the use of snow-water, and by others to the use of water impregnated with calcareous earth: both which opinions are entirely without foundation. The first is sufficiently disproved by observing that persons born in places contiguous to the glaciers, and who drink no other water than what flows from the melting of ice and snow, are not subject to the disorder ; and, contrary wise, that the disorder is observed in places where snow is unknown. The second is contra- dicted by the fact that the common waters of Switzerland, instead of being impregnated with calcareous matter, excel those of most other countries in Europe in purity and flavour. " There is not," observes Dr. Reeve, " a village, nor a valley, but what is enlivened by rivulets, or streams gushing from the rocks. The water usually drunk at La Batia and Martigny is from the river Dranse, which flows from the glacier of St. Bernard, and falls into the Rhone ; it is remarkably free from earthy matter, and well tasted. At Berne the water is extremely pure, yet, as Haller remarks, swell- ings of the throat are not uncommon in both sexes, though cretinism is rare. As comfortable and genial warmth form one of the best auxiliaries in attempting the cure of both cretinism and rickets, there can be no doubt that the chill of snow-water, if taken as such, must consi- derably add to the general debility of the system when labouring 232 ECCRITICA. [CL. VL-OR. L under either of these diseases, though there seems no reason for supposing that it would originate either. It is not difficult to explain why water impregnated with calcareous earth should have been regarded as a cause: for in cretinism, as in rhachia, the calcareous earth designed by nature for building up the bones, is often sepa- rated and floats loose in various fluids of the body for want of a sufficiency of phosphoric acid to convert it into a phosphate of lime, and give it solidity. And as it is, in consequence hereof, pretty freely discharged by the urine, it seems to have given rse to the opinion that such calcareous earth was introduced into the system with the common beverage of the lakes or rivers, and produced the morbid symptoms. M. de Saussure has assigned a far more probable, and unquestion- ably the real cause of.the disease in referring us to a few other physical features of the Alpine districts in which it makes its appear- ance chiefly. The vallies, he tells us, are surrounded by very h:gh mountains, sheltered from currents of fresh air, and exposed to the direct, and, what is worse, the reflected rays of the sun. They are marshy, and the atmosphere is hence humid, close, and oppressive. And when to these chorographical causes we add the domestic ones. which are also well known to prevail very generally among the poor of these regions, such as meagre, innutritious food, indolence and uncleanliness, with a predisposition to the disease from an here- ditary taint of many generations, we can sufficiently account for the prevalence of cretinism in such places, and for the most humiliating characters it is ever found to assume. The general symptoms of cretinism are those of rhachia; but the disease shows itself earlier, often at birth, and not unfrequently before this period, apparently commencing with the procreation of the fetus, and affording the most evident proofs of ancestral conta- mination. The child, if not deformed and cachectic at birth, soon becomes so ; the body is stinted in its growth, and the organs in their developement; the abdomen swells, the skin is wrinkled, the mus- cles are loose and flabby, the throat is covered with a monstrous prominence, the complexion wan, and the countenance vacant and stupid. The cranium bulges out to an enormous size, and particu- larly towards the occiput, for it is sometimes depressed on the crown, and at the temples ; insomuch that to a front view the head, in some cases, appears even diminutive. The blunted sensibility of these wretched beings renders them indifferent to the action of cold and heat, and even to blows or wounds. " They are, gene- rally," observes M. Pinel, " both deaf and dumb. The strongest and most pungent odours scarcely affect them. I know a Cretin who devours raw onions and even charcoal with great avidity. A striking proof of the coarseness and imperfect developement of the organ of taste. Their organs of sight and feeling are equally limited in their operation. Of moral affections they seem wholly destitute ; discovering no signs of gratitude for kindness shown to them, nor any attachment to their nearest relations." «.E. 1V.-SP. II.] EXCERNENT FUNCTION. 233 The medical treatment, if medicine can ever be of any avail, should be conducted upon the principles and consist of the process laid down under the preceding species. GENUS V. OSTHEXIA. ©jstfifjrg. SOFT PARTS MORE OR LESS INDURATED BY A SUPERFLUOUS SECRETION AND DEPOSITS OF OSSIF1C MATTER. Osthexia is derived from t food, and though the soil on which it is grown contains no lime whatever, as is the rase in several of the Polynesian islands, and throughout the whole of New South Wales, on the hither side of the Blue Mountains. In several of the preceding genera we have seen that this material is produced or secreted in deficiency: in the species appertaining to the present genus, it is, on the contrary, produced or secreted in excess : and deposited, sometimes in single organs for which it is not naturally intended, and sometimes throughout the system at large, occasionally in the parenchyma or general substance of organs, and occasionally in the membranes or tunics by which they are covered and protected, or in the vessels by which they are furnished with their proper stores. We see much of this irregularity in old age the cause of which ivehavc already endeavoured to explain. The excernent vessel vol. iv. 30 234 ECCRITICA. [CL. Vl.-OR. I. of both sets, absorbents and secretories, partake of the common debility and torpilude of this advanced period. There is hence, in all probability, a smaller quantity of lime, as of every other secerned material, formed at this period than in the earlier and more vigo- rous stages: but however small the quantity, it is carried oft, on account of the grossness of its corpuscles, less freely by the debilitated absorbents than the finer and more attenuate fluids, and is hence apt to stagnate first in the bones themselves, which, as we have already observed, are hereby rendered unduly impacted and brittle, and next in the lymphatics of every part of the system, and especially those that enter into the tunics of the sanguiferous vessels, which are hereby often rendered rigid or even ossific. This is a natural consequence of the debility of advancing years. But we not unfrequently meet with a like' effect in the earlier stages of life, and in persons of the fullest and most vigorous health, in which case there can be no question that the lime thus profusely and erratically deposited is produced and secreted in excess, and consequently by a state of action the very reverse of that we have thus far contemplated. The mischief thus originating,—as it appears in the parenchyma, and in the membranes or vessels of organs, and thus lays a foundation for two very distinct trains of symptoms,—may be con- templated under the two following species : 1. OSTHEXIA KFARCIENS. PARENCHYMATOUS OSTHEXY. 2. -------- 1MPLEXA. VASCULAR OSTHEXY. SPECIES I. OSTHEXIA INFARCIENS. liarnicngmatous ©stlujry. OSSIFIC MATTER DEFOSITED IN NODULES OR AMORPHOUS MASSES, IN THE PA- RENCHYMA OF ORGANS. The most common organs in which calculous concretions are found, are the kidneys and the bladder ; but, as in these they form detached and unconnected balls, and are intimately united with local symptoms or a morbid state of these organs and constitute only one of various kinds of concretions, it will be most convenient to consider them when treating of the particular diseases to which they give rise, or of which they are prominent symptoms. The organ in whose interior fabric the present concretions are most usually found, seems to be the pineal gland; of which almost all the medical and physiological journals, as well domestie^s v.F.. V.-SP. I.] EXCERNENT FUNCTION. 235 foreign, give numerous examples, as do likewise Dicmerbroek, De Graaf, Schrader, and other monographists. In this gland they have also been found in other animals than man, chiefly those of the deer kind. Such deposits are also frequently found in various other parts of the substance of the brain; in the lungs ;*in the substance of the heart, in one instance weighing two ounces ;f in the thymus gland ;| in the thyroid ;§ in the parotid ;|| the sublingual, and most other glands fH in the deltoid and most other muscles: nor is there an organ in which it has not been traced on different occasions. Paullini records one instance of an ossified penis, and in the Ephemera of Natural Curiosities, we meet with another.** The general pathology we have already given : the symptoms and effects vary to infinity. Most of the above cases seem to have occurred after the meridian of life; and in many instances to have been connected with atonic gout, which, by adding to the debility of advancing age, adds to its tendency to form such deposits. SPECIES II. OSTHEXIA IMPLEXA. avascular ©stfiepg. OSSIFIC MATTER DEPOSITED IN CONCENTRIC LAYERS IN THE TUNICS OF VES- SELS OR MEMBRANES, RENDERING THEM RIGID AND UNIMPRESSIBLE. All the vessels and membranes as well as the more massy or com- plicated organs of the body, are subject to de^posites of phosphate or carbonate of lime, from the causes already pointed out: some of which are those of weak and others of entonic action: the former operating upon the debilitated and the aged, the latter upon the young and vigorous, who labour under a peculiar diathesis or pre- disposition to the formation of bony earth. The chief modifications appertaining to this species may be contemplated under the follow- ing varieties: * Baillie, Morb. Anat. Fasc. II. PI. 6. t Burnet, Thcsaur. Med. Pract. in. 254. X Act. Med. Berol. Tom. i. Dec. iii. 28. ( Contuli, De Lapid. &c. || Plater, Observ. Lib. in. 707. *i Haller, Pr. de induratis corp. hum. partibus Goett. 1753. Pranser, Diss, de induratione corp. in specie ossium. Leips. 1705. ' * Dec. II. Ann. v. 236 ECCRITICA. [CL. VI.-OR. I. x Arterialis. Ossification of the aorta or other Arterial osthexy. large arteries. C Membranacea. Ossification of membranous or con- Membranous osthexy. necting parts. y Complicata. Ossification of different parts sim- Complicated osthexy. ultaneously. Where the deposite takes place in the aorta, it is rarely confined to this arten alone, but spreads to some parts of the heart, and, perhaps, of "the pulmonary, or some other large artery as well. Dr. Baillie gives an instance in which a considerable portion of the right ventricle and right auricle of the heart were affected at the same time ;* and Morgagni another in which the ossification extend- ed to the valves, and this too without having produced in the patient either palpitation or dyspnoea.! So wonderfully is the instinctive or remedial power of nature capable, in various instances, of ac- commodating the general system to morbid changes. We have other examples of the trunk of the aorta being wholly ossified,^ and in one case so rigidly, both in its ascending and descending branches, as to compel the sufferer to maintain an erect position.§ The most troublesome of the membranous os-ifications are those of the pleura, of which an example is given by Dr Baillie in his Morbid Anatomy :|| though the trachea affords at times severe and even fatal examples of this affection.1T in consequence of the stric- ture which is hereby occasionally produced. Mr. Chester gives a singular case of a spread of this disease over the thoracic duct, the ileum, and other abdominal viscera. Yet, in the structure of the arteries, ossification is found more frequently than in any other organ, with the exception of the pineal gland : the cause of which seems to have been first glanced at by Dr. Hunter, and was afterwards followed up with much patient in- vestigation and accuracy of research by Mr. Cruikshank. The for- mer used to send round at his lectures a preparation of the patella, in which he demonstrated that the ossification of that bone began in the arteries running through the centre of the cartilage which, in young subjects, supplies the place of a bony patella. Mr. Cruik- shank on prosecuting the subject, discovered that all other bones o sify in the same manner, and made preparations in proof of this fact; distinctly showing that the ossification of bones is not only be- gun, but carried on and completed by the ossification of their ar- teries : and, consequently, that arteries have a natural tendency * Morb. Anat. Fasc. v. PI. 2. t De Sed. et Cans. Ep. xxnr. 11. X Bucknei, Mi»cel. 1727, p. 305. } Guattani, De Aneurism, &c. || Fascic. n. PI. i. t Kirkring, Specilcg. Anat. Obs. 27 GE. V.-SP. II.] EXCERNENT FUNCTION. 337 to heroine ossific above that of all other parts of the system whatever. One of the most extensive appearances of this habit acting mor- bidly on the tunics of vessels, is related by Dr. Heberden* in the Medical Transactions, in the case of a very old man who at last died suddenly, as well indeed he might, since almost the only viscus that was found, on examination, to be in a healthy state was the liver. The internal carotid and basilarv arteries with many of their primary branches were ossified. Through the substance of the lungs which firmly adhered to their walls, were scattered small calculous tumours. In the heart the valves of the left auriculo- venlricular opening were partially ossified, those of the aorta com- pletely so, and small depositions of bony matter were found in the tendinous portions of the carnea? columnar. The coronary artery was ossified through its whole extent. The descending thoracic and abdominal aorta, with all their primary branches, were convert- ed into cylinders of bone, as were the external and internal iliacs. It is not necessary to pursue the description into the morbid ap- pearances of almost every other organ : and 1 shall only observe farther that though the substance of the brain was healthy, the ven- tricles contained about eight ounces of water. And yet with all this extent of diseased structure, the patient appeared almost to the last to be of a sound constitution and free from the usual infirmities of advanced age. with the exception of an habitual deafness; and at- tained upwards of fourscore years of age before he died. Where tins diathesis prevails very decidedly, it sometimes con- verts not merely the vessels but the whole of the tendons and the muscles into rigid bones, and renders the entire frame as stilf and immovable as the trunk of a tree. There is a striking illustration of this remark in a case communicated to the Royal Society by Dr. Henry of Enniskillen.t The patient was a day labourer who had enjoyed good health till the time of his being attacked with this dis- ease. It commenced with a pain and swelling in the right wrist, which gradually assumed a bony hardness, and extended up the course of the muscles as high as the elbow, the whole of which were converted into a bony hardness, and were of double their natu- ral size. The left wrist and arm followed the fate of the right: and the line of ossification next shot down to the extremities of the fin- gers on both sides, and afterwards up to the shoulders, so that the joints were completely ancylosed, and the man was pinioned. At the time of communicating this history, the same ossific mischief had attacked the right ancle with a like degree of pain, swelling. and bony induration up the course of the muscles : in which state the man was discharged from the hospital as incurable, after sali- vation had been tried to no purpose. Salivation has, indeed, often been tried, probably from its suc- * .Me.I. Trans. Vol. v. Art. xiii. t Phil. Trr.ns. Vol. n. vear 1TJ.0. 238 ECCRITICA. [CL. VI.-OR. I cess in removing venereal nodes, but it does not seem to have been of much more avail in any instance than in the present. We have pointed out two opposite causes, or rather states of bo- dy, in which a tendency to ossification chiefly shows itself. One is that of general debility, and the other of an entonic action in the assimilating organs which are chiefly concerned in the fabrication or separation of lime: and in laying down any plan for relief, it seems necessary to attend to this distinction. Where debility be- comes a predisponent of morbid ossification, it is mostly a result or concomitant of old age, a scrophulous diathesis or atonic gout: and in all these cases warmth, a generous diet, and tonic course of medi- cines will form the most reasonble curative plan that can be pursu- ed ; and that which will tend most effectually to stimulate the ab- sorbents, and prevent that retardation of bony earth in the lympha- tics and vasa vasorum, on which we have already shown the disease to depend in this modification of it. On the contrary, where it occurs in the middle and vigour of life, and we have reason to believe in the existence of too much action in vessels which we cannot very accurately follow up, a reducent plan will be far more likely to prove successful. We should bleed and move the bowels freely, and restrain the patient to a low diet with a copious allowance of diluent drinks. And in both cases with a view of dissolving, as far as we are able, the calcareous matter that may morbidly exist in the system already, or be on the point of entering into it, we should prescribe a free use of the mineral or vegetable acids, as already recommend- ed under parostia fragilis. CLASS VI. ECCRITICA. ORDER II. CATOTICA. Mmamn affecting internal Surface*. PRAVITY of the fluids, or emunctories that open into the inter- nal SURFACES OF ORGANS. Catotica is derived from xxr*, " infra," whence tcxmrtpt and xxru- txthi " inferior," and " infimus." The order includes four genera as follows, some of which will be found of extensive range: I. HYDROPS. DROPSY. II. EMPHYSEMA. INFLATION. WIND-DROPSY. III. PARURIA. MISMICTUR1T10N. IV. LITHIA. URINARY CALCULUS. GENUS I. HYDROPS. PALE, INDOLENT, AND INELASTIC DISTENSION OF THE BODY, OR ITS MEM- BERS, FROM ACCUMULATION OF A WATRY FLUID IN NATURAL CAVITIES. Hydrops is a Greek term {btyvV) importing an accumulation of water : and in nosology there is no genus of diseases that has been more awkwardly handled. The term hydrops does not occur in Sauvages, Linneus, or Sagar, and only once in Vogel in the com- 1M0 ECCRITICA. [CL. VI.-OP.. II. pound hydrops scroti. Linneus connects anasarca and ascites, its chief species, with tympanites, polysarcia, or corpulency and gra- viditas or pregnancy, into oue ordinal division, which he names tumidosi, and of which these constitute distinct genera. Sagar ar- ranges nil the same under the ordinal division cachexia:. Vogel pur- sues the same plan with the omission of graviditas or pregnancy, which he does not chuse to regard as a cachexy Sauvages em- ploys the term hydropes, but only in connexion with partiales, in order to restrain it to local dropsies: so that with him ascites is a hydrops, but anasarca is not a hydrops, and does not even belong to the same order; it is an inliuncscentia, under which, as in the ar- rangement of Linneus, it is united with corpulency, and pregnancy ; while hydrops thoracis is an anhelatio, and occurs in a distinct place and volume. Dr. Cullen has certainly, and very considerably, improved upon his*predecessors in this range of diseases. After Sauvages he takes intumescentle for the name of his order; but divides it into the four sections of adiposae, flatuosa;, aquosa? vel hydropes, and solidae; while under the third section (the aquosae vel hydropes) he intro- duces all the family of dropsies, whether general or local, instead of sending them with those who preceded him, to different quar- . ters. It would, however, have been a much greater improvement. and have added to the simplicity he aimed at, to have employed hydrops as a generic, instead of hydropes as a tribual or family term. It is to Boerhaave we are indebted for the first use of hy- drops as employed in the present method; and he has been follow- ed by Dr. Macbride and Dr. Young with a just appretiation of his correctness. The species of this genus, which extend over the body generally or almost all the different parts of it, are the following: cellular dropsy. dropsy of the head. -------------SPINE. ----------• chest. ----------- belly. -------------OVARY. -------------FALLOPIAN Tl'BK. ——------womb. —w---------SCROTUM. Before we enter upon a distinct view of the history and treat- ment of these several species, it may be convenient to give a glance at the general pathological principles which apply to the whole. All dropsies proceed from similar causes, which, as they are general or local, produce a general or local disease. The common prediches Journ. iv. St. J Vol. II. ;•. 47.-. 4S'2. voi.. iv. ;?1 242 ECCRITICA. [CL. VI.-OR. II. exhausted has occasionally proved sufficient to produce dropsy in one of these forms; of which we have a striking example in the army of Charles V. during its expedition against Tunis, the greater part of it, as we are told by De Haen, having fallen into this disease in consequence of having freely quenched their thirst with cold water in the midst of great fatigue and perspiration.* A like sympathy not unfrequently takes place between several other organs and the mouths of the exccrnents: as the skin and the uterus: the former as loaded with an extension of the same termi- nal vessels, and the latter as maintaining an influence over almost every part of the frame. It was partly perhaps from sympathy with the skin, and as participating in the chill and consequent col- lapse of its capillaries produced by the coldness of the beverage, that the excernent system became affected in the extensive dropsy just alluded to in the army of Charles V. And we frequently per- ceive a similar effect on a sudden suppression or repulsion of cutane- ous eruptions, the mouths of the excernent vessels opening into internal cavities partaking of the torpitude of the cutaneous capil- laries. The sympathetic influence exercised over the same ves- sels by a morbid state of the uterus is not less manifest: for in chlorosis the abdomen becomes tumid, and the lower limbs edema- tous ; and, 0:1 the cessation of the catamenia, cellular or abdominal dropsy are by no means uncommon. Such are the general causes of cellular dropsy as well proximate as predisponent. But there are a few other causes which it is ne- cessary to enumerate as acting occasionally, though the effects pro- duced by some of them can hardly be called dropsy in the proper and idiopathic sense of the term. In the first place, the absorbents are supposed by some patholo- gists, as M. Mezlert and Dr. Darwin, to be at times affected with a retrograde action, and hence to pour forth into various cavities of the body a considerable mass of fluid instead of imbibing and car- rying it oft". Next, the exhalants of an organ, though themselves in a state of health, may throw forth an undue proportion of fluid in consequence of some stimulus applied to them. The most common stimulus to which they are exposed is distention and that by a re- tardation of the blood in the veins, and a consequent accumulation in the arteries. This retardation or interruption of the flow of venous blood may arise from diseases of the right ventricle of the heart or its valves; from various affections of the lungs or their surrounding muscles; from an upright posture continued without intermission for many days and nights, as is often the case in month- ly nurses ; from a gravid uterus, whence the edematous ancles of pregnant women ; from scirrhous or other obstructions in the liver or spleen ; from j-oly^ou^ concretions in the veins, aneurisms in the * Rat. Med. l'..rt v. 38. 90. 1 Von der Wa^ersucht. UE. I.] EXCERNENT FUNCTION. 243 arteries, or steat^matous or other hard tumours in the vicinity of the larger arterial trunks. In some case3 inflammation succeeds to distention, and the quan- tity of fluid poured forth is still more considerable. 4t is from this double source of stimulus, distention and inflammatory action, that the ventricles of the brain become filled in meningic cephalitis, and the cavity of the pericardium occasionally in carditis. Thirdly, the aqueous fluid of a cavity may be unduly augmented, and consequently dropsy ensue, from a rupture of the thoracic duct, or of a large branch of the lacteal vessels. These, however, are not common causes; the lymphatics of the kidneys may, perhaps, most frequently have produced the disease when ruptured by acci- dent or idiopathic affection in the case of renal ischury; during which the watry parts of the blood that should pass off by the kid- neys have been thrown back into the system, and lodged in some cavity. And it is probable that when dropsy follows upon long ex- posure to a cold damp atmosphere, it is produced, in some instan- ces, in the same manner; the fluid that should pass off by the ex- halants of the skin, but which cannot in consequence of having lost their power; being, in like manner thrown back into the blood and transferred to and accumulated in improper channels. Fourthly, the skin is said, at times, to be in a condition to absorb moisture too freely from the atmosphere ;* the stomach is said, as in the case of dipsosis avens, to demand too. large a quantity of li- quids to quench its insatiable thirst ;t and the blood is said to be in a state of preternatural tenuity from saline acrimony ;J and each of these conditions it is affirmed has occasionally proved a source of dropsy. The first of these unquestionably occurs at times during dropsy, and all of them may have operated as causes : but preternatu- ral tenuity of blood, adequate to and producing such van effect is very uncommon from any cause ; and the remedial power of na- ture is at no loss for means to carry off a superabundance of fluidity introduced by any means into the system, provided the excernent function itself be not diseased. From this diversity of causes we may reasonably expect that the dropsical fluid discharged upon tapping should exhibit different properties, not only in different organ*, but in different cases in the same organ. And hence, it is sometimes found nearly as thin as water, incapable of coagulating when exposed to heat, which only renders it turbid; while, at other times, it flows in a ropy state, and acconN, upon exposure to heat, with the natural serum of the blood. A similar discrepancy is discoverable in its colour or some * Erastus, Disp. iv.p. 206. Ut: llawn, Rat. Med. P. iv. p. 125. seq. t Bucliner, Miscell. 1730. p. 3t!8. Mondschicn, p. 12. X ('•akii, Dc Lymph. Caus. Lib. ill. cap. 8. Van Swieten ad Sect. 122!'. 244 ECCRITICA. [CL. Vi.-OR. II. other condition ; for it has sometimes been found black and fetid,* bloody, sanious, niilky,t green,} yellowish, or peculiarly acrid.§ In some instances it has resembled the glairy ichor of sores in a languid constitution or degenerated habit; and according to Gua- thani and Steidele it has at times appeared oily.|| It has been oc- casionally so urinous or ammoniacal as to turn syrup of red poppies green :I and, according to Dr. M'Lacklan, has sometimes contained so much soda as by the addition of sulphuric acid to produce Glau- ber's salt** with little or no trouble. From the nature of the fluid itself, therefore, we have a clear proof that the causes of dropsy must be different in different cases. In augmented secretion, impeded absorption, or the rupture of a lymphatic vessel, the accumulated fluid should contain nothing more than the ordinary constituents of the halitus that naturally moistens the cavity into which it is discharged. A relaxed state of the ex- halants may admit particles of greater bulk, and even red blood: in which case the fluid may differ both in viscidity and colour. While, on the other hand, morbid collections of water must proceed from a cause of a very different nature; probably from the exhalant arteries being themselves so altered by disease as to change the properties of the fluid which passes through them: or the general mass of blood being so attenuate or otherwise vitiated as to affect the secretion. In the last case, dropsy is not a primary disease, but the consequence of some other, generally perhaps of a morbid liver. spleen, or lungs.+f SPECIES I. HYDROPS CELLULARIS. ©ellulai- Brojwg. COLD AND DIFFUSIVE INTUMESCENCE OF THE SKIN, PITTING BENEATH THE PRESSURE OF THE FINGERS. This species includes three varieties, as it is general to the eel- * Galeazzi, in Com. Honon. Tom. vi. t Willis, Pharmaceutice Rationalis. Med. Com. of Edinb. Vol. v. X Riicker, Coram. Lib. Nor. 1736, } Du Verney, Memoirs de Paris, 1701. p. 193. || Guat. De Aneurismatibus. Steid. Chirurg. Beobacht. B. i. U Oe Haen, Rat. Med. P. xi. p. 214. '* Med. Comm. Edinb. ix. n. ft Hewson Descript. of the Lymj h- Syst. Ch. Nii GE. I.-SP. I.] EXCERNENT FUNCTION. 245 lular membrane, limited to the limbs, or accompanied with a com- bination of very peculiar symptoms, and especially severe, and in most cases fatal, dyspnoea : x Generalis. Extending through the cellular mem- General Dropsy. brane of the wholebody. C Artuum. Limited to the cellular membrane of Edema. the limbs, chiefly of the feet and ancles ; and mostly appearing in the evening. v Dyspnoica. Edematous swelling of the feet, stiff- Dyspnetic Dropsy. ness and numbness of the joints ; the swelling rapidly ascending to the belly, with severe and mostly fatal dispncea. It is under the first of these varieties that cellular dropsy usually appears as an idiopathic affection. Where the intumescence is confined to the limbs, it is usually a symptom or result of some other affection, as chlorosis, suppressed catamenia or any other habitual discharge ; a disordered state of the habit produced by a cessation of the catamenial flux; repelled eruptions; or the weak- ness incident upon protracted fevers, or any other exhausting ma- lady. The third variety is introduced upon the authority of Mr. W. Hunter, and taken from his Essay, published at Bengal in 1804. The disease appeared with great frequency among the Lascars in the Company's service in 1801. Its attack was sudden and its progress so rapid that it frequently destroyed the patient in two days. From the description it does not seem to have been connected with a scorbutic diathesis: and Mr. Hunter ascribed it to the concurrent causes of breathing an impure atmosphere, suppressed perspiration, want of exercise, and a previous life of intemperance. All or any of these may have been auxiliaries, but the exciting cause does not seem to have been detected. The second and third varieties, however, may be regarded as the opening and concluding stages of cellular dropsy : for before the disease becomes general it ordinarily shows itself in the lower limbs and in its closing scene the respiration is peculiarly difficult and forms one of its most distressing symptoms. General or local debility is its predisposing cause, ordinarily brought on by hard labour, intemperance, innutrifious food, fevers of various kinds, exhausting discharges, or some morbid enlarge- ment of the visceral or thoracic organs that impedes the circulation of the blood, and produces congestion and distension. The disease is hence common to all ages though most frequently found in advanced life ; the edema of the feet and ancles, with which symptoms it opens, appears at first only in the evening and yields to the recumbent position of the night. By decrees it becomes more permanent and ascends higher, till not only the th'Hi- 246 ECCRITICA. [CL. 1V.-OR. II. and hips, but the body at large is affected, the face and eye-lids are surcharged and bloated, and the complexion, instead of the ruddy hue of health, is sallow and waxy. A general inactivity pervades all the organs, and consequently all their respective functions. The pulse is slow, oftan oppressed, and always inelastic: the bowels are costive, the urine for the most part small in quantity, and conse- quently of a deeper hue than usual: the respiration is troublesome and wheezy, and accompanied with a cough that brings up a little dilute mucus which fiords no relief to the sense of weight and oppression. The apuetite fails, the muscles become weak and flaccid, and the general frame emaciated. Exertion of every kind is a fatigue, andlhe mind, partaking of the hebetude of the body, engages in study with reluctance, and is overpowered wifh drowsi- ness and stupor. An unquenchable thirst is a common symptom; and where this is the case the general irritation that is connected with it sometimes excites a perpetual feverishness that adds greatly to the general debility. In some parts the skin gives way more readily than in others, and the confined fluid accumulates in bags. At other times the cuticle cracks, or its pores become an outlet for the escape of the fluid, which trickles down in a perpetual ooze. The difficulty of breathing increases partly from the overloaded state of the lungs, and partly from the growing weakness of the muscles of respiration : the pulse becomes feebler and more irregular, slight clonic spasms occasionally ensue, and death puts a termination to the series of suffering. Yet the progress is slow, and the disease sometimes continues for many years. In attempting a cure of cellular dropsy, and indeed of dropsy in general, for it will be convenient to concentrate the treatment, we should first direct our attention to the nature of its cause with a view of palliating or removing it. We are next to unload the system of the weight that oppresses it. And lastly to re-establish the frame in health and vigour. Simple edema, or swelling of the extremities is often, as we have already observed, a symptom or result of some other complaint, as chlorosis or pregnancy, or some other cause of distension. In the two last cases it may be palliated by bleeding, a recumbent position, and other means adapted to take off the pressure, in chlorosis it can only be relieved by a cure of the primary affection. In like manner, general dropsy may be; dependent upon a habit of intem- perance^ or a sedentary life, or innutritious food, or an obstinate fit of jaundice ; and till these are corrected no medicinal plan for evacuating the accumulated water can be of any avail. For, if we could even succeed in carrying it off, it would again collect, so long as the occasional cause continues to operate. The occasional cause, however, may no longer exist, as where it has been produced by a fever or an exanthem that has at length ceased though it has left the constitution an entire wreck. Or it may exist and be itself incurable, as where it proceeds from a GE. I.-SP. I.J EXCERNENT FUNCTION. 247 scirrhous induration or some other obstruction of one of the larger viscera of the thorax or abdomen : and in this case our object should be to remove with all speed the mischievous effects, and palliate the organic cause, as far as we are able, according to its peculiar nature, so that it may be less operative hereafter. A removal of the accumulated fluid from the cellular membrane generally has been attempted by internal and external means, as hydragogues of various kinds, and scarification or other cutaneous drains. The hydragogues or expellents of water, embrace medicines of all kinds that act powerfully on any of the extretories, though the term has sometimes been limited to those that operate on the excretories of the intestines alone. And it becomes us therefore to contemplate them under the character of purgatives, emetics, diaphoretics, and diuretics. The purgatives that have been had recourse to are of two kinds, those of general use, and those that have been supposed to act with some specific or peculiar virtue in the removal of the dropsical fluid. Among the first we may rank calomel, colocynth, gamboge, scammony, jalap, and several other species of convolvulus, as the greater white bind-weed (convolvulus Sepiwn, Linn.) : the turbeth plant (c. Turpethum, Linn.) : and the brassica marina, as it is called in the dispensatories (c. Soldanella, Linn.). These may be employ- ed as drastic purgatives almost indiscriminately, and their compara- tive merit will depend upon their comparative effect, for one will often be found to agree best with one constitution and another, with another. We need not here except calomel, unless indeed, where given for the purpose of resolving visceral infarctions; since in any other case it can only be employed in reference to its influence upon the excretories generally, and particularly those of the intestinal canal. The purgatives that have been supposed to operate with a specific effect in dropsies are almost innumerable. We must content ourselves with taking a glance'at the following, giro a Tiglia, or bastard ricinus; elaterium : elder, and dwarf elder; black hellebore ; senega ; and chrystals of tartar. The croton Tiglium, or bastard ricinus, affording the grana Tiglia of the pharmacopoeias, is an acrid and powerful drastic in all its parts, root, seeds, and expressed oil. The oil is of the same character as the oil of castor, but a severer and more acrimonious purge ; insomuch, indeed, that a single drop prepared from the dry seeds is ofteu a sufficient dose; while a larger quantity proves cathartic when rubbed on the na\el. In India the seeds themselvo have long been given as a hyd'-n^oguo ; two being sufficient for a robuster constitution, one for a weaklier ; and four proving some- times fatal. From the uncertainty and violence of the action of this plant, rhe elaterum or inspissated juice of the wild cucumber, is a far 248 ECCRITICA. [CL. VL-OR. fi preferable medicine. Elaterium, however, has been objected to ar unduly stimulant; and both Hoffman and Lister observe that its ef- fect in increasing the pulse is perceivable even in the extremities of the fingers. It is on this account that it seems chiefly to have been neglected by Dr. Cullen ; who admits that he never tried it by itself, or otherwise than in the porportion of a grain or two in com- position with other purgatives. And it is hence, also, that attempts have been made to obtain a milder cathartic from the roots of the plant by infusion in wine or water,* than from the dried fecula of the juice, which is the part ordinarily employed. Admitting the stimulant power here objected to, it would only become still more serviceable in cold and indolent cases from local or general atony; but even in irritable habits in cellular dropsy, 1 have found it high- ly serviceable in a simple and uncombined state, produced, as it ultimately appeared, and especially in one instance, from a thicken- ing of the walls of the heart, in a young lady of only thirteen years of age. It is best administered in doses of from half a grain or a grain to two grains, repeated every two or three hours for five or six times in succession according to the extent of its action. Evacuation by the alvine canal is the most effectual of any; nor can we depend upon any other evacuation unless this is combined with it. The elder tree, and dwarf elder (Sambucus nigra, and s. Ebulus) have been in high estimation as hydragogues by many practitioners. Every part of both t-ie plants has been used ; but the liber or inner bark of the first, and the rob or inspissated juice of the berries ot the last, have been chiefly confided in. Dr. Boerhaave asserts that the expressed juice of the former given from a drachm to half an ounce at a dose, is the most valuable of all the medicines of this class, where the viscera are sound; and that it so powerfully dis- solves the crasis of the different fluids, and excites such abundant discharges that the patient is ready to faint from sudden inanition. Dr. Sydenham confirms this statement, asserts that it operates both upwards and downwards, and in no less degree by urine, and adds, that in his hands it has proved successful in a multitude of hydropic cases.! Dr. Brocklesby preferred the interior bark of the dwarf elder,| as Sydenham and Boerhaave did that of the black, or com- mon elder. Dr. Cullen seems to have been prejudiced against both, though he admits that he never tried either, notwithstanding that he had often thought of doing so :§ and it is chiefly, perhaps, from his unfavourable opinion of their virtues, that they may seem in our own day to have sunk into an almost total disuse. Chesneau employed indifferently the seeds, and their expressed oil, the root * Bonlduc, Hist, de FAcad. Koyal de science* de Paris. t Opp. p. 627, 7G8. X (Econom. and Med. Observ. p. 278. (• Mat, .Med. Vol. 1. p. 534. GE. l.-SP. I.] EXCERNENT FUNCTION. 249 and the inspissated juice of the root: though he preferred the s Ebulus to the s. nigra.* The melampodium or black hellebore, was at one time a favour- ite cathartic in dropsies, and has the testimony of high authorities for having very generally proved efficacious and salutary. The ancients found the plant which they employed under this name so severe in its purgative qualities, that they were obliged to use it with great caution ; but we have reason to believe that the black hellebore of the present day is a different production, as it is mild- er in its effects than the hellebore of Dioscorides, and different in some of its external characters. Its root was the part selected, and the fibres of the roots, or their cortical part rather than the inter- nal. These were employed either in a watery infusion or extract. Mondscheint preferred on all occasions, the latter; Quarin used either indifferently.\ Bacher invented a pill which was once in very high reputation, and sold under his own name all over Europe, for the cure of dropsy, in which an extract of this root, obtained, in the first instance, by spirit, formed the chief ingredient; the Others being preparations of myrrh and carduus benedictus. These pills were said to produce a copious evacuation both by stool and urine; and by this combined effect to carry off the disease. They have however had their day, and are gone by, apparently with too little consideration upon the subject: for the experiments of Daig- nau and De Home, and especially the successful trials in the French Military Hospitals, as related by M. Kichard§ to say nothing of Dr. Bacher himself, do not seem to have excited sufficient attention. In our own country, since the days of Dr. Mead, the black helle- bore has been limited to the list of emmenagogues, and even in this view is rarely employed at present. Whether this plant prove pur- gative, as has been asserted, when applied to the body externally in the form of fomentations or cataplasms like the croton I have ne- ver tried. Ferrara, employed as hydragogues, the black and white hellebore indiscriminately. The seneka or senega (polygala Senega, Linn.) was another me- dicine much in use about a century ago, and reputed to be of very great importance in drops}', from its combined action upon the kid- neys and intestines, and, indeed, all the excretories. It reached Europe from America, where it had been immcmorially employed by the Senegal Indians, from whom it derives its specific name, as an antidote against the bite of the rattle-snake. The root of the plant is the part chietly, if not entirely, trusted to, and this is given in powder, decoction, or infusion M. Bouvart found it highly ser- viceable as a hydragogue, but observes that, notwithstanding this * Lib. ill. Cap. iii. Obs. 8. f Von'der Wassersucht, &c. X Animadvesiones, &c. J Rccueil des Observations de Medicine des Hospitaux Militaires, &c. Tom. n. 4to. Paris. vol. iv. 32 250 ECCRITICA. [CL. VI.-OR. II. effect, it does not of itself carry off the induration or enlargement of infarcted viscera, and ought to be combined with other means. It was very generally employed by Dr, afterwards Sir Francis Mil- man, in the Middlesex Hospital, and has again found a place n the Materia Medica of the London College. There are unquestionable instances of its efficacy in the removal of dropsy when it has been carried so far as to operate both by the bowels and the kidneys. It has, however, often failed; and, as Dr. Cullen observes, is a nause- ous medicine which the stomach does not easily bear in a quantity requisite for success. A far more agreeable, if not a more effectual medicine in the case of dropsy, is the super-tartrate of potass, in vernacular lan- guage the cream or crystals of tartar. In small quantities and very largely diluted with water, or some farinaceous fluid, it quenches the thirst most pleasantly, and, at the same time, in most cases, proves powerfully diuretic. But it is as a purgative we are to con- template it at present: and to give it this effect it must be taken in a much larger quantity, never less than an ounce at a dose, and often considerably above this weight. Thus administered it proves powerfully cathartic, and excites the action of the absorbents in every part of the system far more effectually than is done by the influence of any entirely neutral salts. "• I need hardly say," ob- serves Dr. Cullen, " that upon this operation of exciting the absor- bents, is chiefly founded the late frequent use of the crystals of tartar in the cure of dropsy."* Dr. Cullen, in this passage, appa- rently alludes to the practice of his friend Dr. Home, who was pe- culiarly friendly to its use, and in his Clinical Experiments relates twenty cases in which he tried it, and completed a radical cure in fourteen of them, no relapse occurring notwithstanding the frequen- cy of such regressions. The practice, however, is of much earlier date than Dr. Cullen seems to imagine ; for Hildanus represents the physicians of his day as at length flying to it as their sheet anchor, and deriving from it no common benefit.! On the Continent it has generally, but very unnecessarily, been united with other and more active materials, as jalap, gamboge, or some of the neutral salts, chiefly vitriolated tartar, or common sea-salt; the latter in the pro- portion of from three to eight drachms of each daily, largely dilut- ed with some common drink.:f Another powerful source of evacuation that has often been had recourse to for the cure of dropsy, is emetics. : and, though, little in use in the present day they have weighty testimonies in their fa- vour among earlier physicians. Their mode of action has a resem- blance to that of the drastic purgatives ; for, by exciting the stom- ach to a greater degree of secretion, they excite the system gene- rally ; and, in fact, far more extensively and more powerfully than * Mat. Med. u. 513. 4to. Edit. t Cent. iv. Obs. 42. "t Medicinisches Wechenblatt, 1781. N. 40. GE. I.-SP. 1.] EXCERNENT FUNCTION. 201 can be accomplished by mere purgatives, in some degree from the greater labour exerted in the act of vomiting, but chiefly from the closer sympathy which the stomach exercises over every other part of the system than the alvine canal, or, perhaps, any other organ, can pretend to. In cases of great debility, however, it must be ob- vious that such exertion would be too considerable and would only add to the general weakness; and it is on this account chiefly that the prac- tice has been of late years very much discontinued in our own country. It is in consequence of this extensive sympathy of the stomach with every part of the system that emetics have often proved peculiarly serviceable in various local dropsies, especially that of the scrotum when limited to the vaginal sheath, and that of the ovarium, when dis- covered in an early stage. And from this cause, in combination with powerful muscular pressure, they have often acted with prompt and peculiar efficacy on ascites or dropsy of the abdomen: while Withering, Percival, and many of the foreign journals* abound with cases of the cure of ascites by a spontaneous vomiting. Diaphoretics have also been resorted to as very actively promot- ing the evacuation of morbid fluids; and many instances are relat- ed by Bartholet,t ^uarinj and others, of the complete success of perspiration when spontaneously excited. Tissot tells us that it was by this m.-ans Count Ostermann was cured, a very copious sweat having suddenly burst forth from his feet, which continued for a long time without intermission. In the Medical Transactions there is a very interesting case of an equal cure effected by the same means, in a letter from Mr. Mudge to Sir George Baker. The form of the disease was, indeed, an ascites, but it will be more convenient to notice it here, while discussing the treatment of dropsy generally than reserve it for the place to which it more immediately belongs. The patient, a fe- male of about forty years old, had laboured under the disease for twenty years: the abdomen was so extremely hard as well as en- larged, that it was doubtful whether the complaint was not a para- bysma complicatum, or physcony of various abdominal organs, and tapping was not thought adviseable. She was extremely emaciat- ed : had a quick, small pulse, and insatiable thirst; voided little urine, breathed with difficulty, and could not lie down in her bed for fear of suffocation For an accidental rheumatism in her limbs she had four doses of Dover's powder prescribed for her, of two scruples in each dose, one dose of which she was to take every night. The first dose relieved the pain in her limbs, but did nothing more. An hour or two after taking the second dose on the ensuing night she began to void urine in large quantities, which she conti- nued to do through the whole night, and as fast as she discharged * Sammlung Medicinischen V.ahrnemungen. B. vm. p. 220. N. Sammlung, &.t. B. vm. p. 114. Schulz. Schwi-d. Abhundlungen, B. XXI. p. 102. t Apud. Bonet. Poljalth. iv. 47. X Animadversiones, &c. 252 ECCRITICA. [CL. VI.—OR. IL the water her belly softened and sunk. The third dose completed the evacuation; and "thus," observes Mr. Mudge, " was this formi- dable ascites, which had subsisted near twenty years, by a fortu- nate accident carried off in eight and forty hours." The cure, too, was radical: for the constitution fully recovered itself, and the pa- tient was restored to permanent health. We may observe from this case that the viscera are not neces- sarily injured by being surrounded or even pressed upon by a very large accumulation of water for almost any length of time. It should be noticed, also, in connexion with this remark, that the patient before us was not much more than in the middle of life, even at the date of her cure : at which period we have more reason to hope for a retention of constitutional health in the midst of a chronic and severe local disease, than at a later age. And there can be no question that sudorifics will be found more generally success- ful in establishing a harmony of action between the surface and the kylneys, and produce less relaxation of the system at this than at a more advanced term of life. But except where there is such a concurrence of favourable points sudorifics can be but little relied upon in the treatment of dropsy, and are rather of use as auxiliaries than as radical remedies. They are also open to the same objection as emetics: they are apt, as Biichner has well observed, to do mischief by relaxing and debi- litating ;* and instances are not wanting in which they have very seriously augmented the evil.t Diuretics are a far more valuable class of medicines, and there are few of them that operate by the kidneys alone ; the intestines. the lungs, and oftentimes the whole surface of the body, internal as well as external, usually participating in their action. Of diuretics, the most powerful, if not the most useful, is foxglove. It was in high estimation with Dr. Withering, and Dr. Darwin regards it almost as a specific in dropsies of every kind ; though he admits that it does not succeed so certainly in evacuating the fluid from the abdomen, as from the thorax and limbs. The preparation usually employed by the latter was a decoction of the fresh green leaves, which, as the plant is a biennial, may be* procured at all seasons of the year. Of these he boiled four ounces in two pints of water till only one point remained ; and added two ounces of vinous spirit after the decoction was strained oft'. Half an ounce of this decoction constituted an ordinary dose, which was given early in the morning and repeated every hour from three to eight or nine doses, or till sickness or some other disagreeable sensation was induced. In the hands of Sir George Baker, even when used in the form recommended by Dr. Darwin, its success was, occasionally, very doubtful; while in some cases it was highly injurious without * Diss, de diversa Hydropi Medendi Methodo. Hal. 1766. f Piso, de Morb. ex serosa Coll. Obv. I. GE. I.-SP. I.] EXCERNENT FUNCTION. 253 the slightest benefit whatever.* Even where it acts very power- fully as a diuretic, and carries off five or six quarts of water a day, it often excites such incessant nausea, sinking, giddiness, and dim- ness of sight, and such a retardation and intermission of the pulse, that the increased evacuation by no means compensates for the increased debility. And by a repetition it is often found to lose even its diuretic effects. In the powder made into pills it seems to operate with an equal uncertainty. It has sometimes produced a radical cure without any superinduced mischief: but in other cases it has been almost or altogether inert. Sir George Baker gives an instance of this inert- ness both in the decoction and in pills. In a trial with the former the dose was six drachms every hour for five successive hours during two days, through the whole of which it had not the least efficacy, not even exciting nausea. In a trial with the latter, three pills, containing a grain of the powder in each, were given twice a day for several days in succession. They gave no relief whatever; nor produced any other effect than giddiness and dimness of sight. It is not wonderful, therefore, that the fortune of fox-glove should have been various: that at one time it should have been esteemed a powerful remedy, and at another time been rejected as a plant totd substantia venenosa. Its roots have been tried as well as its leaves; and apparently with effects as variable but less active. It seems to have been first introduced into the London Pharmacopoeia in 1721—folia, flores, semen ; was discarded in the ensuing edition of 1746, and has since been restored in its folia alone : having encountered a like alternation of favour and proscription in the Edinburgh College. It is greatly to be wished that some mode or management could be contrived, by which its power of promoting absorption might be exerted without the usual accompaniment of its depressive effects. When recommended so strenuously by such characters as Dr. Darwin, and more particularly Dr. Withering, from a large number of successful cases, it is a medicine which ought not lightly to be rejected from practice, and should rather stimulate our industry to a separation of its medicinal from its mischievous qualities. Upon the whole, the singular fact first noticed by Dr. Withering seems to be sufficiently established that in all its forms it is less injurious to weakly and delicate habits than to those of firmer and tenser fibres.! The most useful of the diuretic class of medicines is the siliquose and alliaceous tribes; particularly the latter, comprising leeks, onions, garlic, and especially the squill. The last is always a valuable and important article, and Sydenham asserts that he has cured dropsies by this alone. It has the great advantage of actin°- generally on the secernent system, and consequently of stimulating the excretories of the alvine canal as well as those of the kidneys. * Medical Transactions, Vol. m. Art. xvn. t Essay on Digitalis, p. 1H9. 254 ECCRITICA. [cl. yi.-or. ir. It sometimes, indeed, proves a powerful purgative by itself; but is always an able associate with any of the cathartics just enumerated. It may be given in any form, yet its disgusting taste points out that of pills as the least incommodious. When intended to act by the kidneys alone, Dr. Cullen advises that it should be combined with a neutral salt; or, if a mercurial adjunct be preferred, with a solution of corrosive sublimate, which seems to urge its course to the kidneys quicker and more completely than any other preparation of mercury* It may, also, be observed that the dried squill answers better as a diuretic than the fresh ; the latter as being more acrimonious, usually stimulating the stomach into an increased excitement, which throws it off by stool or vomiting, too soon for it to enter into the circulating system. The colchicum autumnale, or meadow-saffron, ranks next, perhaps, in point of power as a diuretic, and is much entitled to attention. It is to the enterprising spirit of Dr. Stoerck that we are chiefly indebted for a knowledge of the virtues of this plant, whose experiments were made principally on his own person. The fresh roots, which is the part he preferred, are highly acrid and stimu- lating ; a single grain wrapped in a crumb of bread and taken into the stomach, excites a burning heat and pain both in the stomach and bowels, stranguary, tenesmus, thirst, and total loss of appetite. And even while cutting the roots, the acrid vapour that escapes, irritates the nostrils and fauces; and the substance held in the fingers, or applied to the tip of the tongue, so completely exhausts the sensorial power, that a numbness or torpitude is produced in either organ, and continues for a long time afterwards. According to Stoerck,s experiments this acrimony is best corrected by infusion in vinegar; to which he afterwards added twice the quantity of honey.t In the form of an acetum, and of the strength he proposed, it is given as a preparation in the extant London Pharmacopoeia, while most of the other colleges have preferred his oxymel. Stoerck used it under both forms, but, perhaps, the best preparation is the wine, as recommended by Sir Everard Home in cases of goat, depurated from all sediment, as already noticed under the latter disease Stoerck began with a drachm of this twice a-day and gradually increased it to an ounce or upwards. Hautesierk asserts that it is less efficacious than the oxymel of squills.J The other diuretics, in common use, are of less importance; though many of them may be found serviceable auxiliaries as they may easily enter into the dietetic regimen. These are the sal dinreti- cus, or acetate of potash, which very slightly answers to its name, unless given in a quantity sufficient to act at the same time as an aperient; nitrous ether; juniper berries, broom-leaves, and which is far better, broom-ashes ; or either of the fixed alkalies ; and the * Mat. Med. Vol. n. Part II. Ch. xxi. t Libellus de Radice Colchice autumnali. Vindob. 1763. 8vo. X Recueil. u. GrJ. i<-SP. I.] EXCERNENT FUNCTION. 255 green lettuce, lactuca virosa, strongly recommended by Dr. Collin of Vienna, but as far as it has been tried in this country far beyond its merits. Dr. Collin, however, asserts that out of twenty-four dropsical patients he cured by this medicine all but one. To this class of remedies we have yet to add dandelion (Leonto- don taraxacum, Linn.) and tobacco. The former of these was at one time supposed to act so powerfully and specifically on the kid- nies as to obtain the name of lectiminga; and is „aid by some writers to have effected a cure in ascites after every other medicine had failed. It is truly wonderful to see how very little of this virtue it re- tains in'the present day, so as to be scarcely worthy of attention : while with respect to tobacco, notwithstanding the strenuous recommen- dation of Dr. Fowler, it is liable to many of the objections already started against fox-glove. The gratiola officinalis or hedge-hyssop, was once extensively employed, both in a recent state of its leaves ard in their extract, and like many other simples, it appear? to have been injudiciously banished from the Materia Medica. In both forms it is a powerful diuretic, and often a sudorific ; and in the quantity of half a drachm of the dry herb, or a drachm of infusion, whether in wine or water, it becomes an active emetic and purgative. It is said to have been peculiarly useful in dropsies consequent upon parabysma, or infarc- tion of the abdominal viscera; and in such cases seems still entitled to our attention. As a strong bitter, it may, like the lactuca virosa, which is also a strong bitter, possess some degree of tonic power, in connexion with its diuretic tendency. The bitter, however, is of a disagreeable and nauseating kind, which it is not easy to cor- rect. The external means of evacuating the fluid of cellular dropsy are blisters, setons, or issues, punctures, and scarification. The last is as much less troublesome as it is usually most effectual. It is, how- ever, commonly poslpoued to too late a period, under an idea that sloughing wounds may be produced by the operation, difficult of cure, and tending to gangrene. In blistering this has often happen- ed, but in scarifying the fear is unfounded, while any degree of vital energy remains: and it should never be forgotten that the longer this simple operation is delayed, the more the danger, what- ever it may be, is increased. 1 have never experienced the slight- est inconvenience from the practice ; and have rarely tried it with- out some advantage ; seldom indeed without very great benefit. The wound should be limited to a small crucial incision, resembling the letter T on the outside of each knee, as the most dependent organ, a little below the joint. The cut thus shaped, and very slightly pene- trating into the cellular membrane will not easily close, and conse- quently the discharge will continue without interruption. In a young lady about twelve years of age, whom the author lately attended, appa- rently labouring under an affection of the liver, but whose enormous bulk of body as well as of limbs, prevented all accuracy of examina- tion, a common jack-towel applied to each leg after the incision was 256 ECCRITICA. [CL. VI.-OR. II. made, was completely wetted through and obliged to be changed every three or four hours, for as many days. She was also purged with small and frequently repeated doses of elaterium: and the quantity of fluid hereby drawn off at the same time by the intestines is scarce- ly credible. The whole system was evacuated in about a week; and the entire figure re-acquired as much elegance of shape and elasticity, as before the attack. She was of a lively disposition and fond of dancing; in which exercise she engaged with as much energy and vivacity as ever. Nearly a twelvemonth afterwards the disease returned : but the same means were not successful. The breathing was now affected, and there was great palpitation of the heart; so frequent and distressing indeed as to render her incapable of sleeping for a moment unless in an upright position. The pa- tient in a few weeks fell a victim to the disorder; and on examining the body, the liver and lungs were found perfectly sound: but the heart was enlarged to nearly double its natural size, and particular- ly on the right side. During the progress of hydropic accumulation there is great dry- ness of the tongue, and, as already observed, an almost intolerable thirst. And the question has often been agitated, whether under these circumstances the patient's strong desire to drink should be gratified. In a state of health it is well known, that whatever be the quantity of fluid thrown into the blood it remains there but a short time, and passes off by the kidneys, so that the balance is easily re- stored : and hence it is obvious that one of the most powerful, as well as one of the simplest diuretics in such a state, is a large por- tion of diluent drink. But dropsy is a state very far removed from that of health ; and in many cases a state in which there is a pecu- liar irritability in the secernents of a particular cavity, or of the cellular membrane generally, which detracts the aqueous fluid of the blood from its other constituents and pours it forth into the cavity of the morbid organ. And hence it has been very generally concluded, that the greater the quantity of fluid taken into the sys- tem, the greater will be the dropsical accumulation: and conse- quently that a rigid abstinence from drinking is of imperative ne- cessity. Sir Francis Milman, however, has very satisfactorily shown, that if this discipline be rigidly enforced a much greater mischief will follow than by perhaps the utmost latitude of indulgence. For, in the first place, whatever solid food is given, unless a due proportion of diluent drink be allowed, it will remain in an hydropic patient, a hard, dry, and indigested mass in the stomach, and only add a second disease to a first. And next, without diluting fluids, the power of the most active diuretics will remain dormant: or rather they will irritate and excite pyrexy instead of taking their proper course to the kidneys. And, once more, as the thirst and general irritation and pyrectic symptoms increase, the surface of the body, harsh, heated, and acrid, will imbibe a much larger quantity of fluid from the atmosphere than the patient is asking for his stomach; for it «E. I.-SP. I.] EXCERNENT FUNCTION. 257 has been sufficiently proved, "that, under the most resolute determi- nation not to drink, a hundred pounds of fluid have in this manner been absorbed by the inhalants of the skin, and introduced into the system in a few days, and the patient has become bulkier to such an extent in spite of his abstinence. Even in a state of health or where no dropsy exists we are in all probability perpetually absorbing moisture by the lymphatics of the skin. Professor Home found himself heavier in the morning than he was just before he went to bed in the preceding evening, though he had been perspiring all night, and had received nothing either by the mouth or in any other sensible way. " That the surface of the skin,M says Mr. Cruikshank, '• absorbs fluids that come in contact with it, I have not the least doubt A patient of mine, with a stric- ture in the oesophagus, received nothing either solid or liquid into the stomach for two months : he was exceedingly thirsty, and com- plained of making no water. I ordered him the warm-bath for an hour morning and evening, for a month : his thirst vanished, and he made water in the same manner as when he used to drink by the mouth, and when the fluid descended readily into the stomach."* Under these circumstances, therefore, our first object,should he to determine by measurement whether the quantity of fluid dis- charged by the bladder holds a fair balance with that which is re- ceived by the mouth : and if we find this to be a fact, and so long as it continues to be a fact, we may fearlessly indulge the patient in drinking whatever diluents he may please, and to whatever extent. In some cases, indeed, water alone, when drunk in large abundance, has proved a most powerful diuretic, and has carried off the dis- ease without any other assistance, of which a striking instance oc- curs in fanarolus ;| and hence PouteauJ occasionally advised it in the place of all other aliment whatever: as does also Sir George Baker, in a valuable article upon this subject in the Medical Tran- sactions^ in which he forcibly illustrates the advantage of a free use of diluent drinks, by various cases transmitted to him, in which it operated a radical cure, not only without the assistance of any other remedy, but, in one or two instances, after every medicine that could be thought of had been tried to no purpose. But the fluid discharged from the kidneys may not be equal, nor indeed bear any proportion to what is introduced by the mouth, and we may thus have a manifest proof that a considerable quantity of the latter is drained off into the morbid cavity. Still we must not entirely interdict the use of ordinary diluents, nor suffer the pa- tient to be tormented with a continued and feverish thirst. If sim- ple diluent drinks will not pass to the kidneys of themselves, it will then be our duty to combine them with some of the saline or aci * Anat. of Absorb. Vessels, p. 103. 4to. 1790. t Pentec. u. Obs. 24. X Oeuvrrs Posthumes I. £ Vol. n. Art. xvii. VOL. IV. 'W 258 ECCRITICA. [CL. VL-OR. II. dulous diuretics we have already noticed, which have a peculiar tendency to this organ ; and we shall generally find, that in this state of union they will accompany the diuretic ingredients, and take the desired course. Of these, one of the most effectual, as well as the most pleasant, is creme of tartar ; and hence this o«ght to form a part of the ordinary beverage in all extensive dropsies, and especially the cellular and abdominal. Any of the vegetable acids however may be employed for the same purpose : as may also rennet-whey, and butter-milk, and the more acid their taste the bet- ter will they answer their end. A decoction of sorrel-leaves makes also a pleasant diet drink for an hydropic patient; as does likewise an aqueous infusion of sage leaves with lemon-juice: both sweeten- ed to the taste. Small stale table-beer, and weak cyder, or cyder intermixed with water, may in like manner be allowed, with little regard to measure. And it was by the one or other of these that most of the cures just referred to, as related by Sir George Baker, were effected. In one instance the cyder was new, yet it proved equally salutary under the heaviest prognostics. The patient was in his fiftieth year; his legs and thighs had increased to such a magnitude that the cuticle cracked in various places; he was ex- tremely emaciated, and so enfeebled as not to be able to quit his bed, or return to it without assistance. His thirst was extreme, his desire for new cyder inextinguishable, and his case being regarded as desperate it was allowed him mixed with water. He drank it most greedily, seldom in a less quantity than five or six quarts a- day ; and by this indulgence discharged sixteen or eighteen quarts of urine every twenty-four hours till the water was totally drained off; and he obtained a radical cure without any other means what- ever. Even ardent spirits, if largely diluted, and joined with a por- tion of vegetable acid, have been found to stimulate the kidneys; and in the opinion of Dr. Cullen may make a part of the ordinary drink.* And it is chiefly owing to the tendency which the neutral salts have to the kidnej's, as their proper emunctory, and the sym- pathy which the secernents of these organs maintain with those of all others, that the cure of dropsy has sometimes been effected by large draughts of sea-water alone ; though sometimes this has also acted upon the bowels, and produced the same salutary result, by exciting a very copious diarrhoea, of which a striking example is given by Zacutus Lusitanus.t It should never, however, be forgotten, that dropsy is a disease of debility, and that the plan of evacuating will rarely ofttself effect a cure ; and never, perhaps, except in recent cases, and where little inroad has been made upon the constitution, in all other cases it should be regarded as a preparatory step alone; a mere palliative ; and an evil in itself; though an evil of a less kind to surmount an evil of a greater. And it is for want of due attention to this fact, * Mat. Med. n. 549. •f Prax. Hist. Lib. vm. Obs. 53. CE. I.-SP. I.] EXCERNENT FUNCTION. 259 that the plan of evacuating, and particularly by drastic purgatives, has by many practitioners been carried to a dangerous and even a fatal extreme. Every purgative that does not diminish the general bulk, adds to the general disease by increasing the debility : and it upon a very few trials the plan be not found to answer this salutary purpose it cannot too soon be desisted from. The radical cure must, after all, depend upon invigorating the constitution, or the organs particularly affected: for even a total removal of the water affords nothing more ilian a palliative and pre- sent relief. Such an intention may often, indeed, be combined with that ol evacuating the fluid; and hence Mondschein with great reason ad- vises us to employ bitters with diuretics,* as Martius does with purgatives.! Bitters, indeed, where the debility does not depend upon visce- ral obstructions, form one of the most efficacious tonics we can em- ploy. They are peculiarly adapted to that general loss of elastici- ty in the whole system and that laxity of the exhalents which consti- tutes the hydropic diathesis. " It ha« been alleged," says Dr. Cul- len, " that bitters sometimes act as diuretics. And as the matter of them appears to be often carried to the kidneys, and to change the state of the urine, so it is possible that in some cases they may in- crease the secretion : but in many trials we have never found their operation in this way to be manifest, or at least to be any ways con- siderable. In one situation, however, it may have appeared to be so. When in dropsy bitters moderate that exhalation into the ca- vities which forms the disease, there must necessarily be a greater proportion of serum carried to-the kidneys: and thereby bitters may, without increasing the action of the kidneys, seem to increase the secretion of urine."J To bitters have been added the warmer balsamics and aromatics, and by many physicians the metallic oxydes; chiefly the different preparations of copper; though Willis, Boerhaave, Bonet, and Dig- by, have occasionally preferred those of silver. Iron has generally been abstained from as too heating, though recommended by Grieve,§ Kichard,|| and llhumelius.1l Where the disease is evidently dependent upon some visceral ob- struction, mercury offers a fairer chance of success than any other metal ; and in this case has often been pushed to salivation with the most salutary result. Du Verney employed it to this extent in an ascitic patient, whom at the same time he tapped ; and by this dou- * Mondschein, p. ?,2. t Martius, Obs. 54. | Mat. Med. n. p. 58. J Med. Com. Edinb. ix. ir. 75. || Journ. de Med. xxix. 140. * Medic. Spagyr. tripart. p. 168. 268 ECCRITICA. [CL. VI.-OR. U. hie plan effected a cure; allowing a regimen of wine and stimulant meals during the process* And Rahn assures us, that in one case, the disease, though it several times recurred, was in every instance put to flight by a ptyalism excited by mercurial inunction.T cut where the system is in a state of great general debility, such a so- lution of the fluids will only add to the weakness and increase the disease. Small doses of calomel steadih per-isted in will be here our safest course, with a nutritious and generous diet ot flesh-meat two or even three times a day; shell-fish; eggs, spice, and the acrid vegetables, as celery, water-cresses, raw red cabbage shred fine, and eaten as sallad. I have dwelt the longer on this species because the general ob- servations which it suggests, as well in respect to its causes and history as to its mode of treatment, apply in a very considerable de- gree to all the rest; concerning which we shall now have little more to do than to enumerate them and point out their distinctive characters. SPECIES II. HYDROPS CAPITIS. Brojjsg of the f&eatt. abater tn the i&cato. EDEMATOUS INTUMESCENCE OF THE HEAD : THE SUTURES OF THE Si I'LL GAPING. This disease has been strangely confounded by nosologists and prac- tical writers with that inflammation of the brain which apparently commences in its substance or lower part, and, producing effusion into the ventricles, distends them, and thus unites the symptoms of fever and great irritability with those of heaviness, and at length of stupor. The accumulation of fluid is here only an effect, and follows upon inflammation of the brain as in any other part, and is only to be removed by removing the inflammation. It is ordinarily denominated, however, acute or internal hydrocephalus ; but Dr. Cullen has correctly distinguished it from proper hydrocephalus or dropsy of the head by placing it in a different part of his classifica- tion, and assigning it a different name. In his view it is an apo- plexy, and he has hence called it apoplexia hydrocephalica. In the present work it occurs under the name of cephalitis profunda* and in treating of it as a cephalitis the author has submitted his reason* for not regarding it as an apoplectic affection. * Mem. de Paris, 1703, p. 174. -'' Medic. Briefwechsel, B. i. 365, OE. I.-SP. II.] EXCERNENT Fl.'NCTION. 261 The disease before u« is common to children. A few singular case- are, indeed, recorded of its commencing in adult age,* and producing an enlargement of the scull by a morbid separation of th<- u'.uros. but these are very rare. That it does, however, occur without such separation and enlargement, and that too occasionally in every period of life, has been proved by a multitude of exami- nations after death, that have shown the ventricles of the brain dis- tended with fluid, and producing a considerable prc-sure upon the bntin. Vet where no such enlargement of the scull takes place, we may sometimes strongly suspect the disease from the symptoms, but cannot during the life of a patient speak with certainty upon the subject. Dropsy of the head, like that of every other organ, is a disease of deb.lity, and as we have already observed in the introductory re- marks to the present gdnus, may proceed from a relaxed condition of the secernents of the brain, a torpitude of its absorbents, or from both. The causes of this morbid state we are rarely able to ascertain : yet in some families there se«ms to be a peculiar pre- dispesition to it, since it occurs in many of the children born in succession : and it may sometimes be connected with a schrophu- lous diathesis. The immediate seat of the dropsy varies considerably: for some- times the fluid accumulates between the bones of the cranium and the dura mater; sometimes between the dura mater or the other membranes and the brain, and sometimes in the ventricles or con- volutions of the organ. With the deficiency of tone there is also not unfrequently some deficiency of structure or substance: and it is in consequence of this that the fluid when morbidly secreted or collected in one part, spreads without resistance to another. A de- ficiency of structure or substance is sometimes found in the brain itsL'lf and sometimes in the cranium. If it occur in the former a path may be immediately opened for the morbid fluid, accumulated in the ventricles or in any other interior part, to reach the mem- branes and distend the scull: and if in the latter, it may even pass beyond the scull, and separate and distend the integuments. I have seen instances of large perforations produced in different parts of the bones by a morbid absorption of the bony earth, as though the trephine had been repeatedly applied, and this too in adult age: and in some instances there has been a total absence of the calvaria.t Generally speaking, there is some deficiency of bony earth, as though it were impossible for this secretion to keep pace with the enlargement of the cranium : and hence the bones of the cranium have occasionally been so thin as to be pellucid and transmit the light of a candle, of which Van Swieten gives an instance,! ^rom * Hildan. Cent. in. Obs. 17. 19. t Act. Helvet. i. 1. t Comment, in Hvdror. Sjct. 1.217. 262 ECCRITICA. [CL. Vl.-OR. II. Betbeder;* or have had their place supplied by a membrane co- vering the entire range of the sinciput, an example of which will be found in Vesalius.f The dropsical fluid is also said by many writers of high authority to originate in some cases between the integuments and the bone, and to be confined to this quarter: and hence, the disease has been divided into external and internal dropsy of the head. It is possi- ble, indeed, as Van Swieten has justly observed, that since water may be collected in the cellular membrane of the whole body, such an accumulation may take place in the integuments of the head.J But the pretended cases are so rare that Van Swieten himself, Pe- tit,^ and many other writers of high credit, have doubted whether such a form of the disease has ever actually occurred. Yet, should it occasionally take place, there can, I think, be no question that it ought rather to be regarded as a variety of anasarca or cellular dropsy, than hydrocephalus or dropsy of the head, properly so call- ed. Celsus has been quoted upon the occasion a, confirming the existence of this external modification, and applying to it the name of hydrochephalus : but this is to misunderstand him egregiously. In the passage referred to he is speaking of internal diseases of the head alone, of cephalaea, and other aches produced by wine, or indigestion, by cold, or heat or the rays of the sun, sometimes ac- companied with fever, and sometimes without; sometimes affect- ing the whole of its interior, and sometimes only a part:—" modo in toto capite, modo in farte." And he then adds, " praeter haec etiamnum invenitur genus, quod potest longum e^se : ubi humor cutem inflat, eaque itumescit, et, prementi digito, cedit: v$£$xt(px*» Graeci appellant."|| It is manifest, therefore, that the hydrocepha- lus here noticed, like the other diseases with which it is associated, is an internal affection of the head: and this idea is still farther confirmed by the treatment which he shortly afterwards proceeds to prescribe for it. It is hence highly probable that the cases which have been called external dropsies of the head, have consisted of internal accumula- tions spreading to and distending the integuments through channels that were not ascertained, and on this account not supposed, to exist. Were the distinctions of external and internal dropsy of the head necessary to be preserved, it would be far more accurate to limit the former to those modes of the disease in which the water is con- fined between the calvaria and the membranes, and the latter to those in which it originates in the cavities of the brain: but as we * Histoire de l'Hydrocephale de Begle, p. 35. t De Corp. human, fabrica. Lib. I. cap. 6. X Comment, loc. citat. 1718. i Acadcm. des Sciences, Mem. p. 121. || De Medicin. Lib. iv. cap. n. GE. I.-SP. II.] EXCERNENT FUNCTION. 263 can rarely, if ever, determine the limits of the collection by the symptoms, it is a distinction which cannot be supported, and would often lead us into error. Hydrops capitis frequently commences in the fetus, and some- times renders the head so large as to retard the labour, and greatly harass the delivery. Blanchard gives a case in which four pounds of water were evacuated from the head of a fetus after its birth. At other times it does not show itself till some months, or even two or three years, after birth. In most cases the whole head enlarges gradually by a gradual separation of the sutures; but in a few cases the first symptom has been a small, elastic tumour on the upper part of the head, produced by an inequality of the dura mater, and its yielding more readily at the part that presents, than in any other quarter. This tumour sometimes grows to a size as large as the head itself. It is seldom, however, that the walls of the tumour burst; for the uniform pressure to which they are exposed, has a tendency to thicken and harden them. And hence, as the resist- ance increases, the sutures give way generally, and the tumour frequently disappears and is lost in the general swell. The brain often exhibits, as we have already observed, some misformation or defect, which of itself may constitute a remote cause: but the proximate cause is a debility of the local secernents, absorbents, or both. If the debility be confined to these, or the defect in structure do not interfere with the proper developement of the mental or corporeal powers of the sensorium, the infant may live and even thrive in every other part, while the water continues to accumulate and the head to become more monstrous, and even insupportable from its own weight: for, provided the pressure ap- plied be very gradual, and unaccompanied with inflammation, the brain, like the stomach and intestines in dropsy of the belly, may be drowned in water for even twenty or thirty years without serious mischief. MichaeUs relates the case of a patient twenty-nine years old, whose appetite and memory were good, and the pupils of the eyes natural, though the disease had continued from birth.* And in treating of vascular osthexy I had occasion to notice, from Dr. Heberden, the history of a patient who, with about eight ounces of water in the ventricles of the brain, as appeared on openin"- him —and which there was good reason for believing had existed there for many years,—and with scarcely an organ free from disease in his whole body, with the exception of the brain itself, which was found healthy in its substance, was enabled to attain the good old %e of upwards of fourscore years with an apparently sound consti- tution, and free from all the usual infirmities of advancing years saving the inconvenience of an habitual deafness. But the torpitude or imbecility of the excernent vessels may ex- tend to the other parts of the brain, and to parts that are immediate- ly connected with the mental faculties; or the defects of structure * Medical Communications, Vol. i. Art. > x.v. 264 ECCRITICA. [CL. VL-OR. U* that are so often combined with dropsy of the head may extend to tje same : and in such cases the hearing, sight, or speech maj, be affected: there may be loss of memory or stupidity, vertigo, epi- lepsy, or convulsion fits. Hie brain has sometimes been found in a sponjjy or fungous slate ;* or otherwise disorganized :t and some- times tense and slender with nerves like mucu*4 The fluid, more- over, may accumulate with rapidity, instead of slowly, as soon as the exciting cause, whatever it miy be, is in operation, and the suddenness of the pressure may impede the action of the sanguifer- ous vessels; and we shall then perceive symptoms of compression, as a heavy pain in the head, stupor, occasional vomiting, quick pulse, and other febrile concomitants, a perpetual flow of tears from the eyes, or of mucus from the nostrils. And hence it is that dropsy of the head is so frequently a symptom or a sequel of inflammation of the brain, and particularly of parenchymatic inflammation. Yet even here we have, sometimes, striking and most singular proofs, that the remedial power of nature is interfering either to obtain a cure, or to render the disease compatible with life, and with the general faculties of the sensorium. There is an interest- ing illustration of this remark in a case, related by Dr. Donald Monro, in the Medical Transactions. It is that of a child which at the ige of a year and a half, was brought into St. George's Hospital with a head "much enlarged from the disease before us. She was feverish and had a slight stupor. The complaint was peculiarly obstinate, and resisted the use of purges, blisters, issues, bandages, and other remedies. The enlargement proceeded and became chronic, though the fever and stupor gradually diminished and at length ceased; yet the head continued to enlarge and kept an equal proportion with the child's growth : so that when in her eighth year, it measured two feet four inches round, which is nearly a foot more than it ought to have done, and the forehead alone was half the entire length of the face, or four inches out. of eight, which is double the proportion it ought to have held,—yet the child was at this time as lively>;ind sensible as most children of her age, and had a strong and peculiarly retentive memory. It was long before she could walk, on account of the vast weight of head she had to carry, and the difficulty of preserving a balance; but at length she learned to walk also with tolerable ease.§ In the following case the efforts of the remedial power were less successful: but it is peculiarly worthy of notice, as much from the lateness of the age in which the disease commenced, and the sutures were separated, as from the natural struggle there seems to hav* been to obtain a triumph over it. It is related by Dr. Baillie, in another volume of the same valuable work. The patient was a * Conrad, Diss, de Hydrocephalo. Argent. 1773. t Bonet, Sepulchr. Lib. I. Sect. xvi. Obs. 9. X Biittner Beschreibr.ng des innern Wasserkopf?, iSrc. Koine;-. 1773. f Medical Transactions, Vol. n. p. 359. CP.. I.-SP. II.] EXCERNENT FUNCTION. 265 boy, not less than seven years of age when he first becam e affected. The pupils, from an early stage, were considerably dila ted and the pulse was somewhat irregular; he complained of pain towards the back of bis head, and was often in a state of stupor. His under- standing, however, was clear, and his sight very little impaired almost to the last. He had twice intervals of great promise, for a few weeks, with considerable abatement of all the symptoms, and an appearance of doing well. Cut in both instances he relapsed, and at the distance of ten months from the commencement, fell under daily attacks of convulsion fits. It is remarkable that, though his intellect continued unimpaired, the frontal and parietal bones, from the force of the accumulated fluid in every direction, were separated from each other, to a distance of from half to three quar- ters of an inch, notwithstanding that they had been firmly united at their respective sutures before the commencement of the disease. Nearly a pint of water was found in the ventricles upon examina- tion. We have observed, that in many cases the bones of the scull be- come peculiarly thin and pellucid, or are altogether deprived of their calcareous earth, and reduced to cartilages. But where the instinctive ort'emedial power of nature, which is always labouring to restore morbMl parts to a state of health, or to enable them in their altered condition to fulfil their proper functions, has succeed- ed in rendering the diseased brain still capable of exercising some of its faculties, a supply of phosphate of time, is, in various instan- ce^, also provided for the bony membrane ; which not only re-as- sumes its ordinary firmness, but has sometimes exhibited a density far beyond the usual proportion and commensurate with the magni- tude of the scull; while the cervical vertebrae have been equally strengthened for the purpose of bearing so enormous a load. Hil- dauus gives a case of this kind in a youth eighteen years old, who, had laboured under a dropsy of the head from his third year. The scull was of an immense magnitude (immensoz magnitudinis) as well as peculiarly hard and solid. The patient spoke distinctly, but his mind was not equal to his articulation, and he suffered greatly from violent epileptic attacks.* " If sculls of this kind," says the Ba- ron Van Swieten, u should be disinhumed in their burial-ground by posterity, there would certainly not be wanting persons who would ascribe them to some gigantic family. If, indeed, the calvaria should be dug up entire the error may be corrected, by observing the size of the upper jaw-bones, which would be found of the ordi- nary proportion: but if the bones should be separated and single, there could be no appeal to this distinctive mark.f The disease is always dangerous from the difficulty of determin- ing its extent and what degree of cerebral disorganization may ac- company it. Where, however, it is limited to a weak condition of the * Observ. Chirurg. Cent. in. Obs. xix. p. 199. r Comment. Tom. iv. Suet. 1217. p. 123. VOL. IV. 31 266 ECCRITICA. [CL. VJ--OR. 11- excernents of the brain it is often remediable and admits of a radi- cal cure. But where on the contrary, no favourable impression can be made upon it, the general frame partakes by degrees of the debility, the vital powers flag, the limbs become emaciated, and death ensues at an uncertain period : or the patient survives, a miserable spectacle to the world and burden to himself; rarely reaching old age, but some- times enduring life for twenty or even thirty years* before he is released from his sufferings. On opening the head twelve or fif- teen pints of fluid have often been evacuated; and occasionally not less than twenty-four or twenty-five pints,! which have the singu- lar property of not jellying even on exposure to heat.| The water has sometimes been found lodged in a cyst, and in a few instances the cerebrum itself has formed a sack for containing it. Morgagni asserts that the disease is more common to girls than to boys.§ 1 do not know that the remark has been confirmed by any collateral authority. The cure, as in the preceding species, must be attempted by evacuating the water by internal or external means, and by giving tone to the debilitated organs. Drastic purges can rarely, in this form of the disease, he carried to such an extent as to be of essential service, ©n account of the early period of life in which it commonly sfcows itself. For the same reason diaphoretics have not been generally recommend- ed, or often found serviceable when ventured upon. Diuretics have been more frequently had recourse to; and particularly the digitalis. Dr. Withering was favourable to its use, but it has com- monly, as in other forms of dropsy, proved more injurious than be- neficial. The best internal medicine is calomel, in small doses, in union with some carminative for the purpose of keeping up the action of the stomach, a healthy state of which is of great importance. The calomel, however, should be employed rather as a stimulant or tonic, so as to excite the mouths of the torpid vessels to a return of healthy action, than as a purgative or with a view of producing salivation; except indeed, where symptoms of inflammation are present, in which case it cannot be given too freely, as already ob- served under parenchymatic cephalitis.*!! Where the disease has been unaccompanied with inflammatory symptoms, but nevertheless has been attended with a feverish irritation, and great heaviness, as well as considerable enlargement of the head, the author has found half a grain of calomel, given three times a-day, in the man- * Van Swieten, Comment, loc. citat. t Bonet, Sepulchr. Lib. i. Sect. xvi. Obs. 1. Eph. Nat. Cur. Dec. m. Ajin. i. Obs. 10. $ Hewson, on Lymph. Syst. Part n. p. 193. $ De Sed. et Caus. Mor. Ep. xn. Art. 6. || Vol. n. p. 224. GE. I.-SP. II.] EXCERNENT FUNCTION. 267 ner above proposed, and continued three times a day for a month, of essential service : and particularly in a case that occurred to him, many years ago, of a little boy who was four years old when the disease first appeared; which, however, had made its attack so insidiously as to escape the observation of the parents till the in- creased bulk of the head attracted their notice, which was soon af- terwards succeeded by the symptoms just adverted to. The com- plaint had increased, the symptoms were more aggravated, and the scull, within six months, had become as large as that of an adult, when the mercurial process was commenced, accompanied with a free fomentation of the head with the solution of the acetate of am- monia, and an occasional use of purgatives. In ten days there was an evident improvement: the child was less languid, and feverish, and showed less desire to rest his head perpetually on a chair. The scull no longer augmented; the mental faculties which began to discover hebetude regained vigour, and the patient, now in his twentieth year, is an under-graduate in one of our universities, ex- hibiting a developement of talents that has already obtained for him various prizes, and gives a promise of considerable success hereafter. The bulk of his head is at this moment very little larger than it was at six years of age : a curious fact in pathology, though by no means uncommon : since where the disease forms space enough for a perfect growth of the brain, the calvaria ceases to expand, and the head becomes once more proportioned to the rest of the body. The external means employed for diminishing the contained fluid have consisted in local stimulants, as different preparations of ammonia, blisters, and cauteries, and puncturing the integu- ments. All local stimulants have a chance of being useful where the dis- ease is seated near the surface, or between the membranes and the cranium, for they tend to excite the absorbents to an increased de- gree of tone and action, and consequently to a diminution of the general mass. But they do not seem to have much effect when the fluid issues from the convolutions or ventricles of the brain. Blis- tering the whole of the sinciput has unquestionably been found ser- viceable, and is perhaps the most effectual external stimulant we can employ. The water has also been evacuated in many instances, with full success by a lancet: and, where the sutures gape very wide, and the integuments are considerably distended, this remedy ought al- ways to be tried. The brain, however, like every other organ, when it has been long accustomed to the stimulus of pressure, can- not suddenly lose such a stimulus without a total loss of energy; and hence, as it is necessary in many cases of dropsy of the belly, to stop as soon'as we have drawn off a certain portion of water, in order to avoid faintness, it is found equally necessary to evacu- ate the water from the brain with caution and by separate stages; for where the whole has been discharged at once, the sensorial ex- 268 ECCRITICA. [CL. VI.-OR. If. haustion has been so complete as to produce deliquium and sudden death. Hence six or eight ounces are as much as it may be pru- dent to let loose at a time in an infant of three or four years of age; when the orifice should be covered with a piece of adhesive plaster, and an interval of a day or two be allowed. The opera- tion, indeed, is very far from succeeding in every instance : for in some cases there is so much internal disease or even disorganiza- tion, that success is not to be obtained by any means. And next, a fresh tide of water will not unfrequently accumulate, and the head become as much distended as before. Still however, the attempt should be made, and even repeated and repeated again if a fresh flow of fluid should demand it: for the disease has occasionally been found to yield to a second or third evacuation, where it has triumphed over the first. Dr. Vose of Liverpool, has published an instructive case of this kind in the ninth volume of the Medico-Chirurgical Transactions. The patient was seven months old, and the head between two and three times its natural size when the operation was first performed. On this occasion a couching needle was made use of, and the ori- fice was closed when three ounces and five drachms of fluid were evacuated: about an equal quantity was conjectured to dribble from the orifice after the operation, at which time the infant became ex- tremely faint, and the integuments of the head had shrivelled into the shape of a pendulous bag. He revived, however, with the aid of a little cordial medicine ; and, the water accumulating afresh, a second operation was performed by a history about six weeks af- ter, when eight ounces of fluid were drawn off with little constitu- tional disturbance; which was succeeded only nine days later by a third operation, that yielded, by the introduction of a groved direc- tor, twelve ounces, without any interference with the general health whatever. A copious and vicarious discharge of serum from the rectum took place shortly after this third puncture of the integu- ments, which was succeeded by some degree of deliquium ; but from this also, the patient soon recovered; the head gradually di- minished in size, and a complete cure was at length effected. Formey,* Pitschel,t and several other writers, have recommend- ed compression, with a view of stimulating the torpid mouths of the absorbents to a resumption of their proper action. But no com- pression can be made on these, whatever they may consist in (for absorbents have not hitherto been detected in the brain,) without compressing at the same time, parts that are injufed by pressure already. Advantage, however, may be taken of the recommenda- tion after the brain has been evacuated; and a proper compress about the shrivelled head, may be of as much use in preventing deliquium, and perhaps, by its excitement, in stimulating the tor- * Ad. Riverii, Observ. Medic. £ent. v. t Anat. and Chir. Anmerk. Dresd. 1734. GE. I.-SP. II.] EXCERNENT FUNCTION. 269 pid vessels to a return of their proper function, as it is well known to be of when applied around the abdomen after the use of the trocar. / SPECIES III. HYDROPS SPINAS. ZJropsg of the &pint- SOFT FLUCTUATING EXTUBERANCE ON THE SPINE ; GAPING VERTEBRAE. This is the spina bifida -of authors, so called from the double chan- nel which is often produced by it through a considerable length of the vertebral column: a natural channel for the spinal marrow, and a morbid channel running in a parallel line, and equally descending from the brain, and filled with the fluid which constitutes the dis- ease. It is sometimes local, but in most instances is connected with a morbid state of the brain, and directly communicates with it. In this last form it may be regarded as a compound dropsy of this or- gan, the accumulating water working its way down towards the fo- ramen ovale in consequence of its dependent position, or a deficien- cy in the substance of the brain in this quarter, instead of up to- wards the fontanel. In both cases the surrounding dura mater gives way, and, in the last, forms a sinus, which, as it descends, winds it- self through any accidental opening that may exist in or between the bones of the vertebra?, and distends the superincumbent integu- ments into the same kind of tumour that we have already noticed as sometimes existing on the crown of the head, when the fluid is pressed in an upper direction. Dropsy of the spine is mostly congenital, and consequently a dis- ease of fetal life; in many instances, however, the tumour does not show itself till some weeks, or even months after the birth of the child. The degree of danger must depend upon the structural de- fect, or other mischief that exists in the brain or the substance of the spinal marrow. It has sometimes appeared as a local affection in adult age, and has admitted of a cure ; but, from its usually oc- curring in the earliest and feeblest stage of life, and often before the sensorium is fully developed, so as, indeed to prevent its develope- ment in a perfect form, it is rarely remediable. We observed in the last species that the bones of the cranium are often found im- perfect ; and it is hence not to be wondered at that the bones of the vertebrae should exhibit a like imperfection in the present, and al- low a protrusion externally. Fieliz gives a case in which the whole 270 ECCRITICA. [CL. VI.—OR. II. of the spinous processes were deficient, and the dropsy extended through the entire length of the spine.* The integuments are here thinner and more disposed to burst than in the head, and hence, if the tumour be left to its natural course, it commonly continues to enlarge till it bursts ; while, if it be opened, the child, in most cases, dies from exhaustion and deli- quium, as in dropsy of the head, provided the water be evacuated entirely; and if it be discharged gradually, an inflammation of the spinal marrow is apt to ensue, which proves as fatal. Hence there is much reason in the advice of Mr. Warner merely to support the tumour, but not to touch it otherwise, and, in the mean while, to see how far we can give the remedial power of nature an opportu- nity of exerting itself by invigorating the frame generally. Some- thing, however, beyond support may be safely ventured upon, for a gentle compression may be tried with propriety, and if found to do no mischief, it should be gradually increased. If the disease extend to the ventricles it will probably be of little use, but if it be local, it may ultimately prove successful. This form of dropsy is mostly fatal; but there are a few cases on record of a successful termination upon the employment of different methods. Thus, Heister, who in his day also recommended com- pression, gives an example of its having radically yielded to this plan, in union with spirituous liniments ;| and Kantoni,| and Heil- mann,§ describe, each of them, an instance of a perfect cure upon opening and evacuating the cavity. In all which instances, how- ever, it seems probable that there was no such communication with the brain, or that the brain, or spinal marrow, was less affected than they ordinarily appear to be. A few singular cases have occurred of young persons protracting a miserable existence under this disease to the age of adolescence. Martini mentions a youth who lived till eleven years old; and Arcrel notices others who survived till seventeen,!) but with paralytic sphincters of the anus and bladder. * In Richter, Chir. Bibl. Band. ix. p. 185. t Wahmehmung. B. n. X In Pacchioni Animadvers. cit. Morgagni De Sed. et Caus. J Prodrom. Act. Havn. p. 136. I| Schwed. Abhandl. B. x. p. 291. seq. GE. I.-SP. IV.] EXCERNENT FUNCTION. 271 SPECIES IV. HYDROPS THORACIS. Mvop$$ of the (Chest. sense of oppression in the chest j dyspnosa on exercise, or de- cumbiture; livid countenance; urine red and spare; pulse ir- regular ; edematous extremities ; palpitation, and start ings during sleep. This is the hydrothorax of authors ; and the secreted fluid, in direct opposition to that of hydrocephalus, commonly, perhaps always, jellies upon exposure to heat. Sauvages, who has made this disease a genus, gives a considera- ble number of species under it, derived from the particular part or cavity of the thorax which is occupied, or the peculiar nature of the effusion; as hydrops mediastini, pleurae, pericardii, hydatido- sus; to which he might have added pulmonahs, as the water is, perhaps, sometimes effused into the cellular texture of the lungs. But as these can never, with any degree of certainty, be distin- guished from each other till after death, and as such distinction could make no essential difference in the mode of treatment, it is unnecessary to notice them, and is scarcely consistent with an ar- rangement founded upon symptoms alone. Those who are desir- ous of examining into the curious, and often contradictory signs by which these several forms of pectoral dropsy have been attempted to be discriminated by various writers, may turn with advantage to Sir L. Maclean's work upon the subject, where he will find them selected with much patient study, and accompanied with many judi- cious remarks.* In the present place it may be sufficient to ob- serve that the disease is, in fact, sometimes limited to any one of those parts, and sometimes extends to several of them: and that when it occurs as a consequence of cellular dropsy, it is in a great- er or less degree common to the whole. The complaint originates with little or no observation and con- tinues its course imperceptibly; there is at length found to be some difficulty of breathing, particularly on exertion or motion of any kind, or when the body is in a recumbent position, usually accompanied with a dry and troublesome cough, and an edema of the ancles to- wards the evening. Then follow, in quick succession, the symp- toms enumerated in the definition, several of which I have drawn directly from my friend Sir L. Maclean's very accurate arrange- ment of them. The difficulty of breathing becomes, at length, pe- * Inquiry into the .Nature, Causes, and Cure ol" Hydrothorax. p. 52, 70. 8vo. 272 ECCRITICA. [CL. VL-OR. II. culiarly distressing, and the patient can obtain no rest but in an erect posture ; while even in this condition he often starts suddenly in his sleep, calls vehemently for the windows to be opened, and feels in danger of suffocation. His eyes stare about in great anxie- ty, the livid hue of his cheeks is intermixed with a deadly paleness, his pulse is weak and irregular, and as soon as the constrictive spasm of the chest is over, he relapses into a state of drowsiness and insen- sibility. By applying the hand to the sides and using a slight de- gree of percussion, we shall sometimes be able to trace a slight degree of fluctuation. The disease, contrary to the preceding species is mostly to be found in advanced life, and its duration chiefly depends upon the strength and habit of the patient at the time of its incursion. It is hence, in some cases, of long continuance, while in others the pa- tient is suddenly cut off, during one of the violent spasms, which at length attack him as well awake as in the midst of sleep. The causes are those of dropsy in general, upon which we have already enlarged, acting more immediately upon the organs of the chest, and inducing some organic affection of the heart, lungs, or the larger arteries. We also frequently find, upon dissection, that the disease has been produced, or considerably augmented by a number of hydatids (taenia hydatis, Linn.) some of which appear to be floating loosely in the effused fluid, and others to adhere to particular parts of the internal surface of the pleura, constituting the hydro- thorax hydatidosus of Sauvages. They consist of spherical vesicles containing a watery fluid, whose circular membrane is possessed of a living power and a peculiar organization that enables them to attach themselves to the internal surface of a cavity, and to suck up the more attenuate and limpid humours from the neighbouring parts. The only decisive symptom in this disease is the fluctuation of water in the chest, whenever it can be ascertained; for several of the other signs are often wanting, or, in a separate state, are to be found in other complaints of the chest as well as in dropsy, more particularly in asthma and empyema. And hence, in determining the presence of this disorder we are to look for them conjointly, and not to depend upon any one when alone. Even when asso- ciated, we are sometimes in obscurity: and the difficulty of indi- cating the disease by any set of symptoms has been sufliciently pointed out by De Haen ;* while Lentin,t Stoerck| and Rufus§ have given instances ol its existence without any symptoms whatever: and Morgagni with few or none.|| Bonet observes that dyspnceall * Rat. Med. P. v. p. 97. t In Blumenbach Biblioth. m. t Ann. Med. n. p. 266. ♦ Ad River. Observ. Med. || Du Sed. et Caus. Morb. Ep. xvi. Ait. 2. 4. 6. 8. 11. T Ep. cit. Art. 23. 30. * ^E. I.-SP. IV.] EXCERNENT FUNCTION. 273 is not an indication common to all cases,* and Morgagni, that start- ing duiing sleep or on waking, do not always accompany the disease, and may certainly exist without it. Hoffmann and Bagliv have given, as an additional symptom, intumescence and torpitude of the left hand and arm ; but even this affection, or the more ordinary one of laborious respiration, has existed without water in the chest. De Rueff relates a singular case in a man who was attacked with mo«t of the symptoms jointly, at the age of about sixty, and was supposed to be in the last stage of this disease. He recovered by an ordinary course of medicine, and died at the age of eighty with his chest perfectly sound to the last.t The general principles to be attended to in the mode of treatment, are the same as have already been laid down under hydrops cellularis -• for, as already observed, the causes are similar, and only varied by an accidental deposition of the morbid fluid in the chest, in conse- quence of a peculiar debility in the thoracic viscera, or of some organic misaflection. The squill is here a more valuable medicine than in most other species; as, independently of its diuretic virtue, it affords great relief to the dry and teasing cough, and in some degree, perhaps, to the pressure of the fluid itself, by exciting the excretories of the lungs to an increased discharge of mucus. Digitalis, as in other species of the s.ime genus, is a doubtful remedy ; its diuretic effects are considerable, but, how ever cautiously administered, it too often sinks the pulse, and diminishes the vital energy generally ; and is particularly distressing from its producing nausea, and endangering deliquium; results which ought more especially to be guarded against in dropsy of the chest, as it is, in most cases, not merely a disease of debility but of enfeebled age. Sir L. Maclean is a firm friend to its use in almost every case : but even he is obliged to admit that the state of the pulse, the stomach, the bowels, and the sensorial function, should be atten- tively observed by every one who prescribes it. And under the Ibllowing provision, which he immediately lays down, there can be no difficulty in consenting to employ it. u If these be carefully watched, and the medicine withdrawn as soon as any of them are materially affected, 1 hesitate not to affirm that no serious inconve- nience will ever ensue from it, and that it may be administered with as much safety as any of the more active medicines in daily use.r| Blisters are, in many cases, of considerable avail; they act more directly, and therefore more rapidly and effectually than in most other modes of dropsy, and should be among the first remedies we have recourse to. The strong symptoms of congestion under which the heart seems, in some instances, to labour, has, occasionally induced practitioners * Sepulchr. Lib. n. Sect. i. Ohs 72. 14. t Nov. Act. Acad. Nat. Cur. Tom. iv. 4to. Noiimb. X Inquiry into the Nature, ic. of Hydrothorax, p. 171. vol. iv. 35 274 ECCRITICA. [CL. VI.-OR. II. to try the effect of venesection : and there are cases in which it has unquestionably been found serviceable : as that more especially related by Dr. Home, in which he employed it seven times in the course of eighteen days, and hereby produced a cure.* I am induced to think, however, that in this instance the dropsy was an effect of the obstruction under which the heart laboured, rather than that the obstruction was an effect of the dropsy. And in all instances of this kind no practice can be more prudent. But where the dropsy is primary and idiopathic, all such obstructions will be more safely and even more effectually relieved by a quick and drastic purge than by venesection. Opium is a medicine that seems peculiarly adapted to many of the symptoms : but by itself it succeeds- very rarely, heating the skin and exciting stupor rather than refreshing sleep. When mixed, however, with the squill pill, or with small doses of ipecacuan, and, if the bowels be confined, with two or three grains of calomel, it often succeeds in charming the spasmodic struggle of the night and obtaining for the patient a few hours of pleasant oblivion. Besides blisters as external revellents, setons and caustics have sometimes been made use of, and especially in the arms or legs. Baglivi preferred the cautery and applied it to the latter ;t Zacutus Lusitanus to both, and employed it in connexion with diuretics and tonics.J Tapping is another external mean of evacuating the water. The practice is of ancient date, and is described by most of the Greek writers. To avoid the effect of a dangerous deliquium from a sudden removal of the pressure, Hippocrates allowed, in many instances, thirteen days before the fluid was entirely drawn off. And to prevent the inconvenience resulting from a collapse of the integuments, and the necessity of a fresh opening or the retention of a canula in the orifice through the whole of this period, he advised that a small perforation should be made in one of the ribs, and that the trocar should enter through this foramen.§ There are two very powerful objections, however, to the use of the trocar. The first is common to most dropsies, and consists in its offering, in most instances, nothing more than a palliative The second is peculiar to the present species, and consists in the uncertainty of drawing off any water whatever, from the obscurity or complicated nature of the complaint, upon which we have touched already. If the fluid be lodged in the pericardium, the duplic dure of the mediastinum, or the ceiiuiar texture of the lungs, it if obvious that the operation must be to no purpose. And veL with the rare exception of a palpable fluctuation in the chest,'we have no set of symptoms that will certainly discriminate these different forms of * Clinical Experiments, p. 346. t Opp. p. 10.5. X Prax. Admir. Lib. i. Obs. 112. ' IIsg( t8?0( B-«t6ay. Lib. Lin. p. S!-t, GE. I.-SP. IV.] EXCERNENT TUNCTION. '21b the disease. It must be also equally in vain if the fluid be confined in a cyst, as has occasionally proved a fact, unless the operator should have the good fortune to pierce the cyst by accident. And, in a few instances, again, the fluid, which has at all times a striking tendency to become inspissated, has been found so viscid as not to flow : of which Saviard has given us a striking example* A considerable pause is necessary, therefore, before tapping is decided upon: nor ought it ever to be employed till the ordinary internal means have been tried to no purpose. But where these have been tried and without avail; and more especially where we have reason to ascribe the disease to local debility or some local obstruction rather than to a general decline of the constitution; and more especially still, where we have the satisfaction of ascer- taining a fluctuation, or of noticing, as has sometimes occurred, that the ribs bulge out on the affected side, the operation may be ventured upon, and will often be found serviceable. The ordinary place for introducing the instrument is between the fourth and fifth of the false ribs, about four fingers1 breadth from the spine. Du Verney, however, recommends between the second and third of the false ribs : and, in different cases, there may be reason for even a greater latitude than this. On the Continent the operation of tapping is far more frequently tried than in our own country : and the German Miscellanies are full of cases of a successful event. In the volume of Nosology I have given an account of many of these; in several of which the quantity of water evacuated appears to have been very considerable. Thus in one instance, a hundred and fifty pounds were discharged at a single time: in others between four and five hundred pounds by different tappings within the year: and in a single example nearly seven thousand pints, in eighty operations, during a period of twenty five years through which the patient laboured under this complaint; having hereby prolonged a miserable existence, which doubtless would have terminated without it much earlier, but which, perhaps, was hardly worth prolonging at such an expense. lu the Berlin Medical Transaction there is a case of a cure effected by an accidental wound mads into the thorax by which the whole of the water escaped at once.t In a few rare instances we have reason to believe that the disease has ceased spontaneously, judging from the trifling remedies that were employed at the time : as, for example, the specific of eighteen ounces of dandelion-juice taken daily, which, according to Haute- sierk, succeeded radically in one patient, or the use of small doses of squills alone, which, in the hands of Tissot, was equally fortunate in another. * Recueil d'Observationes Chirurgiques, »tc. Paris, 1734. t Act. Med. Bern!. Vol. x. D:.r. i. p. 44. 276 ECCRITICA. [CL. VI.-OR. II. SPECIES V. HYDROPS ABDOMINIS. Uropsg of the iJellg. TENSE, HEAVY, AND EQUABLE INTUMESCENCE OF THE WHOLE BELLY ; DIS- TINCTLY FLUCTUATING TO THE HAND UPON A SLIGHT STROKE BEING GIVEN TO THE OPPOSITE SIDE. This is the ascites of nosologists. It is sometimes a result of gene- ral debility operating chiefly on the exhalants that open on the internal surface of the sack of the peritonaeum and the abdominal muscles : sometimes occasioned by local debility or some other disease of one or more of the abdominal organs considerably in- farcted and enlarged, and sometimes a metastasis or secondary disease produced by repelled gout, exanthems or other cutaneous eruptions : examples of all which are to be found in Morgagni,* and offer the three following varieties, which may not unfrequently be applied to the preceding species: x Atonica. Preceded by general debility Atonic dropsy of the belly. o the constitution. s Parabysmica. Preceded by or accompanied Parabysmic dropsy of the with oppilation or indurated belly. enlargement of one or more of the abdominal viscera. y Metastatica. From repelled gout, exanthems Metastatic dropsy of the or other cutaneous eruptions. belly. In the fp and Qvcrx* " inflo" " flatu distendo." It has often been made a question by what means the air is obtained in various cavities, in which it is found in great abundance ; for we cannot always trace its introduction from without, nor ascribe it to a putrefactive process. Fantoni found air seated between the tunics of the gall-bladder, and Hildanjis in the muscles. " In one instance," observes Mr. J. Hunter, " I have discovered air in an abscess which could not have been received from the external air; nor could it have arisen from putrefaction.";}; The case is singular and well entitled to attention, but too long to be copied. From this and various other circumstances, Mr. Hunter conceived the opinion that air is often secreted by animal organs, or separated from the juices conveyed to them : and he appeals, in confirmation of this opinion, to the experiments of Dr. Iugenhouz upon vege- tables. I have not had an opportunity of reading these experiments, but that such a sort of secretion exists in plants must be obvious to every one who carefully examines the inflated legume of the differ- ent species of bladder-senna, (colutea,) and the capsules of several other shrubs quite as common in our gardens, and which can only become inflated by a separation or secretion of air from the surrounding vessels. Yet an appeal to a variety of curious facts in the economy of numerous animals will perhaps answer the purpose much better, as leading us more directly to the point. The sepia officinalis, or cuttle-fish, and the argonauta Nautilus* the ordinary parasitic inhabitant of which—for we do not know the animal that rears the shell,—has a very near resemblance to the cuttle-fish, and as suspected by Rafinesque, and since determined by Cranch, is a species of ocythoe,§ introduce air at option into the numerous cells * Nouveau Recueil, &c. t Journ. de Med. 1700. X Anim. Econ. p. 207. ■ Phil. Tians. 1817, p. 203. CE. II.j i VCERNENT FUNCTION. 289 of the back-bone, and thus render themselves specifically lighter whenever they wi-h to ascend from the depths of the sea to the surface; and, in like manner, exhaust the back-bone of its air. and thus render themselves specifically heavier whenever they wish to descend. All fishes possessing a sound or air-bladder are equally capable of supplying this organ with air, first for the purpose of balancing themselves, and next apparently for that of raising them- selves towards the surface. In all these cases the air, thus intro- duced and accumulated appears to be a direct secretion : at least we cannot otherwise account for its presence, as We can easily do in the bones of birds whose cells are filled with air; for we can here trace an immediate communication with the air-cells of the lungs. Mr. Bauer has lately shown that a gas is constantly shooting forth in small bubbles from the roots of plants into the slimy papulae by which they are surrounded; and that it is by this mean that the slimy matter becomes elongated, is rendered vascular, and converted into hair or down. Mr. Brande has also shown that gas, meaning hereby carbonic acid gas, exists in a considerable quantity in the blood while circulating in the arteries and veins, and is very largely poured forth from blood placed, while warm, under the receiver of an air-pump, so as to give an appearance of effervescence. He calculates that two cubic inches are extricated from every ounce of blood thus experimented upon, the venous and arterial blood contain- ing an equal proportion. And Sir Everard Home, has hence inge- niously conjectured that it is by the escape of bubbles of this gas through the serum, in cases of coagulated blood, that new vessels are formed, as also that granulations are produced in pus; from which it appears that the same gas escapes with equal freedom. These results of Mr. Brande, upon the same subject, are in per- fect accordance with the well known experiments of Dr. Hales and Baron Haller, which of late years appear to have been too much neglected, if not discredited. The former asserts that in distilling blood, a thirty-third part of the whole proved to be air: and the latter confirms the assertion; " utique," says he, " fere trigesima tertia pars totius sanguinis verus est aer." From all which we may reasonably conjecture that the body of air found in many cases, of perhaps all the species of emphysema, is produced, like other fluids found in the different cavities of the animal frame, by a process of secretion. These species are three, and are as follow : 1. I MrHYSEMA CLLLULARE. CELLULAR INFLATION. 2. --------- ABDOMINIS. TYMPANY. ;}. —_------ UTERI. INFLATION OF THE WOMB. There are probably many others—but these are the only ones which have been hitherto distinctly pointed out. vol. iv. 37 290 ECCRITICA. [CL. VI.-OR. IL SPECIES I. EMPHYSEMA CELLULARE. (Kellular Xnflatton. TENSE, GLABROUS, DIFFUSIVE INTUMESCENCE OF THE SKIN, CRACKLING BENEATH THE PRESSURE OF THE FINGER. This is the pneumatosis of Sauvages and Cullen, and consists in a distension of the cellular membrane by air instead of by water, as in hydrops cellularis or anasarca. The distension is sometimes limited to particular parts of the body, and sometimes extends over the entire frame. From the remarks we have just offered on the probable separation or secretion of air from the blood, this disease may originate from various causes, and exhibit itself under various modifications : hut the two following are the only extensive forms under which it has hitherto been traced : x A vulnere thoracis. From a wound in the chest. Traumatic Emphysema. with sense of suffocation. £ A veneno. From fish-poison or other ve- Empoisoned Emphysema. nom ; with extensive signs of gangrene and putrescency. For the first of these varieties there is no great difficulty in accounting. If a wound so far penetrate the chest as to enter any part of the lungs, and divide some of the larger branches of the bronchia?, the inspired air, instead of being cenfined to its proper channels, will rush immediately into the chest and fill up its whole cavity ; as it will also into the cellular membrane of the lungs, from which it will find a passage into the cellular membrane of the entire body, and produce an universal inflation. This last effect is highly troublesome and distressing: but the first is productive of the utmost alarm. The lungs compressed on every side by the extravasated air, are incapable of expansion : and there is consequently an instantaneous danger of suffocation. The patient labours for breath with all his might, and labours to but little purpose ; his cheeks are livid, his senses soon become stupe- fied, and, without speedy relief, death must inevitably ensue. The distress is moreover sometimes aggravated by the excitement of a cough, in the fits of which, if any considerable blood-vessel have been hurst, blood is expectorated along with the rejected mucus. Mr. Kelly, in the Edinburgh Medical Commentaries, has given a very singular case of this affection from another cause, which we will presently explain. The patient almost fifty-seven years of age, CE. II.-SP. I.] EXCERNENT FUNCTION. 291 had long laboured under a chronic cough and difficulty of breathing. The emphysema began to appear on the second day after a most violent fit of coughing, laborious respiration and pain in the side. It ion covered the whole right side to the scrotum which was also much inflated, producing a crackling sound upon pressure; and gradually widening its course, by the fourth day it extended over the whole body. It was at first conceived that air had entered from without into the cellular membrane by means of some wound m he side ; but no such injury or any other channel of communication could be discovered. The symptoms, however, were «o pressing that it was at length determined, under the advice of Dr. Munro to afford an escape for the air, by an opening into the cavity of the chest. The pleura was in consequence tapped ; when upon with- drawing the perforator, such a blast of wind issued through the ca- nula, as to blow out a lighted candle three or four times succes- sively. The patient immediate became easy, and free from op- pression, and his pulse fell from above a hundred strokes in a mi- nute to ninety. Punctures were at the same time made into the cellular membrane, in different parts of the body, and from these also the imprisoned air puffed out upon pressure but not other- wise. The patient recovered gradually, and in about three weeks ate and slept as well as he had done at any time for thirty years before For nearly a twelvemonth he continued to enjoy a good state of health; but about the close of this period was again attacked with a cough, a painin the chest, and a difficulty of breathing; a hectic fever followed, and he died in about six weeks. On opening the thorax, Mr. Kelly tells us, that he found the lungs " in a very putrid diseased state, with some tubercles on the external surface of the right lobe ; there was extensive adhesion to the pleura, par- ticularly at the place where the pain had been felt most keenly be- fore the perforation; and, on making an incision into the right lobe, an abscess was discovered which contained about four ounces of fetid purulent matter."* We are hence, I think, led to conjecture that the emphysema was in this case produced by the bursting of a former abscess in the right lobe of the lungs, accompanied with a rupture of one or more of the bronchial vessels, in consequence of which the same effect followed as if a wound had been inflicted from without. Where it is necessary to evacuate the air from the cavity of the chest, by an artificial opening, the operator cannot do better than follow the example of Mr. Hewson who employed a scalpel, and in- troduced it into the fore-part of the thorax, either on the right or left side ; but between the fifth and sixth ribs in the former case, be- cause here the integuments are thin; and between the seventh and eighth, or the eighth and tenth in the latter, for the purpose of avoiding the pericardium. The inflation which follows so suddenly and so extensively in the '* Edinb. Med. Comment. Vol. II. p. 427. 292 ECCRITICA. [CL. VI.-OR. IL second variety, or upon the introduction of fish-poison, or that of several species of the mushroom or numerous other edible venoms into the stomach, it is not so easy to account for. In most of the cases there is so violent and general a disturbance of every function, as to produce extreme and instantaneous debility ; all the precur- sors of putrescency are present, and speedy dissolution is threaten- ed. Every part of the body is swollen and inflated, particularly the stomach and intestines, the vapour of which, when examined after death, is found to consist of a fetid and putrid gas : a blackish and greenish froth is discharged from the mouth; clonic or tetanic spasms play wildly over all the muscles; the chest labours with suf- focation, the brain is stupefied, and broad, livid or gangrenous spots spread over the body; and on dissection are found still more freely, and of larger diameter on the surface of most of the thoracic and visceral organs. If then, in a state of undisturbed organization, many parts of the body have a power of secreting or separating air from the blood, as we have endeavoured to show in the introductory remarks to the present genus, how much more readily may we suppose such a se- paration to take place in proportion as the organs approach that precise state in which the gases of the blood extricate themselves spontaneously from its other constituents. And it may be added that this explanation is confirmed by our perceiving that the most effectual remedies against all such inflations are the most powerful antiseptics we can employ: as acids, alcohol, and the aromatic-. In few words, we never cease to find a free extrication of air whenever the body or any part of it is running rapidly into a state of putrefaction: and hence another cause of cellular emphysema. and a cause that is perpetually occurring to us in gangrene, SPECIES II. EMPHYSEMA ABDOMINIS. STfimjiang. TENSE, LIGHT, AND EQUABLE INTUMESCENCE OF THE BELLY J DISTINCTLY RESONANT TO A STROKE OF THE HAND. This disease is the tympanites of authors, so called from the drum- like sound which is given on striking the belly with the hand. There have been many occasions of observing that the Greek termination itis or ites, is, for the sake of simplicity and perspicuity, confined, in the present system, to the different species of a single genus of diseases, that of empresma, of which we have treated al- GE. II.-sP. II.] EXCERNENT FUNCTION. 293 ready :* and hence, as well as for other reasons sufficiently obvious, the specific term before us has been selected in its stead. Tympanites, however, is by most writers applied principally to an enormous collection or evolution of air in some part or other of the alvine canal, constituting the tympanites intestinalis of Sauvages: and it is to this disease alone that Dr. Cullen confines his attention, when treating of the subject in his First Lines. This flatulent dis- tention he ascribes to an atony of the muscular fibres of the intes- tines, accompanied with a spasmodic constriction in parts of the canal; by which means the passage of the air, is, in some places, interrupted. In this view of the case, however, tympany, instead of being entitled to the rank of a distinct genus, is nothing more than a symptom or sequel of some other enteric affection, as dyspep- sy, colic, worms, or hysteria: and hence the remedies applicable to these are what Dr. Cullen recommends for tympanites—namely, avoiding flatulent food, laxatives, and tonics. Mr. John Hunter seems to have conceived that a tympany of the stomach or intestines may exist as an idiopathic complaint. " 1 am inclined," says he, " to believe that the stomach has a power of forming air and letting it loose from the blood by a kind of secretion. We cannot, however, bring any absolute proof of this taking place in the stomach, as it may in all cases be referred to a defect in digestion; but we have instances of its being found in other cavities where no secondary cause can be assigned.71! He alludes chiefly to an extrication of air in the uterus, which we shall have occasion to notice in our next species. In concurrence with these remarks it may, also, be observed, that some persons are said to have a power of producing ventricular distensions voluntarily, which it is difficult to account for except by a voluntary power of secreting air for this purpose, or forcing it down the oesophagus, which will be still less readily allowed. Mor- §TagpMt and other writers have hence treated of this form of the disease as well as of that in which the flatus is lodged in the peritonaBal sac: while others have contended that this is the only form, and that a peritonaeal tympany has no real existence.^ If an idiopathic tympany of the stomach should ever be decidedly as- certained, its cure must be attempted by the remedies for flatus of any other kind: but at present the only disease we can fairly contemplate as entitled to the name of tympanites, or emphysema abdominis, notwithstanding the incredulity of some practitioners, is that in which the resonant swelling of the belly is produced by air collected in the sac of the peritonaeum. It is unquestionably a rare disease, though we must contend, in the language of Dr. Cullen, that, " from * Vol. n. Cl. in. Ord. ii. Gen. vn. p. 212. t On the Animal Econom. p. 206. 4to. 1T92. X De Sed. et Caus. Morb. Ep. xxxvni. Art. 23. Collect. Soc. Med. Havn. n.p. 73. (' Litre, Mem. de l'Acad. des Sciences, 1713. p. '235. 294 ECCRITICA. [CL. Vl.-OR. IL several dissections it is unquestionable that such a disease has some- times truly occurred:" nor can we suppose such accurate and cau- tious pathologists as Heister,* Lieutaud,t and Bell,+. who have respectively given examples of it, to have been successively deceiv- ed upon the subject. Admitting it be produced by secretion, its occasional causes are still very obscure. It has been said to follow upon jaundice, and morbid affections of other abdominal viscera, upon debility produced by fever; upon hysteria, violent passions or other emotions of the mind; and probably all these may have operated in different cases. The ordinary natural cure seems to consist in an escape of the air from the umbilicus by an outlet produced by an abscess or ulceration of this protuberant organ, or a sudden and fortunate rup- ture of its integuments. Morgagni and several later writers§ give us well authenticated cases of an occurrence of the first of these, and Stoerck of both.|j We are thus led by nature herself to try the effects of tapping, or making an artificial opening into the cavity of the abdomen in the case of wind-dropsy, as well as in that of water- dropsy : and here, from the protruded state of the umbilicus, the lancet may conveniently be introduced at this point. The belly should, at the time of the operation, be well swathed with a broad girth, which may be tightened at option, and should be kept as tight as the patient can bear it, as well for the purpose of general support as for that of expelling the air within, and preventing the entrance of air from without. Van Swieten dissuaded his pupils from this operation ;TT and Cembalusier,** and a few others have since asserted that it does not answer. But in most of these cases we have reason to believe that the seat of the disease was mistaken, and that the flatulency existed in the intestinal canal rather than in the peritonaeal sac. Antecedently, however, to the operation of the paracentesis, we may try the effect of sending shocks of the electric aura through the abdomen. Cold fomentations, moreover, or even pounded ice may be applied externally, and gelid drinks, reduced nearly to the freezing point, be swallowed copiously at the same time. This plan is said to have answered occasionally.lt And it is obvious that a tonic regimen, with free exercise, and particularly equitation, and, where it can be had recourse to, sea-bathing, should be enter- ed upon as soon as the tympany is dispersed. ': Wahrnehmungen. I. Art. 15. t Hist. Anat. v. p. 432. X On Ulcers and Tumours. Vol. n. i Guisard, Practique deChirurgie. Tom.i. p. 134. || Ann. Med. n. p. 190, 193, 194. IT Ad Sect. 1251. v * Pneumatopathol. p. 503. Dussdau, Journ. de Med. 1779. ; Theden, N. Remerkungen und Erfahrungen, n. p. 251. GE. II.-SP. II.] EXCERNENT FUNCTION. 29j There is a singular case of flatulent distension inserted in the Edinburgh Medical Essays, by Professor Monro, which is called a tym- pany, but does not seem to have been exterior to the intestinal canal; and hence, if a tympany at all, must have been produced by a secretion of air into the stomach or bowels, as conjectured by Mr. J. Hunter. The patient was a young woman aged twenty-two. The inflation continued for at least three months, the belly being sometimes so extremely distended as to endanger its bursting, and sometimes considerably detumefied, at which last period a variety of unequal and protuberant balls were felt all over the abdomen, and seemed to indicate so many intestinal constrictions. The patient's appetite continued good, she was very costive, and men- struated only at intervals of several months. She was at length attacked with borborygmi, and a day or two afterwards had such explosions of wind xmxxi xxtv, that none of the other patients would remain in the same room, and hardly on the same floor with her. From this time she recovered gradually.* SPECIES III. EMPHYSEMA UTERI. Xuttatfon of the ES'omfc. LIGHT, TENSE, CIRCUMSCRIBED PROTUBERANCE IN THE HYPOGASTRICS! ; OB- SCURELY SONOROUS ; WIND OCCASIONALLY DISCHARGED THROUGH THE MOUTH OF THE UTERUS. This is the physometra of Sauvages and later nosologists. Like the last species, it is by no means a frequent complaint, and not easy to be accounted for except upon the principle of a secretion of air: and hence the existence of this species as well as of the last has been denied by several writers who do not happen to have met with examples of it. The description given of it is somewhat obscure in most of the pathologists, but there seems, upon the whole, sufficient reason for admitting it into the list of morbid affections. " It has been said," observes Dr. Denman, " that wind may be collected and retained in the cavity of the uterus till it is distended in such a manner as to resemble pregnancy, and to produce its usual symp- toms ; and that by a sudden eruption of the wind, the tumefaction of the abdomen has been removed, and the patient immediately re- duced to her proper size. Of this complaint 1 have never seen an example : but many cast.* have occurred to me of temporary explo- * Edin. Med. Essays. Vol. i. Art. xxxi 296 ECCRITICA. [CL. VI.—OR. II. sions of wind from the uterus which there was no power of restrain- ing."* The uterus is one of those organs referred to under our last spe- cies, as supposed by Mr. John Hunter to have a power of secret- ing or separating air from the blood : and, as he has examined the , subject with critical attention in direct reference to the present complaint, his remarks are particularly entitled to our attention. " I have been informed," says he, " of persons who have had air in the uterus or vagina without having been sensible of it but by its escaping from them without their being able to prevent it: and who, from this circumstance, have been kept in constant alarm lest it should make a noise in its passage, having no power to retard it, as when it is contained in the rectum. The fact being so extraordi- nary made me somewhat incredulous ; but rendered me more in- quisitive in the hope of being enabled to ascertain and account for it: and those of whom I have been led to inquire, have always made the natural distinction between air passing from the vagina and by the anus: that from the anus they feel and can retain, bat that in the vagina they cannot; nor are they aware of it till it pass- es. A woman, whom I attended with Sir John Pringle, informed us of this fact, but mentioned it only as a disagreeable thing. I was anxious to determine if there were any communication be- tween the vagina and rectum, and was allowed to examine, hut dis- covered nothing uncommon in the structure of these parts. She died some time after; and being permitted to open the body I found no disease either in the vagina or the uterus. Since that time I have had opportunities of inquiring of a number of women concern- ing this circumstance, and by three or four have been informed of the same fact, with all the circumstances above mentioned."t The only difficulty in the case is the means by which air can thus become accumulated in the cavity of the uterus; for admitting this fact, of which there can no longer, I should think, be any doubt, we can easily conceive a distention to the utmost power of the or- gan in consequence of an obstruction of the mouth of the womb from spasm, a coagulum of blood, or any other viscid material. And hence, in all the cases of this disease which have descended to as, we find such a closure described as existing whenever the organ has been examined. Thus, in the instance related by Eisenmen- ger,J we are told that the uterus was completely impervious; and a like account is given of a similar instance recorded in the Ephe- mera of Natural Curiosities. Palfin§ gives a case in which the ob- struction proceeded from an hydatid cyst that had fixed at the mouth of the uterus, and Fernelius|| another in which the obstruction, * Introduction to the Practice of Midwifery, Chap. m. Sect. x. i Animal Economy, p. 406. 4to. 1792. X Collect. Historia foetus Mussi-pontani, &c. $ Description des parties de la femme qui servant a la generation. Leid. 1703. || Patholog. Lib. iv. Cap. xv GE. Il.-SP. III.] > EXCERNENT FUNCTION. 297 and consequently the inflation, returned periodically. Dr. Den- man intimates that this affection is sometimes accompanied with spasmodic pains, resembling those of labour: and the same remark will apply to dropsy of the womb which so much resembles it. The fact is that the uterus, when once enlarged by whatever means, and stimulated, has a natural tendency to run into a series of expul- sory exertions in order to free itself from its burthen, and to ex- cite all the surrounding muscles into the same train of action; and hence, natural labour, false conception, uterine dropsy and inflation produce the same effect, though, perhaps, in different degrees. Emphysemas, like dropsies, are/in all cases, disorders of debility : and hence the mode of treatment in the disease before us is obvi- ous. As an occasional discharge of wind from the vagina affords temporary ease, we should take a hint from this effect: and endea- vour, first, to evacuate the confined air entirely, by a canula in- troduced into the os tinea? ; and secondly, to invigorate the weaken- ed organ by the use of some tonic injection, as a solution of catechu, alum, white vitriol, or diluted port wine. GENUS III. PARURIA. JHtsmfcturfttou. MORBID SECRETION OR DISCHARGE OF URINE. The term paruria is a Greek derivation from ira^x, perperara, and ovp*, " mingo." The genus is intended to include the ischuria, dysuria, pyuria, enuresis, diabetes, and several other divisions and subdivisions of authors, which, like the different species of the pre- ceding genus, lie scattered, in most of the nosologies through wide- ly different parts of the general arrangement. Thus, in Cullen, diabetes occurs in the second class of his system; enuresis in the fourth order of his fourth class; and ischuria, and dysuria, in the fifth order of the same class. All these, however, form a natural group ; and several of them have characters scarcely diversified enough for distinct species, instead of forming distinct genera. Dysuria might have been employed instead of parubia, as a generic term for the whole; but as it has been usually limited to the third species in the present arrangement, it has been thought better to propose a new term than to run the risk of confusion by retaining the old term in a new sense. The species that justly belong to the present genus appear to be. the following: vol. iv. 38 29a ECCRITICA. [CL. VI*—OR- IL 1. PARURIA 1NOPS. 2. ------- RETENTIONIS. 3. ------- ST1LLATIT1A. 4. ------- MELLITA. 5. ------- INCONTINENS. 6. ------- INCOCTA. 7. ------- ERRAT1CA. DESTITUTION OF URINE. STOPPAGE OF URINE. STRANGURY. SACCHARINE URINE. INCONTINENCE OF URINE. UNASSIMILATED URINE. ERRATIC URINE. From this group of family diseases we may perceive that the urine is sometimes deranged in its quantity, sometimes in its quality, and sometimes in its outlet: and that in its quality it is deranged in two ways, by being made a medium for foreign materials, and by being imperfectly elaborated. The most important principle which it seems to carry off from the constitution is the urea or that of the uric acid : and it has been ingeniously remarked by M. Berard, in his Analysis of Animal Substances, " That, as this is the most azo- tised of all the animal principles, the secretion of urine appears to have for its object a separation of the excess of azote from the blood, as respiration separates from it the excess of carbone." SPECIES I. PARURIA 1NOPS. Destitution of 5&rfnr. URINE UNSECRETED BY THE KIDNEYS : NO DESIRE TO MAKE WATER, NOR SENSE OF FULNESS IN ANY PART OF THE URINARY TRACK. A deficient secretion of urine is often a result of renal inflamma- tion, in which case, however, there is necessarily a considerable degree of pain and tenderness in the lumbar region. But the pre- sent species occurs occasionally as an idiopathic affection, some- times followed rapidly by great danger to the general fabric, some- times assuming a chronic form, and running on for a considerable period of time without danger, and sometimes existing as a consti- tutional affection coeval with the birth of the individual. Dr. Parr relates a case that occurred in his own practice in which no urine was apparently secreted for six weeks,* and Haller gives a similar case that lasted twenty-two weeks.t In the Philosophical Transactions^ we meet with various instances of a similar deficien- cy ; among the most singular of which is the case of a youth of * Diet, in verb. Ischuria. t Bibl. Med. Pi. II. p. 200. X Vol. xxviii. year 1783. ■CE. III.-SP. I.] EXCERNENT FUNCTION. 299 seventeen years of age described by Dr. Richardson, who had never made water from his birth, nor had felt the least uneasiness on this account, being healthy, vigorous, and active. Let it not be supposed, however, that so important a recrement as the urine is can have its constituent principles remain behind, and load the blood without danger. The outlet at which these are separated and discharged is not always manifest, and hence they sometimes appear not to be separated and discharged at all; though if the state of the patient be critically examined into by an accurate pathologist, the vicarious channel will generally be detected, and most of the cases that must at present range under the species be- fore us, would be transferred to that of paruria erratica. The two most common emunctories that supply the place of the kidneys are the skin and the bowels. In Dr. Parr's case, he states that there was no vicarious evacuation, except a profuse sweat for a day or two, and he adds that there was no suspicion of imposture, as the patient was in a hospital and constantly watched. But we have no account of the state of the bowels. In Dr. Richardson's case of a natural destitution of urine, the patient is admitted to have laboured under an habitual diarrhoea, though with little uneasiness, and the discharge of the urinary elements is very correctly ascribed to the intestinal flux. The effects that result from a retention of the urinary elements in the system, are a loss of energy and a growing torpitude in eve- ry function, proving that the sensorium is directly debilitated, and rendered incapable of secreting its proper fluid. It is, hence, to be expected that the brain should evince torpitude in a greater de- gree than any other organ, and become oppressed and comatose, as though in a state of apoplexy. Nor is it difficult to account for these effects, since they naturally follow from having the blood sur- charged with that excess of azote which, as we have ju«t observed, it appears to be the office of the urine to carry off. The destruc- tive power of azotic gas to animal life is known to every oi;e, as is also its further power of increasing the coagulability of the blood. I do not know, however, that the great and pressing danger of having the constituent principles of the urine thrown back into the blood, have been distinctly pointed out by any physician before the appearance of Sir Henry Halford's valuable article in a late volume of the Medical Transactions which contains the following interest- ing case : " A very corpulent robust farmer, of about fifty-five years of age, was seized with a rigor which induced him to send for his apothecary. He had not made water, it appeared, for twenty-four hours; but there was no pain, no sense of weight in the loins, no distention in any part of the abdomen, and therefore no alarm was taken till the following morning when it was thought proper to as- certain whether there was any water in the bladder, by the intro- duction of the catheter; and none was found. I was then called, and another inquiry was made, some few hours afterwards, by one 300 ECCRITICA. [CL. VL-OR. M. of the most experienced surgeons in London, whether the bladder contained any urine or not, when it appeared clearly that there was none. The patient sat up in bed and conversed as usual, complain- ing of some nausea, but of nothing material in his own view ; and I remember that his friends expressed their surprise that so much importance should be attached to so little apparent illness. 1 he patient's pulse was somewhat slower than usual, and sometimes he was heavy and oppressed. I ventured to state that if we should not succeed in making the kidneys act, the patient would soon be- come comatose and would probably die the following night; for this was the course of the malady in every other instance which I had seen. It happened so ; he died in thirty hours after this, in a state of stupefaction."* To this short history, Sir Henry has added the following remarks which are of too much importance to be omitted. '• All the pa- tients who have fallen under my care were fat corpulent men be- tween fifty and sixty years of age : and in three of them there was observed a strong urinous smell in the perspiration twenty-four hours before death;" evidently proving that in these cases the in- stinctive or remedial power of nature, aided by the constitutional vigour of the respective patients, was endeavouring to convert the exhalants of the skin into a substitute for the palsied kidneys, but was not able completely to succeed. In attempting a cure of paruria inops we ought, in the first in- stance, whatever be its cause, to take a hint from the light of na- ture which is thus thrown upon us : and, as the excretories of the skin and of the kidneys are so perpetually assisting each other in al- most every way, excite the former by active diaphoretics to take upon themselves for a time the office of the latter, and carry off the urea that should be discharged by the kidneys. We should next endeavour to restore the kidneys to their natural action by gentle stimulants or diuretics, as the alliaceous and sili- quose plants, especially horse-radish and mustard, the aromatic re- sins and balsams, especially those of turpentine, copaiba, and the essential oil of juniper. Digitalis is of little avail, and in idiopathic diseases of the kidneys does not often exhibit a diuretic effect. If given at all it should be in conjunction with tincture of lytta, or the spirit of nitric ether. Stimulants may, at the same time, be applied externally as the hot-bath, or strokes of the electric or voltaic fluid passed through the loins; lo which may succeed rubefacients and blisters. In the mean while the alvine canal should be gently excited by neutral salts; and juniper-tea, broom-tea, or imperial, may alter- nately form the common drink. The juice of the birch-tree (be- tula alba) will often, however, prove a better diuretic than any of these. It is easily obtained by wounding the trunk, and when fresh is a sweetish and limpid fluid, in its concrete state affording a brown- ■" Med. Trans. Vol. vr. p. 410. GE. 111.—SP. I.] EXCERNENT FUNCTION. 301 ish manna. It has the advantage of being slightly aperient as well as powerfully diuretic. From its stimulating the intestines it was at one time supposed to be a good vermifuge, and to have various other properties of which, in the present day, we know nothing: whence it has unjustly fallen into discredit even for properties to which it has a fair claim. SPECIES II. PARURIA RETENTIONS. Stowage of Sln'nc. URINE TOTALLY OBSTRUCTED IN ITS FLOW : WITH A SENSE OF WEIGHT OR UNEASINESS IN SOME TART OF THE URINARY TRACK. This is the ischuria of many writers, and though, like the preced- ing species, it is equally without a flow of urine, it differs very widely from it in other circumstances. In paruria inops the excre- tories of the kidneys are inactive, and, consequently, no urine is produced. In the species before us the secernents possess an ade- quate power, but the secretion is obstructed in its passage. And, as it may be obstructed in different organs and in numerous ways in each organ, we have the following varieties : x Renalis. Pain and sense of weight in the region of Renal stoppage of the kidneys, without any swelling in the urine. hypogastrium. € I'reterica. With pain or sense of weight in the region Ureteric stoppage of the ureters. of urine. y Vesicalis. With protuberance in the hypogastrium ; Vesical stoppage frequent desire to make water; and of urine. pain at the neck of the bladder. 3 Urethralis. With protuberance in the hypogastrium ; Urethral stoppage frequent desire to make water; and a of urine. sense of obstruction in the urethra, re- sisting the introduction of a catheter. Oust ruction of urine may take place in the kidneys from a va- riety of causes, as spa*m, calculus concretions, inflammation or ab- scess ; and the tumour or swelling which occurs in any of these states, may be so considerable as to pre\ent the fluid from flowing into the pelvis of the kidneys as it becomes secreted by,the tubules, or out of the pelvis when it has collected there. The kidney«, however, lie m> deep, and from their minuteness 302 ECCRITICA. [CL. VI.-OR. IL are so completely buried in the loins that the intumescence which produces the obstruction is often imperceptible to the eye, or even to the touch. At times, however, the organ becomes wonderfully augmented as the process of inflammation proceeds. Cabrolius gives us the history of a purulent kidney that weighed fourteen pounds* And where the enlargement is accompanied with but little inflammation, proceeds gradually, and does not enter into a suppurative state, the organ not unfrequently becomes much more enormous, and has sometimes been found to weigh from thirty-five to forty pounds.? In this condition there is no difficulty in conceiving a total ob- struction to the flow of the urine even when elaborated in sufficient abundance. But the kidney, on the contrary, sometimes wastes away, instead of enlarges, and this so much as to become a shri- velled sack, and not exceed a drachm in weight; and as the sinus of the kidney contracts with its body, the organ at its extreme point is sometimes found imperforate: and hence how small soever may be the quantity of fluid which in this morbid condition may be se- parated from the blood, none whatever can pass into the ureter; and if both the kidneys concur in the same emaciation, this also must form as effectual a cause of the disease before us as any other. When the stoppage of urine exists in the ureters, the causes may be as numerous and nearly of the same kind as when the kidneys are at fault: for here also we occasionally meet with calculus con- cretions, inflammation, and spasm: to which we may add grumous blood, viscid mucus, and a closed orifice in consequence of ulcer- ation. Vesical retention of urine is produced by inflammation, pres- sure upon the neck of the bladder, irritation, or paresis. Pressure on the neck of the bladder may be occasioned by distention of the rectum from scybala, or other enterolithic concretions, flatus, in- flammation, or piles; or by distention of the vagina from inflam- mation, or a lodgement of the menstrual flux in consequence of an imperforate hymen. Irritation may be excited by a calculus, or too long a voluntary retention of urine, as often happens on our being so Closely impacted in large assemblies or public courts, or so powerfully arrested by the interest or eloquence of a subject dis- cussed in such places, that we cannot consent to retire so soon as we ought: whence the sphincter of the bladder from being volun- tarily, becomes at length spasmodically, constricted, and the urine cannot escape. It sometimes happens under the last circumstance that, from the pressure of the urine against the sides of the blad- der, the absorbents are stimulated to an increased degree of action, and a considerable portion of the surplus is thus carried back into the vessels, and perhaps thrown off by perspiration, so that we are able to remain for a very long term of time after the bladder hrs become painful from over-distention. * Cabrol. Observ. p. 2!!. t Commerc. Liter. J\or. 1731. p. 32. 1737. p. 32t>. GE. 11I.-«1». II.] EXCERNENT FUNCTION. 303 Atony or paralysis of the bladder by which its propulsive power is destroyed, is a frequent cause ; whence, as Saviard has observed, it is often met with in paraplegia :* and, as Morand remarks, on in- juries to the spine.t And hence, I have occasionally found it an at- tendant upon severe and long protracted attacks of lumbar rheuma- tism :J as most practitioners have probably done on injuries to the kidneys, ureters, urethra, prostate gland,;, or' penis. It is said more- over, to be a result of repelled eruptions of various kinds, chiefly of scabies§ and scalled head ;|| but it has not occurred to me from these causes: though 1 have not witnessed it in infancy from the irritation of teething where dentition has been attended with diffi- culty. In urethral retention of urine, the causes do not essentially vary from those already noticed ; such as inflammation, the lodge- ment of a calculus ; viscid mucus ; and grumous blood. To which are to be added the ligature' of a strangulating phimosis; irritation from a blennorrhoea or clap ; strictures ; an ulceration of the ure- thra producing an opening into the scrotum, or rendering the canal altogether imperforate. There is always danger from a retention of urine when it has continued so long as to distend and prove painful to the bladder: and the danger is of two kinds, first, that of an inflammation of the distressed organ, and next, that of resorption, and a refluence of the urea, and other constituent parts of the urine, as noticed under the preceding species. The retention, however, has occasionally continued for a consi- derable period without mischief. It has lasted from a week to a fortnight.TT Marcellus Donatus gives a case of six months stand- ing ;** and Paullini another of habitual retention/ft But in all these an observant practitioner will perceive the two following accom- paniments : firstly, a constitutional or superinduced hebetude of' ihe muscular coat of the bladder so as to indispose it to inflamma- tion ; and secondly, a resorption of the urinary fluid, and its evacu- ation by some vicarious channel, as already remarked under paruria inops. We have there stated that the two most commonly substi- tuted outlets are the excretories of the bowels and of the skin. Dr. Percival gives an instance of the latter in which the perspira- ble matter was so much supersaturated with the ammoniacal salt of # Observ. Chirurftiques. t Venuichte Schrihen, B. n. X See also Snowden, in the London Medical Journal. ♦ Morgagni, de Sed. et Caus. Morb. Ep. \i.i. Art. 4. || Nov. Act. Nat. Cur. Vol. v. Art. 68. H Eph. Nat. Cur. passim. Comar. Obs. N. 21. ** Lib. iv. cap. 27, 23. ' ' < rut. n. OLs. 2C. 3T04 ECCRITICA. [CL. VI.-OR. IL the refluent urine, as to crystallize on the surface of the body, and this to such an extent that the skin was covered all over with a white saline powder.* Sometimes it has been thrown out from the stomach intermixed with blood, in the form of a hsematemesis ;t and sometimes from the nostrils with the same intermixture in the form of an epistaxis.J And where the absorbents of the bladder have been too torpid for action, it has regurgitated through the ureters into the pelvis of the kidneys, and been resumed by the absorbents of these organs instead of by those of the former.§ The quantity retained, and afterwards discharged, or found in the bladder on dissection, has often been very considerable. It has oc- casionally amounted to eight or nine pints : and there is a case given by M. Vilde in the Journal de Medicine, in which it equalled sixteen pints. In all the varieties thus pointed out the mode of management must be regulated by the cause as far as we are able to ascertain it. If we have reason to believe the suppression is strictly renal from the symptoms just adverted to, and particularly from ascer- taining that there is no water in the bladder or ureters, in most cases, whether it proceeds from inflammation or stone, we shall do right to employ relaxants, and mild aperients: and, where the pain is violent, venesection succeeded by anodynes. But it sometimes hap- pens that the obstruction is produced by a parabysmic enlargement or coacervation of the substance of the kidney without inflamma- tion. If this should occur in both kidneys at the same time, which is rarely the case, we have little chance of success by any plan that can be laid down. If it be confined to one, the sound kidney will often become a substitute for the diseased, and perform double du- ty ; and we may here attempt a resolution of the enlargement by minute doses of mercury continued for some weeks, unless saliva- tion should ensue, and render it necessary to intermit our prac- tice. A mercurial plaster with ammoniacum should also be worn constantly over the region of the affected organ. The same plan must be pursued if we have reason to suspect the obstruction is confined to the ureters. The passage of a calculus is the chief cause of this variety of retained urine : and, indepen- dently of the sense of pain and weight in the region of the ureter-i which an impacted calculus produces, we have commonly also a feeling of numbness in either leg, and a retraction of one of the testicles in men, as the calculus in its passage presses upon the nerves which descend from the spermatic vessels. Opium and relax- ants are here the chief, if not the only, means we can rationally em- ploy ; though the ononis spicata, or rest-harrow of our fields, is said, both in the form of powder, and of decoction, to be useful in this and * Edin. Med. Comin. Vol. v. 437. t Act. Nat. Cur. in. Ob?. 6. X Eph. Nat. Cur. Dec. n. Ann. iv. Obs. 63. v Petit, Traite, kc. 0?.uvrcs rosthmies. Tom. hi. r. 2. GE. 11I.-SP. H.] EXCERNENT FUNCTION. 30.rJ various other diseases of the bladder accompanied with severe pain : on which account it holds a place in the Materia Medica of Bergius. The asplenium Ceterach and athamanta Oreoselinum, or mountain-parsley were formerly in vogue for the same purpose, but seem to be of feeble efficacy. The seeds of the athamanta cre- tensis or wild-carrot, had a wider and better founded fame, both as a diuretic and lithontriptic. Dr. Cullen employed them for the lat- ter purpose but without success. The suppression is seldom total; for the opposite ureter is rarely so much affected by sympathy as to be spasmodically contracted, and equally to oppose the flow of the urine. The most common variety of this disease is that of vesical retention, or a retention of the water in the bladder. This is usually produced by inflammation or spasm by which the sphincter of the bladder be- comes contracted, and rigidly closed. Inflammation is to be re- lieved by the ordinary means ; and, in addition to these, by anodyne clysters, and fomentations, a warm-bath, warm liniments, and blis- ters to the perinaeum. Spasm is excited by various causes : a stone in the bladder will do it, an ulcer about the neck of .the bladder will do it, as will also too long a voluntary retention of urine. Spasm is for the most part to be treated, and will in most cases be subdued, by the method just proposed for inflammation ; to which we may add camphor and opium by the mouth, and bladders of warm water applied to the pubes and perinaeum, or, which is bet- ter, the warm-bath itself. Camphor has the double advantage of being a sedative as well as an active diuretic; but combined with opium we obtain a much more powerful medicine than either af- fords when employed singly. If the retention proceed from Spa- nish flies camphor alone will often answer: though in this case it is far better to combine with it mucilaginous diluents,.as gum-arabic dissolved in barley water. Several of the terebinthinate oils have also been employed with great advantage, as the oil of juniper; the balsamum carpathicum, as it was called by C. Ab Hortis who first introduced it into practice, and recommended it for a mul- titude of other complaints as well; concerning which there was at one time a great secret, but which is, in fact, nothing more than an essential oil very carefully distilled from the fresh cones of the trees which yield the common turpentine ; and the balsamum hun- garicum which is an exudation from the tops of the pinus silvestris, and proves sudorific as well as diuretic. Another remedy, of early origin, and which has preserved its reputation to our own day, is the dandelion, the leontodon Taraxacum, of Linneus. It was at one time regarded as a panacea, and prescribed for almost every disease by which the system is invaded, as gout, jaundice, hypo- chondrias, dropsy, consumption, parabysmas of every species, as well as gravel and other diseases of the bladder: and was equally employed in its roots, stalks, and leaves. It is now chiefly used as a deobstruent; but it possesses unquestionably diuretic powers, and hence, indeed, its vulgar name of piss-a-bed. vol. iv. 39 .106 ECCRITICA. [CL. Yl.-OR. If. If the joint use of these means should fail, the water must be evacuated by the introduction of a bougie or catheter, though the irritation is sometimes increased by the use of these instruments ; and the spasm or the thickening at the prostate or about the necb of the bladder is so considerable, as to prevent an introduction of even the smallest of them. In this case, if the inflammation in- crease, and the distress be alarming, nothing remains but to punc- ture the bladder, either above the pubes, in the perinaeum, laterally, or posteriorly through the rectum, for the operation has been per- formed in all these ways and each has had its advocates. The urethral retention, as already pointed out, arises also from inflammation, which is to be treated in the ordinary way; or from a calculus or a stricture ; both which are best removed by the ap- plication of a bougie. In the last case the bougie, if it pass with- out much pain, should be continued daily, and progressively, en- larged in its size. It has often been employed with a tip of lunar or alkaline caustic: and in many instances with perfect success : but very great caution is requisite in the use of a caustic bougie; and even in the hands of the most skilful it has sometimes proved highly mischievous. When a simple bougie is employed, Ferrand* advises that, if the water do not flow immediately, it should be re- introduced and left in the urethra; and I have myself advised such a retention of the bougie catheter through an entire night with con- siderable advantage; for the water which would not flow at first has gradually trickled, and given some relief to the over distended bladder, which has hereby progressively recovered its tone and propulsive power; so that the water before morning has been pro-' pelled in a stream. But this is a plan only to be pursued where the organ has too little instead of too much irritability, and conse- quently where there is no danger of inflammation. SPECIES III., PARURIA STILLATITIA. Strangurg. painful and stillatitious emission of urine. This is the dysuria of Sauvages and later writers. In the preceding species there is an entire stoppage of the urine ; in the present it flows, but with pain and by drops. "Several of the causes are those of paruria retentionis ; but others are peculiar to the species itself: * Blegny Zod. Ann. 1681. WE. I1I.-SP. IH.] EXCERNENT FUNCTION. 307 and, as they are accompanied with some diversity in the symptoms. they lay a foundation for the following varieties : x Spasmodica. Spasmodic strangury. C Ardens. Scalding strangury. y Callosa. Callous strangury. 3 Mucosa. Mucous strangury. i Helminthica. Vermiculous strangury. £ Polyposa. Polypose strangury. The first variety is characterised by a spasmodic constriction ef the sphincter, or some other part of the urinary canal, catena- ting with spasmodic action in some adjoining part. The spasmo- dic actions of which this variety is a concomitant are chiefly those of hysteria, colic, and spasm in the kidneys. It is hence a secon- dary affection, and the cure must depend on curing the disease* which have occasioned it. Opium and the digitalis will often af- ford speedy relief when given in combination. In the second variety there is also a spasmodic constriction, but of a different kind, and making it more of a primary affection; whence Sauvages and others have distinguished it by the name ol dysuria primaria. It is excited by an external or internal use of various stimulants as acrid foods, or cantharides taken internally ; and is accompanied with a sense of scalding as the urine is dis- charged. This is also a frequent result of blisters: and to avoid it in this case the patient should be always advised to drink freely of warm diluents in a mucilaginous form. Gum-arabic, marsh-mallows root, the jelly of the orchis or salep, infusion of quince-seed, lint-seed, or decoction of oatmeal or barley may be employed with equal advan- tage ; for they do not essentially differ, and the only preference is to be given to that which affords the largest proportion of mucilage. Formerly the winter-cherry (physalis Alkekengi, Linn.) was in much repute, and was supposed to produce speedy relief.* It is unquestionably sedative and diuretic, and possesses these properties without heating or irritating: and seems to be worthy of farther trial. As a sedative, indeed, Hoffman employed it in haemoptysis; and as a diuretic it has been still more generally made use of in dropsy. About five or six cherries or an ounce of the juice forms a dose ; the pericarp is bitter, yet the fruit within possesses but little of this property, and has an acidulous and not unpleasant taste. Camphor has also been employed with great advantage for the same purpose, and acts on the same double principle of being a diuretic and a sedative. It is often found to act in the same manner when applied externally, and even when intermixed with the blister plaster itself, as though in some constitutions it possesses a specific influence over the bladder:, tipon which subject Dr. Perceval has penned the following note in his Commentary to the voluhie of Munardus, Epift. Libr. xm. N. l.\ 308 ECCRITICA. [CL. Vl.-OR. II. Nosology; " In three instances blisters sprinkled with camphor were repeatedly applied without strangury, and as uniformly, when the camphor was omitted with the concurrence of that symptom. I will not say that in all constitutions, camphor will obviate stran- gury ; nor in all constitutions will cantharides without camphor produce it." It will commonly be found useful, and sometimes absolutely neces- sary, in this variety, from whatever cause produced, to employ neutral aperients: and with them the means just recommended in cases of cantharides will rarely fail to succeed in most other cases. If not, the practitioner should have recourse to a decisive dose of opium. Strangury is also occasioned by a callous thickening of the mem- brane of the urethra producing a permanent stricture. Some inte- resting examples of this may be seen in Dr. Baillie's Plates of Morbid Anatomy* We have already had occasion to observe that the most common situation of a stricture is in its bulb or the prostate gland that lies immediately above,t though it may take place in any other part. A stricture of this kind " consists," says Dr. Baillie, " of an approxi- mation for a short extent, of the sides of the canal to each other. Sometimes there is a mere line of approximation, and not uncom- monly the sides of the urethra approach to each other from some considerable length, as, for instance, nearly an inch. The surface of the urethra at the stricture is often sound, but not unfrequently it is more or less thickened." It is this thickening which produces the variety of strangury before us. The sides of the urethra have sometimes approximated so nearly by its increase that the stricture will only allow a bristle to pass through it: and hence ulcers are occasionally formed in the prostate gland, and fistulae in the perine- um ; and the cavity of the prostate is enlarged from distension, in consequence of the accumulation of urine behind the ulcer; of all which Dr. Baillie has also given examples. When the prostate, or urethra, is highly irritable, palliation only can be resorted to ; but where the thickening is recent and there is little irritation, a skilful use of a bougie will sometimes afford temporary relief; after which, -by gradually employing those of larger diameter, the stricture will often give way and the canal widen so as to allow the water to flow with considerable comfort. I have at this moment a patient under my care, who was so grievously afflicted with th:s variety of strangury about six years ago, from two distinct strictures, as never to make water otherwise than by drops : the smallest cat-gut bougie could with difficulty be made to pass through the thickened parts; and he was entirely debarred from going into company. By gradually accustoming himself to bougies of increasing diameter he can now bear the introduction of a t Fascic. vm. PI. iv. v. * Vol. iv. Blenorrhcra luodes, p. 58. OE. IIL-SP. HI.] EXCERNENT FUNCTION. 309 moderately sized one with ease ; the water flows freely, though in a small stream, and he is able to go into company and to travel without inconvenience. He still finds it necessary, however, that the bougie should occasionally be continued, and it is introduced into the urethra every week or fortnight. In the variety which we have called mucous strangury, the urine is intermixed with a secretion of acrimonious mucus, of a whitish or greenish hue, which is frequently a sequel of gout, lues, or blenor- rhcea. It is often, however, produced by cold, and in this last case forms the catarrh us vesica of various authors : so denominated from its being conceived that the bladder and urethra are affected in the same manner as the nostrils in a coryza. The constriction therefore depends upon an excoriated or irritable state of the urethra, or neck of the bladder. And hence the warm-bath, or sitting in a bidet of warm-water, is often of considerable service. Warm and diluent injections have also frequently been found, as well as diluent and demulcent drinks, of great advantage. If this variety continue long it is apt to produce an obstinate and very narrow stricture, of which ulceration and fislulae in perinaeo are frequent results. Strangury is also sometimes accompanied with a discharge of worms of a peculiar kind, and proceeds from the irritation they excite. Of this we have various instances in the Ephemerides of Natural Curiosities,* in some of which the worms were found in the bladder after death, and in others discharged by the urethra during life. They are described as of different forms in different cases, sometimes resembling the larves of insects: sometimes dis- tinctly cucurbitinous, of the fasciola, fluke, or gourd-kind. Dr. Barry of Dublin has given us the case of a solitary worm discharged by the urethra of a man aged fifty, " above an inch in length, of the thickness of the smallest sort of eel, and not unlike it in shape, ending in a sharp-pointed tail." It was dead, but did not seem to have been dead long. The patient had for several years been in the habit of discharging urine mixed with blood, but unaccompanied with pain either in the bladder or urethra. During the whole of this time he had been feverish; and gradually lost his appetite, found his strength decay, and had become turbid and hectic; from all which he speedily recovered as soon as this cause of irritation was removed.t We have also an example of a like vermicule, highly gregarious, and of much longer dimensions in an interesting paper of Mr. Lawrence, inserted in the second volume of the Medico-Chirurgical Transactions. The patient was a female aged twenty-four, and had long laboured under a severe irritation of the bladder, which was ascribed to a calculus. She at length discharged throe or lour worms of a non-descript kind, and continued to discharge more, * Dec. i. Ann. IX. x. Obs. 113. Dec. u. Ann. 1. Obs. 104. Ann. vi. Obs. 31. Dec. m. Aim. i. Obs. ;U. Ann. n. Ob.-. 2UJ. + Etiii!. Med. E.-<. Vol. v. Part n. Ait. i.sxi;. p. 289. 310 ECCRITICA. [CL. VI.-OR. IL especially when their removal was aided by injections into the bladder, or the catheter had remained in the urethra for the night. The evacuation of these animals continued for at least a twelve- month. Twenty-two were once passed at a time ; and the whole number could not be less than from eight hundred to a thousand. A smaller kind was also occasionally evacuated. The larger were usually four to six inches in length; one of them measured eight. For the most part they were discharged dead. The subject is obscure, but it may be observed that the ova of worms, and even worms themselves, are occasionally found in many animal fluids, and have been especially detected in the blood-vessels, where they have been hatched into grubs or vermicules, for the most part of an undecided character; though some, observed in the mesenteric arteries of asses, have been referred to the genus stron- gvlus.* Dr. Barry supposes his isolated worm to have travelled in the form of an ovum as far as to the extremity of an exhaling artery opening into the bladder; to have found, in this place, a proper nid-.is and nourishment for the purpose of being hatched into a larve or grub, and of growing to the size it had assumed when thrown out of the urethra ; and, in consequence of this progressive growth and the proportioual dilatation of the vessel in which it was lodged, he accounts for the discharge of blood without pain. If a worm reach the bladder alive and full of eggs, we have no difficulty in accounting for a succession of progenies. Strangury is also sometimes produced in consequence of the bladder or urethra, or both, being obstructed by the formation of a folypous excrescence which has occasionally shot down to the exter- nal extremity. Dr. Baillie's Morbid Anatomy furnishes several examples of this variety; which, in most cases, is only to be radically cured by an extirpation of the substance which produces the obstruction,! wher- ever it can be laid hold of. When small, however, and in the form of caruncles, these excrescences have sometimes separated spontan- eously, and been thrown out by the urethra with very great relief to the sufferer, and have been followed by a perfect cure.t Upon this variety my venerable friend" Dr. Perceval has added the following note in his manuscript Commentary on the Nosology, from which the present work has been so often enriched : " It might not be amiss to insist on a case which sometimes deceives young prac- titioners : ischuria cum stranguria. A copious draining of urine took place for several days in a patient with a swelled belly. Death super- vening, the bladder was found distended to an enormous bulk, and the parietes of the abdomen wasted. Two excrescences near the neck of the bladder internally had almost closed its outlet, and interfered with the action of the sphincter." * Hodgson on the Diseases of Arteries. t Fascie. ix. Plate m. X Fabric. Hildan. Cent. iv. Obs. liii. Art. Nat. Cur. Vol. i. Obs. xm. «E. III.—SP. IV.] EXCERNENT FUNCTION. 311 SPECIES IV. PARURIA MELLITA. Saccharine SKrfne. urine discharged freely, for the most part profusely; of a vio- let smell and sweet taste; with great thirst, and general de- bility. This is the diabetes, diabetes Anglicus, or diabetes mellitus of au- thors ; from $ixGt>Tng, importing u a siphon," or rather from hxQxn*, " transeo." Diaoetes among the Greek and Roman, and, indeed, among modern physicians till the time of Willis, imported simply a ilux of urine, either crude or aqueous, for no distinction was made between the two, and both were named indifferently diabetes, dipsacus from the accompanying thirst, urinary diarrhoea, urinal dropsy, and hyderus (&««$,) or water-flux.* The writers among the ancients who seem chiefly to have noticed it are Galen, Aretacus, and Tral- lian ; and the reader who is desi-ous of knowing what they say, and is not in possession of the original authors, may turn to Dr. Latham's Treatise upon the diseasef who has translated the whole with very great clearness and fidelity. The form of diabetes, to which we are now directing our attention, Galen describes as having a resemblance to lientery, from the rapidity with which the solids and fluids of the body seem to be converted into a crude and liquid mass, and hurried forward to the kidneys; and to canine appetite, from the voracity and thirst which are its peculiar symp- toms. He supposes a high degree of appetency or irritation to exist in the substance of the kidneys, in consequence of which it attracts the matter of urine with great vehemence from the vena cava; and an equal degree of atony and relaxation to exist in its orifices or pores, so that the same matter flows off unchanged as soon as it reaches them.J This general view of the subject was adopted with a few additions by Aretacus, and without any by Trallian; and seems to have descended with little variation, as we have just observed, till the time of Willis, who first called the attention of practiticners to the curious and important fact that the urine of diabetic patients, seemed in many cases, to contain a saccharine principle. These cases, however, were not, at that time, duly distinguished, and hence, in Sauvages, who was well acquainted with Willis's discovery, diabetes * Galen, de Crisibus, Lib. I. Cap. xn. t Factsand Opinons concerning Diabetes, 8vo. 1811. X De Loc. Affect. Lib. vi. Cap. mil. ir., compared with De Ciisibus, Lib. 1, Tap. xii. 312 ECCRITICA. [CL. VI.-OR. Ii. signifies equally an immoderate flux of urine from hysteria, gout, fever, spirituous potation, as well as urine combined with saccha- rine matter: though the only relation which the last has to the rest is that of its being usually secreted in a preternatural quantity: but as even this last quality, though mostly, is not always, the case, it shonld be distinguished by some other name than that of diabetes, and form a distinct division : or, if the name of diabetes be applied to it, it should be given to it exclusively. Dr. Young, who retains the name in the latter sense, and employs it as that of a genus, justly allows but one species to the genus, the diabetes mellitus of Cullen, and describes the diabetes insipidus under the genus and species of hyperuresis aquosus. There is great doubt whether this last ever exists as an idiopathic affection. Cullen himself, indeed, candidly expresses the uncertainty of his mind upon the subject: " Almost all the cases of diabetes of late times," he observes, " exhibit saccha- rine urine, ita ut dubium sit, an alia diabetis idiopathicae et perma- nentis species revera detur." If such be found it will probably be nothing more than a variety of the next species in the present arrangement, paruria incontinens :* while the honeyed diabetes or saccharine urine ought to be studied as a distinct affection. The pathology of this disease is still involved in a considerable degree of obscurity : for though anatomy has pointed out a few morbid changes that exist more or less extensively in the urinary or digestive organs, and chemistry has sufliciently explained to us the morbid character of the discharge, they have thrown less light upon its origin than could be wished for, and have hitherto led to no satisfactory opinion upon the subject. Even the seat of the disorder is, to the present hour, a point of controversy; and as its seat, together with the nature of its cause, can only be collected from its symptoms, we will first lay down its general history and afterwards glance at a few of the leading hypotheses which have been started in respect to its pathology. Saccharine or honeyed paruria is rarely, though sometimes,! found in early life, but is often a sequel to a life of intemperance, on which account it is occasionally connected with a morbid state of the liver. It makes its approach insidiously, and often arises to a considerable degree and exists for some weeks without being particularly attended to. If the urinary symptoms take the lead it is without the patient's noticing them, for the first morbid change he is sensible of is in the stomach. At this time, to adopt the description of Dr. Latham, " It is attended, for the most part with a very voracious appetite, and with an insatiable thirst; with a dry harsh skin, and clammy, not parched, but sometimes reddish tongue ; and with a frequent excreation of very white saliva, not inspissated, but yet scarcely fluid. As the disease proceeds it is accompanied often with a hay-like scent or odour issuing from the * Spec. V. t Latham's Facts and Opinions, p. 176. OE. 1II.-SP. IV.] EXCERNENT FUNCTION. 3l3 body, with a similar sort of halitus exhaling from the lungs, and with a state of mind dubious and forgetful: the patient being dis- satisfied, fretful, and distrusting, ever anxious indeed for relief, but wavering and unsteady in the means advised for the purpose of procuring it."* In the mean time the kidneys discharge a fluid usually very limpid and large in quantity, though sometimes slightly tinged with green, like a diluted mixture of honey and water, and possessing a saccharine taste more or less powerful. The pulse varies in dif- ferent individuals, but, for the most part, is quicker than in health; and not unfrequently there is a sense of weight or even acute pain in the loins occasionally spreading to the hypochondria, a symptom which Aretaeus notices as one of the earliest that appears; the un- easiness extending still lower till, as the same writer remarks, a sympathetic smarting is felt at the extremity of the penis whenever the patient makes water. The flesh wastes rapidly; and, as the emaciation advances, " cramps,"' says Dr. Latham, " or spasms of the extremities some- times supervene, the pulse is more quick and feeble, and the saliva more glutinous." And when the strength is almost exhausted in a still more advanced stage of the disease, the lower extremities of- ten become edematous, and the skin cold and damp : the diabetic discharge is then frequently much diminished, and is sometimes even found to become more urinous for a few hours before death closes the distressing scene." A pulmonic affection occasionally accompanies or precedes the attack ; Dr. Bardsley, indeed, affirms that he does not recollect a case that was entirely free from (his symptom. And it is probably on this account, as also from the feverish state of the pulse, which by some writers h;is been supposed to partake of a hectic character, that by M.M. Nicolas and Gueudeville the disease has been deno- minated Plnhisurie sucree.X The state of the bowels is extremely variable, though there is commonly a troublesome costiveness; sometimes, indeed, so much so, that the feces are peculiarly hard- ened and scybalous: which is well described by a patient of Dr. Latham's, in a letter of consultation; "The beat of my body," says he, u 1 suppose arises from a most determined costivene.«s that I cannot find means to conquer, and which occasions me great pain and misery, frequently feeling an inclination without the ability of discharging: and when, after much difficulty, the excrement is ejected, it has almost the solidity of lead."J in a few iirltances the disease seems to be connected with family predisposition. Mr. Storer has noticed a case of this kind in his communication with - Facts and Opinions concerning Diabetes, &c. p. 1. t Recherches et Experiences Alcdicales et Chimiques sur la Diabete sucne/ ou la Phthisie sucrec. 8vo. Paris, 1803. X Facts and Opinions, Sic. p. 135. VOF.. iv. 40 314 ECCRITICA. [CL. VI.-OR. II. Dr. Rollo; and M. Isenflamm has given the history of seven chil- dren of the same parents who fell victims to it in succession. The real nature of the fluid evacuated has been very sufficiently determined both in our own country and on the Continent by chem- ists of the first authority, who have concurrently ascertained that, whilst it is destitute of its proper animal salts, it is loaded with the new ingredient of saccharine matter. Dr. Dobson from a pound of urine collected an ounce of sac- charine substance; and Mr. Cruikshank, from thirty six ounces Troy, obtained, in like manner, by evaporation, not less than three ounces and a quarter: which, from the quantity discharged by the patient, would have amounted to not less than twenty-nine ounces every twenty-four hours. Chevreul has shown that by concentrat- ing this morbid urine and setting it aside we may obtain a deposit of sugar in a crystallized state. The absence of animal salts has been ascertained not less satis- factorily. M. M. Nicolas and Gueudeville showed, by a series of experiments in 1802, that the saccharine urine contains no urea, nor uric or benzoic acid ; that the phosphoric salts exist in a very small proportion: and that in consequence of its sugar it will enter into the vinous and acetous fermentation, and yield an alcohol of a disagreeable odour.t The same results have since been obtained by M. M. Dupuytren and Thenard by experiments still more satis- factory. They also found an albuminous substance in the urine which is always discharged in a sensible form when the disease be- gins to take a favourable change, and is the constant harbinger of a return of the proper animal salts ; for after having appeared for a little while it gradually diminishes and yields its place to the urea and uric acid. In an excellent paper of Dr. Henry's inserted in the Transactions of the Medico-Chirurgical Society,! he appears to have arrived at many of the same conclusions though by a some- what different process. Dissection has also been had recourse to for collateral informa- tion on this complicated malady: but its researches have been less successful than those of the chemists. The only organ in which any morbid structure has been clearly ascertained is the kidneys. Mr. Cruikshank affirms generally that the arteries of the kidneys are, on these occasions, preternaturally enlarged, particularly those ofthecryptae or minute glands which secrete the urine."§ And this state of inflammation or morbid activity is confirmed by Dr. Baillie in his ' Account of a case of diabetes, with an examination of the appearances after death,'j| in which he tells us that •• The * Versuct einiger practicher Anmerkungen iibcr die Eingeweide, &c. Erlans 1781. & ' ° t Recherches et Experiences, ut supra citat. X Transact, of Medico-Chirurg. Soc. Vol. x. § On the Lacteals and Lymphatics, p. 69. || Transactions of a Society for the Improvement of Medical and Chirurgical Knowledge, &c. CE. 11I.-SP. IV.\ EXCERNENT FUNCTION. 315 veins upon the surface were much fuller of blood than usual, put- ting on an arborescent appearance. When the substance of both kidneys was cut into it was observed to be every where much more crowded with blood-vessels than in a natural state, so as, in some parts, to approach to the appearance of inflammation. Both kid- neys had the same degree of firmness to the touch as when healthy : but I think, were hardly so firm as kidneys usually are, the vessels of which are so much filled with blood. It is difficult to speak very accurately about nice differences in degrees of sensation un- less they can be brought into immediate comparison. A very small quantity of a whitish fluid, a good deal resembling pus, was squeezed out from one or two infundibula in both kidney<, but there was no appearance of ulceration in either." These premises, taken conjointly or separately„according to the light in which they may be viewed by different persons, open an abundant field for speculation concerning the nature of the malady: and hence, an infinity of hypotheses have been offered of which the following are the chief: I. The disease is dependent upon a morbid action of the stomach, or some of the chylifacient viscera, which necessarily, therefore, constitute its seat. II. The disease is dependent upon a dyscrasy or intempera- ment of the blood, produced by a morbid action of the assimilat- ing powers. III. The disease is dependent upon a retrograde motion of the lac- teals, and is consequently seated in the lacteal vessels. IV. The disease is dependent upon a morbid condition of the kidneys, and seated in these organs. I. The first of these hypotheses, though not the most ancient, has been by far the most commonly received, and is, perhaps, the most prevalent in the present day. It is derived from observing the increased action which exists in the stomach, and probably also in the collatitious viscera, in conjunction with the untempered fluid which is discharged by the kidneys, whose morbid crasis is referred to these organs. But even here there has been much difficulty in determining which of the digestive viscera is principally at fault. Dr. Mead having remarked that the disease is frequently to be traced amongst those who have lived intemperately, and particular- ly who have indulged in an excess of spirits and other fermented liquors, ascribed it to the liver, and the idea was very generally re- ceived in his day. Dr. Rollo has since, and certainly with more plausibility, fixed the seat of the disease in the stomach, and confin- ed it to this organ : conceiving it to consist " in an increased action and secretion with a vitiation of the gastric fluid, and probably too active a state of the lacteal absorbents:—while the kidneys, and other parts of the system, as the head and skin, are only affected secondarily." According to thi* hypothesis the blood is formed imperfectly 316 ECCRITICA. [CL. VI.-OR. IL from the first, and the morbid change of animal salts for sugar is the work of the stomach or its auxiliary organs, which are immediate- ly influenced by it. It is a strong if not a fatal objection to this view of the subject, that the blood before it reaches the kidneys, is found, upon the most accurate experiments to which it has hitherto been submitted, " to contain the salts of the blood, but no trace whatever of sugar." The experiments I allude to are those of Dr. Wollaston, and Dr. Marcet, detailed in the Philosophical Tran- sactions* Prior experiments had, indeed, been made under the superintendance of Dr. Rollo, which induced those engaged in them to conjecture that some small portion of sugar might exist in the blood ; but these trials led to no definite conclusion, and did not satisfy the experimenters themselves. The results of Wollaston have since been confirmed by other experiments of Nicholas, Sorg, Thenard, and Bostock. II. The second hypothesis, or that which regards the disease as dependent upon a dyscrasy or intemperament of the blood, produc- ed by a morbid action of the assimilating powers, is of parallel date with the preceding, and has had the successive support of many of the ablest and most distinguished pathologists from its origin to our own day. It was first started by Dr. Willis and immediately fol- lowed upon his discovery of the saccharine property of diabetic urine, who thus expresses his opinion of the seat and nature of the disease in his treatise upon this malady :—" Diabetes is rather an immediate affection of the blood than of the kidneys, and thence de- rives its origin ; for the mass of the blood becomes, so to speak, melted down, and is too copiously dissolved into a state of serosity: which is sufficiently manifest from the prodigious increase of the quantity of urine which cannot arise from any other cause than from this solution and waste of blood." He admits, however, that the orifices of the kidneys are at this time peculiarly relaxed and patulous, in consequence of which the untempered fluid passes off with a greater ease and rapidity. This hypothesis of Willis was readily embraced by his distin- guished contemporary'Sydenham, who fortified himself in the same by observing, that those who have long laboured under an intermit- tent, and have been unskilfully treated, and especially old persons, sometimes fall into a diabetes, from a crude or debilitated condition of the blood. And hence, he tells us in his letter to Dr. Brady, Re- gius Professor of Physic in the University of Cambridge, that "the curative indication must be completely directed towards invigorat- ing and strengthening the blood, as well as restraining the preter- natural flux of urine." Thus advanced and advocated by two of the brightest luminaries that have ever enlightened the medical world, it cannot be a mat- ter of surprize that this opinion should have been extensively adopted, in truth it was espoused on the continent as well as at vol. ci. 1811. p. 90. GE. III.-SP. IV.] EXCERNENT FUNCTION. 317 home, and, in 1784, gave birth to M. Place's able dissertation at Gottingen :* and continued to be the prevailing opinion till the ap- pearance of Dr. Rollo's work, to which we have just adverted ; and even since the appearance of tnis work, it has been still warmly and ably maintained by Dr. Latham, who, while he pays all the homage to Dr. Rollo's labours and abilities to which they are enti- tled, and scrupulously adopts the general principles of his practice, opposes his doctrine of a morbid condition of the stomach,! which, as well as the kidneys,^ he believes to be perfectly sound in its ac- tion. " I must take leave," says Dr. Latham, " to differ in opinion most materially from Dr. Rollo, who seems to consider this most enormous appetite as such an evil in diabetes, as to endeavour, by every possible means, to repress it, having founded his theory principally upon the Idea that on this action of the stomach depends the evolution of sugar with the whole train of consequent symp- toms: whereas, 1 consider the appetite, however great it may be, and which I would never check by medicines, as a natural sensation, calling into its full exercise that organ through which the constant waste^of the body must be directly supplied, and without which the patient must soon inevitably persh: and I look upon the more mo- derate appetite which takes place usually in a few days after a strict conformity to animal diet, as the surest sign of convalescence, inas- much as I hold it in proof that the blood being thereby rendered firmer in its cras.s, there is less disposition in it to be decomposed, and, consequently, (as is the fact) that there must soon be a dimi- nished discharge of nutritious matter from the kidneys. An opinion promulgated and maintained in succession by authori- ties so hi;?ii, and names so deservedly dear to the healing art, ought not to be lightly called in question : but it is as difficult to reconcile the present notion as the preceding with the existence of the ordinary "aits and the non-existence of sugar in the blood of diabetic patients. Dr. Latham, however, has argued the pointwith great and elaborate ingenuity, and has endeavoured to show, by a train of reasoning which is worthy of attention, that the sugar, in respect to its elements, may exist in the blood, though the substance itself be not discoverable in it, being "• so weakly and loosely oxyge- nated as to be again readily evolved by the secretory action of the kidneys, not from any fault in the kidneys the.mselves, but from the regular and natural exercise of their function, in separating from the imperfect blood such matters as are not properly combined with it."§ 111. A bold and plausible effort was made, between forty and fifty years ago, to get rid of the stumbling-block of the absence of sugar • Diss.de Vera Diabctis tauss.i in di.-f.-ciu ;usimilationis quajrenda. Goett. 1784. t Facts and Observation?, &<■. p. 2:'0. X Id. p. 1l<>. » t It si j.i a, p. 97. 318 ECCRITICA. [CL. VI.—OR. n. from the blood by showing that provided it were once formed by the digestive organs, there is no necessity for its travelling in this direction. This hypothesis was brought forward by that very acute and ingenious physiologist, Mr. Charles Darwin, in an essay presented to the jEsculapian Society of Edinburgh in 1778, that obtained for him an unanimous grant of the prize-medal tor the year: an honour dearly earned, as almost immediately afterwards he fell a martyr to his indefatigable pursuits, while on the verge of graduating. In this essay he endeavoured to account for thejdisease of saccharine urine by a retrograde motion of the lymphatics of the kidneys. Having endeavoured to establish the general principle of a retrograde lymphatic action, he proceeds to remark, that all the branches of the lymphatic system have a certain sympathy with each other, insomuch that when one branch is stimulated into any unusual motion, some other branch has its motions either increased, or decreased, or inverted, at the same time: thus, when a man drinks a moderate quantity of vinous spirit, the whole system acts with more energy by concert with the stomach and intestines, as is seen from the glow on the skin, and the increase of strength and activity : but when, says he, a greater quantity of this inebri- ating material is drunk, at the same time that the lacteals are quick- ened in their power of absorbing it, the urinary branches of the absorbents which are connected with the lacteals by many anasto- moses, have their motions inverted, and a large quantity of pale, unanimalized urine is hereby discharged. Where, continues Mr. Darwin, this ingurgitation of too much vinous spirit occurs often, the urinary branches of absorbents at length gain a habit of invert- ing their motions whenever the lacteals are much stimulated : and the whole or a great part of the chyle, is thus carried to the blad- der without entering the circulation, and the body becomes ema- ciated : while the urine is necessarily sweet and of the colour of whey. And on this account Mr. Darwin proposed to denominate the species before us a chyliferous diabetes. This hypothesis, for, ingenious as it is, it has never been entitled to a higher character, became at one time also very popular, and was supported by the talents of the celebrated author of Zoonomia, the father of its ingenious inventor. A few singular facts which have occurred since the decease of both these writers, seem at first sight to give it a little colourable support: such as the rapid passage of certain substances from the stomach to the bladder appa- rently, according to the experiments of Dr. Wollaston and Dr. Mar- cet, without their taking the course of the circulation; and M. Ma- gendie's experiments upon the lymphatic system, and the doctrine he has founded upon them. These, however, the author has ex- amined with some attention in the Physiological Proem to the pre- sent Class, and has endeavoured to reconcile them with the ascer- tained and admitted structure and laws of the animal frame : so that they can add but little to the speculation before us. And in truth, how much soever it may have been caught up hastily by men of «E. Ilt.-SP. IV.] EXCERNENT FUNCTION. 319 warm imagination, or those who are fond of novelty, the soberer physiologists have never been made converts to it. " In the diabe- tes," says Mr. Cruikshank," it has been supposed that the chyle flows retrograde from the thoracic duct into the lymphatics of the kidney, from them into the cryptae, so into the tubuli uriniferi, thence into the infundibula, pelvis, ureter, and so into the bladder. This opinion is mere supposition, depending on no experiments. And, besides that all such opinions should be rejected, why should the chyle flow retrograde into the lymphatics of the kidney and not in the lacteals themselves ? and why are not the feces fraught with a similar fluid as well as the urine ? The arteries of the kidneys are, on these oc- casions pretematurally enlarged, particularly those of the cryptae or minute glands which secrete the urine. And it is infinitely more probable that the fluid of the diabetes arises from some remarkable change in the vessels usually secreting the urine, than from any imaginary retrograde motion of the chyle through the lymphatics of the kidneys."* Even Dr. Wollaston prefers a state of doubt con- cerning the course pursued by the above-mentioned substances to an adoption of this conjecture, notwithstanding the ready solution it offers to his experiments. u With respect," says he, " to Dr. Darwin's conception of a retrograde action of the absorbents, it is so strongly opposed by the known structure of that system of ves- sels, that 1 believe few persons will admit it to be in any degree probable."! IV. We come now to the fourth hypothesis to which the disease before us has given rise, and which places it in the kidneys. These form, indeed, the most ostensible seat, and hence, as we have al- ready seen, they were the first suspected, and were supposed by the Greek writers to be in a state of great relaxation and debility, and hence also of great irritability. To this irritability was ascrib- ed their morbid activity, and the accumulation of blood with which they were overloaded : while their weakened and relaxed condition allowed the serous or more liquid parts of the blood to pass off through the patulous mouths of the excretories without restraint or change, and, consequently, in a crude and inelaborated form like the food in a lientery. Such was the explanation of Galen : and of all the hypotheses before us there is no one that seems to be so fully confirmed, as well by the symptoms of the disease during its progress, as by the appearances it offers upon dissection. The anatomists have hence generally adopted this opinion, which is to be found in Bonet,f ltuysch§ and Cruikshank ;|| and in proof that it has of late been gaining additional ground among physicians and medical practition- * On the Lacteals and Lymphatics, p. 69. t Phil. Trans, ut supra. 1911. p. 105. X Sepulchr. Lib. in. Sect. xxvi. Obs. 1. I Observ. Anat. Chir. N. 13. || On the Lacteals and Lymphatics, p. C9 320 ECCRITICA. [CL. VI.-OR. llr ers in general, as well on the Continent as in our own country, it may be sufficient to refer to the writings of Richter, the works of M. M. Nicholas and Gueudeville, and M. M. Dupuytren and The- nard, already quoted from, and the communications of Mr. Watt, Dr. Henry, and, still more lately, of Dr. Satteriey; several of whom, however, conceive the stomach or some other chyhfactive organ to be affected at the same time secondarily or sympatheti- cally. . , iL ,. By far the greater number of these writers regard the irritation of the kidneys as connected with inflammation : though several of them ascribe it to a spasm. They seem to reason from the pain found occasionally in the region of the loins, and the limpidity and enormous quantity of the fluid that is discharged, which in their opinion is analogous to that evacuated in hysteria or hypochondri- as; such was the opinion of Camerarius upwards of a century ago.'* and of Richter and Gueudeville in our own day : " la phthisurie,"" says the last, for under this name he describes saccharine urine, " est une consomption entretenue per une deviation spa-modiqite et continuelle des sues nutritifs non animalism, sur l'organe urinaire."! There seems after all but little to support this doctrine, and yet it was adopted by Cullen, and that so completely as to induce him to arrange diabetes in his Class Neuroses, and Order Spasmi, imme- diately before hysteria, and hydrophobia. His reason for doing so is contained in the following passage in his First Lines: " As hard- ly any secretion can be increased without an increased action of the vessels concerned in it, and as some instances of this disease are attended with affections manifestly spasmodic, I have had no doubt of arranging the diabetes under the order of spasmi."}. A more unsatisfactory reason has, perhaps, never been offered, nor does the author himself seem satisfied with it, for we find him. shortly afterwards, not indeed, like M. Gueudeville, uniting it with another cause to give it potency, but abandoning it for this auxiliary cause which seems to be adopted exclusively: for he adds within a few aphorisms, " I think it probable that, in most cases, the proxi-' mate cause is some fault in the as4milatory powers, or those em- ployed in converting alimentary matter into the proper animal fluids."§ But admitting the kidneys to be in a morbid and highly irritable state, which is the oldest, and apparently the best supported doc- trine upon the subject, and that this state is connected with an in- flammatory action of a peculiar kind, what necessity is there for supposing an idiopathic affection of any other part, whether the stomach or the nerves, the chylifacient or the assimilating powers? And why may not every other derangement that marks the progress * Diss, do Diabete Hypochondriacorum periodico, Tub. 169G. t Recherches et Experiences Mcdicales, &c. 8vo. Parti, 1803. X Pract. of Phys. Aph. mdiv. } Pract. Phys. Aph. mdxii. GK. IIL-SP. IV.] EXCERNENT FUNCTION. 321 of the disease be regarded a< consequent upon the renal mischief/ I ask the question with all the deference that is due to the distin- guished authorities that have passed in review before us, the value of whose writings, and the extent of whose talents no man is more sen-ible of than myrelf: but 1 ask it also, after having studiously at- tended to the nature of these derangements both in theory and in all the practice which has fallen to my own lot, and with a strong disposition to believe that the whole can be traced and resolved into this single and original source, and consequently that diabetes is a far less complicated disease than has hitherto been imagined. That an inordinate excitement of the kidneys is capable of aug- menting the urinary secretion, whatever be the cause of such ex- citement, is obvious to every one who has attended to the stimulant effects of spirits drunk to exces-, hysteria, and several other irregu- lar actions of the nervous system, and the whole tribe of diuretics. In all these cases, however, the excitement is only secondary, aud follows upon a previous affection of some other organ or part of the system. But in the disease before u*, we are contemplating a primary excitement, a morbid action originating and seated in the kidneys themselves. And surely when we reflect upon the pro- digious quantity of serum the excretories of the cellular membrane are capable of separating and carrying off from the blood in cellular dropsy, and those of the more limited range of the pleura or the peritoneum in dropsy of the chest or of the belly, there can be no difficulty in conceiving that the emunctory of the kidneys, whose function, when in health consists in eliminating a very large portion of the more attenuate parts of the blood, should, when in a state of morbid and increased action, be capable of secreting quite as pro- digious an excess of fluid as is found secreted in any kind of dropsy whatever. And hence, from a morbid irritation of the kidneys alone, we may, I think, satisfactorily account for the largest quantity of water that is ever discharged in the disease before us, and see with what peculiar force it was denominated by the Greeks hydervs (vJip#5,) or water-flux, as also hydrops matellce, or urinal dropsy. This analogy will be still more obvious from our following up the common forms of dropsy to their ordinary consequences, and comparing them with the consequences of diabetes. As the watery parts of the blood in cellular or abdominal dropsy are drawn off with great rapidity and profusion to a single organ, every other organ becomes necessarily desiccated and exhausted ; the skin is harsh and dry, the muscles lean and rigid, the blood-vessels collap- sed, the bowels costive, and the adipose cells emptied of their oil. Every part of the system is faint, and languishes for a supply, and hence that intolerable thirst which oppresses the fauces and sto- mach, and urges them by an increased action to satisfy the general demand. Thi* is a necessary effect of so profuse a depletion, be the cause what it may : and we have reason, therefore, to augur a priori that such an effect must follow in this form of the Greek hydervs or water-flux. That it does follow we have already seen voi. iv. 11 322 ECCRITICA. [CL. VI.-OR. II. and we are hence led almost insensibly to adopt, in its fullest lati- tude, the correct doctrine of Dr. Latham, that " the increased ap- petite in this last disease, however great it may be, is a natural sen- sation, calling into its full exercise that organ through which the constant waste of the body must be directly supplied, and without which the patient must soon inevitably perish.''* From a morbid excitement then, a weak and irritable inflamma- tion, if I may be allowed the expression, of the kidneys alone, we are able to account, not only for all the local symptoms of an enor- mous flux of water, lumbar, or hypochondriac pains, and occasionally fullness, and the post-obit appearances of distended or ■• preternatu- rally enlarged arteries," as observed by Mr. Cruikshank, " blood- vessels more crowded than in a natural state, so as in some parts to approach to the appearance of inflammation,'* as observed by Dr. Baillie, " ossified arteries," as observed by Mr. Gooch, and " a glutinous infraction of the parenchyma of the kidneys," as observed in other cases by Plenciz ;t but also for all the constitutional symp- toms of a dry, harsh, and heated skin, general emaciation, and sense of exhaustion, depression of animal spirits, great thirst and voraci- ous appetite. In dropsy, indeed, the appetite is not uniformly voracious, nor is it always so in diabetes: but that inanition of al- most every kind has a tendency to produce this system, where the tone of the stomach is not interfered with or has re-established itself, is manifest from its occurring so commonly after severe fatigue, long fasting, protracted fevers, or any other exhausting state of body. And hence the very existence of the symptom in diabetes is a direct proof that the action of the stomach, instead of being mor- bid, is perfectly sound though inordinately excited. But the grand question, it may, perhaps, be said, still remains untouched. How are we to account for that crude, fused, or dis- solved state of the blood, which appears so conspicuously in diabe- tes, and which reduces it from an animalized to a vegetable crasis? Now upon tnis point, let us fairly put to ourselves this previous question: Does such a state of the blood appear at all ? and is it in fact reduced or changed in any respect from its animalized charac ter antecedently to its arrival at the morbid organ of the kidneys? So far as we have been able to obtain information from chemical experiments, the blood of a diabetic patient continues in full pos- session of its animalized qualities, and evinces no approach towards those of vegetable fluids: and so far as we can judge from its being drawn from the arm during life, instead of evincing a thin, dissolv- ed, and colourless state, it discovers that very condition which we should anticipate as a natural consequence of a very copious abstrac- tion of its serous or more liquid, principles. For we are told, without a dissentient voice, by those who have drawn blood freely and repeatedly during the disease, that it has the general appear- * Practical Treatise, &c. 1. p. 417. t Acta et Observation:? Med. p. 153. C.E. HI.—SP. IV.] EXCERNENT FUNCTION. 32J ance of treacle ; thicker than natural from the.drain of its finer parts, and darker from a closer approximation of its red corpuscles, little capable of coagulability from its loss of coagulable lymph, and hence not separating by rest into a proper serum and crassament. And we are told farther that wherever venesection has been ser viceable, and the renal flux has diminished, the latter instantly as- sumes a greater disposition to coagulate, and loses the darkness of its hue. The grand reason, after all, for supposing that this change from an animalized to a vegetable, or Tather from an uric to an oxalic character, takes place in the blood itself, is from the difficulty of conceiving how it can take place in the kidneys: the difficulty of explaining how an organ whose common function is to secern alka- lies, and an acid strictly animal, should be brought to secern an acid directly vegetable. But, in the first place, is the difficulty one which is diminished by transferring this wonderful change of action to the assimilating powers, or to the stomach, or to any other or- gan ? For let us lay the fault where we will, we are still involved in the dilemma of supposing, that an animal structure whose healthy function consists in the formation of ammonia, has its action so per- verted by the disease before us, as to produce sugar in its stead. And hence, by enlisting the assimilating powers into service upon the present occasion, we only gain two levers instead of one. We place the globe upon the elephant instead of upon the tortoise, but we have still to inquire what it h that supports the latter. There are, however, if I mistake not, various pathological and physiological facts perpetually occurring before our eyes, which if properly applied, may at least reconcile us to this supposed anoma- ly, if they do not explain its nature : a very few of which 1 will briefly advert to. We see a tendency in most animal organs to produce sugar un- der particular circumstances, whatever be the character of their ordinary secretion ; and this both in cases of health, where we have no ground for supposing an imperfectly animalized fluid; and in cases of disease where such a change may perhaps be contended for and supported : and we see this also, and equally, under an animal and under a vegetable diet; in some instances, indeed, most so where the former predominates. No one, if he did not know the fact, would predict that the breast of a healthy woman, which forms no sugar at any oilier time, would become a saccharine fountain immediately after child-birth; and still less so that an animal diet, or a mixed diet of animal and vegetable food, would produce a lar- ger abundance than a vegetable diet alone: and iea>t of all, that woman's milk produced By animal food would yield more sugar in a given quantity than ass's, goat's, sheep s, or cow's ; and less case- ous matter than any of these quadrupeds* though this last is the * Experimens des M. M. .Stipriaan, Liviscius, et De Bondt, in Mem. de la So- ciete de Med. a Paris. 178U. • 321 ECCRITICA. > [CX. VI.-OR- 11. only matter of a strictly animalized quality which milk of any kind contains. . * e This, however, is a natural process. Yet under the action 01: a morbid influence sugar is often produced in other organs, wmie what should be sugar in the mammas is changed to some other sub- stance. Under the genus Ptyalismus, we have observed, that the saliva is sometimes so impregnated with a saccharine principle as to acquire the name of p. mellitus:* it is indeed by some authors represented as having the sweetness of honey. Pus, under vari- ous circumstances, evinces a sweetish taste, and hence the occasion- al sweetness of the sputum in consumptive patients. So in fevers of various kinds, as we have already had several occasions to ob- serve, and particularly in hectic fever, the sweat throws^ forth a vapour strongly impregnated with acetous acid. Even the cera- men sometimes both smells and tastes sweet; a fact noticed by Hip- pocrates, who at the same time remarks that it is a fatal symptom. As an animal product it might be reasonable to expect that the gastric juice would be alkaline, and it is so in some animals : yet those who have paid but little attention to animal chemistry will be surprised to learn that while it is for the most part neutral in animals that feed jointly on flesh and vegetables, it is alkaline in ruminating and graminivorous animals, or those that feed on grass, and acid in carnivorous animals, as the falcon, hawk, and heron. Upon which points the experiments of Brugnatellij coincide with those of Carminati and Macquart. It is unnecessary to pursue these illustrations any further. Can- didly reflected upon they cannot fail, 1 think, to diminish in a conside- rable degree, the repugnance which the mind at first feels in admit- ting a secretion of sugar by an organ, whose common function is so inaccordant with such a production: and consequently they co-ope- rate in leading us to the conclusion which it has been the design of these remarks to arrive at, that paruria mellita, or diabetes, is a disease seated in the kidneys alone, and dependent upon a peculiar irritability or inflammation of the renal organ. Of the predisposing or occasional causes of this disease, however, we are still involved in considerable darkness ; with the exception that whatever debilitates the system seems at times to become a predisponent, and only requires some peculiar local excitement to give birth to the disease, without which it is in vain to expect that it should take place. Hence it occurs to us, in some instances, as a consequence of old age, in others of a constitution broken down by intemperance or other illicit gratifications; in others again of a diseased liver, or diseased lungs,J of atonic gout, or suppressed eruptions : and particularly of chronic carbuncles, or ill-conditioned * Vol. i. p. 55. t Saggio d'un Analisa Chemica di Succi gastrici. Vide Crell, Beitrag. zu dem Chem. Annal. 1787. X See Case in Latham's Tracts, «S:c. p. 142, as also the remarks already quoted from Dr. Bardsley. GE. III.-SP. IV.] EXCERNENT FUNCTION. 325 sores approaching to their nature, and showing like themselves a considerable degree of constitutional debility. I am greatly obliged to Dr. Latham for calling my attention to this last fact while drawing up the present history of the disease, and for referring me in support of his own opinion upon this subject to the following passage in Cheselden : " There is sometimes a large kind of boil or carbuncle in this membrane, which first makes a large slough and a number of small holes through the skin which in time mortifies and casts off, but the longer the slough is suffered to remain the more it discharges, and the more advantage to the patient: at the latter end of which case the matter has a bloody tincture, and a bilious smell, exactly like what comes from ulcers in the liver ; and both these cases are attended with sweet urine as in diabetes."* In concurrence with this remark of Cheselden, Dr. Latham in- forms me in a letter as follows: " I have a patient at this moment, whose diabetes was first observed after a long confinement from carbuncle : he is upwards of seventy, and is moreover afflicted with a mucous discharge from the internal coats of the bladder." Not dissimilar to which, is the following case, which is well worthy of notice, and occurs among the earliest, in Dr. Latham's treatise on this disease. " About the year 1789 there was a most remarkable case of diabetes in St. Bartholomew's hospital, under the imme- diate care of the late greatly to be lamented Dr. David Pitcairn. The patient's history of himself was this: that a rat had bitten him between the finger and thumb, that his arm had swelled violently, and that boils and abscesses had formed, not only in that arm but in other parts of the body : that his health from that time had decay- ed, and emaciation followed. His urine had then the true diabetic character both in quantity and quality : the saccharine part was in very great proportion, constantly oozing through the common earth- em pot over the glazing, and affording an infinity of pure saccha- rine crystals, adhering like hoar-frost to the outside of the utensil, and which were collected by myself and by every medical pupil daily, in great abundance."! How far the grand agent in this change of renal action, admit- ting the disease to be seated in the kidneys, is to be ascribed to a change in the quality or intensity of the nervous power transmitted to it, or, as the chemists call it, in the state of the animal electrici- ty of the organ, to which power Dr. Wollaston has referred the production and distinction of all the secretions, I am not prepared to say: but the subject ought not to be concluded without noticing this conjecture, which at the same time imports, on the part of those who hold it, an admission of the general principle of the disease which 1 have endeavoured to support. " Since," says Dr. Wollas- ton, " we have become acquainted with the surprising chemical * Anatomy, 8vo. p. 139. t Facts and Opinions p. 134. 326 ECCRITICA. [CL. VI.—OR. II. effects of the lowest states of electricity, I have been inclined to hope that we might from that source derive some explanation ot such phenomena. But though 1 have referred secretion in general to the agency of the electric power with which the nerves appear to be indued, and am thereby reconciled to the secretion of acid urine from blood that is known to be alkaline, which, before that time, seemed highly paradoxical, and although the transfer of the^prus- siate of potash, of sugar, or of other substances may equally be ef- fected by the same power as acting cause, still the channel through which they are conveyed remains to be discovered by direct expe riment."* Whilst such is the diversity of opinions which have been held concerning the pathology ofhoneyed paruria it cannot be a matter of much surprise that the proposed plans of treatment should also exhibit a very great discrepancy. On a first glance, indeed, and without keeping the grounds of these distinct opinions in view, nothing can be more discordant or chaotic than the remedial process proposed by different individuals. To- nics, cardiacs, astringents, and the fullest indulgence of the vora- cious appetite in meals of animal food, with a total prohibition of vegetable nutriment on the one side, and emetics, diaphoretics, and venesections to deliquium, and again and again repeated, on the other: while opium in large doses takes a middle stand, as though equally offering a truce to the patient and the practitioner. It is easy, however, to redeem the therapeusia of the present day from the charge of inconsistency and confusion, to which at first sight it may possibly lie open. Different views of the disease have led to different intentions : but so long as these intentions have been clearly adhered to, how much soever they may vary in their respective courses, they are free from the imputation of absurdity. These intentions have been chiefly the following: I. To invigorate the debilitated organs whether local or gene- ral, and to give firmness and coagulability to the blood. This was the object of all the Greek physicians, and it regulated the practice to a very late period in the history of the disease. " The vital intention," says Dr. Willis, " is performed by an incras- sating and moderately cooling diet; by refreshing cordials, and by proper and seasonable hypnotics." Hence agglutinants of all kinds were called into use, as tragacanth, gum arabic, and the albumen of eggs; and these were united with astringents as rhubarb, cinnamon, and lime-water, with or without an anodyne draught at evening as might be thought prudent. Sydenham carried the tonic and cardiac part of this plan considerably further than Willis : for while the lat- ter chiefly limited his patients to milk or a farinaceous diet, the for- mer allowed them an animal diet, with a vinous beverage. " Let the patient," says he, " eat food of easy digestion, such as veal, mut- * Phil. Trans. 1811. p. 105. GE. 1U.-SP. IV.J EXCERNENT FUNCTION. 327 ton, and the like, and abstain from all sorts of fruit and garden-stuff, and at all his meals drink Spanish wine." This plan continued in force with little variation, except as to the proportionate allowance of animal and vegetable food, till with- iu the last thirty years. The chief tome medicines being the warm gums, or resins^ astringents and bitters. Alum and alum-whey ap- pear to have been in particular estimation with most practitioners. They were especially recommended by Dr Dover and Dr. Brock- lesby in our own country, and by Dr. Herz* on the Continent. Dr. Brisbane, and Dr Oostendyk,t on the contrary assert, that in their hands they were of no use whatever. Sir Clifton Wintringham ap- plied alum dissolved in vinegar, as a lotion, to the loins. The other astringents that have been chiefly had recourse to are lime-water, as noticed already, chalybeate waters, kino and catechu in tincture, powder, and decoction; none of which, however, seem to have been eminently serviceable. While cantharides as a local astrin- gent has been exposed to a very extensive range of experiment both at home and abroad. Dr. IVIorgan gave it in the tincture, Dr. Herz in the form of powder, and both esteemed it salutary. Dr. Brisbane tried it in the first of these ways, giving from twenty to thirty drops, twice a-day : but appears to have been as dissatisfi- ed with cantharides as with alum, and declares that all astringents are hurtful, as Amatus Lusitanus} asserted long before, that they are of no use. 11. A second intention of pathologists in the present disease has been that of adding to the deficient animal salts, and resisting the secretion of sugar, by confining the patient to a course of diet and medicines calculated to yield the former, and to counteract the latter. This intention may have been indirectly acted upon by some part of the process we have just noticed, and particularly by the dietetic plan of Sydenham : but it is to Dr. Rollo that the medical world is immediately indebted for its full illustration, and the means of carrying it directly into effect, which consists in enforcing upon the patient an entire abstinence from every species of vegetable matter, and consequently limiting him to a diet of animal food alone : some form of hepatized ammonia being employed as an auxi- liary in the mean time. Narcotics, as under the preceding inten- tion, are also occasionally prescribed by Dr Rollo: and, in accord- ance with his doctrine that the stomach is the chief seat of morbid action, and that the thirst and voracity are indications of such action, the aid of an emetic is occasionally called in to allay the high-wrought excitement. From this last part of Dr. Rollo's curative method Dr. Latham appears to dissent upon the ground, and in the present author's opi- * Sell Neuc Beitrkge. i. 124. t Samml. auserl. Abhandl. fur Pract. aerzte. B. i. 179. X Cent. V. Cur. 33. ,328 ECCRITICA. [CL. VL-OR. II. nion a correct ground, that the increased action of the stomach pro- ceeds from a sound instead of from a morbid appetency : but to the injunction of an exclusive use of animal food, and a total abstinence from fermented and fermentable liquors, he accedes, with a full conviction of its importance, and without permitting the smallest deviation. And as Dr. Rollo, with a view of completiug the inten- tion of supplying the readiest means for a recruit of the deficient animal salts, prescribed hepatised ammonia as an auxiliary, Dr. Latham, for the same purpose, prescribes phosphoric acid, having observed in various cases of the disease an evident deficiency in the supply of phosphate of lime ; whence, indeed, the destruction that is occasionally met with of the fangs of the teeth together with their alveolar processes. Some severe remarks, which I am at a loss to account for, have occasionally been thrown out upon this last recommendation since the publication of Dr. Latham's very candid and ingenuous work. The idea is in perfect accordance with his own view of the gene- ral nature of the disease : and, in every view of it, is more likely to be of service than Dr. Rollo's hepatized ammonia, or, perhaps, than alkalies of any kind. For while, like the last, it has been sug- gested upon the principle of supplying to the kidneys the deficient materials upon which they are to work, it has a claim to attention as a very valuable tonic and astringent, even by those who may abjure this principle as incorrect, and particularly by the advocates for the mineral acids. I ought not indeed, while upon this subject, to conceal the following paragraph of a letter in direct allusion to it, addressed to me by Dr. Latham, so lately as May 26 of the car- rent year, in which he communicates with much candour, his pre- sent opinion upon the general line of practice he thus undertook to recommend to the public, little less than twelve years ago. " The experience," says he, " which I have had in diabetes since the pub- lication of my observations on that disease, does not excite, in any degree, a wish to alter the opinions which I had then formed con- cerning it: and I am more and more convinced that although my theory may be wrong, the practice has been successful. As to the theory about the phosphoric acid, I cannot help thinking that there is more in it than 1 ever suspected : be that however as it may, 1 urge my patients to persevere in its use, and am certain that it may do something more than produce a mitigation of the thirst, which circumstance of itself would be sufficient to maintain it as a remedy even if it went no further in effecting a cure." III. Some of the indications of the disease, however, have given rise to a much bolder intention. We have already seen that, from a few of its symptoms, and the appearances discoverable on dissec- tion, there is reason to apprehend an irritable and inflammatory state of the kidneys; and it has hence been attempted to cut short the complaint, and, so to speak, to strangle this condition at its birth, by copious and repeated bleedings. Le Fevre appears to have adopted and acted upon this principle almost as early as the GE. III.-SP. IV.J EXCERNENT FUNCTION. 329 beginning of the preceding century ;* but he does not seem to have obtained any considerable number of converts to his opinion; and it is to Dr. Watt of Glasgow that we are principally indebted for whatever advantages may have resulted from this mode of practice in our own day; and particularly for trusting to it mainly or exclu- sively, and cairying it to a very formidable extent. The plan pur- sued by Dr. Watt, has since been pursued by Dr. Satteriey, and the success obtained by the former has apparently been more than equalled by the latter, in the course of various trials, of which a very interesting account is detailed in a late volume of the Medical Transactions.! These trials embrace four distinct cases, the first of which is given most at length. The patient was thirty-two years of age : and had been in a state of progressive debility for nearly six months, brought on in the first instance, as was appre- hended, by his having drunk copiously of cold water when over- heated. He fell under Dr. Satterley's care in consequence of being taken to the Middlesex Hospital ; the symptoms were strongly marked, and the disease unequivocal: the pulse was quick, small, and hard. Fourteen ounces of blood were taken from the arm on the day after his admission, which was Feb. 19, 1808 : he was put upon a meat diet, with an allowance of drink sufficient to allay, though not to satiate, his distressing thirst. The abstraction of blood appearing to afford relief, eighteen ounces more were taken from him the next day, the 20th ; twenty ounces more on the 23d; the same quantity on the 25th; and eighteen ounces successively on the 28th, on March the 3d, and March 11th: making a total of a hun- dred and twenty-six ounces in twenty days. On the day and night of admission, he had evacuated sixteen quarts of urine ; after the first use of the lancet, the quantity was reduced to eleven quarts in twenty-four hours; after the second, to six quarts; after the third it varied from five to seven quarts; after the fourth, it stood at six; after the fifth, it varied from five to six ; after the sixth, it sunk below five ; and at the time of the seventh, was calculated at three, and had sometimes been not more than two: at which time his mor- bid thirst had entirely left him, he was in tolerably good health, and increased in strength and size. In consequence of some pneu- monic symptoms, he was afterwards blooded once or twice, and de- tained in the hospital for a long period of time, though the term is not stated. He was, however, at length discharged cured, and was found several years afterwards to have kept free from any return of the complaint. The regimen and accompanying course of medicines are not very accurately stated. He seems to have been limited to a diet of ani- mal food; to have used alternately as a part of his beverage, alum- whey and lime-water; to have taken occasionally calomel, and cas- tor-oil, and for a part, if not the whole period, a grain of calomel * Opera, p. 134. Vtrunt. 1737. 4to t Vol. v. Art. i. vol. iv. 42 330 ECCRITICA. [CL. VL-OR. IL and a dose of compound powder of ipecacuan every night, the quan- tities of which are not given. But it was the depleting plan that was altogether depended upon, and no very minute attention was paid to any thing else. The two next cases admitted of easier cure under the same treatment. The patients were both males. The fourth case breaks off incompletely, for, in consequence of a removal of the patient, the termination was not known. In each of these there was the local symptom of great pain in the loins, which in the first is described as having been " always severe but at times excessively acute." Here also the testicles were occasionally retracted ; and in one of two female cases there was a distressing itching in the pudendum : so that there is reason to conclude that these instances were accompanied with a more than ordinary degree of irritability or inflammation. " This," says Dr. Satteriey, " is the extent of my experience respecting bleeding in diabetes : an experience that fully warrants my asserting the safety, and 1 think the efficacy, of the practice, in some species of this complaint." IV. It has, however, been thought possible by other practitioners, to subdue the irritation whether local or general, and which is often strikingly conspicuous, by powerful narcotics repeated in quick succession; and thus to obtain a cure without that increase of debility which, in many cases, must necessarily ensue upon an active plan of depletion—and this has constituted a fourth intention. Anodynes, though of no great potency, were occasionally admi- nistered by Willis and Sydenham; and their benefit was expressly insisted upon by Buckwald.* The ordinary form has been that of Dover's powder, thus aiming at a diaphoretic as well as a sedative effect: and in this form it has sometimes been found successful, particularly in a case published by Dr. M'Cormick in the Edinburgh Medical Commentaries :| but 1 am not aware that narcotics alone have been relied upon, or their effects completely ascertained before the late experiments of Dr. P. Warren, an interesting state- ment of which he has communicated in the same work that con- tains Dr. Satterley's practice in venesection.J These experiments embrace the progress of two cases that occurred under Dr. Warren's care in St. George's Hospital. In the first he directed his attention, like Dr. M'Cormick, to opium, in conjunction with some relaxant ; and hence made choice of the compound powder of ipecacuan. So far as the present cases go, however, they prove very satisfac- torily that whatever benefit is derivable from the use of this valuable medicine, depends far more upon its sedative than its sudorific power. Dr. Warren, indeed, seems rather to have found the latter a clog upon his exertions, as he could not carry the opium * Dissert, de Diabetis curatione, &c. t Vol. ix. Art. II. p. 56. $ Vide supra. GE. III.—SP. IV.] EXCERNENT FUNCTION. 331 far enough to produce a permanent effect on account of the nausea or vomiting occasioned by the ipecacuan. from which symptoms no benefit whatever appeared to be derived. In his first case, there- fore, he soon trusted himself to opium alone, and persevered in the same practice through the second. These patients also were in the prime or middle of life: the one aged twenty-two, the other thirty-eight: and both had been declin- ing for some months antecedently to their applying to St. George's Hospital for relief The first seems to have been worn down by the fatigue of journeying, and was considerably disordered, before the attack of diabetes, in his stomach and bowels. When received into the hospital, however, with this last complaint upon him, he had a considerable pain in his back and loins. Of the origin of the second case no account is given. To ascertain whether an animal diet would succeed by itself, or whether it be of any collateral advantage, the patients were sometimes restricted to animal food alone, to opium alone, and to opium with a mixed diet of animal and vegetable food. It appears to me from the tables that the animal regimen was of advantage, but certainly not alone capable of effecting a cure, for in every instance the quantity of urine increased and became sweeter, whatever the diet employed, as soon as the opium was diminished. Dr. Warren, however, is inclined to think that it wa3 of no avail whatever ; and, consequently, the second patient had no restriction upon his food, whether animal or vegetable. The quantity of opium given was considerable. When Dover's powder was employed it was gradually increased from a scruple to a drachm twice a-day. And when opium was employed alone, or with kino, with which it was for a short time mixed, but without any perceptible advantage, it was augmented from four grains to six grains and a half twice a-day in one patient: and to five grains four times a-day in the other. It is singular that the opium seldom produced constipation. Few other medicines were employed.* The disease in both cases was as decided as in the preceding treated by venesection: but the flow of urine was much less, the maximum in the one patient being only fifteen, and in the other only eight pints in the twenty-four hours : and the cure occupied a much longer period of time ; running on to nearly four months in the first instance, and to more than six in the second. The sum of the whole appears to be, that paruria mellita attacks persons of very different ages, constitutions, and habits, and hence, in different cases, demands a different mode of treatment: and that the morbid action is seated in the kidneys; with the irritable, and, often, inflammatory, state of which all the parts of the system more or less sympathize. It appears that under a diet of animal food strictly adhered to, the tendency to an excessive secretion, and particularly to a secretion of saccharine matter, is much less than under any other kind of regimen, though, from idiosyncrasy or some * Med. Transact. Vol. jv. Art. xvi. p. 188. 332 ECCRITICA. [CL. VI.-OR. IL other cause, this rule occasionally admits of exceptions. It appears also that the irritation is in* some instances capable of being allayed, and at length completely subdued by a perseverance in copious doses of opium, probably by an exhaustion of the general excita- bility ; and in others by a free use of the lancet, leading more rapidly to a like effect. The skin, through the progress of this complaint, does not seem to catenate in the action of the kidneys so much as in many others, except in a few individuals ; and hence diaphoretics are rarely of advantage. As the irritability of the affected organ is connected with debility and relaxation, tonics are frequently found serviceable, and particularly the astringents; those mostly so, that are conveyed to the kidneys with the least degree of decomposition. And hence the advantage that has been so often found to result from an use of lime-water, alum-whey, and many of the mineral springs. The mineral acids are, on this account, a medicine of very great importance, and in some instances have been found to effect a cure alone ; of which Mr. Earnest has given a striking proof in a professional journal of reputation.* Their sedative virtue is nearly equal to their tonic, and they surpass every other remedy in their power of quenching the distressing symptom of intolerable thirst. Cinchona and various other bitters have been tried, but have rarely proved successful. Some benefit has occasionally been derived from irritants applied to the loins, and especially from caustics ; but these have also failed. How advantageous soever the plan of sanguineous depletion may be found occasionally, it is clear that it cannot be had recourse to generally, for the present disease, is, for the most part, though by no means always, a result of advanced years and of a debilitated constitution. Under such circumstances, indeed, it has uniformly occurred to the present writer, in the few instances he has been called upon to superintend it, in which, while the thirst was intense, the appetite by no means kept pace with it, and was sometimes found to fail completely. Where, on the contrary, the constitution does not seem seriously affected, and the soundness and, indeed, vigour of the stomach and collatitious viscera are sufliciently proved by the perpetual desire of food to supply the waste that is taking place, a free use of the lancet may probably be allowed as offering what may be called a royal road to the object of our wishes: but the practice should, I think, be limited to this state of the animal frame; since, while this favourable condition of the digestive organs remains, whatever be the prostration of strength induced by the lancet, it will soon be recovered from. By what means an animal diet effects the beneficial change that so generally follows from its use, has never, that I know of, been distinctly pointed out: but there is a fact of a very singular kind that has lately been discovered in animal chemistry which is, I think, capable of throwing a considerable light upon the subject. * Medical Journal, Vol. xm. GE. 111.—SP. IV.] EXCERNENT FUNCTION. 333 In healthy urine, the predominant principle is that of uric acid, in diabetic, that of saccharine or oxalic. The uric acid, indeed, exists so largely in sound urine as to be always in excess, as we shall have occasion to observe under lithia or urinary calculus. It is not only a strictly animal acid, but till of late years was supposed to ex- ist in no other urine than that of man; though it has since been found, but in a smaller proportion, in the urine of various other animals. Whatever then has a tendency to reverse the nature of the acid secretion in the disease before us, to produce uric instead of oxalic acid, and in this respect to restore to the urine its natural principle, must go far towards a cure of the disease, as well by taking off from the kidneys a source of irritation, and hereby di- minishing the quantity of the secretion, as by contributing to the soundness of the urine itself. Now the physiological fact I refer to is, that animal food has a direct tendency to induce this effect: for Dr. Wollaston has satisfactorily ascertained that a greater quantity of uric acid is produced in the dung of birds in proportion as they feed on animal food: and he has hence ingeniously suggested, that where there is an opposite tendency in the system to that we are now contemplating, a tendency to the secretion of an excess of uric acid, as in the formation of uric calculi and gouty concretions, this evil may possibly be obviated by a vegetable diet. SPECIES V. PARURIA INCONTINENT Snronttnrncc of Wlvint frequent or perpetual discharge of urine, with difficulty of retaining it. This is the enuresis of most of the nosologists, and admits of four varieties from diversity of cause and mode of treatment, with often a slight diversity in some of the symptoms. tt Acris. From a peculiar acrimony in the Acrimonious incontinence fluid secreted. of urine. C Irritata. From a peculiar irritation in some Irritative incontinence of part of the urinary channel. urine. y Atonica. From atony of the sphincter of Atonic incontinence of the bladder. urine. 3 Aquosa. From superabundant secretion Flux of aqueous urine. the fluid limpid and dilute. 334 ECCRITICA. [CL. Vl.-OR. II. In the first variety, proceeding from a peculiar acrimony of the secreted fluid, the cause and effect are mostly temporary; as too large a portion of spirits combined with certain essential oils as that of the juniper-berry. Diluents and cooling laxatives offer the best cure. In the second variety, the irritation usually proceeds from sand or gravel, or some foreign substance, as hairs, accidentally intro- duced into the urethra. We have some accounts, however, of a discharge of hairs, in such quantities that it is not possible to ascribe the aflection to an accidental cause ; and we should rather, per- haps, resolve them into a preternatural growth of hair in the blad- der itself, an idea the more tenable as we shall have to observe, in due time, that calculi of the bladder have occasionally been dis- charged or found after death surmounted with down. In this case the disease may be regarded as a species of trichosis, under which name it is described by Goelicke,* as it is under that of trichiasis by Sculletus.t But at present we are in want of de- cisive information upon the subject. If the last view be correct, filling the bladder with injections of lime-water or any other depi- latory liquid of as much acrimony as the bladder will bear without injuring its internal and mucous surface, will be the best mode of cure. , Frequently, however, the irritation is that of simple debility: and hence, tonics and stimulants, as the terebinthinates or even the tincture of cantharides, may be employed internally with success, while externally we prescribe blisters to the perinaeum, or the cold water of a bidet. Pressure is also of great service in many instan- ces. In the sixth volume of the Medico-Chirurgical Transactions, Mr. Hyslop gives a case of nine years' standing, in which a cure was effected in three days by binding a bougie tightly to the urethra through its course by means of adhesive plaster. And Mr. Burns gives another case, in the same volume, in which great benefit was derived from a similar plan : which is also in many instances equally adapted to the next variety. In incontinence of urine from an atony of the sphincter of the bladder, the same means may be had recourse to, though with less hope of success. Stoll recommends the use of an acetum armoracium, which, from combining a stimulant with a tonic and astringent power, may pos- sibly be found serviceable, and is certainly worthy of trial.J Small shocks of electricity passed from the pubes to the perinaeum seem also to have succeeded in a few cases. As the perpetual dribbling of the urine in this, and even the preceding variety, is always troublesome, and often produces ex- coriation, the patient will find it very convenient to be provided with a light urinary receptacle. This, for males, may consist of a * Dissert, de Trichosi. Frankf. 1724. t Trichiasis admiranda, sen Morbus Pilaris, &c. Norib. 1658. X Ptfelect. p. 287. GE. III.—SP. V.J EXCERNENT FUNCTION. 335 small bag of oiled-silk worn as a glove for the penis, with a small piece of sponge placed in it as an absorbent. The simplest contri- vance for females is a larger piece of soft sponge loosely attached to the pudendum. The fourth variety, or flux of aqueous urine, is often a nervous affection, as in hysteria, or hypochondrias; but it more generally proceeds from a relaxation of the mouths of the cryptae or tubuli uriniferi, which in consequence suffer a much larger quantity of fluid, and with too little elaboration, to pass through them than they should do. In treating of paruria mellita, we observed that antecedently to the discovery of the singular secretion of sugar in the genuine form of this disease, the term diabetes, by which it was commonly ex- pressed, imported any extraordinary or profuse flow of urine, whether watry or saccharine : whence the term was made to em- brace at least two affections of the kidneys of very different kinds: as a simple relaxation of the mouths of the urinary tubules from debility; and vehement excitement and a morbid change of action ; the former expressed by diabetes insipidus, and the latter by d. mellitus. The variety we are now contemplating constitutes the first of these; as the second runs parallel with the preceding spe- cies. It is the urina aquosa* of Galen which was also by himself, as well as the Greek writers in general, blended with the urina mellita, from their not having been acquainted with the difference of their constituent principles, and of the state of the kidneys in the one case and in the other; and hence both were equally described by them under the names of hyderus or water-flux, and hydrops matellae or urinal-dropsy. As this variety, like the preceding, is dependent on a debilitated state of the organ, it should be attacked with the same remedies, and particularly with astringent tonics and stimulants both local and general. Blisters applied to the loins will be found often useful, as may also tincture of cantharides in doses of from twenty drops to half a drachm or even a drachm. The warm and resinous balsams will moreover frequently afford aid, as turpentine and balsam of copaiva, or the essential oil of juniper. The quantity discharged under this variety of the disease has occasionally been enormous: amounting to from thirty to forty pints a-day and sometimes more, for one, two or even three months with- out intermission; a variety of examples of which are offered in the volume of Nosology. ^Tonseca mentions a case of two hundred pints evacuated daily, but for what term of time is uncertain.! • De Crisibus, Lib. i. Cap. xn. t De Natursc Artisque Miraculis, p. 538. 336 ECCRITICA. [CL. VI.-OR. II. SPECIES VI. PARURIA INCOCTA. aanaj3Stmtlate& WLvint. urine impregnated with fluids taken into the stomach, and ex- creted WITHOUT CHANGE. The Greek pathologists evidently allude to this morbid state of the urinary organs in comparing some varieties of their diabetes, or urinary diarrhoea, to a lientery or laevitas intestinorum, under which last the food is described by them as evacuated in a crude and undigested state, with very little alteration from the condition in which it was introduced into the stomach. The experiments of Sir Everard Home, and those of Dr. Wollas- ton, and Dr. Marcet, both contained in the Philosophical Transac- tions for the year 1811, show that rhubarb and prussiate of potash, may pass from the stomach into the bladder, without undergoing any decomposition ; and, in these cases, apparently without taking the course of the blood-vessels. By what other path it is possible for them to have travelled is to this moment a subject of mere con- jecture, upon which, however, the author has offered a few hints in the Physiological Proem to the present class. Oil of almonds has frequently reached the bladder with an equal destitution of change and has been discharged in the form of oil by the urethra :* and oil of turpentine and juniper pass off in the same manner daily. Actuarius mentions a discharge of urine of a blue colour, in a boy who had taken a bitter pill designed for another patient, but does not state the materials. Urine containing a sediment resembling Prussian blue was discharged copiously by a patient in a low fever about three days before his death: it afterwards became greenish, and possessed a strong ammoniacal smell. Another case is related by the same author of a discharge of blue urine in a woman of sixty without mischief. We do not know, however, that either of these two last cases was connected with any thing introduced into the stomach, and the blue or dark-coloured matter consisted proba- bly of extravasated venous blood, interallied with the yellow or other tinge of the urine. Copious diluents, mucilaginous or farinaceous, will at all times afford the best means of deterging the kidneys of any such untemp- ered materials as those we are now contemplating; and if the co- lour should appear to proceed from a rupture of blood-vessels in ,v- Pachotoni, Comment. Bonon. Tom. n. Part. i. OE. III.—SP. VII.] EXCERNENT FUNCTION. 337 the same organ*, the affection will become a variety of hematuria, and should be treated accordingly.* SPECIES VII. PARURIA ERRATICA. Krrattt ©trine- URINE DISCHARGED AT SOME FOREIGN OUTLET. Under the preceding species, we have seen that certain substances introduced into the stomach, will find their way unchanged to the kidney. The present species presents to us a singularity of differ- ent arid almost opposite kind, by shewing us that the urine itself, in a certain condition of the organ that secretes it, or of the sys- tem generally, nv»y travel from the kidneys to other regions in a form equally unchanged. We know nothing of the means by which all this is accomplished, but we can sometimes avail ourselves of the fact itself, by employing a variety of medicines, which, in con- sequence of their being able, in this manner, to arrive at a definite organ without being decomposed in the general current of the blood, are Supposed to have a specific influence upon such quarter, and have often been denominated specifics for such an effect; as cantharides in respect to the bladder, demulcents in respect to the lungs, and cinchona in respect to the irritable fibre. This disease has often been described under the name of uropla- nia, which is nothing more than a Greek compound for " erratic urine" as it is here denominated, but it has seldom been introduced into nosological arrangements. The cases, however, are so numer- ous and distinct, in writers of good authority, that it ought not to be rejected. In most instances it is not a vicarious discharge; or, in other words, a secretion of a different kind compensating for a destitution of urine, but a discharge of an urinous fluid apparently absorbed after its secretion by the kidneys, and conveyed to the outlet from which it issues by a path or under a protection that has hitherto never been explained. We sometimes meet with it while there is a free secretion of urine by the kidneys, and a free passage by the bladder and urethra, in which case alone it can be called a disease. On other occasions we find it, as already observed under paruria iuops, performing a remedial part, and travelling in the new direction to carry off recrementory matter that cannot be * See Vol. n. p. 468. VOL. IV. -1-5 U38 ECCRITICA. [cl. vi.-or. n. discharged at its proper outlet, nor retained in the blood without mischief. It has in different persons been evacuated by the salivary glands, the skin, at the navel, and by a fistulous opening into the perinaeum. The volume of Nosology gives a reference to cases and autho- rities illustrating each of these forms of discharge : and others are probably to be met with in other writings. GENUS IV. LITHIA. aarfuars Calculus. MORBID SECRETION OR ACCUMULATION OF CALCULOUS MATTER IN INTER- NAL CAVITIES. Lithia is a Greek term from xdos whence Mdtx* " calculo laboro.;' It has often been written lithiasis, which is here exchanged for lithia, since iasis, in the present arrangement, is limited, as a ter- mination, to words indicating diseases affecting the skin or cuticle, and that for reasons which will be explained presently. The name of lithus or lithiasis, as used by Aretaeus and Aurelia- nus, and that of calculus or sabulum, as employed by Celsus and Plinj', sufficiently evince the elementary principles of which the Greeks and Romans conceived urinary calculi to consist. The mis- take is not to be wondered at when we reflect, that it is not till about thirty years ago that these principles were detected with any degree of accuracy; and that we are indebted to the minute and elaborate experiments of Fourcroy and Vauguelin for an analysis that till their time, though successively pursued by Hales, Boyle, Boerhaave, and Slare, had been left in a very unsatisfactory state; and which even since this period has required the further correc- tions of Wollaston, Marcet, Cruikshank, Berzelius, Brande, and vari- ous other animal chemists to produce all the success we could desire. So generally was the belief that the calculi of the bladder were formed in the same manner and consisted of the same materials a* the stones of the mineral kingdom, that Dr. Shirley pubhshed a learned book as late as 1671, which is now become extremely scarce, entitled " Of the causes of stones in the greater world in order to find out the causes and cure of the stones in man." The urinary secretion in a state of health is one of the most com- pound fluids of the animal system: and consists of various acids, and alkalies, the former, however, bearing a prepouderaucy, with a certain proportion of calcareous earth, and other materials which in consequence become more than ordinarily dilated, they occasionally pass off in great numbers in a short space of time. We have hence, in different professional journals and transactions, accounts of a hundred and twenty voided in the course of three days ;|| two thousand in the course of two years ;1T and three hundred of a pretty large size within the same term.** The largest discharged in this manner, which has ever occurred to me. in reading, weighed five * Blegny, Zodiac. Ann. iv. Febr. Obs. 4. t Gen. in. Spec. v. part, in cont. X Bartholin. Act. Hafn. Tom. n.Obs. 85. i Act. Erudit. Leips. 1627. p. 332. Dotajus, Ep ad Waldschmidt. p. 253. || Eph. Nat. Cur. Dec. m. Ann. v. vi. p. 99. J Griindlicher Bericht, von Blatterstein. ** Hildan. Fabric. Cent. i. Obs. 89. GE. IV.-SP. II.] EXCERNENT FUNCTION. 34tJ ounces. Dr. Huxham describes one instance of such a fact ;* and another is given in a distinguished foreign miscellany.t By females they have often been discharged of the weight of two ounces and a half; and my excellent friend Dr. Yellowly mentions a calculus of nearly three ounces and a half;J in one case we are told of a stone thus evacuated that weighed twelve ounces.§ The general character of the uric calculus has been given already. Its texture when formed in the bladder is commonly laminated; and, when cut into halves, a distinct nucleus of uric acid is almost always perceptible. Its exterior is generally smoother than that of other calculi, except the calculus of bone-earth, or phosphate of lime.|| The appearance of the second or fusible calculus is generally white, and often resembles chalk in its texture. Strongly heated before the blow-pipe this substance evolves ammonia, and readily fuses; whence the name assigned to it. It often breaks into layers, and exhibits a glittering appearance when broken. The third division, consisting of the bone-earth calculus, or phosphate of lime unmixed with any other substance, has a pale brown, smooth surface ; and when sawn through is found of a laminated texture, and easily separates into concentric crusts. This calculus is peculiarly difficult of fusion. The fourth division embracing the mulberry calculus, or oxalate of lime, is of a rough and tuberculated exterior, and of a deep red- dish-brown or mulberry colour, probably produced by a mixture of blood that has escaped from some lacerated vessel, whence the name assigned to it. The nucleus is generally oxalic, and of renal origin ; but it is sometimes uric. It is also frequently enveloped by the fusible calculus. The fifth, or cystic calculus has a crystalline appearance but of a peculiar greasy lustre, and is somewhat tough when cut. Its colour is a pale fawn bordering upon straw-yellow. It is very rarely to be met with. Such are the calculi which are principally found in the bladder; and we may readily conceive with what facility they are formed there, when an accidental tendency is given to their formation by a lodgement of any thing that may serve as a nucleus, by noticing the deposites of phosphates of lime and other materials that are perpe- tually encrusting every substance over which a current of urine is frequently passing; as the public 'drains in our sireets, which are daily exhibiting them in regular crystals. *it" The ordinary causes of renal calculi are*^:essarily those of vesical calculi, but any local injury or infirmity, which prevents the • Huxh. Vol. in. p. 42. t Sammlung. Med. Wnhrnrmung. Band. vm. p. 25S. X Trans, of the Medico-Chir. Soc. Vol. vi. & Eph. Nat. Cur. Dec. n. Ann. v. Ob.<. 71. || Braude's Journal, Vol. vm. p. 207. 350 ECCRITICA. [CL. VL-OR. II. urine from passing off freely from the bladder, accelerates their formation and enlargement, not only by the confinement it causes but by the decomposition which rest soon produces, in which case it becomes ammoniacal, and a larger portion of the phosphates will be precipitated. And hence, an obstruction in the urethra of any kind, but particularly a diseased prostate becomes a frequent auxi- liary, and sometimes even a primary cause of the formation of a stone without any mischief in the kidneys, or any disordered secre- tion of urine.* " The bladder," says Sir Everard Home, " never being completely emptied, the dregs of the urine, if I may be allowed the expression, being never evacuated, a calculus formed on a nucleus of the ammoniaco-magnesian phosphate and mucus is produced, when it would not have been produced under other cir- cumstances. This species of stone, or a stone upon such a nucleus, can only be produced where the bladder is unable to empty itself. It may therefore be arranged among the consequences of the enlarge- ment of the middle lobe of the prostate gland."t It does not appear from the experiments or observations of Dr. Marcet, that a difference in the waters of different places is much, if at all, concerned in the production of calculous disorders: nor have we any satisfactory evidence of their being more prevalent in cider than in other countries, notwithstanding the general opinion that they are so. But we are yet in want of sufficient data upon this subject to speak with much decision. As the disease of stone in the bladder is very generally a sequel of calculi in the kidneys, the symptoms indicative of the preceding species form, in most instances, the first symptoms of the present. Yet occasionally, from causes we have just pointed out, the concre- tion commences in the bladder, and the symptoms of an affected kidney are not experienced. One of the first signs of a stone in the bladder is an uneasy sensation at the point of the urethra occurring in conjunction with a discharge of urine that deposites red or w hite sand, or after having occasionally voided small calculi or fragments of a larger. This pain is sympathetic, and proceeds from the irritation of the prostate or the neck of the bladder, agreeably to a law of nature we have often found it necessary to recur to, which ordains that the extremities of nerves which enter into the fabric of an organ, and particularly of mucous canals, should possess a keener reciprocity of feeling than any intermediate part, and consequently participate with more acuteness in any diseased action. This un- easy sensation at tb^Jpoint of the urethra, is at first only perceived on using any violeftr%r jolting exercise ; or in a frequent desire to make water, which is often voided by drops or in small quantities, or, if in a stream, the current stops suddenly while the patient is still conscious that the bladder is not fully emptied, and has still an inclination to evacuate more, but without a power of doing so. * Brande's Journal, -ct. 3. 352 ECCRITICA. [CL. Vl.-OR. 11. thod M. Garangeot informs us he once tried with success. In seve- ral other cases, however, that he has described, tbe vessels of the bladder had spread luxuriantly over the stone, and apparently grown into it; and the extraction was followed by a mortal hemorrhage* Generally speaking, calculi, when seated in pouches of this kind, continue without much disturbance for vears, and sometimes for the whole of a man's natural life, of which Dr. Marcet has given various striking examples in his treatise. Art cannot scoop out such convenient receptacles, but it may do something to allay the irritability of the bladder when severely ex- cited, and in this manner palliate the distressing pain that is often endured. This may frequently be accomplished by the warm-bath; by rubefacients impregnated with opium applied to the region of the pubes, and in the course of the perinaeum; by cooling aperients and a steady use of sedatives, and particularly of conium. If these do not answer we must have recourse to opium, which will often succeed best, and with least inconvenience to the constitution if in- troduced into the anus in the form of a suppository. Our next intention should be to prevent, as far as possible, an augmentation of the calculus already existing-in the bladder. In order to accomplish this, it will be necessary to inform our- selves of its chemical constituents, for otherwise any method we may propose will probably do harm. From the remarks already made, it is obvious that the chief constituent principles of the cal- culi in the bladder, like those in the kidneys, are uric acid and -bone-earth, or phosphate of lime. If the former predominate the urine will often throw down a precipitate or incrustation of red sand, if the latter, of white sand : and in the former case, as there is an excess of uric acid, our remedial forces must be derived from the alkalies and alkaline preparations to which we have already advert- ed under the preceding species : in the latter case, as there is, in all probability, a deficiency of acid, we must have recourse to an opposite mode of treatment, and empioy the mineral and vegetable acids, with a diet chiefly composed of vegetables as recommended above under renal calculus. But the calculus may consist of both, for it may exhibit, and often does, a nucleus of crystallized uric acid with lamina? of phosphate of lime, magnesia, or some other substance : or. by carrying either of the above processes to an extreme, we may convert one morbid action into another. For if, by the use of alkalies, we diminish too much the secretion of uric acid, we may let loose the calcareous earth, which, in a healthy proportion, it always holds in solution, and hereby increase the vesical calculus by supplying it with this maicrial; while, on the contrary, by an undue use of acicis where these are required to a certain extent, we may obtain a secretion of uric acid in a morbid excess, and augment the stone in the blad- der by a crystallization of an opposite kind. Hence a very consi- * Mem. de i"Ac:i■'. dc Chirm;-;. Ton:, i. GE. 1V.-SP. 11.] EXCERNENT FUNCTION. 353 derable degree of skill and caution is requisite in tbe mode of treat- ment, and the character of the urine should be watched perpetually. Nor, where the calculus is of a still more composite kind, can either of these plans be attended with all the success they seem to ensure, so that the augmentation will sometimes be found to pro- ceed in spite of the best directed efforts. From the success that has attended the use of the colcbicum autumnale in many cases of gout, and the tendency there is in many cases of this disease to form calculi in the joints, Mr. Brande has ingeniously thrown out the idea of trying the virtue of the colchi- cum in the disease before us, and hints that he has received from one quarter a very flattering account of its success, though not suffi- ciently precise for publication. If the reasoning pursued in examin- ing the powers and effects of the colcbicum in that part of the present work which is allotted to the history of gout be correct, we can have little hope of any permanent advantage from its use in respect to the lithic concretions before us. It has there appear- ed that the colchicum does not act as a preventive, but as an anti- dote, during the prevalence of a paroxysm. Nor does it act in this last way in all paroxysms, but chiefly, if not solely, in those of the regular form of gout, in which the general state of the con- stitution is sound and vigorous, while in atonic gout, it seems from the violence of its effects, not unfrequently to add to the evil. Yet it is in this last modification of gout that calculi are only found to concrete in the joints: the.deposite rarely, if ever, taking place, till the constitution has been seriously shaken by a series of at- tacks, evidencing, as in the case of similar deposites in the coats of the vessels and the parenchyma of various organs in old people, a general torpitude and debility of the excernent system. Upon which subject the reader may turn to the genus osthexia* in a pre- ceding Order of the present Class. There is something perhaps more plausible in the remedial regi- men proposed by M. Magendie, who, on reflecting that azote is an essential constituent of urea and uric acid, advises that the patient be confined to food that possesses no sensible portion of azote, as sugar, gum, oil-olive, butter, and a vegetable diet generally:! thus treating it with a dietetic course directly the reverse of what is now generally proposed for paruria, mellita, or diabetes. From the whole that has been advanced not only under the pre- sent genus, but also under much of the preceding, it is .obvious that the soundness of the urine keeps pace, in a considerable degree, with the soundness of the stomach and its auxiliary organs, and is dependent upon them : and hence in calculous concretions of every kind it is of the utmost importance that the chylifacient viscera, and the whole course of the intestinal canal, should be kept in as healthy a state as possible. * Supra, p. 233. 1 Rechcrches Physiolojiques et Medicalc?, ice. ut supia. vol. iv. 45 354 ECCRITICA. [CL. Vl.-OR. IE Astringents and bitters offer to us the best remedies for this pur- pose; From the supposed absorbent power of the former, Dr. Cullen, as we have already seen, ascribes to them much of the pe- culiar benefit resulting from the use of alkalies and magnesia,, in- dependently of their decided virtue as a tonic: nor ought we, while upon this subject, to overlook the advantage which, in calculi of uric acid at least, the same distinguished writer asserts that he derived from the use of soap, which he ascribes entirely to U- correcting acidity in the stomach ;* thus acting the same part as magnesia, and in many cases with greater potency. If such be the difficulty of preventing a calculus already formed in the bladder from enlarging, we may readily see how hopeless must be every attempt at dissolving the matter that has already be- come crystallized or concreted. Calculi of uric acid will dissolve in caustic alkalies, but in no alkalies of less power : nor can those of the phosphates be acted upon by acids of any kind, except in a state far too concentrated for medical use. " These considera- tions,1' says Mr. Brande, "■ independently of more urgent reasons, show the futility of attempting the solution of a stoue of the bladder by the injection of acid and alkaline solutions. In respect to the alkalies, if sufliciently strong to act upon the uric crust of the cal- culus, they would certainly injure the coats of the bladder: they would also become inactive by combination with the acids of the urine, and they would form a dangerous precipitate from the same cause. The acids, even when very largely diluted, and qualified with opium, always excite great irritation. They cannot, there- fore, be applied strong enough to dissolve any appretiable portion of the stone, and the uric nucleus always remains as an ultimate obstacle to success.**! The greatest impediment of all, however, consists in the difficulty of ascertaining the nature of the surface of the stone that is to be acted upon, and the diversity of substances of which its various lamina; very frequently consist: insomuch that had wo glasses that could give us an insight into the bladder and uniold to us the nature of the first layer, and could we even re- move this superficial crust by a solvent of one kind, we should be perpetually :aeet;ng w ith other crusts that would require other li- thontriptics; while the very means we employ to dissolve them, b\ decomposing the principles of the urine, would build up fresh layers faster than we could hope to destroy those that have already concreted. In truth if we examine the most famous lithontriptics that have had dieir day, we shall find that by far the greater number of them were e*icubHed to deceive either their own inventors, or the pub- h*-, by a palliative rather than a solvent power. Some of them v.er,! oleag. 1'ius or mucilaginous; others, that contained a consi- derable portion of alkali, contained also some narcotic preparation : * Mat. Med. Part is. Clnp. x. p. 402. t Journal, Vol. vm. p. 215. liE. 1V.-SP. II.J EXCERNENT FUNCTION. 3jD while a third sort seem to have acted by a diluent power alone, in consequence of being taken into the stomach or injected' into the bladder in a very large quantity; and by these means all had a tendency to r.,,oense the irritation. Even Mrs. Stephens's rude and operose prop; rations which exercised so much of the analytical skill of Dr. Hales, and Dr. Martlev, and Dr. Lobb, and Dr. Junn, and many other celebrated thnr.i, ;ers of their day, were combined with opium when the patient was in pain, and with aperients when he was costive; and through their ent.r. use, with an abstinence from port wines and other fermented liquors, salt meats, and heat- ing condiments, and with rest and a reclined position instead of ex- ercise ; and with these auxiliaries there is no great difficulty in supposing she might often succeed in allaying a painful fit of stone or irritation of the bladder, whatever may be the talismanic virtue of her egg-shells, and pounded snails, and best Alicant soap, and cresses, and burdock, and parsley, and fennel, and hips, and haws, and the twenty or thirty other materials that held a seat in the ge- neral council.* How far filling the bladder with sedative or demulcent injections may succeed in diminishing irritation and alleviating pain, has not perhaps been sufficiently tried : but from the supposed success of many of the old lithontriptics employed in this way, and whose vir- tue can be ascribed to no other cause, it is a practice worth adven- turing upon in the present age of physiological experiments. \\ hen, however, there is much disease of the prostate or bulb of tbe urethra, the attempt should be desisted from, but wherever the sound can enter without much pain, we need not be afraid of in- creasing the irritation. This operation is of very ancient date, and of equally extensive range, as appears from a brief account, pub- lished in a professional journal of considerable merit, of the manner in which it is performed in the present era, and has been from time immemorial in the dominions of Muscat, beyond the mountains of Sohair in Arabia. The instrument employed is a catheter of gold made long enough to pass directly into the bladder, so as to avoid injuring any part of the urethra with such solvent as might be had recourse to. The usual form it appears, and I notice it for the purpose of confirming the remark I have made upon the nature of such lithontriptics as have been most in vogue in every age, con- sisted of a weak ley of alkali or alkaline ashes, united with a cer- tain proportion of mutton suet and opium.t And when we are gravely told that this preparation never fails to dissolve the stone, we are at no loss to settle the account upon this subject, and can trace the real cause of whatever degree of ease may have been derived from such an injection, and can allow that even the alkali itself, if not in too concentrated a state, may have been of occa- sional advantage. * See a full account of them in Edin. Med. Essay*, Vol. v. Part n. Art. lxiv. • Edin. .Mod. Comm. Vol. Ml. p. 334. 356 ECCRITICA. [CL. Vl.-OR. II. When, however, all these means of relief fail, and the general health is worn out by a long succession of pain and anxiety, no- thing remains but the operation of extraction. The shortness and expansibility of the urethra in women which allows, as we have already seen, a passage for calculi of a considerable calibre to pass naturally, has suggested an idea of the possibility of introducing a stone forceps into the female bladder so as to supply the place of lithotomy. The first hint of this kind that has occurred to me, is to be found in the Gallicinium Medico-practicum of Gockel, publish' ed at Ulm in 1700. It was afterwards taken up, perhaps originally started, by Mr. Bromfield, who ingeniously advised that the urethra should, for this purpose, be dilated by forcing water through the gut of a fowl introduced into the urethra as an expansile canula. Mr. Thomas has since, by the use of a sponge-tent gradually en- larged for the purpose, succeeded in introducing his finger into the bladder, and bringing away an ivory ear-pick which had been in- cautiously used as a catheter, and had slipped into the cavity of this organ.* This, however, is a method that can never be applied to males, nor even successfully to females, except where the calculus is com- paratively of small dimensions, or the meatus is so far dilated by the passage of former calculi as to render it unnecessary. In all other cases lithotomy offers the only means of removing the indis- soluble stone from the bladder; and for the various modes in which this is performed, the reader must consult the writers on practical surgery. Calculi thus extracted have been found of all weights and bulks A stone from a quarter of a pound to half a pound may, perhaps, be regarded as the ordinary average : but they have sometimes grown to a much larger size, and have still been safely extracted. The largest for which lithotomy seems at any time to have been per- formed in this country, weighed forty-four ounces, and was sixteen inches in length. The operation was performed by Mr. Cline, but the stone could not be brought away, and the patient died a few days after.t In a foreign journal of high reputation, we have an account of a calculus found in the bladder after death, that weighed four pound and a half or seventy-two ounces, and seems to have filled nearly the whole of its cavity.J * Transactions of the Medico-Chir. Soc. Vol. i. p. 124.' t Phil. Trans, year 1809. X Brcsl. Sammlung. Band. n. 1724. 434. 11. CLASS VI. ECCRITICA. ORDER III. ACROT1CA. mmnnen affectttifl the Erternal Surface. TRAVITY OF THE FLUIDS OR EMUNCTORIES THAT OPEN ON THE EXTER- NAL SURFACE; WITHOUT FEVER, OR OTHER 1NTERRAL AFFECTION, AS A NECESSARY ACCOMPANIMENT. Acrotica is a Greek term, from xx^tg, " summus," whence «*g«Tns- irrtg, " summitas," " cacumen." The excretories of the skin form a most important outlet of the system, and although the fluid they se- crete is, in a state of health, less complicated than that of the kid- neys, under a variety of circumstances it becomes more so. It is to this quarter that all the deleterious or poisonous ferments pro- duced by eruptive fevers are directed by the remedial power of nature, as that in which they can be thrown off with least evil to the constitution. By the close sympathy which the surface of the body holds with the stomach, the heart, the lungs, and the kidneys, its excretories are almost perpetually varying in their action, and still more so from their direct exposure to the changeable state of the atmosphere : in consequence of which they are one moment chilled, torpid, and collapsed, and perhaps the next violently excit- ed and irritated: now dry and contracted, now relaxed and stream- ing with moisture ; now secreting their natural fluid alone, and now charged with acrimonies of every kind, acid, alkaline, and saburral: and sometimes with a load of gluten or calcareous earth that har- dens into horn or shell. But the mouths of the cutaneous exhalants are in their own na- ture peculiarly delicate and tender; and hence the necessity of their being covered by the epithelium of a fine cuticle, which defends them in a considerable degree from the rudeness of external im- 358 ECCRITICA. [CL. VI.-OR. III. pressions or irritants with which the air is impregnated. This de- fence, however, they frequently lose; often from external violence, and often also from the acrimony or roughness of the materials that are thus transmitted to them, and which excoriate as effectually as friction, a keen frosty north-east wind, or the direct rays of a tropi- cal sun. And at times tbe absorbents of the skin are torpid or weak in their action; and the finer parts only of the fluids that are se- cerned are imbibed and carried off, while the grosser parts remain and accumulate in the cutaneous follicles, and become acrimonious from decomposition. And hence a great variety of superficial erup- tions, papulous, pustulous, and ichorous, squammose, or furfura- ceous. And not unfrequently there is a constitutional irritability of the skin which not only renders it peculiarly liable to be excited by small causes in every part, but to sympathize in the morbid ac- tion through its whole extent in whatever part it may commence: and hence the spread of eruptions to a greater or less extent, some- times, indeed, over the entire surface. From these sources of affection a variety of complaints must ne- cessarily take their rise, none of them perhaps fatal to life, but ma- ny of them peculiarly troublesome and obstinate. They may be arranged under the following genera : I. EPHIDROSIS. MORBID SWEAT. II. EXANTHESIS. CUTANEOUS BLUSH. III. EXORMIA. PAPULOUS-SKIN. IV. LEPIDOSIS. SCALE-SKIN. V. ECPHLVS1S. BLA1NS. VI. ECPYESIS. SCALL. TETTER. VII. MALIS. CUTANEOUS VERMINATION VIII. ECPHYMA. CUTANEOUS EXCRESCENCE IX. TRICHOSIS. MORBID HAIR. X. EPICHROSIS. MACULAR SKIN. Most of these genera contain numerous species, many of which though by no means all, form a part of Dr. Willan's arrangement! and have been described by himself or my late excellent friend Dr. Bateman, of whose labours I shall avail myself as far as they may answer the present purpose. GE.I.] EXCERNENT FUNCTION. 359 GENUS I. EPHIDROSIS. jHorfcttr Stoeat. PRETERNATURAL SECRETION OF CUTANEOUS PERSPIRATION. Ephidrosis (tQfyvaig) is a Greek term for " sudor." The matter of sweat and that of insensible perspiration are nearly the same ; the former consisting of the latter with a small intermixture of animal oil. It is affirmed by some writers that there are persons who never perspire. This demands ample proof; for experience teaches us that all warm-blooded animals either perspire by the skin, or have some vicarious evacuation that supplies its place, as in the case of the dog kind, in which an increased discharge of saliva seems to answer the purpose; though in violent agony, 1 have known a Newfoundland dog thrown into a sweat that has drenched the whole of his thick and wavy hair. In cold-blooded animals we sometimes find partial secretions, as in the lizards, the exudation from some of which, particularly the lacerta Geitja of the Cape of Good Hope, is highly acrid; and as it touches the hands and feet of men occasionally produces dangerous gangrenes. Generally speak- ing, however, cold-blooded animals secrete but a small quantity of fluid from the surface, and consequently suffer but little exhaustion or diminution of weight, and can live long without nourishment: and it is hence probable that, among mankind, those who throw off but a small quantity of halitus may exist upon a very spare supply of food ; which may afford a solution to many of the wonderful stories of fasting persons, most of whom seem to have passed seden- tary and inacthe lives, recorded in the scientific journals of differ- ent countries, a subject we have already discussed r* for the matter of insensible perspiration is calculated, upon an average, as being- daily equal in weight to half the food introduced into the stomach in the course of the day. Thus if a man of good health and middle age, weighing about 146 pounds avoirdupois, eat and drink at the rate of fifty-six ounces in twenty-four hours, he will commonly be found to lose about twenty-eight ounces within the same period by insensible perspiration: sixteen ounces during the two thirds of this period allotted to wakefulness, and twelve ounces during the re- maining third allotted to sleep. It sometimes happens that this evacuation is secreted in excess, and becomes sensible, so as to render the whole, or various parts of the body, and especially the palms of the hands covered with mois- * Vol. I. Class i. Ord. r. LimCii* expers, •-. To. 360 ECCRITICA. [CL. VI.-OR. HI. ture, without any misaffection of the system. It is to this species that the term ephidrosis has been usually applied and limited by nosologists. Sauvages, however, has employed it in a wider signifi- cation, so as to include various other species, and perhaps correct- ly ; though Cullen inclines to regard all but the first as merely symptomatic of some other complaint. The following appear to be those which are chiefly entitled to a specific rank: 1. EPHIDROSIS PROFUSA. PROFUSE SWEAT. 2.---------CRUENTA. BLOODY SWEAT. 3.---------PARTIALIS. PARTIAL SWEAT. 4.---------DISCOLOR. COLOURED SWEAT. 5.---------OLENS. SCENTED SWEAT. 6. --------- ARENOSA. SANDY SWEAT. SPECIES I. EPHIDROSIS PROFUSA. ^rofttise Stoeat. CUTANEOUS PERSPIRATION SECRETED PROFUSELY. This is commonly a result of relaxed fibres : the mouths of the cu- taneous exhalants being too loose and patulous, and the perspirable fluid flowing forth copiously and rapidly upon very slight exertions, sometimes without any exertion at all; as we have already seen the urine flows in paruria aquosa and the serum in various species of dropsy. There is here, generally speaking, less solution of animal oil than in perspiration produced by exercise or hard labour:* but from the drain that is perpetually taking place, no animal oil accumulates, and the frame is usually slender. Corpulent persons also perspire much, but this is altogether from a different cause, being that of the weight they have to carry, and the labour with which breathing and every other function is performed in consequence of the gene- ral oppression of the system. Here also an extenuation of the frame would soon follow, but that from the peculiar diathesis which so readily predisposes to the formation of fat the supply is always equal to, and for the most part continues to exceed the waste, unless a more than ordinary course of exertion be engaged in. In persons of relaxed fibres, but whose general health is sound, I have frequently perceived that there is no particularly liability to * Biichner, Diss, de Sudore colliquative. Hal. 1757. GE. I.-»-SP. I.] EXCERNENT FUNCTION. 361 catch cold, notwithstanding this tendency to perspiration, and have very often seen it suddenly checked without any evii: such is the wonderful effect of an established habit. But |£e moment the gene- ral health suffers, or the system becomes seriously weakened by its continuance, the sweat is apt to become colliquative, and to termi- nate in a tabes or decline.* Tulpius gives a case of its continuing for seven years.t Astrin- gents of all kinds have been tried, but with variable effects. Dr. Percival relied chiefly on bark; De Haen employed the white agaric,J an(' 1° tne Journal de Medicine,§ the same medicine is re- commended under the name of fungus laricis ; it is the boletus laricis of the present day. It was given in the form of troches and pills. Cold sea-bathing, and the mineral acids, with temperate exercise, light animal food, and the use of a hair mattrass instead of a down bed at night, have proved successful on many occasions, and form rlie best plan we can adopt. SPECIES II. EPHIDROSIS CRUENTA. Blooftg Storat. CUTANEOUS PERSPIRATION INTERMIXED WITH BLOOD. This species has nofbeen very commonly described by nosologists; but the cases of idiopathic affection are so numerous and so clearly marked by other writers that it ought not to be passed over.|| We have noticed a sympathetic and vicarious affection of this kind under the genus mismenstruation,H and have there observed that the cutaneous exhalants, in such instances, become enlarged in their diameter, and suffer red blood or a fluid of the appearance of red blood to pass through them. In cases of extreme debility from other causes, as in the last and fatal stage of atonic fevers, or in sea or land scurvy** blood has been known to flow from the cutaneous exhalants in like manner, evidently from weakness, and a relaxation of their extremities, in connexion perhaps with a thinner or more * See Vol. n. p. 474. t Lib. in. Cap. 42. X Rat. Med. P. xn. Cap. vi. ♦ 6. i Tom. xi.vn. || Ploucq. Init. vn. 31G. ^i Vol. in. p. 15. ** N. Am. Nat. Cur. Vol. iv. Obs. 41. Bresl. Sanunl. 1725. i. p. 1SS. vol.. iv ir> 362 ECCRITICA. [CL. VI.-OR. IH. dissolved state of the blood itself. None of these, however, are idiopathic affections. When the discharge shows itself as a prima- ry disease, the cause has generally been some violent commotion of the nervous system forcing the red particles into the cutaneous ex- cretories, rather than a simple influx from a relaxed state of their fibres. And hence it has taken place occasionally during coition ;* sometimes during vehement terror; and not unfrequently during the agony of hanging or the torture.! It is said also to have occurred in some instances in new-born infants,}; probably from the addition- al force given to the circulation, in consequence of a full inflation of the lungs accompanied with violent crying. SPECIES III. EPHIDROSIS PARTIALIS. $artfal Storat. CUTANEOUS PERSPIRATION LIMITED TO A PARTICULAR PART OR ORGAN. There are some persons who rarely perspire, others who perspire far more freely from one organ than another as the head, or the feet, or the body. Such abnormities rather predispose to morbid affections, than are morbid affections themselves. Sauvnges in il- lustration of the present species, quotes a case from Hartmann, of a woman who was never capable of being thrown into a sweat either by nature or art in any part of her body except when she was preg- nant, at which time she perspired on the left side alone.§ Schmidt has noticed a like anomaly.|| In this last case it is probable that the kidneys became a substi- tute for the action of the cutaneous exhalants, as we see they do on various occasions, as when their mouths become collapsed from the chilly spasm that shoots over them on plunging into a cold bath, or in a tit of hysterics. The sweat thus discharged from a partial outlet, is frequently fetid, as under the fifth species of the present genus; and where it is constitutional, it is often repelled with great danger to some more important organ. * Panlini, Cent. in. Obs. 46. Eph. A at. Dec. n. Ann. vi. Appx. pp. 4. 45. 55. t Barlhniinus, Epist. i. p. 718. X Eph. Nat. Cur. Dec. n. Ann. x. Obs. 65. } Ilartmanni, De Sudore unius lateiis, 4to. 17-10. |j Collect. Acad. Vol. in. p. 577. r.E. I.-SP. IV.] EXCERNENT FUNCTION. 363 SPECIES IV. EPHIDROSIS DISCOLOR. eroiourco- Sfocat. CUTANEOI S PERSPIRATION POSSESSING A DEPRAVED TINGE. Sweat is often tinged with a deeper yellow than is natural to it from a resorption of bile into the blood-vessels: and, as we have already seen, it is sometimes intermixed with blood from violence, or a re- laxed state of the cutaneous exhalants. And where these, or causes like these, co-operate, we can readily account for the various co- lours it has sometimes exhibited as green, black, blue, saffron, or ruby: examples of all which are referred to in the volume of No- sology. We see, indeed, the whole of these hues produced daily under the cuticle from the extravasation of blood, according as the effused fluid is more or less impregnated with the colouring matter of the blood, and the finer and more limpid parts are first absorbed and carried off. It is possible also that in some of the cases refer- red to, the stain may have been produced by inhaling a vapour im- pregnated with metallic corpuscles or some other pigment; and especially when working in metallurgical trades or quicksilver mines. SPECIES V. EPHIDROSIS OLENS. Scentefc Stocat tlTANEOLS PERSPIRATION POSSESSING A DEPRAVED SMELL. The varieties that have been chiefly noticed are those of a sulphu- reous scent; of a sour scent; of a rank or fetid scent; of a violet,* and of a musky scent.t The rank or fetid scent is sometimes par- tial ; being only evacuated from particular organs as the leet and axilla. De Monteaux, however, has found the same thrown off gene- rally :J and as a symptom in atonic fevers it must have been witnessed * Paullini, Cent. i. Oh*. 21. Eph. Nat. Cur. Dec. n. Ann. v. Appx. p. 9, t Id. Dec. Hi. Ann. IX. x. Obs. 96. X Maladies de Femmes, Tom. n. 364 ECCRITICA. [CL. VI.-OR. Ill' by most practitioners, as also in several sordid cutaneous eruptions. In fevers, moreover, we frequently meet with a secretion of sour perspiration, which, in a few instances, has had the pungency of vinegar. When such smells accompany diseases they usually cease on the cessation of the disease which gives rise to them. Where they are habitual they often depend upon a morbid state of tbe sto- mach, or of the cutaneous excretories; and will often yield to a course of aperients or alterants, a frequent use of the warm, and, when the constitution will allow, of the cold-bath, and such exercise as shall call forth a copious discharge of perspirable matter, and free the cutaneous follicles or orifices of whatever olid materials may lurk there. Many of these, however, are often dependent upon the diet or manner of life. Thus the food of garlic yields a perspiration pos- sessing a garlic smell: that of peas a leguminous smell, which is the cause of this peculiar odour among the inhabitants of Greenland; and acids a smell of acidity. Among glass-blowers, from the large quantity of sea-salt that enters into the materials of their manufac- ture, the sweat is sometimes so highly impregnated that the salt they employ and imbibe by the skin and lungs, h.is been seen to collect in crystals upon their faces. A musky scent is not often thrown forth from the human body, but it is perhaps the most com- mon of all odours that escape from the skin of other animals. We discover it in many of the ape kind, and especially the simia Jacchus; still more profusely in the opossum, and occasionally in hedge-hogs, hares, serpents, and crocodiles. The odour of civet is the produc- tion of the civet-cat alone ; the viverra Zibetha, and viverra Civetta of Linneus, though we meet with faint traces of it in some varieties of the domestic cat. Among insects, however, such odours are con- siderably more common, and by far the greater number of them are. of an agreeable kind, and of very high excellence ; for the musk scent of the cerambix moschatus, the a\risfragrans, and the tipula mos- chifera, is much more delicate than that of the musk quadrupeds: while the cerambix suaveolens, and several species of the ichneumon yield the sweetest perfume of the rose ; and the petiolated sphex a balsamic ether highly fragrant, but peculiar to itself. • E. I.-SP. VI.] EXCERNENT FUNCTION. 365 SPECIES VI. EPHIDROSIS ARENOSA. Sairts Stoeat. CUTANEOUS PERSPIRATION CONTAINING A DISCHARGE OF SANDY OR OTHER GBANULAR MOLECULES. As the odorous particles of both animal and vegetable food are sometimes absorbed by the lacteals and impregnate the matter of perspiration, so at times are the more solid particles of the mate- rials employed in handicraft trades absorbed by the lungs, and equally thrown forth upon the surface. This, as observed un- der the last species, is particularly the case with glass-blowers, upon whose forehead and arms salt is often seen to collect and crystallize in great abundance, from the quantity of this material which they employ in the manufacture of glass, and its diffusion through the heated atmosphere of the workshop in minute and im- perceptible particles. But a reddish sandy material is occasionally found to concrete on the surface of the body under other circumstances and which can- not be charged to any material volatilized in the course of business. Bartholin, Schurig,* Mollenbroek,t and various other writers have given instances of this kind of crystallization, which seems to con- sist in an excess of free uric acid, translated from the kidneys to the skin by an idiopathic sympathy, and forming red sand on the surface, as it probably would otherwise have done in the bladder or the urinal. It is possible, indeed, that a man may hereby escape from the fabrication of an urinary calculus, or stone in the bladder: and were such a transfer at all times in our power, we should gladly avail ourselves of it in many cases of a lithic diathesis, and employ it as a preventive of urinary concretions. When the sand is trou- blesome from the quantity collected the alkaline and other medi- cines recommended under lithia renalis^ will easily remove it.§ * Litholog. p. 235. t De Vans, Cap. xm. X Hist. Anat. Cent. I. 31. f Supra, p. 346. 366 ECCRITICA. [CL VL-OR. III. GENUS II. EXANTHESIS. eutaneous JJlusft. SIMPLE, CUTANEOUS, ROSE-COLOURED EFFLORESCENCE, IN CIRCUMSCRIBED PLOTS, WITH LITTLE OR NO ELEVATION. Exanthesis is a Greek compound fromsg" extra" anda»9e« " floreo," superficial or cutaneous efflorescence, in contradistinction to enan- thesis in Class in. Order iv. rash-fever or " efflorescence springing from within." This genus affords but one known species, the specific name for which is taken from Dr. Willan : 1. EXANTHESIS ROSEOLA. ROSE-RASH. SPECIES I. EXANTHESIS ROSEOLA. EFFLORESCENCE IN BLUSHING PATCHES, GRADUALLY DEEPENING TO A ROSE- COLOUR, MOSTLY CIRCULAR, OR OVAL ; OFTEN ALTERNATELY FADING AND REVIVING; SOMETIMES WITH A COLOURLESS UMBO J CHIEFLY ON THE CHEEKS, NECK, OR ARMS Roseola was sometimes employed by the older WTiters, though in a very loose .sense, to signify scarlet-fever, measles, and one or two other exanthems that were often confounded : but as it is now no longer used for these it may stand well enough as a name for the present species, which Fuller has described as a flushing all over the body like fine crimson, which is void of danger, and l* rather a ludicrous spectacle than an ill symptom.*** As a symptom this rash is frequently met with in various mala- dies. Thus in the dentition of infancy it appears on the cheeks ; in the inoculated cow-pox, around the vesicle ; in dyspepsy, and various fevers, in different parts of the body, constituting varieties, several of which by Dr. Willan are named, according to the disease •'* Exanthematologia, p. 128. Batetnan's Synops. 95. GE. IL-SP. I.] EXCERNENT Ft NTTION. 367 they accompany, Roseola infantilis, R. variolosa, R. vaccina, and R. mi- liaris: but which, as mere symptoms of other disorders, are to be sought for in the diseases of which they occasionally form a part. In the spring and autumn it often appears to be idiopathic espe- cially in irritable constitutions. The occasional causes are fatigue, sudden alterations of heat and cold, or the drinking of very cold water after violent exercise. Dr. Willan mentions one instance of its occurring after sleeping in a damp bed. It has sometimes been mistaken for an eruption of the measles, and still oftener for that of a mild rosalia or scarlet-fever, of which last error the same author gives an example in a child that was extensively affected with it, about Midsummer, for several years in succession, and whose attendant physician informed the parents that the scarlet fe- ver had recurred in their child, seven times; and hence one reason why the same name was formerly applied to all these. The attack is sometimes preceded during the heat of summer, by a slight febrile indisposition. It appears first on the face and neck, and, in the course of a day or two, is distributed over the rest of the body. The eruption spreads in small patches of various figures but usually larger than those of measles, often as large as a shilling, at first of a brightish red, but soon settling into the deeper hue of the damask rose. It sometimes assumes an annular form, and appears over the body in rose-coloured rings with central areas or umbos of the usual colour of the skin: the rings being at first small, but gradually dilating to the diameter of half an inch. This rash is troublesome, but of little importance otherwise. In the medical treatment of it the state of the stomach and bowels should be particularly inquired into, and, for the most part, will be found to require correction. Acidulated drinks, with occasional and gentle laxatives generally remove the disease, unless it be con- nected with any constitutional or visceral affection, when it some- times proves very obstinate, and can only be cured by curing the primary malady. GENUS III. EXORMIA. $ajmlQU0 Sftfu. SMALL ACUMINATED ELEVATIONS OF THE CUTICLE; NOT CONTAINING * FLUID, NOR TENDING TO SUPPURATION; COMMONLY TERMINATING IN SCURF. For the acuminated elevation cf the cuticle, which the Latins call papula, the Greeks had two synonymou* terms ecthyma, (i*fo«** 368 ECCRITICA. [CL. VI.-OR. III- and exormia {t%tQtut.) The first was used most frequently in this sense ; but as this nas by some unaccountable means been employed very generally to import a very different eruption, a crop of large pustulous, rather than of small solid pimples, forming a species of ecpyesis, or the sixth genus of the present order, I have chosen the second term for the present purpose. The common terminating diminutive (ula or ilia) is probably de- rived from the Greek fan (ule or ile,) " materia," u materies"— of the matter, make, or nature of; " thus papula or papilla," of the matter or nature of pappus; " lupula," of the matter or nature of the lupus; " pustula," of the matter or nature of pus ; and so of many others. Papula and pustula, which by Sauvages are degraded into mere symptoms of diseases, and not allowed to constitute diseases of them- selves, are raised to the rank of genera by Celsus, Linneus, and Sa- gar, and, under a plural form (papulae and pustula?,) to that of or- ders by Willan. In the present system exormia and ecphlysis, in- tended to supply their place, are employed as generic terms, and run parallel with those papulae and pustulae of Willan, which are not essentially connected with internal disease ; and are only made use of instead of papula and pustula, first as being more immediate- ly Greek, and next, in order to prevent confusion from the variety of senses assigned to the latter terms by different writers. Exormia and ecphlysis, therefore, as distinct genera under the present ar- rangement, import eruptions of pimples and pustules in their sim- plest state, affecting the cuticle, or at the utmost the superficial in- tegument alone, and consequently without fever, or other internal complaint as a necessary or essential symptom ; although some part or other of the system may occasionally catenate or sympathize with the efflorescence. It is difficult, indeed, to draw a line of se- paration, and perhaps impossible to draw it exactly, between efflo- rescences strictly cutaneous and strictly constitutional, from the nu- merous examples we meet with of the one description combining with or passing into the other. But a like difficulty belongs to eve- ry other branch of physiology in the widest sense of the term, as well as to nosology; and all we can do in any division of the sci- ence, is to lay down the boundary with as much nicety and caution as possible, and to correct it, as corrections may afterwards be call- ed for. The species which belong to this genus, or which, in other words, are characterised by a papulous skin not necessarily connected with an internal affection are the following: 1. EXORMIA STROPHULUS. GUM-RASH. 2.-------LICHEN. LICHENOUS RASH. 3.-------PRURIGO. PRUR1GINOUS RASH. 1.-------MILIUM. MU.I.F.T-RASH. GE. IU.-SP. I.] EXCERNENT FUNCTION. 369 SPECIES I. EXORMIA STROPHULUS. e?um=2vasli. ERUPTION OF RED PIMPLES IN EARLY INFANCY, CHIEFLY ABOUT THE FACE. NECK, AND ARMS, SURROUNDED BY A REDDISH HALO ; OR INTERRUPTED BY IRREGULAR PLOTS OF CUTANEOUS BLUSH. Dr. Willan has observed, that the colloquial name of Red-gum, applied to the common form of this disease, is a corruption of Red- gown, under which the disease was known in former times, and by which it still continues to be called in various districts; as though supposed, from its variegated plots of red upon a pale ground to resemble a piece of red printed linen. In effect it is written Red- gown in most of the old dictionaries: in Littleton's as late as 1684, and I believe to the present day. The varieties in Willan are the following, whose descriptions are large and somewhat loose. We may extract from them, however, the subjoined distinctions of character: a Intertinctus. Pimples bright red; distinct; inter- Red-gum. mixed with stigmata, and red patch- es ; sometimes spreading over the body. Q Albidus. Pimples minute, hard, whitish ; sur- White-gum. rounded by a reddish halo. y Confertus. Pimples red, of different sizes, crowd- Tooth-rash. iDg or in clusters; the larger sur- rounded by a red halo ; occasionally succeeded by a red crop. 3 Volaticus. Pimples deep-red, in circular patches, Wild-fire-rash. or clusters ; clusters sometimes soli- tary on each arm or cheek ; more generally flying from part to part. t Candidus. Pimples large, glabrous, shining ; of a Pallid gum-rash. lighter hue than the skin : without halo or blush. Generally speaking none of these varieties are of serious impor- tance ; and all of them being consistent with a healthy state of all the functions of the body, they require but little attention from medical practitioners. Several of them are occasionally connected with acidity or some other morbid symptom of the stomach and bowels, and, hence, particular attention should be paid to the primse viae. The system, also, suffers generally, in many cases, if the vol. iv. 47 370 ECCRITICA. [CL. VL-OR. HI. efflorescence be suddenly driven inwards by exposure to currents ot cold air or by the use of cold-bathing. Both these, therefore, should be avoided while the efflorescence continues; and if such an acci- dent should occur, the infant should be immediately plunged into a warm-bath, which commonly succeeds in reproducing the eruption, when the constitutional illness ceases.* In every variety, indeed, the nurse should be directed to keep the child's skin clean, and to promote an equable perspiration by daily ablutions with tepid water, which are useful in most cutaneous disorders; and will be found in other respects of material importance to the health of children. In the tootb-rash, strophulus confertus, there is no difficulty in tracing the ordinary cause. Yet this also, has often been ascribed to a state of indigestion or some feverish complaint in the mother or nurse. " I have, however," says Dr. Willan, " frequently seen the eruption, where no such cause for it was evident. It may with more propriety.be ranked among the numerous symptoms of irrita- tion arising from the inflamed and painful state of the gums in denti- tion, since it always occurs during that process, and disappears soon after the first teeth have cut through the gums." It may, however, like the red-gum, s. intertinctus, be occasionally connected with a weak and irritable state of the bowels : though the tender and deli- cate state of the skin, and the strong determination of blood to the surface, which evidently takes place in early infancy, and is the common proximate cause of the red-gum, is probably the common remote cause of the tooth-rash. The tooth-rash is the severest form in which strophulus shows itself. Instead of being confined to the face and breast, it oftentimes spreads widely over the body, though it appears chiefly, in a diffused state, on the fore-arm. Dr. Willan notices a very obstinate and painful modification of this disorder which sometimes takes place on the lower extremities. " The papulae spread from the calves of the legs to the thighs, nates, loins, and round the body, as high as the navel; being very numerous and close together, they produce a continuous redness over all the parts above mentioned. The cuticle presently becomes shrivelled, cracks in various places, and finally separates from the skin in large pieces." It has some resemblance to the intertrigo, which however may be distinguished by having an uniform red, shining surface without papulae, and being limited to the nates and thighs. In like manner, those children are most liable to the scrophulus volaticus or wild-fire rash, who have a fair and irritable skin, though this also occasionally catenates with a morbid state of the stomach and bowels. It appears sometimes as early as between the third aod sixth month, but more frequently later. This last is the erythema volaticum of Sauvages, the aestus vola- ticus of many earlier writers: whence the French name of feu volage. All these terms, have however, been often used in a very Bronzet, sur rEducation des Enfans. p. 187. GE. 1IL-SP. I.] EXCERNENT FUNCTION. indefinite sense, and hence, also applied to one or two> species of porrigo, and especially porrigo Crustacea or crusta lactea. And hS, Dr. Armstrong has described this last disease as a strophulus or tooth-rash.t , ... iUn tmn The strophulus albidus, and strophulus candidus, are the two slightest varieties of this species of indispositions. I he first s chiefly limited to the face, neck, and breast, and often continues in the form of numerous, hard, whitish specks for a long time, which on the removal of their tops do not discharge any fluid, though it is probable they were originally formed by a deposition of fluid, whicti afterwards concreted under the cuticle. The pimples in the scro- phulus candidus are larger and diffused over a wider space ; often distributed over the loins, shoulders and upper part of the arms though it is rarely that they descend lower. Several of the varie- ties occasionally co-exist and run into each other particularly the first two.f SPECIES II. EXORMIA LICHEN. Stchtuous Hash, ERUPTION DIFFUSE? PIMPLES RED; TROUBLESOME SENSE OF TINGLING OR PRICKING. Lichen (a«™» -»g) is a term common to the Greek phytologists as well as the Greek pathologists. By the former it is applied to that extensive genus of the algae, or rather to many of its species, which still retains the name of lichen in the Linuean system: and it is conjectured by Pliny that the physicians applied the same name to the species of disease before us from the resemblance it produces on the surface of the body to many of the spotty and minutely tubercular lichens, which are found wild upon stones, walls, and the bark of trees or shrubs. Gorraeus, however, gives two other origins of the term ; one, of which he does not approve, from the eruption being supposed to be cured by its being licked with the human tongue ; and the other, to which he inclines, from its creeping in a lambent or tongue-like form, over different parts of the body. The derivatioa«n both these cases being *uy,* " lambo," " lingo." It is a far more troublesome rash than the preceding; from the severest modifications of which, however, it chiefly differs by the * Astruc, De Morb. Infant, p. 44. t On the Diseases of Children, p. 34. ■ Under"^o:", on tl-ie Diseases of Children. Vol. I. nissira 372 ECCRITICA. [CL. Vl.-OR. HI. intolerable tingling or pricking which accompanies, and peculiarly characterises it. The following are its chief varieties : x Simplex. Simple Lichen. C Pilaris. Hair-Lichen. y Circumscriptus. Clustering Lichen. d Lividus. Livid Lichen. i Tropicus. Summer-rash. Prickly-heat. £ Ferus. Wild Lichen. n Urticosus. Nettle-Lichen. General irritation; sometimes a few febrile symptoms at the commencement ; tingling ag- gravated during the night; pim pies scattered over the body; which fade and desquammate in about a week. Pimples limited to the roots of the hair; desquammate after ten days ; often alternating with complaints of the head or sto- mach. Pimples in clusters or patches of irregular forms, appearing in succession over the trunk and limbs : sometimes coalescing: and occasionally reviving in successive crops, and perse- vering for six or eight weeks. Pimples dark-red or livid; chiefly scattered over the extremities ; desquammafion at uncertain pe- riods, succeeded by fresh crops, often persevering for several months. Pimples bright red, size of a small pin's head; heat, itching, and needle-like pricking; some- times suddenly disappearing, and producing sickness, or other internal affection; relieved by the return of a fresh crop. Pimples in clusters or patches, surrounded by a red halo; the cuticle growing gradually harsh, thickened, and chappy : often preceded by general irritation. Pimples very minute, slightly ele- vated, reddish: intolerably itch- ing, especially at night; irregu- larly subsiding7 ana* reappear- ing ; chiefly spotting the limbs; occasionally spreading over the body with gnat-bite-shaped wheals: from the violence of the irritation, at times accom- GE. III.-SP. II.] EXCERNENT FUNCTION. 373 panied with vesicles or blisters, and succeeded by an extensive exfoliation of the cuticle. Under this species, as under the last, we may observe that all the varieties are in their purest state simple affections of the skin, though occasionally, probably from peculiarity of habit, or some ac- cidental disorder of the digestive function, connected with the state of the constitution or of the stomach or bowels. Dr. Willan, indeed, makes it a part of his specific character, that lichen is " connected with internal disorder:" but his description is at variance with his definition; for with respect to the first variety, or simple lichen, he expressly asserts,* that it " sometimes appears suddenly without any manifest disorder of the constitution ;" while in regard to the tropical lichen or prickly heat, one of the severest modifications under which the disease appears, he states, and with apparent ap- probation, from Winterbottom, Hillary, Clark, and Cleghorn, that it is considered as salutary; that even, " a vivid eruption of the prickly heat is a proof that the person affected with it is in a good state of health ;"—that " its appearance on the skin of persons in a state of convalescence from fevers, &,c. is always a favourable sign, indicating the return of health and vigour ;"t that " it seldom causes any sickness or disorder except the troublesome itching and pricking:"'| that itis not attended with any febrile commotion whilst it continues out;"§ and that " it is looked upon as a sign of health, and, indeed, while it continues fresh on the skin, no inconvenience arises from it except a frequent itching."|| And, in like manner, Dr. Heberden observes that some patients have found themselves well on the appearance of the eruption, but troubled with pains of the head and stomach during the time of its spread; but by far the greater number experience no other evil from it besides the in- tolerable anguish produced by the itching, which sometimes makes them fall away by breaking their rest, and is often so tormenting as to make them almost weary of their lives. Most of these re- marks apply equally to the urticose variety, one of its severest forms, as I shall have occasion to observe presently. The simple lichen shows itself first of all by an appearance of distinct red papulae about the cheeks and chin or on the arms, with but little inflammation round their base: in the course of three or four days the eruption spreads diffusely over the neck, body, and lower extremities, attended with an unpleasant sensation of tingling which is sometimes aggravated during the night. In about a week the colour of the eruption fades, and tbe cuticle separates in scurf. * Willan, p. 39. t Id. p. 35, from Winterbottom. X Id. p. 59, from Hillary. i Id. p. 61, from Clark. || Id. p. 63, from Cleghorn 374 ECCRITICA. [CL. VI.-OR. III. All the surface of the body, indeed, remains scurfy for a long time, but particularly the flexures of the joints. The duration of the complaint varies; and hence, in different cases, a term of from fourteen to thirty days intervenes between the eruption and a reno- vation of the cuticle. " The eruption sometimes appears suddenly without any manifest disorder of the constitution :"* and some- times there is a febrile state or rather a state of irritation at the beginning of the disorder though " seldom considerable enough to confine the patient to the house"!—and which is relieved by the appearance of the eruption. It has occasionally been mistaken for measles or scarlatina: but its progress, and, indeed, the general nature of its symptoms from the first are sufficiently marked to dis- tinguish it from either of these. The causes are not distinctly pointed out by any of the writers, and it is singular that they should have been passed by both by Willan and Bateman. So far as I have seen, this and all the va- rieties depend upon a peculiar irritability of the skin as its remote cause, and some accidental stimulus as its exciting cause. The ir- ritability of the skin is sometimes constitutional, in which case the patient is subject to frequent returns of the complaint; but it has occasionally been induced by various internal and external sources of irritation: as a diet too luxurious or too meagre; the debility occasioned by a protracted chronic disease, or an exacerbated state of the mind; an improper use of mercury, or of other preparations that have disagreed either with the stomach, or the chylifacient viscera. Under any of which circumstances, a slight occasional cause is sufficient for the purpose, as exposure to the burning rays of a summer sun, a sudden chill on the surface, cold water drunk during great heat or perspiration; a dose of opium or any other narcoctic, or substance that disagrees with the stomach or the idiosyncrasy. Dr. Heberden has suggested another cause, as per- haps operating in various cases, and inquires whether it may not be produced by some irritant floating in the atmosphere of so fine a structure as to be invisible to the naked eye, as the down of va- rious plants or insects; and he particularly alludes to the delicate hairs of the dolichos pruriens or cowhage as occasioning the dis- ease in the West Indies, from their attacking the skin in this man- ner imperceptibly. But since general ablutions afford little or no relief, and all medicated lotions are even more ineffectual; and as we can often trace it to other causes in our own country, and are at no loss for a different cause in the West Indies, the present can hardly be allowed to be the ordinary cause, though it may become an occasional excitement. The remedial process should consist in keeping the bowels cool and free by neutral salts; a mixed diet of vegetables, ripe fruits, * Willan, ut supra, p. 39. r Id. p. 37. i»E. III.—SP. II.J EXCERNENT FUNCTION. 375 especially of the acescent kind, as oranges and lemons, and fresh animal food; with an abstinence from fermented liquors, a light and cool dress, an open exposure to pure air, and an occasional use of the tepid-bath. The mineral acids have sometime proved service- able, but not always; and the red or black hydrargyria sulphuratus, has been thought useful by many. Where the system is evidently in an impoverished state from previous sickness, innutritive food, or any mesenteric affection, bark, the mineral acids, or the metallic tonics afford a reasonable hope of relief, and especially such prepa- rations of iron as may sit easy on the stomach. The hair lichen, and clustering lichen differ frpm the preceding in little more than a difference of station or of form. Their causes or mode of treatment run parallel, and it is not needful to enlarge on them farther. The livid lichen is evidently connected with a weak and debili- tated habit. Its papulae are often interspersed with petecchiae, sometimes, indeed, with purple patches or vibices, and manifest a state of constitution bordering on that of scurvy or porphyra. Here the diet regimen and medical treatment should be altogether tonic and cordial, and may be taken from the plan already proposed for this last malady.* The tropical lichen, or prickly heat, is a disease of high anti- quity and is equally described by the Greek and Arabian writers. The latter denominate it eshera, which is the plural of sheri, lite- rally papulce, and hence the papula, or papulous disorder, by way of emphasis. And this term, softened or corrupted into essera, has been adopted and employed as the name of the disease by many European writers of great reputation, as Bartholin, Hillary, and Ploucquet. The term, however, has sometimes been used both in the East and among Europeans in a looser sense, so as occasionally, but most improperly, to embrace urticaria, and some other febrile rashes as well. The symptoms of the disease I shall give in the words of my va- lued friend Dr. James Johnson, whose excellent work on the Influ- ence of Tropical Climates, I lament that I was not in possession of so early in the progress of the present undertaking as I could wish to have been. Dr. Johnson delineates the disease as he has felt it, and as, in recollection, he seems almost to feel it still, and hence his description flows Warm from the heart and faithful to its fires. " From mosquittoes," says he, " cock-roaches, ants, and the nume- rous other tribes of depredators on our personal property, we have some defence by night, and, in general, a respite by day; but this unwelcome guest assails us at all, and particularly the most unsea- sonable hours. Many a time have I been forced to spring from ta- ble and abandon the repast, which I had scarcely touched, to writhe * Vol. ii. p. 582. 376 ECCRITICA. [CL. VI.-OR. 111. about in the open air, for a quarter of an hour: and often have I returned to the charge, with no better success, against my ignoble opponent! The night affords no asylum. For some weeks after arriving in India, I seldom could obtain more than an hour's sleep at one time, before I was compelled to quit my couch, with no small precipitation, and if there were any water at hand, to sluice it over me, for the purpose of allaying the inexpressible irritation! But this was productive of temporary relief only; and what was worse, a more violent paroxysm frequently succeeded. " The sensations arising from prickly heat are perfectly inde- scribable ; being compounded of pricking, itching, tingling, and ma- ny other feelings, for which 1 have no appropriate appellation. " It is usually, but not invariably accompanied by an eruption of vivid red pimples, not larger in general, than a pin's head, which spread over the breast, arms, thighs, neck, and occasionally along the forehead, close to the hair. This eruption often disappears, in a great measure, when we are sitting quiet, and the skin is cool; but no sooner do we use any exercise that brings out a perspiration, or swallow any warm, or stimulating fluid, such as tea, soup, or wine, than the pimples become elevated, so as to be distinctly 6een, and but too sensibly felt! " Prickly heat, being merely a symptom, not a cause of good health, its disappearance has been erroneously accused of produc- ing much mischief; hence the early writers on tropical diseases, harping on the old string of " humoral pathology," speak very se- riously of the danger of repelling, and the advantage of u encourag- ing the eruption, by taking small warm liquors, as tea, coffees, wine whey, broth, and nourishing meats." "Indeed, 1 never saw it even repelled by the cold bath; and in my own case, as well as in many1 others, it rather seemed to aggra- vate the eruption and disagreeable sensations, especially during the glow which succeeded the immersion. It certainly disappears sud- denly sometimes on the accession of other diseases, but 1 never had reason to suppose, that its disappearance occasioned them. 1 have tried lime juice, hair powder, and a variety of external applications, with little or no benefit. In short, the only means which I ever saw productive of any good effect in mitigating its violence, till the constitution got assimilated to the climate, were—light clothing— temperance in eating and drinking—avoiding all exercise in the heat of the day—open bowels—and last, not least, a determined resolu- tion to resist with stoical .apathy its first attacks." The wild lichen, or lichen ferus, is particularly noticed by Cel- sus under the name of agria, as applied to it by the Greeks from the violence with which it rages. It occurs in him after a brief de- scription of a variety of papula of a milder kind, which Willan sup- poses, and with some reason, to be the clustering. " Altera autem est, quam *Ayg<«» Graeci appellant: in qua similiter quidem, sed ma- gis cutis exasperatur, exulceraturque, ac vehementius et roditur, et rubet, et interdum inter pilos remittit. Quae minus rotunda est, diffi- C.L. I1I.-SP. II.] EXCERNENT FUNCTION. 37; cilius sanescit: nisi sublata est, in impetiginem vertitur."* Thi- variety, however, in its general range, its vehemence, and protract- ed duration, approaches nearer to the nettie-lichen than to any oth- er: yet the pimples are larger, more clustered, and more apt to run into a pustular inflammation, so as often to produce cutaneous exulcerations and black scabs; and hence the remark of Celsus that it is disposed to terminate in an impetigo, or, as others have it, in psora or lepra. The urticose or nettle-lichen is, perhaps, the most distressing form of all the varieties, if we except the tropical: and like the tro- pical, notwithstanding its violence, it is often totally independent of any constitutional affection. I can distinctly say from various cases that have occurred to me, that even where the patient has been worked up to such a degree of madness as to force him against his own will into a perpetual scratching, which greatly exasperates it, still the constitution has remained unaffected, the pulse regular, the appetite good, and the head clear. In most of the cases, the author alludes to, however, there was an established or idiopathic irritability of the system, and especially of the skin; and in one or two of them it was unfortunate that opium, under every form and in every quantity always increased the irritability; while no other narcotic was of any avail. 1 freely confess that I have been more perplexed with this obstinate and intractable variety, which has, in some cases, irregularly subsided for a few days or weeks, and then re-appeared with more violence than ever, than I have been with almost any other complaint that has ever occurred to me. A tepid bath and es- pecially of sea-water has sometimes been serviceable, but I have often found even this fail; and have uniformly observed the bath mis- chievous when made hot; for the skin will not bear stimulation. From the alterant apozems of sarsaparilla, elm-bark, juniper-tops, and snake-root, no benefit has accrued ; and as little from sulphur, sulphurated quick-silver, nitre, the mineral acids, and the mineral oxydes and salts. I once tried the arsenic solution, but the stomach would not bear it. Sea-bathing, however, in connexion with sea-air, has rarely failed ; and 1 am hence in the habit of prescribing it to a delicate young lady who has been several times most grievously afflicted with this distressing malady, as soon as it re-appears; as well from the known inetficacy of every other remedy, a long list of which she has tried with great resolution, as from the benefit which this has almost uniformly produced. 1 have said that the wild lichen in its severity and duration offers a near resemblance to this. The former, however, is more apt to run into a pustular inflammation, though in the nettle-lichen we sometimes find a few of the vesicles filled with a straw-coloured fluid, but which are not permanent. There is also a greater tendency to some constitutional ailection in the wild than in the nettle modification, and particularly to a sickness or some other * De Medicina. Lib. v. Cap. xxvm. vol. iv. 48 378 ECCRITICA. [CL. Vl.-OR. ILL disorder of the stomach upon repulsion by cold. Under the nettle- lichen the patient seldom finds the stomach or any other organ give way, and will endure exposure to a sharp current of air with a full feeling of refreshment, without any danger of subsequent mischief. There is a singular modification of this disease described in a letter from Dr. Monsey, of Chelsea College, to Dr. Heberden, in which the cause was exposure of the skin to a bright sun in the open air. The patient was a man thirty years of age, of a thin, spare, habit; and his skin, as soon as the solar rays fell upon it, became instantly almost as thick as leather, and as red as vermilion, with an intolerable itching: the whole of which abated about a quarter of an hour after he went into the shade. Dr. Monsey adds that this was not owing to the heat of the sun, for the sun in winter affected him full as much, if not more, and the heat of the fire had not such an effect. He was, in consequence, thrown into a state of " confinement for near ten years. It may not be amiss," continues Dr. Monsey, " to mention one particular, which is, that one hot day having a mind to try if he were at all benefited by his immersions" (he seems to have used a salt-bath under cover for many weeks) " he undressed himself and went into the sea in the middle of the day : but he paid very dearly for the experiment, the heat diffusing itself so violently over his whole body by the time he had put on his clothes, that his eye-sight began to fail, and he was compelled to lie down upon the ground to save himself from falling. The moment he lay down the faintness went off; upon this he got up, but instantly found himself in the former condition: he, therefore, lay down, and immediately recovered. He continued alternately getting up and lying down till the disorder began to be exhausted, which was in about half an hour, and so gradually went off. He had frequently been obliged to use the same practice at other times, when be was attacked with this disorder.** That this case is to be regarded as a peculiar form of the present species, the extraordinary irritation and intolerable itching of the skin seem to vouch for sufficiently. It discovers, howe\er, a cuta- neous excitement of an idiopathic and most singular kind: and, keeping this idea in mind, it is not difficult to account for the ten- dency to deliquium related in the latter part of the account. The patient, it seems, could endure cold bathing under cover or in the shade, and was not rendered faint by the re-active glow that ensued upon his quitting the water; but when to this re-active glow was united, in consequence of his bathing in the open air and in the middle of the day, the pungent heat of the sun, he was incapable of enduring both, till, by a certain length of exposure to this con- joint stimulus, the cutaneous nerves became torpid, which it seems they did in about half an hour; when the affection we are told " gradually went off."1 A daily exposure to the same exhausting power would, in all probability, soon have rendered the torpitude habitual, or at least have reduced the cutaneous sensibility to its proper balance, which. 6E. HI.—SP. II.] EXCERNENT FUNCTIOK. 379 after all, forms the real cure in the West Indies, and in most of tbe chronic cases of our own country. This, however, does not seem to have been thought of: but, after having tried a long nst of different series of medicines in hospital and in private practice to no purpose, the patient was at length fortunate enough, when under the care of Dr. Monsey, to be put, as a forlorn hope, upon a brisk course of calomel, of which he took five grains every night with a purge of rhubarb or cathartic extract the ensuing morning for nearly a fortnight in succession; and having thus transferred the morbid irritability of the skin to the intestinal canal, the disease left him. SPECIES III. EXORMIA PRURIGO. tarurtatnous i&asfi. eruption diffuse: pimples nearly of the colour of the cuticle; when abraded by scratching oozing a fluid that concretes into minute black scabs ; intolerable itching, increased by sudden ex- posure TO HEAT. In the symptoms of a papular eruption, and an intolerable itching, this species bears an approach towards the preceding : but it differs from it essentially in the colour of the papulae, and in the nature of the itching, which is often far more simple ; and, when combined with a sense of stinging, gives ajfeeling peculiar to itself, like that of a nest of ants creeping over the body and stinging at the same time. It offers the three following varieties, the last of which chiefly differs from the second in being more inveterate :— x Mitis. Pimples soft and smooth: itching Mild Prurigo. at times subsiding ; chiefly com- mon to the young and in spring time. C Formicans. Pimples varying from larger to Emmet-prurigo. more obscure than in the last; itching incessant, and accom- panied with a sense of pricking or stinging, or of the creeping of ants over the body ; duration from two months to two or three years, with occasional but short intermissions : chiefly common 'o adults. 380 ECCRITICA. [CL. VI.-OR. IU, y Senilis. Pimples mostly larger than in Inveterate prurigo. either of the above, sometimes indistinct, giving the surface a shining and granulated appear- ance ; itching incessant: com- mon to advanced years, and nearly inveterate. In all the varieties the itching differs in its extent: being some- times limited to a part only of the body, and sometimes spreading over the entire frame* Courmette relates a case in which it alter- nated from side to side :t and in many instances it appears periodi- cally. Hence, in Willan we have not only an account of the three preceding varieties, but of several others, which chiefly, if not entirely, differ from them in being limited to particular parts; as prurigo podicis, p. praeputii, p. urethralis, p. pubis, p. pudendi muliebris. A common cause of this species in all its varieties, though by no means the only cause, is want of proper cleanliness of the skin and of apparel; and hence it is found most frequently in the hovels of the poor, the squalid, and the miserable. Yet as it i- not always found under these circumstances even where there is the grossest uncleanliness, some other cause jointly operating in such situations, some idiopathic condition of the skin by which the sordes thus col- lected and obstructing tbe mouths of the cutaneous exhalants be- comes an active irritant, must be admitted. One of these conditions appears to be a skin peculiarly delicate and sensible, which is most- ly to be found in early life ; and another, a skin peculiarly dry and scurfy, which is a common condition of old age ; on which account repelled perspiration is correctly set down as a cause by Riedlin. Even in the cleanliest habits, these peculiarities of the skin often become causes of themselves, and of a more intractable kind than mere sordes, as they are far more difficult of removal. A diet of fish alone has sometimes excited such a habit: and an habitual ad- diction to spirituous drinks, whether wine, ale, or alcohol, produces also, in many persons, a like sensibility of the surface, and lays a foundation for the disease in its most obstinate form. Where the rash continues long and becomes pertinacious, the papulae form minute exulcerations, degenerating, in the first varie- ty, into a species of contagious itch, and in the second, into a run- ning scall; which last, in the third or inveterate variety, sometimes forms nests for various parasitic insects,^ and especially for several species of the acarus and pediculus, to which Dr. Willan adds the pulex. In treating of intestinal animalcules, we had occasion to observe that " they appear, from the luxuriance of their haunts and * Sitonus, Tr. 34, Loeschcr. t Journ. Med. Tom. lxxxv. X Sommer, Diss, de affectibus prurkinosis Senum. Loescher, Diss, de pmritu scuili totius corporis. Witcb. 1723. OK. III.-SP. 111.] EXCERNENT FUNCTION. 381 repast", to be, in various instances, peculiarly enlarged and altered from the structure they exhibit out of the body; whence a difficul- ty in determining, in many cases, the exact external species to which a larve, worm, or animalcule found within the jbody may beloug."* This remark applies with peculiar force to the parasites detected in the diseases before us, some of which grow to such an enormous size, and with such altered characters from rioting on so plentiful a supply of juices, that it is by no means easy to recognize them. Dr. Willan describes an insect of this kind found in great abundance on the body of a patient suffering under the inveterate prurigo, which he at first took for a pedicuius, though from the nimbleness of its motions, as well as from other characters, he at length ascer- tained it to be a pulex, not described by Linneus: more probably, from the causes just stated, so altered in its form, as not to be easi- ly referred to the species to which it really belongs. Thorough and regular ablution and cleanliness are here, there- fore, peculiarly necessary, and these will often succeed alone, espe- cially in the first variety. If they should not, sulphur and the sul- phureous waters, as that of Harrowgate, taken internally and ap- plied to the skin itself, have sometimes been found serviceable. Fossile alkali combined with sulphur and taken internally with in- fusion of sassafras or juniper tops is peculiarly recommended by Dr. Willan. If the constitution have suffered from a meagre diet, or be otherwise exhausted, general tonics and a nutritive food must necessarily form a part of the plan. In many cases, however, of the second variety, and in still more of the third, this pertinacious and distressing complaint bids defi- ance to all the forms of medicine, or the ingenuity of man: and I cannot adduce a stronger illustration of this remark than by refer- ring to an attack which it has lately made on one of the brightest ornaments of medical science in our own day, whose friendship allows me to give the present reference to himself. It is now con- siderably more than a year and a half since he was first visited with this formicative but colourless rash which affected the entire sur- face, but chiefly the legs : and he has since tried every mean that the resources of his own mind or the skill of his medical friends could suggest, yet for the most part without any thing beyond a palliative or temporary relief. The tepid bath produced more harm than good, though several times repeated : Harrowgate water internally and externally had recourse to has been of as little avail: acids and alkalies, separate or conjoined, in whatever way made use of, have failed equally: nor have purgatives or diaphoretics or any of the alterative diet drinks, or the alterative metallic prepara- tions answered better. The coldest spring water employed as a bath or lotion, and free doses of opium as a sedative, are the only medicines from which he has at any time derived any decided re- lief, and these have constantly afforded it for a short time. In the 4 Vol. i. Helminthia etratica. p. 208. 382 ECCRITICA. [CL. VI.-OR. HI. middle of the coldest nights of last winter, and the still colder nights of the winter before, he was repeatedly obliged to rise and have recourse to sponging with cold water, often when on the point of freezing. The opium he has taken never effected real sleep, nor abated the complaint but generally threw him into a quiet kind of a revery which produced all the refreshment of sleep: and to ob- tain this happy aphelxia or abstraction of mind he has been com- pelled to use the opium in large doses, often to an extent of ten grains every twenty-four hours, for weeks together, and rarely in less quantity than five or six grains a day and night for many months in succession. The change operated on the general habit by this peculiar sensibility of the skin is not a little singular; for first, in the midst of the distraction produced by so perpetual a harassment, and the necessary restlessness of nights, neither his animal spirits nor his appetite have in any degree flagged, but, upon the whole, rather increased in energy, and his pulse has held true to its pro- per standard. And next, though opium was wont to disagree with him in various ways antecedently, it has proved a cordial to him through the whole of this tedious affection without a single unkind- ly concomitant, and has never rendered his bowels constipated. From the long continued excess of action there was at length an evident deficiency in the restorative power of the skin : for two ex- coriations arising from the eruption, degenerated into sloughing ulcers. At the present period, forming a distance of nineteen or twenty months from the first attack, he is apparently getting well; the skin which has been so long in a state of excitement is losing its morbid sensibility, and becoming torpid : he has rarely occasion to have recourse to cold ablutions, but dares not trust himself through the day without a dose of opium, as an exhilarant, though the quantity is considerably reduced. He has also, for many months, been taking the bark and soda as a general tonic. Perhaps the most instructive part of this case is the great advantage and safety of the external application of cold water, as a refrigerant and tonic in cutaneous eruptions accompanied with intolerable heat and irri- tation. And it is possible that half the wells, which in times of superstition were dedicated to some favourite saint, and still retain his proper name, derive their virtue from this quality rather than from any chemical ingredient they contain, which has often as little to do with the cure as the special interposition of the preternatural patron. OE. III.-SP. IV.] EXCERNENT FUNCTION. 3»J SPECIES IV. EXORMIA MILIUM. $Hi\UUKanh. PIMPLES VERY MINUTE; TUBERCULAR ; CONFINED TO THE FACE ; DIS- TINCT ; milk-white; hard; glabrous; resembling millet-seeds. This species is taken from Plenck who denominates it grutum sive milium. It is a very common form of simple pimple or exormia, and must have been seen repeatedly by every one, though, with the exception of P'enck, I do not know that it has hitherto been de- scribed by any nosologists. It has a near resemblance to the white- gum of children, as described by Dr. Underwood, the strophulus albidus of Willan, and the present system. But the pimples in the milium are totally unattended with any kind of inflammatory halo or surrounding redness: and are wholly insensible. They are sometimes solitary, but more frequently gregarious. Itis a blemish of small importance and rarely requires medical interposition: but as it proceeds from a torpid state of the cutaneous excretories, or rather of their mouths or extremities which are balled up by hard- ened mucus, stimulant and tonic applications have often been found serviceable, as lotions of brandy, spirit of wine, or tincture of myrrh, or a solution of sulphate of zinc with a little brandy added to it. When this species becomes inflamed it lays a foundation for a varus or stone-pock, which we have already described^under the order of inflammations in the third class of the present system.* GENUS IV. LEPIDOSIS. Scale=Sfctu, EFFLORESCENCE OF SCALES OVER DIFFERENT PARTS OF THE BODY, OFTEN THICKENING INTO CRUSTS. Lepidosis is a derivative from Awn? -hg, " squamma." The Greek is preferred to the Latin term, in concurrence with the general Vol. h. p. 196. 384 ECCRITICA. [cl. vi.-eR. m rule adopted in the present system in regard to the names of the classes, orders, and genera. The genus includes those diseases which consist in an exfoliation of the cuticle in scales or crusts of different thickness, and with a more or less defined outline, in ma- ny cases owing to a morbid state or secretion of the rete mucosum or adipose layer of the part immediately beneath, which is some- times too dry, or deficient in quantity; sometimes perhaps absent altogether; sometimes charged with a material that changes its natural colour ; and sometimes loaded with an enormous abundance of a glutinous fluid, occasionally combined with calcareous earth. In the severer cases the true skin participates in the change. As this colorific substance, forming the intermediate of the three lamellae that constitute the cutaneous integument, is only a little lighter in hue than the true skin among Europeans, it is not often that we have an opportunity in this part of the world of noticing the changes effected upon it by different diseases : but as among ne- groes it contains the black pigment by which they are distinguished. such changes are very obvious and frequent: for the individual is sometimes hereby, as we shall see presently, rendered pye-balled, or spotted black and white, and there are instances in which the whole of this substance, or rather of its colouring part, being car- ried off by a fever, a black man has suddenly been transformed into a white. Changes of this kind often occur without any separation of the cuticle from the cutis, but if the fever be violent such separation takes place over the entire body, and the cuticle is thrown off in the shape of scurf, or scales, or a continuous sheath. And some- times the desquammation from a hand has been so perfect that the sheath has formed^an entire glove. The same effect has followed occasionally from other causes than fever, as on an improper use of arsenic* or other mineral poisons, on being bitten by a viper,T and sometimes on a severe fright. + There are various instances in which the nails have been exfoliated with the cuticle,§ and others in which the hair has followed the same course. Sometimes, in- deed, a habit of recurrence has been established and the whole has been thrown off and renewed at regular periods,|| in one instance once a month.11 In the genus before us the exfoliations are of a more limited kind, and in some instances very minute and comparatively insigni- ficant. In the severer forms, however, the true skin participates in the morbid action, and the result is far more troublesome. * De Haen, Rat. Med. Part. x. Cap. n. t Eph. Nat. Cur. Dec. l. Ann. iv. v. Obs. 33. X Act. Nat. Cur. Vol. vn. Obs. 43. & Eplf. Nat. Cur. Dec. in. Ann. ii. Obs. 124. || Gooch, Phil. Trans. 17(59. fl Eph. Nat. Cur. Dec in. Ann. i. Obs. lfM. OE. 1V.-SI'. I.] EXCERNENT FUNCTION. 385 The species it presents to us are the following: DANDRIFF. LEPROSY. DRY SCALL. SCALY TETTER. t.--------ICTHYIASIS. FISH-SKIN. I. LEPIDOSIS PITYRIASIS 2. -------- LEPRIASIS. X PSORIASIS. SPECIES I. LEPIDOSIS PITYRIASIS. PATCHES OF FINE BRANNY SCALES, EXFOLIATING TENDERNESS. WITHOUT CUTICULAR This species is the slightest of the whole: its varieties are as fol- low : Capitis. Dandriff of the head. " Rubra. Red dandriff. y Versicolor. Motley dandriff. Scales minute and delicate : con- fined to the head; easily sepa- rable. Chiefly common to in- fancy and advanced years. Scaliness common to the body ge- nerally ; preceded by redness, roughness, and scurfiness of the surface. Scaliness in diffuse maps of irre- gular outline, and diverse co- lours, chiefly brown and yellow : for the most part confined to the trunk. Pityriasis is a term common to the Greek Physicians, who con- cur in describing it, to adopt the words of Paulus of ./Egina, as " the separation of slight furfura matters (jcnvqai&ui aetfunm), from the surface of the head, or other parts of the body, without ulceration."' The same character is given by the Arabian writers, and especially by Avicenna and Ali Abbas. But several writers, both Greek and Arabian, who have thus described it generally, limit its extent to the head, which is the ordinary seat of the porrigo or scabby scall, characterized by ulceration, and a purulent discharge, covered by minute scabs; and hence in some writers, pityriasis has been con- founded with porrigo; or, in other words, tbe dry and branny scale with the pustular scab; which, however, there is no difliculty in accounting for, since the first variety, whose seat is also in the head, has a tendency, if neglected, and the minute and «curfv scales grow VOL. IV. 1() 386 ECCRITICA. [CL. VI.-OR* 111. thicker and broader, and crustaceous, to degenerate into porriginous pustules. The first variety, or dandriff of the head, when it attacks in- fants, exhibits minute scales, and when it appears in advanced age, scales of larger diameter. It shows itself at tbe upper edge of the forehead and temples as a slight whitish scurf, set in the form of a horse-shoe ; on other parts of the head there are also cuticular ex- foliations, somewhat larger, flat and semipellucid. Sometimes, however, they cover nearly the whole of the hairy scalp, imbricate in position, or with an overlap, as in tiling. Little attention is necessary to this complaint beyond that of clean- liness, and frequent ablution; where, however, the hairy scalp is attacked it is better to shave the head, when the scales may be re- moved by a careful use of soap and warm water, or by an alkaline lotion. This is the more expedient because the scales in this situa- tion are often intermixed with sordes, and pustules containing an acrimonious lymph are formed under the incrustations ; and in this way pityriasis, as we have already observed, may, and occasionally does, degenerate into porrigo. The second variety, or red dandriff, sometimes affects the gene- ral health in a perceptible degree from the suppression which take's place in the perspiration, and the consequent dryness, stiffness, and soreness of the skin; and the general itching which hence ensues, is often productive of much restlessness and languor. This, which is the severest modification of the disease, appears chiefly at an advanced period of life, though it is not limited to old age. A tepid bath of sea-water is, perhaps, the most useful application, as serving to soften the skin, and produce a gentle diapnoe. With this external remedy Dr. Willan advises we should unite the compound decoction ^>f sarsaparilla, and antimonials, which operate towards a like ef- *Tect. The tinctura hellebori nigri in small doses has also some- times been found useful; and, where the irritability of the skin is not very great, Dr. Bateman was in the habit of using a gently re- stringent lotion or ointment, consisting of the superacetate of lead with a certain proportion of borax or alum. The variegated or motley dandriff, pityriasis versicolor, often branches out over the arms, back, breast, or abdomen, but rarely in the face, like many foliaceous lichens growing on the bark of trees ; and sometimes, where the discolouration is not continuous, suggests the idea of a map of continents, islands, and peninsulas, distributed over the skin. We have a more distinct proof of a morbid condition of the rete mucosum, or adipose colorific layer of the skin in this than in any other affection belonging to the entire genus. The morbid action, indeed, seems confined to this quarter and consists in the secretion of a tarnished pigment, though possibly, in some instances, it may be only discoloured by a mixture with a small portion of extrava- sated blood. And, were it not for the furfuraceous scales which determine its real nature, this affection would belong to the genus GE. 1V.-S1'. I.J EXCERNENT FUNCTION. 387 epichrosis of the present order. There is no elevation; and the staining rarely extends over the whole body. Dr. Willan tells us that it seldom appears over the sternum or along the spine of the back. 1 had lately a patient, however, in a gentleman about forty years old, who was suddenly attacked with a discolouration and bran- ny efflorescence of this kind, which extended directly across the spine over the loins, and very nearly girded the body. It continu- ed upon him for about three years without any constitutional indis- position, or even local disquietude, except a slight occasional itch- ing, and then went away as suddenly as it made its appearance. The hue was a fawn-colour: and, as the patient was anxious to lose it, he tried acids, alkalies, and other detergents of various kinds, but without any effect, whatever. This variety of dandriff gene- rally continues for many months, and not unfrequently, as in the present case, for several years. Being altogether harmless, it re- quires no medical treatment. The pityriasis nigra of Willan, referred to by Bateman, but only glanced at by either of them, so far as I have seen it, is rather a modification of the genus epichrosis, and species Poecilia, under which it will be noticed. It is a cuticular discoloration, but with- out cuticular exfoliation. SPECIES II. LEPROSIS LEPR1ASIS. &cjnosg. This genus constitutes the vitiligo of Celsus. The term lepriasis is a derivative from Aurpoj " scaber, vel asper, ex squammulis dece- dentibus;"" with a termination appropriated by a sort of common consent, to the squammose tribe of diseases.* Lepra, which is the more common terra, is derived from the same root: but lepriasis is preferred to lepra as a more general term, and hence better calcu- lated to comprise the different varieties of this species so generally described or referred to by the Greek and Oriental writers, but whose descriptions, not very definite when first written, at least with a few exceptions, have been rendered altogether indefinite and incongruous in modern times, from a misunderstanding or confusion of the names under which the descriptions are given. The embarrassment which Dr. Bateman felt upon this subject, when writing on the geuu^ elephantiasis, and which has been no- ticed already,t he was equally sensible of when he came to lepra, * See the Author's volume of Nosolocy. Prelim. Diss. p. 51. 1 Vol. n. p. .ifir. 388 ECCRITIC^ [CL. VI.-OR. III. and the researches of Dr. Willan gave him little or no assistance- I could not then find time to render him the aid he stood in need of, but I have since directed*my attention to the subject, and will now give the reader its results as briefly as possible. In the admirable and exact description of the cutaneous efflores- cences and desquammations, to which the Hebrew tribes were sub- ject on their quitting Egypt and which they seem to have derived from the Egyptians, drawn up by Moses, and forming a part of the Levitical law,* there are three that distinctly belong to the present species, all of them distinguished by the name of berat (jYYLl) or " bright spot ;" one called boak (pro) which also imports bright- ness, but in a subordinate degree, being " a dull-white berus," not contagious, or, in other words, not rendering a person unclean, or making it necessary for him to be confined; and two called tsorat (fijns) " venom or malignity :" the one a berat lebena or w; bright-white beral,"t and the other a berat cecha, " dark or dusky berat,"! spreading in the skin; both of which are contagious, or, in other words, render the person affected with it unclean, and exclude him from society .§ The Arabic and Greek writers have in fact taken notice of and described all these, but with so much confusion of terms and symp- toms, from causes I will presently point out, that without thus turn- ing back to the primary source it is difficult to unravel them or understand what they mean. The boak, or slighter and uncontaminating berat, is still denomi- nated by the same name among the Arabians, boak, and is the Afx-gc AA0os or " dull-white leprosy" of the Greeks: while the bright- white and dusky berats of the Hebrews, which the latter distinguish- ed on account of their malignity by the name of /"Ijnj*; (tsorat,) are still called among the Arabians by the Hebrew generic term with a very slight alteration; for the berat lebena (H3*l7 JTini) or bright- white berat of the Hebrew tongue, is the beras bejas of the Arabic, and the berat cecha (nrQ mro) or dusky berat, its beras asve&: the former of these two constituting the >.tx^x Atvxn or " bright- white" leprosy of the Greeks, and the latter their Anr$* poos " dusky or nigrescent leprosy." So far the whole seems to run in perfect harmony : but as many of the Arabians, in. process of time, used boak and beras indiscrimi- nately, the different species of the disease as well as their qualities became immediately confounded, and we are told sometimes that leprosy is, and at other times that it is not unclean or contagious. And what increased the confusion is, that the Arabians employed * Levit. Cap. xin. t Id. Cap. xm. 38, 39. X M. v. 3. k Id. v. 6. 8. tiK. IV.-SP. II.] EXCERNENT FUNCTION. 389 also another term of still wider import than either of these being kuba er kouba, which imported scaly eruption- of every kind, run- ning not merely parallel with the entire genus lepidosip before us, but something beyond, so as to include the humid as well as the dry scall; and consequently diseases of very different qualities and de- grees of malignancy, contagious and uncontagious, cuticular and ulcerative. It is a term peculiarly common to the writings of Avi- cenna and Serapion. And as kouba, or with the article alkouba was also frequently applied to all the species of beras or leprosy, the real characters of the latter were rendered doubly doubtful and intricate. And hence a very obvious source of confusion upon this subject originating among the Arabians. But while the Arabian writers borrowed two terms appropriated to the disease bejtfe us from the Hebrew tongue, beras and boak, and employed both oWhem in a loose and indefinite manner, the Greeks themselves borrowed one and employed it still more indeterminate- ly : for from the Hebrew /"tyiX (tsorat) they obtained their •\>*^x (psora)—as our own language has since the word sore. Tsorat, as we have already seen, is restrained by the Hebrew legislator to the two forms of beras or leprosy which were contagious or ren- dered a man unclean : and as the Greeks introduced this term into their own tongue it would have been better to have restrained it to the same import, and to have used psora as the translation of tsorat. But the Greeks had the word lepra already by them, as signifi- cative of the same disease generally, or a synonym of berat or beras ; and hence instead of psora they employed lepra which is the word made use of in the Greek, as well as in the Latin versions As lepra, however, is a generic term and runs parallel with berat, so as to include the boak or uncontaminating, as well as the conta- minating forms of the disease, the clearness, if not the entire sense, of the Hebrew is greatly diminished in the Greek version. When we are told by Moses, in the language of the Hebrew bible, that the priest shall examine the berat, or bright spot, accurately, and if it have the specific marks, it is a tsorat, (which the berat is not ne- cessarily,) we readily understand what he means. But when he tells us in the language of the Greek bible, that the priest shall look at the berat or rn^xvyng (which is itself necessarily a lepra) and if it have the specific marks it is a lepra, the meaning, to say the least of it, is obscure and doubtful. It is probable, however, that psora, when first introduced into the Greek tongue, imported the very same idea as in the Hebrew : but it soon gave way to the older term of lepra, and having thus lost its primitive and restricted sig- nification, it seems to have wandered in search of a meaning, and had at different times, and by different persons, various meanings attributed to it; .being sometimes used to express scaly eruptions generally, sometimes the scales of leprosy ; but at last and with a pretty common assent the far slighter efflorescence of scaly tetters or scalls. denominated in the Levitical code saphat (Also) : and 390 ECCRITICA. [CL. VL-OR. III. by the Latins scabies or impetigo sicca: constituting the psoriasis, or ensuing species of the present classification. So that whilst in He- brew, or under its primitive sense, tsorat or psora denoted the most malignant form of lepidosis, in Greek or under its secondary sense, it denoted one of the mildest forms of the same. And hence, an- other source of confusion upon the subject before us originating among the Greek writers, as the preceding originated among the Arabian. And when to these two sources of perplexity we add that the Greek term lepra was, from a cause I have formerly explained, employed equally to express elephantiasis, we shall easily be able to account for the indefinite and incoherent descriptions of all these diseases which are given by many of the Greek and Arabian writers, and the inaccuracy with which the symptoms of ona»specific disease are run into another. Actuarius endeavoured toThrow something of order into the midst of this confusion by contemplating all these maladies, in conjunction with lichen, as different forms of a common genus, and dividing them into four separate species : " A less vio- lent disease," says he, " than elephantiasis is lepra ; lepra is, how- ever, more violent than psora, and psora than the lichenes. But lepra penetrates deep, forms circular eruptions and certain funguses or deliquescences of flesh (r»xg rvrrn%ug cagxtg) and throws off scales from which also it derives its name : while psora is more superficial, assumes indeterminate shapes, and only casts off furfuraceous cor- puscles. A roughness and itching of the skin is common to both.*'* And to the same effect Paulus of iEgina. The real fact is, that the two last are nearly connected in nature, and in the present work follow in immediate succession, while both are widely remote from the first; and though it is possible they have occasionally terminated in it, are by no means naturally con- nected with it, or form a necessary harbinger. Lepra or lepriasis in Celsus occurs under the name of vitiligo, and like the berat of the Hebrew legislator, is made to include three modifications; the ordinary forms of it, indeed, that have descended to us, though delineated with much error and incongruity. The description of Celsus is drawn up with peculiar accuracy and con- cinnity, and makes the nearest approach to that of Moses of any I am acquainted with : and by uniting them and combining a few well ascertained symptoms from other authors, we shall be able to obtain a pretty clear insight into the genuine characters of these modifica- tions, freed from the extraneous concomitants that have so often be- wildered us. * Actuar. De Meth. Medend. n. 11. And compare Paul ^*in. iv. 2. Serapion. Breviar. T,. v. Cap. iv. Avicenn. Lib. i. iii. 1. GE. 1V.-SP. II.] EXCERNENT FUNCTION. 391 m Aibida. Scales glabrous, dull-white, circular and Boak (p»"Q). Hebr. definite ; preceded by reddish, and Boak. Arab. glossy elevations of the skin; sur- Alphos. CAxQt) Auct. rounded by a dry, red, and slightly Gr. Cels. elevated border: scattered ; some- Common or dull-white times confluent; irregularly exfoliat- leprosy ing and reproduced : rarely found on the face: not contagious. 5 Nigricans. Scales glabrous, dusky or livid, without Berat cecha; Hebr. central depression, patches increas- f-»j13 rn-rl") ing in size * scattered, or confluent. feeras asved, Arab. Contagious. Melas (Mia*«) Auct. Gr. Cels. Dusky or black leprosy. y Candida. Scales on an elevated base glossy-white, Berat lebena. Hebr. with a deep central depression ; en- (rftl1? J"n»"Q) circled with a red border; patches Beras bejas. Arab. increasing in size: hairs on the Leuce (Aw*„.) Auct. Patches white or hoary ; diffused Gr Cels over the body. Contagious. Bright-white leprosy. All these, at least in their origin, are strictly cutaneous affec- tions : though we shall presently have to observe that the last two when they become inveterate, sometimes seem to affect the habit; and it is hence possible that the first may do so in a long course of time if neglected. It is on this account that the boak, common or dull-white lepro- sy has been regarded as in every instance a constitutional malady by many writers of recent times; but it was not so regarded either by the best Greek and Arabian physicians, who also duly distin- guished it from elephantiasis and other complaints with which it has been confounded by later writers; nor is it so regarded by Dr. Willan, who ascribes it chiefly to cold, moisture, and the accumula- tion of sordes on the skin, especially in persons of a slow pulse, languid circulation, and a harsh, dry, and impermeable cuticle : or whose diet is meagre and precarious. It is hence found chiefly in this metropolis among bakers and bricklayers' labourers: coal-hea- vers, dust-men, laboratory-men, and others who work among dry, powdery substances, and are rarely sufficiently attentive to cleanli- ness of person. In the common, and, perhaps, in all the varieties, the scaly patch- es commence where the bone is nearest to the surface, as along the skin about the elbow, and upon the ulna in the fore-arm, on the scalp, 'and along the >pine, os ilium, and shoulder-blades. They rarely appear on the calf of the leg, on the fleshy part of the arms, or within the flexures of the joints. Both sides of the body are usually affected at the same time and in the same manner; but.con- 392 ECCRITICA. [CL. VL-OR. III. trary to the erysipelatous erythema and some other maladies of the skin, the parts first affected do not run through their actfon and heal as other parts become diseased, but continue with little alteration, till, from medical application or the natural vigour of the constitu- tion, returning health commences; when all the patches assume a like favourable appearance at the same time, those nearest the ex- tremities, and where the disease, perhaps, first showed itself going off somewhat later than the rest. The scaly incrustations sometimes extend to the scalp, and a little encroach on the forehead and tem- ples ; but it is very rarely that they spread to the cheeks, chin, nose, or eyebrows. The eruption is seldom attended with pain or uneasiness of any kind, except a slight degree of itching when the patient is warm in bed, or of tingling on a sudden change of tempe- rature in the atmosphere. We have said that this variety is strictly a cutaneous eruption, and rarely, if ever, affects the constitution. It is in consequence regard- ed as of but little importance in the Levitical code, which contem- plates it as not penetrating below the skin of the flesh, and not de- manding a separation from society. " If a man or a woman," says the Jewish law, " have in the skin of their flesh a berat, a white be- rat, then the priest (who after the manner of the Egyptians united the character of a physician with his own,) shall look ; and, hehold, if the berat in the skin of the flesh be dull, it is a boak growing in the skin: he is clean.'** Not essentially different Celsus, ;: the viti- ligo, though it brings no danger, is, nevertheless, offensive, and springs from a bad habit of body. The dull-white and the dusky forms in many persons spring up and disappear at uncertain pe- riods. The bright-white when it has once made its attack, doe> not so easily quit its hold. The cure of the two former is not diffi- cult : the last scarcely ever heals.*" \ We may hence distinctly affirm that the variety of the dull-white or common leprosy, is not contagious : and had it been so among the Jews, Moses would have condemned the patient to a quarantine under this form, as well as under the two ensuing. Dr. Willan, in- deed, yielding to the general opinion upon this subject, derived from a proper want of discriminating one form of the disease from another, inclines to believe that it may occasionally become in time so interwoven with the habit as to be propagable, but still rejects the idea of its being contagious. In reality, although in most coun- tries where leprosy is a common malady, places of separate resi- dence are usually allotted to those who are affected with it under whatever modification it may appear, this has rather been from an erroneous interpretation of the Jewish law, and an ignorance of the exceptions that are introduced into it. The lepers of Haha, a pro- vince in the Barbary states, though banished from the towns, are seen in parties of ten or twenty together, infesting the roads, and * Levit. Cap. xiu. 38, 39. t Dc Medicinii, Lib. v. Cap. xxvni. Sect. 10. l,E. IV.-SP. II.] EXCERNENT FUNCTION. «*"-> approach travellers to beg charity. In Morocco they are confined to a separate quarter, or banished to the outride of the walls. They arc, according to Mr. Jackson, but little disfigured by the dis- ease, except in the loss of the eyebrows, which the females endea- vour to supply by the use of lead-ore ; while they give an addi- tional colour to their complexion by the assistance ot al akken or rouge. In like manner, Niebuhr asserts that one of the species ot leprosy to which the Arabs are subject, is by them still called Boak ; but that it is neither contagious nor fatal. Upon which remark his annotator M Forskal adds, « the Arabs call a sort of leprosy in which various spots are scattered over the body Behaq; which is without doubt the same as is named pill (bohak or behaq) in Ley. xiii. They believe it to be so far from contagious that one may lie with the person affected without danger.—On May 15, 1?63,' says he, " I saw at Mokha a Jew who had the leprosy bohak. The spots are of unequal size : they do not appear glossy ; they are but little raised above the skin, and do not change the colour of the hair : the spots are of a dull-white inclining to red."* The nigrescent leprosy; forming the second variety, is impro- perly called black, though it was so named by the Greeks. The colour, as repeatedly described by the Jewish legislator, is rather obscure, darkling, or dusky. The term is nfD (cecha) whence the Latin caecus: and it immediately imports obfuscous, or overcast with shade or smoke. The character in Celsus is in perfect accord- ance with this, as he explains to us that fctXag, or niger, in its appli- cation to this variety imports " umbrae similis,*" "shade-like," or " shadowed." The hue is tolerably represented in Dr. Willan's plate, but better in Dr. Baleman's in which it has been retouched. The natural colour of the hair, which in Egypt and Palestine is black, is not changed, as we are repeatedly told in the Hebrew code, nor is there any depression in the dusky spot; while the patches, instead of keeping stationary to their first size, are perpetually enlarging their boundary. The patient labouring under this form was pronounced unclean by the Hebrew priest or physician, and thereby sentenced to a separation from his family and friends: and hence there is no doubt of its having proved contagious. Though a much severer malady than the common leprosy, it is far less so than the leuce or third variety : and on this account is described more briefly in the Hebrew canon. In cur own quarter of the world the exfoliated surface in the nigrescent or dusky leprosy remains longer without new scales, discharges lymph, often intermixed with blood, and is very sore. When it covers the scalp it is particularly troublesome. Willi us it is chiefly found among soldiers, sailors, sculler-men, stage-coachmen, brewers' labourers, and others, whose occupations are attended with much fatigue, and lleisebcschreibung nacb \iabien und aiulern unliegenden I andern. Hind. r. K.:pt i.hag. 4to. 1774. VOL. IV. 50 394 ECCRITICA. [CL. Vl.-OR. III. expose them to cold and damp, and to a precarious or improper mode of diet. For the same reason, women habituated to poor living, and constant hard labour, are also liable to this form of the disease. In consequence of the increased excitement and irritability of the skin in the hot and sandy regions of Egypt and Palestine, there is, however, a far greater predisposition to leprosy of all kinds, than in the cooler temperature of Europe. And hence, under the next variety, we shall have occasion to observe, from the Levitical account, that all of them were apt to follow upon various cracks or blotches, inflammations or even contusions of the skin. The bright-white leprosy, is by far the most serious and obstinate of all the forms which the disease assumes. The pathognomic characters dwelt upon by the Hebrew legislator in deciding it are, " a glossy-white and spreading scale upon an elevated base, the elevation depressed in the middle but without a change of colour, the black hair on the patches which is the natural colour of the hair in Palestine, participating in the whiteness, and the patches themselves perpetually widening their outline." Several of these characters taken separately belong to other lesions or blemishes of the skin as well, and therefore none of them were to be taken alone : and it was only when the whole of them concurred, that the Jewish priest, in his capacity of physician, was to pronounce the disease, a tsorat (j"»jn!£) or malignant leprosy. We have said that in lepriasis, the rete mucosum, or colorific adipose layer of the --kin, is peculiarly affected, and we have here a still more distinct proof of this assertion in the change of the hair, the colour of which is derived from this material. This change is produced by the barter of a black for a white colouring material, probably a phosphate of lime, which gives also the bright glossy colour, not hoary or dull, to the scaly patches; and which in ichthyiasis, forming the fourth species of the present genus, we shall find is occasionally deposited on the surface in prodigious abundance. Common as this form of leprosy was among the Hebrews, during and subsequent to their residence in Egypt, we have no reason to believe it was a family complaint, or even known amongst them antecedently : and there is hence little doubt, notwithstanding the confident assertions of Manetho to the contrary, that they received the infection from the Egyptians instead of communicating it to them. Their subjugated and distressed state, however, and the peculiar nature of their employment, must have rendered them very liable to this as well as to various other blemishes and misaffections of the skin : in the production of which there are no causes more active or powerful than a depressed state of body and mind, hard labour under a burning sun, the body constantly covered with the excoriating dust of brick-fields and an impoverished diet; to all of which the Israelites were exposed whilst under the Egyptian bondage. It appears also, from the Mosaic account, that in consequence of these hardships, there was, even after they had left Egypt, a general GE. IV.-SP. II.] EXCERNENT FUNCTION. 395 predisposition to the tsorat or contagious forms of leprosy, so that it often occurred as a consequence of various other cutaneous affec- tions ; sometimes appearing as a berat lebena (("0*27 mm) or bright-white leprosy, and sometimes as a berat cecha (HrO rni"T*2,) dusky leprosy, according to the peculiar habit or idiosyncrasy. The cutaneous blemishes or blains which had a tendency to termi- nate in leprosy, and which were consequently watched with a suspicious eye from tbe first, are stated by Moses to have been the following : 1. Saat (jINttf).* 2. Saphat (^H2D).t 3. Netek (p/*0).f Herpes, or tetter, «uAjj, Sept. an irritated cicatrix. Psoriasis, or dry scall.—Dry sa- hafata. Arab. Porrigo, or humid scall. Por- rigo. Lat. vers J tin. et Tre- mel. Moist sahafata. Arab. Leuce, bright-white scale : the critical sign of contagious le- prosy. Alphos, dull-white scale : the critical sign of uncontagious leprosy. Ictus, blow or bruise : &$*, Sept. Furunculus, or boil, as in Job, ii. 7. Anthrax, or carbuncle : literally " a fiery inflammation." On the appearance of any one of these affections upon a person he was immediately brought before the priest for examination. If the priest perceived that in connection with such blemish there were the distinctive signs of a tsorat or contagious leprosy, as a bright glossy and squammous surface, with a depression in the mid- dle, and white hairs, the person was immediately declared unclean and is supposed to have been sent out of the camp to a lazaretto provided for the purpose. If the priest had any doubt upon the 4. Berat (nrni).§ 5. Boak (pm).|| 6. Nega (jttaYl 7. Shechin (]T!*tf).** 8. Mecutash (tt*K /Yl30).tt * Levit. cap. xiii. 2, 10, 19, 43. t Id. v. 2, 6, 7, 8. X Id. v. 30, 31. } Id. v. 2, et saepe alibi. |( Id. v. 39. V Id. v. 29. 42. ** Id. v. l:i. it Id. v. '21 396 ECCRITICA. [CL. VL-OR. II. subject, the person was put under domestic confinement for seven days, when he was examined a second time ; and if in tbe course of the preceding week the eruption had subsided and discovered no tendency to the above distinctive characters, he was discharged at once. But if the eruption were stationary, and the result still doubtful, he was put under confinement for seven days more : at the expiration of which, on a third examination, the nature of the disease always sufficiently disclosed itself; and he was either sen- tenced to a permanent separation from the community, or pronounc- ed clean, and set at liberty These doubtful cases, as we have just noticed, sometimes super- induced the bright-white, and sometimes the dusky leprosy, appa- rently according to the particular constitution of the skin, or of the habit generally. And we are further told that there were two ways in which the disease, and particularly the severest or bright- white form of it, terminated ;—a favourable and an unfavourable. If it spread over the entire frame without producing any ulcera- tion, it lost its contagious power by degrees; or, in other words, run through its course and exhausted itself. In which case, there being no longer any fear of further evil either to the individu- al himself or to the community, the patient was declared clean by the priest, while the dry scales were yet upon him, and restored to society.* If, on the contrary, the patches should ulcerate, and quick or fungous flesh (^D ~lt*/"2),T spring up in them, the priest was at once to pronounce it an inveterate leprosy ;J a tempora- ry confinement was declared to be totally unnecessary, and he was regarded as unclean for life. The accuracy with which this second termination is described, is fully confirmed by the passage quoted already, but for another purpose from Actuarius, and it is curious to observe how closely they coincide. w- The lepra," says the lat- ter, speaking of it in its worst form, " penetrates deep, forms circular eruptions and certain funguses or deliquescences of flesh."' But we meet with nothing in the Mosaic account that approximates it to ele- phantiasis : nothing of a thick, rugose, livid tuberculate, and, particu- larly, an insensible skin ; nothing of tierce and staring eye5, hoarse, and nasal voi^e, or of a general falling off of the hair. And hence we have additional proof that these maladies wore distinct, and unconnected. This malignant state of the disease, however, is still generally called after the Greek misnomer elephantiasis : and the two maladies in con- sequence hereof are to this hour confounded in the Greek islands, and even as far north as Iceland, the ultima Thule to which the lite- rature of the Greeks has travelled : but we have sufficient proof in all these cases, from some of the best travellers of the present day, that the disease thus described is not the tubercular or thick-legged elephantiasis, but the above malignant form of genuine leprosy. Thus, 31 r. Jowett, in his very interesting *t Christian Researches * Levit. cap. xiii. v. 12. 13. t Id. v. 10, 14. 15. X Lb v. 11. GE. IV.-=iP. IL] EXCERNENT FUNCTION. 397 in the Mediterranean,"" in describing the beautiful, but now, from its political reverses, most pitiable island of Haivali or Kydonia, near Scio, " a little farther on is the hospital for lepers: it was founded by a leper. Elephantiasis is no uncommon disorder in these parts ; its effects are very offensive. I saw poor men and wo- men with their fingers or legs literally wearing or wasting^ ancay :"* —forming a character directly opposite to what occurs in proper elephantiasis; where the limbs, though they continue to crack, con- tinue to thicken enormously, even to the moment of separation. Dr. Henderson, on the contrary, while describing the real elephan- tiasis in Iceland, calls it the Jewish leprosy, and offers a sort of apology for .Moses that he " has not noticed the very striking anaes- thesia, or insensibility of the skin,'"t which, continues he, " is an inseparable attendant of the genuine elephantiasis." The direct answer is that Moses delineates a different disorder and one in which no such sj'mptoms exist. As leprosy, except in its less common and contagious modifications, has always been accounted a blemish rather than a serious disease in the East, the art of medicine has rarely, in that quarter, been gravely directed towards it, save in the use of the oxyde of arsenic, which is by far the most efficacious of every remedy that has hitherto been tried in any quarter. I have already had occasion to notice the preparation and proportion of this mineral, employed from time immemorial, in treating of elephantiasis, for which disease, also, it is in common use : and the reader may turn to the passage at his leisure. But, with the exception of arsenic, the remedies proposed by the Asiatics are trifling and little worthy of notice. In Europe the mode of treatment has, indeed, been far more complicated, but I am afraid not much more skilful or successful: consisting, till of late years, of preparations quite as insignificant as any that occur in the Arabian writers, and often highly injurious by their stimulating property. Of the insignificant the simplicity of modern practice has banished by far the greater number: and it is now, perhaps, hardly known to the general, or even to the medical botanist, that meadow scabious, and several other species of the same genus were so denominated from their being supposed, when em- ployed as a wash in the form of decoction, to possess an almost specific virtue against leprosy, itch, and almost every other kind of foul and scabious eruption. Warm bathing, simple or medicated ; and this frequently repeated, i* advantageous to all the varieties; for it tends to remove the scales, soften the skin, and excite perspiration. In the nigrescent leprosy, which proceeds chiefly from poor diet in connexion with sordes, the bath should be of pure fresh water, and the remainder * Christian Researches'in the Mediterranean, p. 65. 8vo. h'22. ...+ Iceland ; or, the Journal of a Residence in that Island. 398 ECCRITICA. [CL. VI.-OR. III. of the cure will generally, in such case, depend upon a better regi- men, and general tonics. In the other varieties, when they occur among ourselves, the sulphureous waters of Harrowgate, Croft, and Moffat, whether applied externally or internally, seem frequently to prove more efficacious. As external applications, most benefit appears to be derived from the tar-ointment, as employed by Dr. Willis, and a dilute solution of sublimate, or the unguentura hy- drargyri nitrati, as recommended by Dr. Willan. These medicines should be applied to the skin, and the former of them be well rub- bed in upon the parts affected every night, and carefully washed off the next morning with warm water, or a slight alkaline lotion. As internal medicines the most useful seem to have been the sola- num Dulcamara, and ledum palustre, in decoction or infusion. Dr. Crichton strongly recommends the former, and speaks in high terms of its success. I have not been so fortunate in the trials I have given it. The ledum in Sweden,* and, indeed, over most parts of the north of Europe, as high up as Kamschatka, has long maintained a very popular character, and the form of using it is thus given by Odhelsus in the Stockholm Transactions for 1774. Infuse four ounces of the ledum in a quart of hot water; strain off when cold; the dose from half a pint to a quart daily. The bark of the ulmus campestris or elm-tree, has also been warmly recommended by various writers, for this, as well as nume- rous other cutaneous eruptions ; and, in connexion with more active medicines, appears to have been of some use, but it is feeble in its effect when trusted to alone. Its form is that of a decoction, two ounces to a quart of water: the dose half a pint morning and evening.! The oenanthe crocata, or hemlock drop-wort, is another plant that has been recommended in obstinate and habitual cases of this kind; and there are unquestionable examples of it having produced a beneficial effect. Dr. Pulteney has especially noticed its success in a letter to Sir William Watson. The herb, however, is one of the most .violent poisons we possess in our fields, and when mistaken for wild cellery, water-parsnip, or various other herbs, ha? fre- quently proved fatal a few hours after being swallowed, exciting convulsions, giddiness, lock-jaw, violent heat in the throat and stomach, and sometimes sickness, and purging: and where the patient has been fortunate enough to recover, it has often been with a loss of his nails and hair. Goats, however, eat it with impunity, though it is injurious to most other quadrupeds. As a medicine, it is given in the form of an infusion of the leaves : though sometimes the juice of the roots has taken the place of the leaves. Three tea-spoonfuls of the juice is an ordinary dose, which is repeated every morning. * Linnaeus, Diss, de Ledo palustri. Upsal, 1775. Abhandl. der Konigl. Schwed. Academie der YyisbcnchafTen. Band. xli. p. 194. t Medical Transactions, Vol. n. p. 20J GE. 1V.-SP. II.] EXCERNENT FUNCTION. 399 But by far the most active and salutary medicine for every form of leprosy, in Europe as well as in Asia, is arsenic. I have already adverted to its common use in the latter quarter, and at home, in the form of the College solution, it has often been found to succeed, when every other medicine has been abandoned in despair. The ordinary dose is five minims twice or even three times a-day, in- creased as the stomach will allow. SPECIES III. LEPIDOSIS PSORIASIS. Brg Scall PATCHES OF ROUGH, AMORPHOUS SCALES ; CONTINUOUS, OR OF INDETERMI- NATE OUTLINE ; SKIN OFTEN CHAPPY. Psormsis is a derivation of 4<»g<*, " scabies, asperitas," with a termi- nal trig, as in the preceding species. The primary term •^u^x, or psora, was used in very different senses among the Greek writers from a cause I have already explained under lepriasis, where it has been shown that the real radical is the Hebrew term JHl*; (tsora), •' to smite malignantly, or with a disease," whence iiytl*; tsorat), imports the leprosy in a malignant or contagious form, but not in an uncontagious. The lexicographers not hitting upon the proper origin of 4-*g« have supposed it to be derived from <\>x* (psao), which means. however, unfortunately u tergo, detergo," "• to cleanse, purify, or deterge,**—instead of " to pollute :" but as one way of cleansing is* by scraping, and, a* persons labouring under psora scrape or scratch the skin on account of its itching, the difliculty is supposed to be hereby solved, and psora is allowed to import derivatively, what, upon this explanation, it opposes radically. The actual origin of the term, however, is of little importance. It was mostly employed by the Creek writer-, and has been very generally so in modern times to import a dry scall or scale, for the terms are uuivoenl, the Saxon sceala or scala being tbe origin of the former, and denoting the latter, of a rough surface and in indeter- minate outline, as expressed in the specific definition. Psoriasis, as thus interpreted, is the dry Sahafati of the Arabian writers, the A12D -aphat of the Le\ itical code, as already ex- plained; the Arabic being derived from the Hebrew root. It embraces the following varieties : m ('uttata. Drop-like, but with irregular Gutiated dry scall margin. In children contagious. 400 ECCRITICA. [CL.V1.-OR. 11L 6 Gyrata. Scaly patches in serpentine or Gyrated dry scall. tortuous stripes. Found chiefly on the back, sometimes on the face. y Diffusa. Patches diffuse, with a ragged, Spreading dry scall. chopped, irritable surface : sense of burning and itching when warm: skin gradually thicken- ed and furrowed, with a pow- dery scurf in the fissures. Ex- tends over the face and scalp. 5 Inveterata. Patches continuous over the whole Inveterate dry scall. surface ; readily'falling off and reproducible with painful, dif- fuse excoriations. Extend to the nails and toes, which be- come convex and thickened. Found chiefly in old persons. i Localis. Stationary and limited to particu- Local dry scall. lar organs. In the first or guttated variety, the patches very seldom ex- ' tend to the size of a sixpence ; and are distinguished from those of leprosy by having neither an elevated margin nor an elliptic or * circular form, often spreading angularly, aud sometimes running in- V* to small serpentine processes. The eruption commences in the spring mostly on the limbs, and appears afterwards distributed over the body, sometimes over the face. It subsides by degrees towards the autumn, and sometimes reappears on the spring ensuing. In children, probably from the greater sensibility of their skin, this variety of scall spreads often with great rapidity, and is scat- tered over the entire body in two or three days. The second or gvrated varietv runs in a migratory course, and apes the shape of earth-worms or leeches when incurvated, with slender vermiform appendages. Not unfrequently the two ends meet, and give the scall an annulated figure like a ring-worm, par- ticularly about the upper part of the shoulders or on the neck, in which case they are sometimes confounded with shingles or some other modification of herpes. The spreading scall commences commonly on the face or tem- ples, as the first of the preceding does on the extremities, and the second on the back. It is sometimes confined to a single patch, which nevertheless, is occasionally to be seen in some other part, as the wrist, the elbow-joint, breast, or calf of the leg. It is often obsti- nate and of long duration, and has been known to continue for a series of years : in which cases, however, there is usually an ag- gravation or extension of it at the vernal periods. It is at times preceded by some constitutional affection; and at times seems to produce the same. When limited to the back of the hand this, like 6E. 1V.-SP. 111.]** EXCERNENT FUNCTION. 401 some other forms of lepidosis, is vulgarly catfed the Baker-s Itch. On the hands and arms, and somet mes on the face and neck, it is peculiarly troublesome to washer-women; probably from the irri- tation of the foap they are continually making use of. The inveteracy of tlje fourth variety seems principally to spring from the general torpitude and want of power in the class ot persons whom it chiefly attacks, which is those who are m the de- -^ cline of life. It is accompanied with painful excoriations, in niany f instances occasioned by the pressure of some parts of the clothing against the sores, or by the attrition of contiguous surfaces, as of the nate«, groins, thighs, and scrotum!'' At an advanced period ot the disease, the cuticle is often still more extensively destroyed; and the extremities, the back and nates have been seen excoriated at the same time, with a verv profuse discharge of thin lymph from the surface:, after .which the discharge itself thickens, from an ab- sorption ofitfre finer parts, and formf a dry, harsh, and almost horny cuticle, which progressively separates in large pieces. At first, ' this variety intermits in the summer, but at length becomes per- manent and intractable. % The local variety is found chiefly on the lips, eye-lids, pre- ^pucfr scrotum, and inside* of the hands. _lt is peculiarly common to shoemakers, and artificers in metallic trades, as braziers, tinmen, and silversmiths; probably from filth and the irritation of the sub- . stances «4hey make use of. w^ The drv scall, under one or other ,of the above forms, is one of the most frequent cutaneous diseases in this kingdom, and the first variety, guttated or drop-scall, psoriasis guljtota, is sometimes con- tagious in irritable skins, and especially among children. Several of these modifications are also found, occasionally, as symptoms or sequels of lues, particulaaly the first three ; but are in every in- stance distinguishable by the livid c-r chocolate hue of the scales. As cutaneous sordes, in connexion with a peculiarity in the con- stitution of the skin, and especially in connexion with a meagre ^ diet, indolence, and want of exercise, appears to be the general *, cause of this as well as of many other, perhaps most other, simple *: cutaneous eruptions, the first principles of a curative intention must ^* 'consist in washing and softening the skin by warm bathing, regu- larly persevered in; and in improving the diet, and exciting to a life of more activity. Beyond this the common treatment of pso- riasis should be with little exception, that of lepriasis: and hence the sulphureous waters of Harrowgate, Croft, Sharpmore, Brough- ton, Wrigglesworth, and other places, used both externally and in- ternally, will succeed better than common spring or river-water. Chalybeate medicines, and particularly chalybeate waters, have been powerfully recommended by Dr. Willis and many others: but. excepting where the disease is combined with a languid circulation, as in the inveterate form, and demands excitement, these do not appear to be of any certain efficacy. Bleeding and the repetition «f purgatives arc of no avail though a common practice with man)", vol. iv. f 51 402 ECCRITICA. [CL. Vl.-OR. III. and founded also on the authority of Dr. Willis. '$ Strong mercu- rial preparations," observes Dr. Willan, " are of no advantage, but1' eventually rather aggravate the complaint." Nor do the fresh^ juices of tbe alterant plants, scurvy-grass, succory, fumitory, or sharp-pointed dock, appear to be of any material benefit. A gentle purgative should open the course ofmedical treatment; to which should succeed an internal use of the fixed alkalies with precipitated sulphur, and decoctions of elm-root, sarsaparilla, sasa- ^ fras, mezereon, or dulcamara; and where the skin is very dry an . antimonial at night, or five grains of Plummer's pill,-the compound submuriate mercurial pill of the London College. Yet here, as in the preceding species, the most effectual remedy, in obstinate cases, is the arsenic solution, with an abstinence from fruits, acidsvand fermented liquors : under which plan in conjunction with the above regimen, most of the ordinary cases will be found to disappear in about three weeks or a month. y *1 SPECIES IV/ LEPIDOSIS ICTHYIASIS. JFfehs&fttn. thick, indurated incrustation encasing the skin to'a greater" or less extent; scaliness imperfect. The specific term is derived from iyfivg " piscis** with the terminal adjunct of the preceding species. The word is commonly written, but less correctly ichthyosis, since as 1 have already observed the suffix iasis is by general^consent applied to all species appertaining to the genus,,or tribe of diseases before us: % In treating of the genus parostia* as well as in various other places, 1 have had occasion to observe that the calcareous earthly *1f which the assimilating powers of the animal frame elaborate from the materials of the food or of the blood, for the use of the bones, \1 to give them increased size and solidity in adolescence, and to- * k maintain their firmness in mature life, is, in many cases,'secreted irregularly; sometimes in excess, sometimes in deficiency, and some- times imperfectly, or without a due proportion of phosphoric acid, and. other constituents: while, on the other hand, in the advance of old age, although the secretion may not be much disturbed as to its quantity or quality, in the process of carrying off the waste mat- ter the finer parts alone are removed in consequence of the debili- ty of the absorbents, and the bones become brittle and easily ^broken. * Vol. iv. p. 216. r.E. IV.-SP. IV.] EXCERNENT FUNCTION. 403 In the genus lithia we have seen that one of the outlets for the discharge of the waste calcareous earth is the kidnies:' and that when these are supplied with"* an excess of earth, or a quantity beyond what the uric acid will hold in solution, it is apt to subside, accumulate, and concrete, and consequently Jojprm calculi. We have also seen under paruria erratica as well as under lithia that the excretories of the skin become at times an outlet of the same kind for the removal of calcareous earth, whence the calcare- T ous deposits in gout and the calcareous scurf which isdften accumu- lating on the head of those who perspire much. —^ In the disease befdre us the cutaneous excretories throw forth such an excess of this earthy material that it often encases the entire body like a shell; and the cutis, the refe mucosum, and the cuticle being equally impregnated with it, the order of the tegumental laminae is destroyed, and the whole forms a common mass of bony or horny cofium, generally scaly or imbricate, according as the cal- careous earth is deposited with a larger or smaller proportion of * V gluten, in; many instances'of enormous thickness, and sometimes giving rise to sprouts or branches of a ver> grotesque appearance : thus offering to us numerous varieties, of which the following arc '"•■ the'chief: Lr- h Simplex. The incrustation forming a harsh Simple Fish-skim populated or warty rind ; hue X* .■* dusky; subjacent muscles flexi- ble.1* Sometimes catering the whole body except the head and .^ > face, palms of the hands, and j»4 < ft soles of the feet. V^C Cornea. The incrustation forming a rigid, • • papilla of the cutis; which are elongated and enlarged into roundish ' ' cones or tubercles, often void of sensation. Some of the scaly papill.-e have a short, narrow neck, and broad irregular tops. Somc- yi times the scales are flat and large, and imbricate or placed like tiling, or the scales on the^back of fishes, one'overlapping- another. They also differ considerably in colour in different instances, and are blackish, brown, or white. The skin, to a very considerable extent, has sometimes been found thickened into a stout, tougb 404 ECCRITICA. [CL. Vl.-OR. IU. leather. In a singular enlargement! of the lower extremity produc- ed by a puerperal sparganosis Mr. Chevalier found the thickness of ; the corium in* some parts near a quarter of ap inch; which, on being ^ cut into, presented the same grained appearance that is observable^ W^y in a section of the hides of the larger quadrupeds. Below the coriaceous skin the adipose membrane exhibited an equal increase of substance,~and in front of the tibia was not less than an inch and a half thick. Mr. Machin gives a very extraordinary case of icthy- iasis of the same kind*, originating, indeed, from a different and un- known cause, which covered,the whole body wifhtthe exception of ^ ^ the head and face, the palms of the hands, and the. soles of the feet, The entire skin formed a dusky, ragged, thick case, which,"did not . r bleed when cut intoor scarified,'was callous and insensible, and: was r ^shed annually like the crust of a lobster, about autumn, at which / time it usually acquired the thickness of three-fourths of an inch, and was thrust off by the sprouting of a new skinibeneatb.* This maif : married, and had a family of six children, allof w^om possessed the ^ same ragged covering as himselfT'XThe "father~was twice salivated W for the complaint, and threw off the casing each time, as did one of the children during the small-pox; but the disease soon returnea on 4 both of them. In the Transactions of the Medico-ChirrSgical Socie- ty there is a case in which the face"' alone was exempBep frgm the fish-scale covering.! •* '• + '"" . There is a remarkable passage T in * the Lettres Edifiantes et . Curieuses, of the Jesuits which injima^es that, this'disease is by no means uncommon among the inhabitants of Paragua}', the. words,' - which have been quoted byjVI. Buffon and Dr. Willan, are as fol- ; lows: " 11 regne parmi eux une maladie extraordinaire: c'est une espece de Lepre, qui leur couvre tout de^Scorps, et y forme fune ' > * croute semblable.a des ecailles de pojssoo : ^ette iqcommodite ne leur cause aucone dqul^ur, ni meme^aucun autre derangement dans la sante."J There is "perhaps-not part of the world where we should sooner,jexpect to meet with this, and indeed various other % /id species of squammosfc or leprous affection's of 'the' skin, considering .-^p the sultry heat of the atmosphere, t|je rankness of the perspiration *£ that issues from the bodies of the natives, and their deficiency in --^^ ^ personal cleanliness; yet I dp not know that the same account has been given by any other travellers, and have looked in vain over Estalla and Dobrizhoffer: nor does this particular incrustation of , ' *i the skin seem to be prevalent in other inlaojd, countries exposed to the same excitements, though most of them exhibit squammose dis- orders of the surface of some kind or other. In our own country it often shows itself locally and is restricted ^ to a single limb, as an arm, leg, or soles of the feet, and it has \-: \ * Phil. TransrNo. 42 t. t Traus. Medico-Chir. Soe. Vol. IX. p. 52. X Recueil de LAtjres, &c. xxv, p. 122. ^ * HE. IV.-SP. IV.] EXCERNENT FUNCTION.^ *, 405 sometimes fixed on a cheek, an interesting figure of which, is given ' in Dr. Bateman's Delineations. , „ x '* Examples of the cornigerous variety, or that in which the incrus- tation is accompanied with a sprouting of horns or horn-shaped pro- jections are by no means uncommon. Sir Egerard Home has given. two cases in the Philosophical Transactions that occurred within his own knowledge.' The patients were women, about the midd e ■ „of life, or father later: one had four horns, and the other a s.ngle horn. Each of them grew from a cyst which formed gradually, S Shd at last Opened spontaneously and .discharged " a thick gritty ' fluid "* The "foreign ^journals are'full of similar accounts, in some ** ot which the horAs are of considerable length, mostly growing upon » 'Iherfiead, though in atfew instances on the back,!* In the British Museum »shqwn«us,as'a curiosity, a horn of thiskbd eleven inches , long, and.Vwoand a half in circumference at the base. It is sajd to have issued from a wen that formed in, theHiead of a woman, and to have reached its full length in four.years. » When these are single they rather perhaps belong to the genus ecphyma, and particularly the species verruca and ciavus; but they vare very frequently" connected with a dry furiuraceousorsc.ily skm, V often oozing a calcareous material. A very singular example ot this c icomplex modification occurred a few years ago in a Leicester- shire heifer which was publicly exhibited, and of which the au- thor presented a description atW' a drawing to the Royal Society. The whole of the skin was covered with a thick, dry, chalky scurf, often producing an itching; and whenever the skin was scratched, a calcareous fluid oozed from it that soon hardened, and put forth ' corneous, recurvating excrescences, frequently divaricating, and as- "If'fwming sometimes a leafy, sometimes a horn-shaped appearance. * The back was covered with them;, over the forehead and below the ' V dew-lap they hung in some hundreds; many as large as natural horns, V and rattling together whenever the animal moved. The heifer % > M was otherwise in good health, and secreted the same chalky fluid %mX whatever food it was Ted upon. » *" • Medicine has hitherto been fpund of but little avail under any form of this«ffection. Dr. Willan advises to immerse the incrusted ' part in water, and to pick off the, scales »with the finger-nails, while ■• > thus soaked. Dr. Bateman'recommends that the bath should be tf i of sulphureous waters, and the scales rubbed off with a flannel or '/t "rough cloth. But both, admit that their methods produce only a ' ' partial cure ; that the skin does not recover its proper texture, and *''y*4 that the eruption will probably recur. Dr. Bateman further recom- mend*, as having been actually. serviceable, pills made of pitch "> hardened by flour or any other farinaceous substance, which makes ______j--------------------------------------■------—--------*------------------------ * PhiT. Trans. Vol. ijfXM. $5. t Eph. Nit. Cur. Dec. l. Ann. i. Qbs. 30. * See also Hist, do la Sociwa Royalc de la Medicine, 1 < < b, p. 316. i 406 ECCRITICA. v \CL. V1.-0R. III. ■ , » ,;,-* the cuticle crack and fall off, as he tells us, without the aid of external means, and leaves a sound skin underneath. Where there is an .^evident excess of calcareous earth the most efficacious remedy is probably to be found in a free use of acids, and especially the mineral acids, as in Whtte urinary sand,* to which this disease bears a near resemblance. The arsenic .solution, however, is worth trying, but 1 have no documents of its ^fleets. _______r* - GENUS V.* -•'* ' ECPHLYSIS. * Mains. orbicular elevations of the cuticle containing a watery fluid. Ecphlysis, (" E^wV Quotidianns. Blebs with a dark red base, appear- • Quotidian water-blebs. , . ing> at night and disappearing in * the morning, or appearing in the morning Aid disappearing at night. Found chiefly on the hands and legs. • Vol. u. 40-'. Emphlysis Pempbisuis. 408 ECCRITICA. [CL, VI.-OR. Ill ■■■ ► £^ ^* J 5 Solitarius. . r <|^ v Bleb solitary; but reproductive in Solitary water-bleJ). ( *. t an adjoining part; very large, and 7 ^» ^* containing a tea-cup-full of b^pph. jg . > Ot_ H. *■ Preceded by tingling:^often ac- -J companied with languor. W The third, *or quotidian variety, is here introduced upon the authority of Sauvages, for it does, not occur in Willan, who seems to have overlooked it: and hence it is not noticed by Bateman. Sauvages, from the time of its more usual appearance, calls it epinyctis ; but as Vandermonde has given a case of an opposite*kind. »** *" in which the bulla showed itself .daily and* subsided nightly, this name will not properly apply. w -up ^ J* Under whatever form, however, the pompholyx appears, its causes seem to be debility and irritability either general or confined J to the cutaneous exhalants. The. begign variet^has hence been found in infancy during teething and bowel complaints, and occa- jL sionally immediately after vaccination. The quotidian has evidently *"^ succeeded to great anxiety, fatigue, watching, and low diet. It W appears also chiefly in persons of advanced age, or who have been unduly addicted to spirituous liquors. It is by-far the most severe ^ of all the forms of the disease, as being painful as well as tedious. The other varieties are to be referred to like causes. In early or middle life, Peruvian bark given freely, with an improved diet, where necessary, has formed the most successful xeiriedy:^ In old age, softening the skin, and gently exciting the - cutaneous exhalants, has been equally useful: 'hut while the bark is less serviceable in old age, warm bathing has proved rather injn- * ^ rious in earlier life. A ' % . SPECIES II. |. ECPHLYSIS *H1JRPES; > '* Eettrr. ERUPTION OF VESICLES IN,SMALL, DISTINCT CLUSTERS ; WITH A RED MARGIN / AT FIRST PELLUCID,-AFTERWARDS OPAKE ; ACCOMPANIED WITH ITCHING OR TINGLING ; CONCRETING INTO SCABS : DURATION FROM FOURTEEN TO- TWENTY-ONE DAYS. . ' ^' '; ^ i Herpes from tpcv, " serpo," " repo,".1ias'Deentused.#n very different senses by different writers: being sometimes restricted to one or two of the modifications of the present classification, and by others extended so widely as to include both the preceding and the ensu- ing genus—or, in other words, cutaneous eruptions, dry, vesicular, i* <• «* GE. V.-SP. 11.J ^^ EXCERNENT FL.nCTIOT.. ^Tj^ V .<*^ ^ and puWilar, and in tliis*4p^tbdinanal| sefl of the Term it employed by Mr. B. BeWfwho giife nsa h^rjp^s farih^sus^ and *pustuta>us, as well as a herijsjniliariyn whi^hhe^ French have |? tffe derived natu deri\ 'Vrorru ed thttlr popular, namejgfor it of dartre, whicliAby^an-easy ption, has Keen c.h^|%eclfc ,our o|hi tongua into tetter^, * ^ ThetfbllowingMre Jhe ijajietieisiwhichj^eemTairly to bjflfonglo it i \ ■|K! ■*! r mm'* ^T^ - - > • ^ 4 Miliaris. ' Vesicl**|^millet-s^|d ;"p^lbfotd ; clusters * MiliarjJAter. v ^ommendpg.at .§n indetetaunate part \ %m MiliarajAter. -k F ifc% ^^ w • M^h^ur&je,'jHd progressively strew- \ ' A W ^ mMj, cd ovtrtlrthAjty; Ifcceed^ by fresh ^Ttf *4^ fe ji cropsi"k t£ * ,#• *^ * ftf C Exedens..J* 4^4. Vesicles Tiard ; Wine size and or|gin oltj**- * Erosive g)tter. f .. t*fc last; clusters thronged jJluid^ense*; & JL 4fi "i^flSkow or rj|ddi^h ; ho^^ridy corrod- t^A ^ Hy th$6u¢ skin, and spreading ■^F .-.. in se*|entinP trajifs. :sicles pearl-siz^r, t y Zoster^ ^t Vesicles pearl-si Shingles. ^K ** ing r©unp.^ % Jk * +. rJHie hr>A oj^ miliary variety,J» the berpjj^niliaris of Hippo- -\ . crttfte and Hoffman, th*h. phlyctenJIresif Bafem^. The cause offjj*/' . » t ^the peculiar irrAability*||f the skinJ^at eicites this affection is ve^ *%$) * obscure. TJie. lymph^ containeCin the •vee^cloais sometimes. 1jrow"nisn*, amKfor the spa|e^)f tWllfror three imnja*ien belOw, that still continues to exude fresh matter, which also|srms intoxakes, an|l falls .off like VOL. W. ^ ■•>'- ' > 410 CCfcRITlCw.' y* -[cL.VI.-OR.lIL ' W h ■ that which preceded.^ The itching is always very troublesome: and the matter discharged from the vesicles is so tough and viscid, that every-thing applied in the way of dressing adheres very g closely, and is removed withlgreat trouble and uneasiness. ^* To the second, or erosive variety, the Greeks gave the name of % wwus zrfitopttog, or herpes esthiomenos, of which the Latin herpes exedens is a mere translation. The herpes esthiomenos, however, has hitherto been much misundjjffstood, and been held of a far severer character than it-really possesses, in consequence of*an error that has long since crept: into the text of Celsus, and been propagated in the common editions, in which he is made to say that j the livid and fetid ulcer which theHSreeks called %^*fix, sometimes * degenerates into a herpes*esthiome»os*, oriexedena,'" eating herpes ;" as though the herpes exedens formed the worst and most gangrenous 'stage of this ulcer In the volume of Nosology I have examined f this passage critically, and have shown that for Ht*rpes esthiomenos we ough«*to read Quyt&xwx, " the ulcer called phagyiana" as it is ■ properly given in the'corrected: text of the variorum'1 edition, which settles the dispute at once, and clears Celsus from the absurdity vf which has been ascribed to him of converting* a cutaneons vesicular affection into a deep* spreading ulcer of a^feancerous character.* Celsus, therefore, in reality makes no mention whatever of the herpes exedens or esthiomenos; and it is to other writers we mustv turn for its character. ■ Galen has described it very accurately: and in the volume of>Nosology.1 have copied and translated Galen's description,, as it occurs in different parts of bis-fwritings. The defi- ''* nition given of it above, is entirely taken from his representation. 1 The ulcerative ring-worm of Dr. Bateman is, perhaps, a modifica- * tion of thtf variety:" ffis of tedious and difficult^eure, but is limited to hot ^limates. ^ 4lk * Where this variety is connected, as it is sometimes Jound to«be, with the state of the constitution/and particularly of the stomach, r d lys other clusters continue to arise in succession, and with coo4 ierable regularity, that is nearly in a line with the first, extending always towards the spine at one extremity, and towards the sternum or linea alba at the other; most comnonly passing round the waist like half a sash, but sometimes, like a sword-belt, across the shoulder. As the patches which first appeared subside, the vesicles become partially confluent, and assume a livid or blackish hue, and terminate in thin dark scabs, the walls of the utricles being thickened by the exsic- cation of the grosser parts of the contained fluid. The scabs fall off about the twelfth or fourteenth day, when the exposed surface of the skin appears red and tender; and, where the ulceration and discharge have been considerable, is pitted with numerous cica- trices. The complaint is generally of little importance, but is some- times accompanied, especially on the decline of the eruption, with an intense deep-seated pain in the chest, which is not easily allayed by medicine. By some authors, as Hoffman and Platner, it is said to be occasionally malignant and dangerous, and Languis alludes to two cases in noblemen that terminated fatally.* The disorder, how- ever, seems in these instances to have been of a different kind from shingles, and to have depended upon a morbid state of the consti- tution. This affection is found most frequently in the summer and au- tumn, when the skin is most irritable from increased action, and in persons of a particular diathesis disposed to herpes, rather than to any other form of scaly eruption. Under these circumstances slight exciting causes will produce it, as exposure to cold after violent exercise with great heat; cold cucurbitaceous vegetables, or other substances that disagree with the stomach; inebriety; or even a sudden paroxysm of passion or other strong mental emotion, of which Schwarz tells us that he had seen not less than three cases.f It is more common to early than to later life, being found principally between twelve and twenty-five years of age. It has sometimes appeared critical in bowel-complaints, or pulmonic affec- tions.! ^ does not seem to be contagious, though asserted to be so by some writers. " In the course of my attendance," says Dr. Bate- man, " at the Public Dispensary during eleven years, between thir- ty and forty cases of shingles have occurred, none of which were traced to a contagious origin, or occasioned the disease in other in- dividuals." * Epist. Med. p. 110. r Diss. , " efferveo" is the hidroa of Sauvages and Vo- gel: it is common to all countries in the summer, and has been described in all ages. Its proximate cause is irritation in conse- quence of exposure to the direct rays of the sun, or to air heated to a high temperature, or violent exercise. Hence it chiefly af- fects those parts that are most exposed to this influence, as the face, neck, and fore arms in women, but particularly the back of the hands and fingers, the latter being sometimes so tumefied that the rings cannot be drawn off. The blushing halo by which they are surrounded is popularly called a heat-spot. In men of a san- guine temperament, and who use violent exercise in hot weather, these vesicles are intermixed in various places with minute pus- tules possessing a hard, circular base, the phylzacium of Willan, or with hard and painful tubercles, which appear in succession, and rise to the size of small boils, and suppurate very slowly, though without a central core. The vesicles are apt to be confounded with two other eruptions of very different kinds, miliaria, while it spreads widely over the body, and scabies, when fixed chiefly about the wrists, the ball of the thumbs, and the fingers. It is, however, distinguishable from the former by being unaccompanied with fever 416 ECCRITICA. [CL. VI.-*R» lli. - or any other constitutional derangement; and from the latter by the pellucidity and acumination of the vesicles, the closeness and uniformity of their distribution, and the absence of surrounding in- flammation, or subsequent ulceration. The sensation moreover, to which it gives rise, is that of a smarting or tingling rather than of itching. The eruption is irregularly successive, and has no determinate period of decline, which very much depends upon the irritability of the skin itself. Generally, however, it runs its course in two or three weeks, and subsides slowly and almost imperceptibly. But where the skin is highly irritable it will sometimes continue till the weather grows cool in the autumn, and consequently for two or even three months. Medicine external or internal seems to accomplish but little. The re-action of a cold bath, in most cases, increases the irritation: and hence a tepid bath is most serviceable. Astringent lotions add equally to the irritability, as do unguents of all kinds. Washing the parts with mild or Windsor soap and tepid water, I have found most effectual—when, in a few days, the skin will bear a soap of a coar- ser kind with still more advantage. Where the irritability of the skin is connected with that of the general frame, the mineral acids, and other astringent tonics, have proved decidedly beneficial. The eezema impetiginodes of Dr. Bateman is an eczema set down on an impetiginous habit of the skin, and is hence a mixed com- plaint. His eczema rubrum or merSUriale has already been describ- ed as an erythema.* GENUS VI. ECPYESIS. f&umft Scall. ERUPTION OF SMALL PUSTULES DISTINCT OR CONFLUENT ; HARDENING INTO CRUST ULAR PLATES. Ecpyesis is a Greek term from ixttvu, " suppuro." It is here used in contradistinction to empvesis already employedt to import deep- seated suppurations ; and consequently i? intended to describe pus- tular eruptions simply cutaneous, or not necessarily connected with internal affection as opposed to those which result from an internal cause. The genus, therefore embraces the pustulae of Dr. Willan, * Erythema vesiculare. Vol. n. p. 210. t Vol. ii. p. 411. Class in. Ord. n. EXCERNENT FUNCTION. 417 flE. VI.] which he has correctly defined '• elevations of the cuticle with an inflamed base containing pus." Tbe old English term for ecpy^sis or pustula in this sense of the word, is scall, from the Saxon scala or sceala,not essentially different from the medical sense of scale. The scall was of two kinds, dry and moist: both which are clearly referred to in the Levitical law that governed in the matter of plague. The former is there denominated A1SD (saphat,) as we have already observed when treating of lepra, and the latter, or the eruption before us pD) (netek.)* The Arabians, like our own ancestors, denominated both these by a common name 'sahafata) from (sahaf,) squammse, or rattier from the Hebrew JVT2D (saphat): distinguishing the one from the other, like our ancestors also, by the adjuncts dry and hu- mid : so that the sahafata of the Arabians is a direct synonym ot tbe old English or Saxon scale. In our established version the He- brew pri3 netek,) which imports the eruption before us or humid sort, shy mistake rendered dry scall, which as remarked above is a nnSD s iphat.) The expletive dry does not occur in the original, and that pP3 (netek,) denotes humid scall rather than dry scad, is clear from the explanation contained in the bible-context, in which it is represented as a scall seated on the hair or beard, and affecting its strength and colour, forming so thick a crust or scab that its re- moval by shaving cannot be accomplished, or ought not to be at- tempted. It is distinct Iv, therefore, a porrigo or scabby scall, and is thus actually rendered in the Latin version of Tremellius and Ju- nius, forming one of the species of the present genus; and seems to be one of the two modifications of it, which, in our own language, are denominated honevcomb-scall, and scalled-head. Q^xvaux, by which netek is rendered in the Septuagiut, is literally crust, a very significant term in common use to express the peculiar nature of the scab that hardens on the porriginous SOre. Tetter, a corruption from the French dartre, or the Greek luprog, has of late years been used synonymously with scall, and has almost supplanted it: but the proper meaning of dartre, or tetter, is herpes, to which, in this work, it is confined, an excoriating eruption of a vesicular or icho- rous kind. The specie* that belong to this genus are the following:— 1. ECPYU.-IS IMPETIGO. RUNNING SCALL. 2. ------- 1'ORF.IGO. SCABBY SCALL. ;i.------- EC I'lli MA. PAPULOUS SCALL. 4.-------SCABUIS. ITCH. All these specific terms have been very loosely employed, and in very different significations by most writers. They are here limit- ed to the definite senses assigned them by Dr. Willan ; and, with the * Leviticus >:iii. S(i, 31. vol. iv. b3 418 ECCRITICA. [CL. VI.-OR. HI- exception of ecthyma, by Celsus, whom Willan has followed. Ec- thyma does not occur in Celsus, though it is found in Galen, but in a sense somewhat different from its use in modern times, as will be further noticed hereafter. SPECIES I. ECPYESIS IMPETIGO. l&untitng Stall. EUSTULES CLUSTERING, YELLOW, ITCHING; TERMINATING IN SCALY CRUST, INTERSECTED WITH CRACKS. A YELLOW The specific term is a derivative from impeto " to infest," and the following are the varieties the species offers us: x Sparsa. Scattered humid Seal!. £ Herpetica. Herpetic Scall. y Erythematica. Erythematic Scall. 9 Laminosa. Laminated Scall e Exedens. Erosive Scall. £ Localis. Local humid Scall. Clusters loose; irregularly scat- tered ; chiefly over the extre- mities ; often succeeded by fresh crops. Clusters circular, crowded with pustules, intermixed with vesi- cles; often with exterior con- centric rings surrounding the in- terior area as it heals; itching accompanied with beat and smarting. Chiefly in the hands and wrists. Pustules scattered; preceded by erythematic blush and intumes- cence ; often by febrile or other constitutional affection. Chiefly in the face, neck and chest. Pustules confluent; chiefly in the extremities; the aggregate scabs forming a thick, rough, and rigid casing around the affect- ed limb, so as to impede its motion; a thin ichor exsuding from the numerous cracks. The purulent discharge corroding the skin and cellular membrane. Confined to a particular part; most- ly the hands or fingers ; and pro- duced by external stimulants, as sugar or lime. eied, which art chiciy the hands, as -u^.ir among the labourers in grt'^erv wareLoun-. and lime among bricki i\or». Whence this yaru.-lyh's U-en vul^irly .ailed Grocer's Itch, or Bricklayer's licit. According tu the peculiar < 420 ECCRITICA. [CL. VI.-OR. III. character of the skin the eruption is sometimes vesicular, and be- longs to the preceding genus, being a modification of eczema; but more generally pustulous, and appertains to the genus before us. In neither instance does it seem to be contagious. Most of the causes enumerated under lepriasis, and many of the species of ecflhysis operate in the present species, as general de- bility or relaxation with a skin peculiarly irritable ; poor diet; filth; fatigue ; and local stimulants. And hence, where the constitution seems to catenate with the disease, the same general remedies have been found successful; as the alkalies, sulphur taken freely, Plum- mer's pill, the alterative decoctions or infusions of dulcamara, ledum palustre, juniper-tops, sarsaparilla, and mezereon; together with a frequent use of warm bathing for the purpose of purifying and sof- tening the skin. In connexion with these we should have recourse to such external applications as may best tend to diminish the ir- ritability of the cutaneous vessels and give tone to their action. The most useful of these are the metallic oxydes, with the excep- tion of those of lead which are rarely useful, at least if employed alone : and are often found injurious. About ten grains of sublimate dissolved in a pint of distilled water, with a small proportion of muriated ammonia, will frequently prove a valuable remedy. Or the oxyde of zinc may be applied in the form of an ointment, which I have often found serviceable prepared in the manner already noticed under the species prurigo. Lime-water is also recommend- ed by many writers, and has proved useful as a stimulant astrin- gent ; as have also solutions of alum, and sulphate of zinc, and sul- phuret of potash ; the old liver of sulphur, but 1 have found them less useful than the zinc ointment. The acrid oil contained in the shell of the cashew-nut has often been employed with great advantage in some of these varieties and especially where the disease is decidedly local, and a local change of action is the grand desideratum. In many cases, however, the skin is too irritable for stimulants of any kind, and will only bear warm water, or a decoction of mallows, poppy-beads, or digitalis: after which the excoriated surface may be illined with cream or an emulsion of almonds. In general, nevertheless, astringent stimulants agree far better with this affection than with herpes. The burning and maddening pain in the erosive scall can rarely be alleviated but by opium. The Harrowgate waters are generally recommended, and in many instances have certainly been found useful. GE. VI.H5P. II.] EXCERNENT FUNCTION. 421 SPECIES II. ECPYESIS PORRIGO. Scabbg Scill. PUSTULr.S STRAW COLOURED ; CONCRETING INTO SCALES OR YELLOW SCABS. This is the porrigo of Celsus and Willan, from porrigo " to spread about;" and the tinea of Sauvages and most of the nosologists. It offers the following: varieties :• Crustacea. Milky scall. C (laleata. Scalled-head. y Favosa. Honey-comb scall i Lupinosa. Lupine scall. t Furfuracea. - Furfuraccous scall. £ Circinata. King-worm scall. Pustules commencing on the cheeks or forehead in patches; scabs often con- fluent, covering the whole face with a continuous incrustation. Found chiefly in infants during the period of lactation. Pustules commencing on the scalp in distinct, often distant patches; gradu- ally spreading till the whole head is covered as with a helmet; cuticle below the scabs, red, shining, dotted with papillous apertures, oozing fresh matter ; roots of the hair destroyed. Contagious. Found chiefly in chil- dren during dentition. Pustules common to the head, trunk, and extremities ; pea-sized ; flattened at the top ; in clusters, often uniting; discharge fetid ; scabs honey-combed, the cells filled with fluid. Found both in early and adult age. Pustules minute in small patches, most- ly commencing on the scalp ; patch- es terminating in dry, delving scabs resembling lupine seeds; the inter- stices often covered with a thin, whi- tish, exfoliating incrustation. Found chiefly in early life. Pustules very minute, with little fluid ; seated on the scalp : terminating in scurfy scales. Found chiefly in adults. Clusters of very minute pustules seat- ed on the scalp in circular plots of baldnecs with a brown or reddish, 422 ECCRITICA. [CL. VI.-OR. III. and somewhat furfuraceous base. Found chiefly in children. The first variety is the crusta lactea of numerous authors, the tinea lactea of Sauvages, so called from the milky or rather the creamy appearance and consistency of the discharge, whence the French name of croute de lait, and our own of milky-scall. It is almost exclusively a disease of infancy, at which period the skin of the head is peculiarly tender and delicate. It commences ordinari- ly on the forehead and cheeks in an eruption of numerous, minute and yellowish white pustules, which are crowded together upon a red surface, and break and discharge a viscid fluid that concretes into thin yellowish scabs. As the pustular patches spread the dis- charge is renewed, and continues to be thrown forth from beneath the scabs increasing their thickness and extent till the forehead, and sometimes the cheeks and entire face become covered as with a cap; the eye-lids and nose alone remaining free from the incrustation. The quantity of the discharge varies considerably, so that in some instances the scabs are nearly dry. As they fall off and cease to be renewed, a red and tender cuticle is exposed to view, like that in impetigo, but without a tendency to crack into fissures. Smaller patches are occasionally formed about the neck and breast, and even on the extremities, and the disease runs on for several weeks, sometimes several months: during which the constitution suffers but little except from a troublesome itching which sometimes inter- feres with the rest, and destroys the digestion. And, where the last takes place, a foundation is immediately laid for general debility, and especially for torpitude and enlargement of the mesen- teric glands. In many instances the eruption returns at irregular intervals, after having appeared to take its leave ; apparently re- produced by cutting additional teeth, or some other irritation. Dr. Strack affirms that, when the disease is about to terminate, the urine acquires the smell of that voided by cats; and that, where there is no tendency to this change of odour, the disease is gene- rally of long continuance. It is singular that notwithstanding the extensive disfigurement and sometimes depth of the ulcerations, no permanent scar or deformit}r is hereby produced. The second variety, or scali.ed head originates generally in the scalp, and consists of pustules somewhat larger, and loaded with a still more viscid material than the first. The pustules are circular in form with a flatfish, and irregular e^ge. They sometimes com- mence on the cheeks, but where the face is affected the ordinary course is from the scalp towards the cheeks by the line of the ears. They are usually accompanied with a considerable degree of itch- ing, and harass children from six months to four or five years of age. The disease is rarely found in adults. From the quantity of the discharge the hair is matted together, the scabs become con- siderably thickened, the ulceration spreads into the integuments, and the indurated patches seem, in some cases, to be fixed upon a IjE. vi.-sp. h.] EXCERNENT FUNCTION. 423 quagmire of offensive fluid The lymphatic system, if not in a state of debility before the appearance of the eruption, soon be- comes affected and exhibits marks of irritation, but whether from general debility or absorbed acrimony it is difficult to say. The glands on the side of the neck enlarge and harden, exhibiting at first a chain of small tumours lying loose under the skin ; after which some of them inflame, the integuments become discoloured, and a slow and painful suppuration ensues. The ears unite in the inflammation, and from behind them, or even from their interior a considerable quantity of the same viscous and fetid fluid is poured forth. In some cases the submaxillary and parotid glands catenate in the inflammatory action. The fluid is peculiarly acrimonious, and consequently whatever part of the body it lights upon acci- dentally becomes affected by iU influence. Hence the arras and breasts of nurses evince frequently the same complaint, and other domestics receive the disease by contagion. Its duration is uncer- tain, but it is more manageable than the preceding species : and if not maintained by the irritation of teething or any other excite- ment, it may be conquered in a few weeks. The honey-comb scall, or third variety, differs very little from the preceding except in the seat of the patches and in an increased size and thickness of the scab, which is often cellular or honey- combed. And as pustules of this form have been called favi, from their resemblance to honey-combs, this variety of the disease from the time of Ali Abhas to the present has been distinguished by the name of tinea favosa, scabies favosa, or porrigo favosa. By Dr. Bateman it is united with the preceding variety. The colour of the scab is yellowish or greenish, and semi-transparent, its surface highly irregular, and indented, and its consistency softish. The pustules are found on the face, trunk, and extremities. The irri- tation they produce excites the little sufferer to be perpetualh picking and scratching them about the edges, by which means the skin is kept sore and the ulceration extended. This is particularly the case about the heels and roots of the toes, the extremities of which last are sometimes ulcerated, while the pustules even creep under the nails. The odour from this and the preceding variety is not only most rank and offensive to the smell, but occasionally in- flames the eyes of nurses and others who are officially surrounded by its vapour. The lli'ine variety, is peculiarly characterised by the driness of its scabs, which are formed upon small clusters of minute pustules, the finer part of whose fluid is rapidly absorbed, so that the part remaining concretes, and shows in the central indentations of its surface a white scaly powder. The size of the scab is that of a sixpence : it is found in the head, and in other parts, but, when in other part- than the head, it is often much smaller in diameter, and sometimes does not exteed two lines. It is liable to increase i! neglected, and is usu ;!1_) tedious and of long- duration. The FURFvn venous or luivivny scall make? u still nearer approach 424 ECCRITICA. [CL. VI.—OU. 11L to the tribe of lepidosis, and is often mistaken for a pityriasis, or lepriasis, particularly where it appears in the scalp, which is its most common seat. It commences, however, if its course be watched, with an eruption of minute pustules which nevertheless possess a very small quantity of fluid, so that the whole is soon absorbed, and the excoriation or ulceration is but sight. It is apt to be renewed, is attended with a considerable degree of itching, and some soreness of the scalp, the hair partially falls off, becomes thin, less strong in its texture, and somewhat lighter in its colour: none of which symptoms occur in any species of the true scaly erup- tion. The glands of the neck moreover ar» occasionally swelled and painful. The ring-worm scall has been known and described under dif- ferent names, from the Greek writers to our own day. It consi-ts of clusters of very minute pustules forming circular plots if a brown or reddish hue. There is sometimes only a single plot; and the pustules are so small as to elude all notice unless very closely examined, though a papular roughness is obvious to every one. The exudation is small, yet if neglected it concretes into thin scabs, sometimes irregularly tipped with green, while the plots expand in diameter, and become confluent. The hair is in- jured from the first attack; appearing thinner and lighter in colour, and breaking off short; in progress of time the roots are affected and the plots are quite bald, and, a« they spread into each other, the baldness extends over the whole head, and nothing remains but a narrow border of hair forming the outline of the scalp. It is chiefly confined to children, and since the multiplication of large boarding-schools and manufactories, in which last they are employ- ed with too little attention to their'health, it has been strikingly common in our own country: and from its cphtagious property has been propagated^with great rapidity. It sometimes spreads from the head over the forehead and neck. Porrigo, therefore, is a disease which appears under different modifications of ulceration, from sores of some depth oozing a thick fetid pus, and covered with a broad, scalv scab, to eruptions so minute as to require the aid of a glass, being covered with fine furfuraccous exfoliations^ and discharging a thin purulent ichor, manifested rather by its/cffects than its presence. The predisposing cause is in every instance irritability of the cutaneous exhalants; and as we find this irritability much greater in infancy than in mature life, the different varieties of porrigo are •chiefly confined to this season. The exciting causes are filth, or want of cleanliness, bad nursing, innutritions diet, want of pure air, and whatever else has a tendency to weaken the system generally, and irritate the skin locally. Ami we may hence see why some of the varieties are found occasionally as sequels on lues, or on those who have debilitated their constitutions by high living, iwu] espe- cially by an immoderate use of spirits. OE. Vl.-SP. II.] EXCERNENT FUNCTION. 425 It is hence obvious that many, perhaps all these varieties may, in some instances, be connected with the general state of the sys- tem; and in such ca«es the restorative diet-drinks and alterative tonics, enumerated under the genus ecphlysis will often be equally advantageous here. Sulphur and the vegetable alkalies have also been found serviceable, but especially small doses of calomel, or the black or red oxyd of mercury. And if there be much general irritation it will be adviseable to unite these with the conium or hyoscyamus. The pansy or heart's ease (viola tricolor) was in high vogue for cutaneous eruptions, generally and particularly for those before us during the sixteenth and seventeeth centuries. It fell, however, into disrepute, but was revived by Dr. Strack, towards the close of the eighteenth century, in consequence ofh.s prize dis- sertation delivered at Leyden, in 1779, in which he speaks warmly of its success in all the diseases belonging to the present and the ensuing genus.* In employing this herb Dr. Strack directs that a handful of the fresh, or half a drachm of the dried leaves, be boiled in half a pint of milk to be strained for use, and form a single dose, which is to be repeated morning and evening. He asserts that during the first eight days the eruption usually increases consi- derably, and that the patient's urine acquires the cat-like smell we have already alluded to: but that, where the medicine has been taken a fortnight, the scab or scurf begins to fall off in large scales. leaving the skin clear. The remedy is to be persisted in till the skin has resumed its natural appearance, and the urine its natural odour. Dr. Strack also recommends, as an internal remedy, which we should little have expected, a decoction of the leaves of the tussilago Farfara or coltsfoot, which I should scarcely have noticed were it not that this medicine was also esteemed useful by Dr. Cullen, as we had formerly occasion to observe, in sores dependent upon a scrophulous habit, many of which he tells us he has seen healed under its employment both in extract and decoction.! As to the viola tricolor, Baldinger, who seems also to have tried it, and upon a pretty large scale, asserts that it is of inferior value to sulphur,^ an<^ Selle, that if given in small doses it is useless, and if in larger that it does more harm than good.§ There is some difficulty in determining upon the external appli- cations. Generally speaking, the skin under all the modifications of this species bear astringent and even stimulant remedies well, and yield without obstinacy to their use : but in a few instances we meet with the contrary, and aggravate the pustules, and extend their * De Crusta Lactea Infantum. Francf. 1779. See also Commen. Lips. Vol. xxvn. p. 170. Marcard. Beschreibung von Pyrmont. Mezger. Vermiclue Scriften. B. ir. f Mat. Med. Part. n. Chap. xviu. X Neues Magazin fur practische Aerzte ix. p. 117. » Medicina Clinka. I, 185, vol. iv. 64 426 ECCRITICA. [CL. VL-OR. 111. range by the slightest irritants. The most irritable varieties are the honey-comb, where it occurs at the extremities of the joints, as about the toes and heel and behind the ears, and the furfuraceous. The last, however, will usually bear a lotion of mild soap and water, and afterwards equal parts of starch and calamine reduced to a very fine powder, and dusted over the patches. The honey- combed scall often requires sedative fomentations and cataplasms at first, but will afterwards allow an application of the zinc ointment, or even that of the nitric oxyde of mercury diluted with an equal part of calamine cerate. Dr. Willan was attached to the coculus Indicus in cases of this sort, which he prescribed in the proportion of two drachms of the powdered berry to an ounce of lard. In common, however, we may employ a bolder practice and use pretty actively alkaline or acid lotions, or solutions of zinc, or warm resinous ointments of pitch or gum elemi. All that is want- ing is the excitement of a new and healthier action, which the cutaneous vessels for the most part receive with but little trouble; and this, with a punctilious attention to cleanliness, is in most cases sufficient to ensure a cure. With the sulphur ointment, or, which is better, sulphur and cream, I have often succeeded in curing very virulent attacks of the porrigo favosa that have covered the whole of the face, and matted the beard into a most disgusting spectacle. In the external treatment of porrigo galeata, or scalled-head, one of the most effectual applications is a modification of Banyer's unguentum ad scabiem, for in its original form it is both too irritant and too astringent as well as very unscientifically compounded. I was first induced to try this preparation from the recommendation of my excellent and learned friend Dr. Parr; it has since been recommended by Professor Hamilton, and more lately by Dr. Bateman. Each has altered its composition in a slight degree, and the following form, which is more simple than any of the rest, is that which I have been in the habit of employing with great success for many years. To a powder consisting of two drachms of calomel and an ounce of exsiccated alum and cerusse, add six drachms of Venice turpentine and an ounce and. a half of spermaceti cerate. The hair is first to be cut off as close as may be, for shaving is often impossible ; the scalp is then to be slowly and carefully washed with soap and water, and, where there is very little irritation, with soft soap as being more stimulant, in preference to hard; the washing to be repeated night and morning, and the scalp to be well dried afterwards, The ointment is to be applied after the washing every night, and is to be well rubbed all over the head. It may be washed off in the morning ; and, when the scalp is made dry, instead of applying it through the day, the head may be thoroughly powder- ed with nicely levigated starch contained in a fine linen or cambric bag. The scabs and incrustations will hereby become desiccated, and often brittle, for the ointment alone will diminish, and at length utterly suppress the morbid secretion. And in this state they GC. VI.-SP. II.] EXCERNENT FUNCTION. 427 should be gently picked or combed off, one after another as they grow loose and become detached at the edges. In the last variety the ring-worm porrigo, or alopecia porriginosa of Sauvages, though the appearance is far less disgusting, and unac- companied with smell of any kind, the bulbs of the hair seem more affected than in any of the preceding. And hence this, which is one of the most common modifications of the disease, and, as we have already observed, has been peculiarly frequent of late years, has been found one of the most obstinate. It has ordinarily made its appearance among children at school, but is not confined either to schools or to childhood ; for I have at this moment a medical friend under my care, troubled with the same complaint, whose age is about forty. The disease appears to be seated under the cuticle in the mouths of the secernents of the rete mucosum, which secrete a material of a different colour from what is natural and healthy, and hence give a brown or reddish hue to the entire patch. This material affords no nutriment to the bulbs of the hair, and seems sometimes to be acrimonious : whence the hair, like the rete mucosum itself, changes its colour; and, with the change of colour, becomes thinner and weaker, and breaks off short at the base of the cuticle, sometimes at the roots below. The acrimony of the secretion occasionally produces a morbid sensibility in the minute vessels of the part affected, so that the patient can hardly bear the patch to be pressed upon or the comb to pass over it; yet this is not a common effect, for irritants may usually be employed from the first. Where this morbid sensibility exists we must endeavour to shorten its stage, for it will at length pass off naturally, by tepid and sedative fomentations, as of poppy-heads, or digitalis : and afterwards have recourse to depilatories, without which we can do nothing, for we cannot otherwise penetrate to a sufficient depth; and hence the more active"they are the more radical will be their effects. Dif- ferent preparations of mercury have for this purpose been chiefly employed, and mostly a solution of sublimate. The other metallic acids have been tartar emetic, sulphate of zinc, sulphate of iron, aerugo or the green oxyde of copper, and even arsenic: while practitioners of a more timid character have confined themselves to the pitch-plaster, balsam of sulphur, or decoctions of tobacco, hemlock, or the viola tri-color. In slight cases most of these applications will be found sufficient but, in severe and obstinate cases, none of them. And hence, in every case, 1 have for many years confined myself to a solution of the nitrate of silver in the proportion of from six to ten grains to an ounce of distilled water, according to the age of Ihe patient, or the irritability of his cuticle ; and with this application I have never failed. It destroys the hair to its roots, gives tone to ihe morbid vessels, and changes their action. It often excites a slight vesica- tion or soreness on the surface, and it is in most instances necessary to push it to this point. 428 ECCRITICA. [cl. vi.-or. ni. Where porrigo is of long standing, and has become chronic, the irritation must be lessened gradually, and a steady use of alterants is absolutely necessary; especially in the varieties accompanied with a considerable discharge, for many writers of authority, as Pelargus,* Sennert,t Stoll,J and Morgagui,§ have given examples of epilepsy, apoplexy, and even death itself following upon a sudden retro- cession of the eruption. In the Berlin Medical Transactions there is a case or two of amaurosis produced by a metastasis of this disease.il ■ SPECIES III. ECPYESIS ECTHYMA. PUSTULES LARGE ; DISTINCT ; DISTANT ; SPARINGLY SCATTERED ; SEATED ON A HARD, ELEVATED RED BASE ; TERMINATING IN THICK, HARD, GREENISH, OR DARK-COLOURED SCABS. Ecthyma from txivur, " to rage, or break forth with fury," was used by the Greek writers synonymously with exormia, in the sense of papula: to which effect Galen " apertum est ab tx$vut, quod est f^»pftxy, id est erumpere, derivatum esse ex6vf*xc-t, id est papulis, no- men in iis quae sponte extuberant in cute."1I I have observed, how- ever, under exormia,** forming Genus in. of the present Order, that ecthyma has of late years been limited by the nosologists, and especially by Willan, Young, and Bateman, to the species before us, probably on account of its more papulated form, and there seems no reason for deviating from arrangement. The following are its chief varieties : x Vulgare. Base bright-red; eruption complet- Common papulous scall. ed with a single crop. Duration about fourteen days. C Infantile. Base bright-red; eruption recurrent Infantile papulous scall. in several successive crops, each more extensive than the preced- * Medicinische Jahrgange. i. P. 1. p. SO. t Paral. ad L. V. Med. Pract. 4. 2. X Praelect. p. 48. J De Sed. et Caus. Morb. Ep. Iv. Art. 3. || Dec. I. Vol. vn. p. 7. n. Vol. vi. p. 28. IF in Hippocr. Lib. m. Sect. 51. Supra, p. 367, ** GE. VI.-6P. III.] EXCERNENT FUNCTION. 429 ing. Found chiefly in weakly infants during the period of lac- tation. Duration two or three months. Base dark-red ; elevated ; pustules larger, and more freely scatter- ed, discharging a bloody or curd- ly sanies.—Found chiefly in ad- vanced age. Duration several weeks, sometimes months. This last is the melasma of Linneus, Vogel, and Plenck. They are all diseases of debility, local or general; and hence, whether they occur in infancy, adult life, or age, are to be cured by general tonics, pure air, and exercise, tepid bathing, and preparations gently stimulat- ing applied externally in the form of lotiflps, ointments, or powders. None of them are contagious, and in tnis as well as in their ap- proaching more nearly to a papulous or broad pimply character, especially that of the small-pox, they differ essentially from the preceding. Nutritious food alone, with pure air and regular exer- cise, are often sufficient for a cure. But as this species is manifest- ly dependent upon a debilitated or cachectic state of the constitu- tion, it is often connected with those other symptoms which apper- tain to such a condition, as a tumid belly, diarrhoea, and general emaciation in infants ; and dyspepsy and scirrhous parabysmata, or enlargements of the abdominal viscera, in adults. Dr. Bateman has given a very excellent coloured print of what he calls a cachectic, or fourth variety, in his Delineations, in which the scabby pustules are thickly scattered over the limbs, mimicking very closely in size and number an ordinary appearance of discrete small-pox at the time of its scabbing. It is, however, distinctly a symptomatic affec- tion, or rather a sequel, of some long or chronic disease of an ex- hausting nature, and always disappears in the train of its cure, SPECIES IV. ECPYESIS SCABIES, Xtcn. ERUPTION OF MINUTE PIMPLFS, PUSTULAR, VESICULAR, PAPULAR, INTER- MIXEP OR ALT1.R.NAT1VG; INTOLERABLE ITCHING; TERMINATING IN SCABS. FOUND CHIEFLY BETWEEN THE FINGEhS OR IN THE FLEXURES OF THE JOINTS ; CONTAGIOUS. This disease is peculiarly com])lex; but the specific characters now y Luridum. Lurid papulous scall. 430 ECCRITICA. [CL. VI.-OR. III. given embrace the modifications which constitute its chief varieties, and which are as follow : * x Papularis. Eruption of miliary, aggregate pim- Rank itch: pies; with a papular, slightly in- flamed base, and vesicular apex ; pustules scantily interspersed; tips, when abraded by scratching, cover- ed with a minute, globular brown scab. C Vesicularis. Eruption of larger and more perfect Watry Itch. vesicles, filled with a transparent fluid, with an uninflamed base ; in- termixed with pustules; at times coalescing and forming scabby blotches. -y Purulenta Eruption of distinct, prominent yellow Pocky itch. pustules, with a slightly inflamed base ; occasionally coalescing, and forming irregular blotches, with a hard, dry, tenacious scab. 3 Complicata. Eruption complicated of pustular, ve- Complicated itch. sicular, and papular pimples co-ex- isting ; spreading widely over the body ; occasionally invading the face ; sometimes confluent and blotchy. • Exotica. Eruption chiefly of rank, numerous Mangy itch. pustules with a hard, inflamed base, rendering the skin rough, and brownish; itching extretie; abrasion unlimited from excessive scratching. Produced by handling mangy ani- mals. That all these affections are not distinct species of a common ge- nus, but mere varieties of a single species, is manifest from the fact that in different individuals, or under different conditions of the skin, every variety, even the mangy itch itself, will produce every other variety, while all of them in some instances co-exist, and are de- stroyed by the same means. The above English names for the first three are those in common or vulgar use, and it would be difficult to find names more appropriate. The pocky itch is so denominated from the resemblance of the pustules to minute small-pox, and not from any supposed connexion with syphilis. It gives the largest pimples of all the modifications, as well as the most purulent, but it has never the hard base of either the small-pox or the ecthyma or papulous scall we have just noticed, nor has it the hard raised bor- der or round imbedded scab of the last, and h< nee is easily distin- guished from both. The two former varieties are far more readily GE. Vl.-SP. IV.J EXCER N EN T F UNCTION. 431 confounded with some varieties of prurigo and of lichen, and espe- cially in consequence of the black dots on the tips of the papulae, and the long red lines common to all as produced by scratching. But they are distinguished by the greater simplicity of the itching sensation, which, however intolerable, is not combined with ting- ling or formication ; and by their being highly contagious which the others are not. Yet from their general resemblance, all these have, by many writers, been confounded, and by others who were fully sensible of their distinction, beenincorrecty described under scabies or psora as a common name. As a primary disease, itch is, in every instance, the result of per- sonal uncleanliness, and an accumulation of sordes upon the skin, though the most cleanly are capable of receiving it by contact: and it always appears most readily where close air, meagre diet, and little exercise are companions of personal filth; for here, as we have already had frequent occasions of observing, the skin is more irritable, and more easily acted upon by any morbid cause. Like many other animal secretions the fluid hereby generated is contagiousV^B&dj on close intercourse, but not otherwise, and chiefly in the warmth of a common bed, or of a bed that has been slept in before by a person affected with the disease, is capable of com- munication. Where the cutaneous irritation hereby produced is general to the surface, and has been suffered to remain without check, or with little attention, for a long time, a sudden suppression of the irritation by a speedy cure, like the sudden suppression of a long standing ulcer or issue, is often attended with some severe in- ternal affection; in one instance, indeed, related by Wantner, it was succeeded by mania. And in camps, and prisons, where the consti- tution has been debilitated by confined air, and innutritious diet, the eruption has sometimes been known to assume a malignant cha- racter ; of which Ballinger gives us an example, the whole surface of the body, in the instances to which he refers, having exhibited a -ordid tesselation of crusts, excoriations, and broad livid spots, with an indurated base accompanied with fever at night and severe head-ache. Whenever an organ is weakened in its action it is extremely apt to become a nidus for worms or insects of some kind or other to bur- row in. Hence the numerous varieties of helminthia or invermi- nation in debility of the stomach or other digestive organs; and hence the lodgement, as we have already observed, of the grubs of a minute insect, probably a species of pulex, in one or two of the varieties of prurigo; and hence again in gangrenous ulcers, and es- pecially in warm climates, the appearance almost every morning of innumerable grubs or maggots, of which we have frequent exam- ples in the wounds inflicted on the backs of the negro-slaves in the West Indies by severe flogging. A similar deposite of eggs, appa- rently of the genus acarus or tick, is sometimes found in itch pus- tules, or in the immediate viciuity of them. And hence itch 432 ECCRITICA. [CL. Vl.-OR. Ilk. has, by Wichmann and many other writers of great intelligence, been ascribed solely to this cause :* while others who have sought for the appearance of the grub hereby produced, but in vain, have peremptorily denied the existence of such a fact in any case.t The statement now given constitutes, however, the actual history, and readily reconciles these conflicting opinions. Such insects are not always to be traced, but they may be seen occasionally: and wherever they appear they are not a cause but a consequence of the disease. There are few complaints that have been treated with so many remedies, and none with so many pretended specifics. Sulphur, zinc, acids of all kinds, bay-berries, white hellebore, arsenic, alum, muriate and other preparations of quicksilver, alkali, tobacco, and tar, have all been used externally in the form of lotions or oint- ments ; and sulphur and sulphuric acid have been given internally, and been strongly recommended both in Germany and in our own country for their success. Sulphuric acid was first used in the Prussian army in 1756, by Dr. Colthenius, chief phnBcian; after which Professor Schroeder of Gottingen, emplojn^Hpery freely and asserted that he never failed herewith to cure tiVubh in four- teen days at farthest.;}; Dr. Linckius, in the Nova Acta Naturae Curiosorum, gives an account of an epidemic itch which raged very generally around Nuremberg about the middle of the last century, and resisted all the usual means of sulphur, lead, turpentine, arsenic, mercury, hu- man and animal urine, chalybeate waters, lime-water, and drastic purgatives, and only yielded to diuretics urged to such an extent as to irritate the urethra with a considerable degree of pain. The medicine he employed was a sub-nitrate of pot-ash, obtained by de- flagrating common nitre with charcoal. The first hint of this practice he received from a treatise of Mauchart. The urine hereby excreted was very fetid, and threw down a copious sedi- ment.^ It is very possible that all of these have been successful under peculiar degrees and modifications of the complaint. For the itch is not difficult to cure, and seems only to require an applica- tion that will excite a new and more healthy action in the cutane- ous vessels. The simplest and most certain cure is to be obtained by the sulphur ointment, of which that of the London College gives as good and as simple a form as any. On the Continent they usually combine with the sulphur an equal quantity of powdered * Wichmann, Aetiologie der Kraze. Hanov. 1786. Rochard, Journ. de Med. Tom. xn. p. 26. t Sager, Baldinger, N. Maga. B. xi. p. 484. Hartmann, Diss. Quaestiones super W ichmanni JEtiologia, Scabiei. Fr. 1789. X See Dr. Helonicli's Disseriatio de Olci Vitriolis usu, &c. Hal. 1762. » Therapeia Scabiei epidemical per Diuresin, &.-, Nov. Act. ISat. Car. Tom. iv. GE. Vl.-SP. 1V.J EXCERNENT FUNCTION. 433 bay-berries and of sulphate of zinc, which is mixed up into an ointment with linseed or olive oil. This form was first proposed by Jasser, and under the name of unguentum Jasserianum has main- tained an unrivalled character for the last half century.* The of- fensive smell of the sulphur, whether in the simple ointment or Jasser's compound preparation, is very much diminished by adding to the materials a few drops of the essence of burgamot and as much rose-water as the powders will absorb before they are mixed with the animal or vegetable oil. These are the safest and most effectual applications, and should be employed wherever practicable. But where there is an imprac- ticability the most elegant mode of treatment is to be obtained by a mercurial lotion made by dissolving a drachm of muriated quick- silver in half a pint of water, and adding two drachms of crude sal ammoniac, and half an ounce of nitre. The hands are to be washed with this solution night and morning, and a little of it is to be applied with a clean sponge to the pustules in other parts. About eight and forty hours steady use of this lotion or the sul- phur ointment, will generally be found sufficient to effect a cure j after which the person should be well cleansed and rinsed with warm water: and it will tend much to expedite and ensure the cure if the body be in like manner exposed to a warm-bath before the curative process is entered upon, as much of the contagious matter and impacted sordes will hereby be removed, and tbe ointment or lotion will have a chance of taking a greater effect. Where the constitution has been influenced, aperient and alterative medicines will also be necessary, and ought not to be neglected. In India a pleasant and easy cure is said to be effected by wear- ing linen that has been dipped in juice expressed from the agreea- ble fruit of the bilimbi tree (averhoa Bilimbi. Linn.,) which has also the reputation of being an antidote in many other cutaneous disorders : but I cannot speak of its effects from any personal know- ledge. How far scabies may, under any circumstances, cease naturally 1 cannot say: we are informed, however, by Bennet, that a case which had resisted all remedies was cured by a phthisical expec- toration which continued for a month.t * Sclnnurher, Verrnischtc-chiiuigische Scriften. Band. m. p. 183. Frank. 1783, Svo. Young, On Consumptive Diseases, p. 171. vol. iv 434 ECCRITICA. [CL. VI.-OR. III. GENUS VII. MALIS. (Eutanrous termination. THE CUTIGLF. OR SKIN INFESTED WITH ANIMALCULES. Malis and maliasmus (pxXig, fixXtxcrpog) are Greek nouns importing eutaneous vermination. In the present system the genus is design- ed to include both the malis and phthiriasis of Sauvages and several other writers which are very unnecessarily divided. Common as this disease is to man, it is still more so to animals of perhaps every other class and description, from the monkey to the fish- tribes, and from these to the lowest worms. All of them are infest- ed with parasitic and minute living creatures on their skins, shells, or scales, which afford them an asylum, and for the most part supply them with nutriment. Yet the same affection is still more common to plants; which are not only infested with parasitic plants but with parasitic animals as well. The volume of Nosology contains many curious examples of this kind which the reader may turn to at his leisure. These external parasites, whether animal or vegetable, by our old botanical writers, were significantly called dodders, from a term which has lately, but improperly been restrained to a particular tribe or genus of plants to which Linneus has given the name of cuscusa, a parasite found very extensively on the nettles and the wild thyme of our own wastes: but which formerly was applied to external parasitic plants of all kinds; and hence Dryden in his Fables speaks 6f doddered oaks, and in his Eneid of doddered laurels : iNe.ar Ihe hearth a laurel grew Doddered with age, whose boughs encompass round The household gods, and shade the holy ground. Dodders are, therefore, parasites generally, and as strictly apply to those which constitute the present genus as to any that infest the vegetable world. Generally speaking, vermination is a proof of weakness, whether in animals or in plants ; and hence the weaker the plant or the animal the more subject are they to be attacked, and the more readily to be infested. A few instances may possibly be adduced of plants and animals in perfect health being thus haunted, but they do not oppose the gene- ral rule. The remote cause of this disease, however, is most com- monly filth; for filth debilitates the cutaneous vessels in every in- GE. V1I.-SP. I.J EXCERNENT FUNCTION. 435 stance by obstructing the pores of the exhalants and confining the perspirable matter till it becomes acrimonious. The animalcules that infest mankind are the following: which will constitute so many species : MALIS PEDICULI. ---- l'ULICIS. ---- ACARL ---- FILARI.E. ---- CESTRI. ---- GORDII. LOUSINES>. FLEA-BITE. TICK-BITE. GUINEA-WORM. GADFLY-BITE. HAIR-WORM. SPECIES 1. MALIS PEDICULI. Houstness. CUTICLE INFESTED WITH LICE, DEPOSITING THEIR MTS OR EGGS AT THE ROOTS OF THE HAIR : TROUBLESOME ITCHING. The insects of this name that trouble our own race are the two fol- lowing : x Pediculi humani. Infestment of the common louse, chiefly Common louse. inhabiting the head of uncleanly chil- dren, where it produces a greasy scurf or other filth ; and sometimes exulceration and porrigo : occasion- ally migrates over the body. Z Pediculi pubis. Infestment of the morpio or crafclouse ; Crab-louse. found chiefly on the groins and eye- brows of uncleanly men: itching ex- treme, without ulceration. The common pedu ulu-, is two well known to render any particu- lar description necessary. Leewenhoeck, who cautiously watched them, by way of experiment, on his own person, affirms that the male is furnished at the extremity of the abdomen with a -nng, and that it is this sting which produces the usual irritatio.i, the suction of the proboscis hardly seeming to produce any irksome sensation on the skin of the hand. The male i* readily distinguished from the female by having the tail or tip of the abdomen rounded, which in the female is forked or bifid. The animal is produced from a small oval egg, vulgarly called a nit, which is agglutinated by its ^nailer end to the hair on which it is deposited. From thi- egg 436 ECCRITICA. [CL. VI.-OR. m. proceeds the insect complete in all its parts, and differing only from the parent animal in its size. To determine the time of pregnancy and proportion of increase this indefatigable physiologist took two females and placed them in a black silk stocking which he wore day and night that they might have the full benefit of feeding upon him. He found that in six days each laid fifty eggs without ex- hausting its store, and that in twenty-four days the young were capable of laying eggs themselves: and, carrying on the calculation, he estimates that the two females conjointly might produce eighteen thousand in two months. The largest animals of this kind were discovered by Linneus in the warm caverns of Falhum in Sweden. It has been observed, however, by many entomologists that those which conceal them- selves in clothes, forming the pediculus vestimentorum, are, in some respects, a different animal from the lice of the hair, or p. capitis. Dr. Willan remarks that the latter lay single nits on the hairs of the head, and do not spontaneously quit the scalp or its natural covering. The former are large, flat, and whitish, and seldom appear on the head, but reside on the trunk of the body, on the limbs, and on the clothes. Their nits are conglomerate and usually deposited in the folds of linen or in other articles of dress. The pediculis pubis is distinguished by the cheliform structure of its legs, whence its name of crab-louse ; its antennas consist of five articulations. Its excrement stains the linen and appears like dilut- ed blood. It is a frequent cause of local prurigo; for these animals burrow in the skin, and, being almost unknown among decent persons, may remain a long time unsuspected, since even an examination for the purpose will scarcely detect them. They are chiefly discoverable by their nits which may be seen attached to the basis of the hairs, the insects themselves appearing only like discolourations of the skin. All these are bred among the inhabitants of sordid dwellings, jails. and workhouses, or who are habitually uncleanly. Monkeys, the Hottentots, and some tribes of negroes are said to eat them. The cutaneous secretion is sometimes so changed by disease, that it becomes offensive to them, and they quit the person who is labour- ing under it; various infectious fevers seem to produce this result. It is affirmed by some writers that the pediculus capitis or humanus, has been found useful in epilepsies, diseases of the head, and in scrophula, and that the worst consequences have arisen from drying the little ulcerations they produce. In Russia and other parts of the Continent, where this kind of uncleanliness is, perhaps, less attended to than in our own country, all this may have occurred; for we have already had occasion to observe, that any cutaneous irritation, whether from scabies, porrigo, or any another excitement. maintained till it has become habitual should be suppressed gradu- ally, or we shall endanger a transfer of the morbid action to a part of far more importance. Upon the whole, however, such remarks are qnly apologies for filth and indolence, as we are in no want ot. GE. V1I.-SP. I.J EXCERNENT FUNCTION. 437 much more effectual cutaneous irritants,, where such means are called for, than can be obtained from so disgusting a source. The most fatal poisons to all these vermin are the mercurial oxydes, staphisacre, menispermum, rue, ophim, angelica, and laurel; saffron, pepper, sedum, lycopodium, pinguicula, tobacco, and the seeds of veratrum. Cleanliness itself, however, is a sufficient anti- dote, and a sure prophylactic. The pediculus pubis is best destroy- ed by calomel mixed with starch powder, and applied by a down puff. SPECIES II. MALIS PULICIS. iFlea=Bfte. CUTICLE INFESTED WITH FLEAS ; OFTEN PENETRATING THE CUTIS WITH THEIR BRISTLY PROBOSCIS, AND EXCITING PUNGENT PAIN ; EGGS DEPOSITED ON OR UNDER THE CUTICLE. This species offers us the two folllowing varieties : x Pediculi irritantis. Infestment of the common flea, Common flea. t ^with a proboscis shorter than the body; eggs deposited on the roots of the hair, and on ^ flannel. C Pediculi penetrantis. Infestment of the chigoe or chiggre, Chiggre. a West Indian flea, with a pro- boscis as long as the body; of- ten penetrating deeply into the skin, and lodging its eggs under the cuticle, particularly of the feet; producing malignant, oc- casionally fatal ulcers. The common flea infests not mankind only, but quadrupeds and birds of all kinds. It is probable that it has many varieties, but these have not been ascertained by entomologists. Contrary to the economy of the pediculus, the flea undergoes all the changes of the metamorphosing tribes of insects, being produced from an egg, which gives rise to a minute vermicle or larve, that is transformed into a chrysalis, and finishes in a winged animal. The eggs, in the summer months, take six days before they are hatched, the larve the same period before it becomes a chrysalis, the chrysalis twelve days before it assumes its perfect form: so that the entire process i* completed in a little more than three weeks in the summer 438 ECCRITICA. [CL. VI.-OR. III. though a longer period of time is consumed in the colder months. It obtains its nourishment from tbe juices of the animal it infests, by driving its sharp proboscis under the cuticle The chgoe or chiggre is thus excellently described by Catesby. " It is a very small flea found only in warm climates. It is a very troublesome insect, especially to negroes and others that go hare- foot and are slovenly. They penetrate the skin, under which they lay a bunch or bag of eggs, which swell to the bigness of a small pea or tare, and give great pain till taken out: to perform which great care is required for fear of breaking the bag which endangers mortification and the loss of a leg, and sometimes life itself. This insect, in its natural size, is not above a fourth part so big as the common flea. The egg is so small as -to be scarcely discerned by the naked eye." As these animalcules are fostered like the pediculus by filth and laziness, they are best destroyed by vigilance and cleanliness: and in the mean time most of the poisons recommended in the former case will prove effectual in the latter. SPECIES III. MALIS ACARI. 2T(cfe=i3tte CUTICLE INFESTED WITH THE TICK ; ITCHING HARASSING, OFTEN WITH SMART- ING PAIN. The tick insect offers us the following varieties : x Acari domestici. « Observed on the head in cousi- Domestic tick. derable numbers." This is not a common variety, but Dr. Young has an example, and I have introduced the variety up- on his authority and in his words. C Acari Scabiei. Infestment of tbe itch-jick; bur- Itch-tick. rowing under the cuticle in or near the pustules or vesicles of the scabs in those affected. y Acari autnmnalis. Infestment of the harvest-bug, less Harvest bug. in size than the ccmmon mite; inflicting its bite in the autumn, and firmly adhering to the skin ; itching intolerable, succeeded by glossy wheal* uE. VII.-SP. HI.] EXCERNENT FUNCTION. 439 The acarus is a very numerous genus of very minute insects, in- cluding, besides those enumerated above, a multitude of other spe- cies well known to every one, as a. Ricinus or dog-tick, a. Siro or mite, a. dysentericc or dysentery tick, of which we have spoken al- ready.* The first in the above varieties is probably the a. Leucurus of Linneus, with a testaceous exterior found frequently in the neigh- bourhood of gangrenous sores, and dead bodies. The second a. scabiei, or exulcerans, for though enumerated as two by Linneus, they are the same animal, is white with reddish legs. It burrows, not in, but near the exulcerations of the itch, as already observed under scabies, as also in the neighbourhood of other exulcerations, and adds considerably to their irritation. The harvest-bug is a globular ovate-red insect, with an abdomen bristly behind. From the glossly wheals which its bite produces it has sometimes been called WHEAL-WORM. The wounds inflicted by vermin of this kind are to be avoided by avoiding their haunts; or a tepid bath when we have been ex- posed to them. Where the punctures have taken place they are easiest relieved by a lotion composed of equal parts of the aroma- tic spirit of ammonia and water, which I have often found also highly serviceable in the bite of an animal that does not, indeed, harbour in the cuticle or on the skin, though he is as troublesome by his sudden and predacious sallies, I mean the gnat and the mus- queto-fiy. SPECIES IV. MALIS FILARI^E. (SrUtnca^Worm SKIN INFESTED WITH THE GUINEA-WORM J WINDING AND TURNING UNDER THE CUTICLE, FOR THE MOST PART, OF THE NAKED FEET OF WEST IN- DIAN SLAVES ; SEVERE ITCHING, OFTEN SUCCEEDED BY INFLAMMATION AND IEVER. This worm is found chiefly in both the Indies, most frequently in the morning dew ; often twelve feet long, not thicker than a horse- hair. It should be drawn out with great caution, by means of a piece of silk tied round its head ; for if, by being too much strained, the animal break, the part remaining under the skin will grow with redoubled \igour. and often occasion a fatal inflammation. ■• Vol. u. p. :\i7. 440 ECCRITICA. [CL. VI.-OR. III. This animal is the irk Medini of Avicenna, and the Arabians. literally, vermis Medinensis, but which has, by some means or other, been by most writers corruptly translated nervus, or vena Medi- nensis. The Guinea-worm was well known to the Greek writers, who, according to Pliny, denominated it fyxxnrtx, (dracontia,) whence the name of dracunculus which is frequently applied to it. Aetius and Agatharcides have both given an account of this worm, as has also Paulus of Mgina. The inflammation produced by this animal commences with an itching in the part affected, without acute pain. The part swells and inflames, and at length resembles a furunculus or boil, in hard- ness, and when on the point of breaking, in vehement pain. Soon after the tumour has burst, the head of the worm may "be seen peeping from the bottom of the sore, when it is to be cautiously laid hold of as already described. Sir James M'Gregor informs us that the native practitioners are far more expert in extracting it than Europeans : and that after a nice feel with their fingers for the body of the worm they make an incision, as nearly as they can judge, through its middle, and by nicely tyeing a piece of silk to each end, curl out both at the same time. Mr. Hutcheson gives an account of his having extracted one that measured three yards and a half in length.* SPECIES V. MALIS (ESTRI. <&att=flj> Mtz SKIN INFESTED WITH THE LARV'ES OF THE GAD-FLY ; CHIEFLY BURROWI.V IN THE SCHNE1DERIAN MEMBRANE OF THE NOSTRILS. This complaint is more common to quadrupeds than to mankind; especially to sheep, horses, and hiack cattle ; the insect depositing its eggs in different parts of the bodies of these animals, and hence producing painful tumours, occasionally succeeded by death, from the violence of the inflammation. We sometimes, however, and in the West Indies not unfrequently, find the egg^ of this insect de- posited in the interior membrane of the human nostrils; acciden- tally inhaled with the air, or lodged by a sudden ascent of the in- sect itself. Mr. Kilgour of J ami ica, gives a striking example of this, though he does not indicate the insect. The patient was re- * Edin. Med. Essays. Vol. v. Part n. p. 309. GE. VIL—SP. V.] EXCERNENT FUNCTION. 441 duced almost to a state of madness before the appearance of a single larve ascertained the real nature of the disease. The cure was effected by an injection of tobacco decoction. Two hundred were discharged in ten days.* SPECIES VI. MALIS GORD11. Utatr^lTorm. SKIN INFESTED WITH THE HAIR-WORM J CHIEFLY INSINUATING ITSELF UN- DER THE CUTICLE OF THE BACK, OR LIMBS OF INFANTS ; PRODUCING PRICKING PAINS, EMACIATION, AT TIMES CONVULSIONS. This is the morbus pilaris of Horst, the malis a crinonibus of Et- muller and Sauvages. The nature of the disease is still involved in some uncertainty, the fibrils thrown forth from the surface of the skin accompanied with the symptoms above described, are by some authors supposed to be a morbid production of real hairs; but the greater number, and among the rest Ambrose Pare, ascribe to them a distinct living principle. The disease is uncommon: but upon the whole it seems to be often produced by a species of the gordius or hair-worms; some of which are well known to infest other animals in like manner; and especially the cyprinus alburnus or bleak, which, at the time, appears to be in great agony. Hoffman tells us that the children of Misnia are much infested with worms of this kind, which he describes as resembling black hairs lodged under the skin: and which, by a perpetual irritation, so emaciate them that they become little more than living skeletons. When the skin is warm they appear, but while cold they keep buried under its cover. A similar disease is said by M. Bassignet to have been peculiar, in 1776, to the town of Seyne and its neighbourhood, and to have made its attack upon almost all the new-born children. In Seyne it was at that time called ce*es, a corruption of ceddes, a provincial term for a bristle. It appeared from the first twelye hours till the end of the first month after birth, rarely later than the last period. The symptoms were a violent itching, and general erethism so as to prevent sleep; hoarseness, a diminution of the voice, and an inability of sucking. Friction with the hand over the body proved llibtory of a cme in which worms'in the nose were removed, &c. 8vo. 1782. VOL. iv. b6 442 ECCRITICA. [CL. VI.-OR. 111. a certain cure, and brought forth a kind of dark rough filaments resembling hair, often not more than the twelfth of an inch in length, in some cases furnished with a minute bulb at the extremity.* A decoction of the cocculus lndicus is serviceable in this and in most of the preceding species: but perhaps the most determinate cure for the whole, is to be found in the civadilla, supposed to be a species of the veratrum, which I have already recommended in many cases. No insect or vermin of any kind is capable of resisting or living under the pungent and acrid aroma of its seeds when reduced to powder, which it is only necessary to sprinkle over the linen or bed-clothes that are thus infested. The powder, indeed, is a powerful errhine ; and when tasted affects the tongue with the pungency of needles and excites a severe and protracted ptyalism. On account of this acrid and penetrating power it ought not to be used where the surface of the body is exulcerated. In porrigo, or scabby scall, it has even proved fatal: and hence it is omitted in Rosenstein's fhird edition of his work " On the Diseases of Children," though recommended in the two preceding. GENUS VIII. ECPHYMA. (Cutaneous 22j:crcsccucc. SUPERFICIAL, PERMANENT, INDOLENT EXTUBERANCE ; MOSTLY CIRCUMSCRIBED. Ecphyma is a Greek term from txQva " educo, egero," in contra- distinction both to phyma " an inflammatory tujnour," and emphyma " a tumour without inflammation originating below the integuments." Extuberances similar to those belonging to this genus are frequently found in the rinds of fruits, as apples and oranges, and form a peculiar character in some species of melon ; none of which are produced by insects, nor are we acquainted with the immediate cause. The species of this genus are the four following : 1. ecphyma caruncula. caruncle, 2. ------ verruca. wart. 3. ------ clavus. corn. 4. ------- CALLUS CALLUS. Hist, de la Societe Royale, &c. Ann 1776. 6E. VITI.-SP. I.] EXCERNENT FTXCTION. 443 SPECIES I. ECPHYMA CARUNCULA. £ar uncle. SOFT, FLESHY, OFTEN PENDULOUS, EXCRESCENCES OF THE COMMON INTEGU- MENT. This species is found over the surface generally and occasionally, as a sequel of lues, about the arms and sexual organs. From its shape or position it often obtains a particular name, as ficus, when fig or raisin-shaped; encanthis, when seated on the canthus or angle of the eye. These excrescences on their first formation seem to be produc- tions of the cuticle alone ; but by gradually thickening and a fresh vascularity they come at length to be connected with the skin itself, and, in some instances, even to proceed to the depth of the subja- cent muscles. They are of very different degrees of hardness: being in some instances not much firmer than the parts with which they are connected: whilst in others they are found to acquire the obduracy of a rigid scirrhus. Their colour also is very various: in some cases they are of a pale white, and in others of different shades of red. In some instances they are single and in others gregarious. In many cases they are not larger than ordinary warts, but in others they are much broader and thicker. Where they are neither painful nor unsightly there can be no reason for attacking them, but in other cases they should be removed. Those of a soft consistency may be often destroyed by rubbing them frequently with a piece of crude sal ammoniac, or washing them with a strong solution of that salt. Savin powder is a still more effectual escharotic. Pressure alone will also sometimes succeed when it can be fairly applied. But if none of these answer, recourse must be had to lunar caustic or the scalpel. 444 ECCRITICA. [CL. VI.-OR. III. SPECIES II. ECPHYMA VERRUCA. a^art. FIRM, HARD, ACRID, INSENSIBLE EXTUBERANCE OF THE COMMON INTEGU- MENT : FOUND CHIEFLY ON THE HANDS. Warts are small sarcomata that offer the following varieties: at Simplex. Simple and distinct: sessile or pensile. Simple Wart. C Lobosa. Full of lobes and fissures. Lobed Wart. y Confluens. In coalescing clusters. Confluent Wart. All these rise, like the caruncle, from the cuticle at first, and gradually become connected with the cutis by being supplied with minute arteries that rarely extend far into its substance, as the sur- face, when of any bulk, is hard, ragged, and insensible. The ex- treme sensibility of the base of a wart renders its connexion with a subcutaneous nerve highly probable. It is destroyed by ligature, the knife, escharotics, or powerful astringents. Many of our common pungent plants are employed by the vulgar for the same purpose, and in various instances answer sufliciently. One of the most frequent is the celendine or chelido- nium majus, whose yellow acrid juice is applied to the excrescence daily or occasionally till it disappears. The pyroligneous acid how- ever obtained, answers the same purpose, as does the meloe proscara- ba;us,the liquor potasse or ammonia?, mineral acids,muriated ammonia. In Sweden they are destroyed by the gryllus verrucivorus, or wart- eating grasshopper, with green wings spotted with brown. The common people catch it for this purpose; and it is said to operate by biting off the excrescence, and discharging a corrosive liquor on the wound. They often disappear spontaneously and hence lay a foundation for being charmed away. GE. V11I.-SP. III.] EXCERNENT FUNCTION, SPECIES III. ECPHYMA CLAVUS. <&ovnn. ROUNDISH, HORNY, CUTANEOUS EXTUBERANCE WITH A CENTRAL NUCLEUS, SENSIBLE AT ITS BASE: FOUND CHIEFLY ON THE TOES FROM THE PRESSURE OF TIGHT SHOES. Corns originate in the same manner as caruncles and warts. They are sometimes spontaneous, and gregarious, spreading over the whole head and body : and sometimes rise to a considerable height, and assume a horny appearance In the last case the tubercle makes a near approach to some of the species of the genus lepido- sis, especially 1. Icthyiasis cornea, and cornigera. In the ninth vo- lume of the Transactions of Natural Curiosities, is a case of an an- nual fall by a spontaneous suppuration. The cure consists in cutting or paring the excrescence down nearly to its roots; and then applying some warm resinous, or other stimulating preparation, as the juice of squills, house-leek, or purs- lane, or the compound Galbanum or ammoniac emplaster. SPECIES IV. ECPHYMA CALLUS ttallu*. CALLOUS EXTUBERANT THICKENING OF THE CUTICLE ; INSENSIBLE TO TH* TOUCH. This species is found chiefly on the palms of the hands and soles of the feet as a consequence of hard labour. Among those who ac- custom themselves to long journeys over the burning sands of Egypt some have had their feet as indurated with a thick callus as an ox's hoof, so as to bear shoeing with iron; and in Siam such persons have been known to walk with their naked feet on red-hot iron bars. This species is produced also by a frequent exposure of the hands or feet to hot water, or to mineral acids. The cuticle of the feet has been rendered so thick and insensible by the use of sul- phuric acid as to endure fire without pain. This acid is hence 446 ECCRITICA. [CL. VL-OR. III. commonly employed by professed fire-walkers, and fire-eaters, the interior of the mouth being hardened and seared in the same way as the soles of the feet. In the Medical Museum is a singular case of this complaint as it occurred in a young man, the cuticle of whose hands was so thick- ened and indurated as to render them of no use. He was by trade a dyer; and the disease was gradually brought on by cleaning brass wire, with a fluid consisting of sulphuric acid, tartar, and alum. His fingers were so rigid from the callosity of the cuticle, that on a forcible endeavour to straighten them, blood started from every pore. As the disease was chiefly ascribed to the use of the acid, the patient was ordered to apply .to his hands an emollient liniment consisting of equal parts of olive-oil and aqua-kali. After two days, one half the alkali was omitted, and the yolk of two eggs added. By means of this application, the hardened cuticle began to peel off; and a new flexible one to appear beneath; he acquired the use of his fingers by degrees, and in about two months the cure was perfected GENUS IX. TRICHOSIS. WorfuK Hair. MORBID ORGANIZATION OR DEFICIENCY OF HAIR. Trichosis (t$<;u«ws) " pilare malum," is a term of Actuarius, and other Greek writers from tei% " pilus." trichiasis is the more com- mon appellation; but it has often been used in a somewhat differ- ent and more limited sense. The terms athrix and distrix, which express two of the species under this genus, are evidently from the same root. Hair may be regarded as a vegetation from the surface of the body; it rises from a bulbous root of an oval form which fixes in the cuticle or rete mucosum, and seems sometimes to shoot into the cutis. The separate hairs are spiral and hollow, furnished with vessels, and knotted at certain distances like some sorts of grass, and in some cases send out branches at their knots. Their roots or bulbs are found over the whole surface of the body, though they only vegetate in particular parts, for which it is not easy to assign a reason. The hairs in the stems of the roots are nourish- ed by the gluten at its base, and as this is more copious or more fluid the stem is more succulent: when in a smaller quantity or GE. IX.] EXCERNENT FUNCTION. 447 more dense, the hair is dry, crisp, and soon falls off: when not car- ried to the extremities, the stems or hairs become brittle, or split. The rete mucosum furnishes the hair with its colour: and as this colour, together with the nutritive mucus of the hair, diminishes, and is at length altogether suppressed in old age, we see one rea- son why the hair becomes gray, and perishes. As hairs, at least in a state of health, have no more nerves than the filaments of vegetables, it is probable that the circulation is carried on in them in the same manner as in plants. By combing we free the fluid from those obstructions which must necessarily be produced by their being bent in all directions : and hereby pro- mote a circulation through the bulb, and relieve the head from accumulations : for though the vessels of the bulb are - small they are numerous.* And we are hence enabled to account for the re- lief and refreshment which is often felt by a patient after the op- eration of combing. Long hair has been in all ages esteemed an ornament. There is no question, however, that it requires more nutriment for its support than short hair; and some physiologists have gone so far as to doubt whether it may not hereby be in- jurious to the general health, as productive of debility. But there seems no real ground for such a belief, as a healthy system, like the roots or trunk of a healthy tree, will always be able without inconvenience to furnish sustenance enough for its branchy foliage. Dr. Parr, however, affirms, that suddenly cutting off long hair has to his knowledge been injurious and attended with every appear- ance of plethora: while very thick hair may occasionally weaken by the undue warmth and perspiration it occasions. According to the experiments of Vauquelin, read to the Institute in 1808, human hair is not soluble in boiling water, but, when exposed to a greater temperature in PapphVs digester, it dissolves readily. From a solution of black hair, a black matter was deposited, which proved to be an oil of the consistence of bitumen, together with iron and sulphur. And as the hair of some persons has a smell approaching to that of sulphur, and especially those who have red hair, we are no longer at a loss to account for this. The same excellent chemist found that alcohol extracts from black hair a whitish, and a grayish- green oil, the last of which separates as the alkohol evaporates. It is probable, therefore, that the black matter is gummy or al- buminous ; the white we are told resembles cetaceum in appearance though it differs in chemical affinity. Red hair affords the white matter, and instead of the grayish-green oil, an oil as red as blood. White hair contains phosphate of magnesia, affording us another proof of the greater facility with which calcareous matter is either formed or left loose in old age than in any other period of life ;t and its oil is nearly colourless. When hair becomes suddenly white * Parr. Med. Diet. Art. Pilu?. Vol. iv. ,.. 2\n. 448 ECCRITICA. [CL. VL-OR. HI. from terror, Vauquelin thinks it may be owing to a sudden extrica- tion of some acid, as the oxymuriatic acid is found to whiten black hair- but it is suggested by Parr, that this may more probably be owing to an absorption of the oil of the hair by its sulphur, as in the operation of whitening woollen cloths. These remarks will assist us in comprehending something ot the nature of the following species of diseases which are included in the genus before us: 1. TRICHOS1S SETOSA. BRISTLY HAIR. 2._____—__ PLICA. MATTED HAIR. 2,________HIRSUTIES. EXTRANEOUS HAIR. 4. -------- DISTRIX. FORKY HAIR. 5.--------POLIOSIS. GRAY-HAIR. 6. -------- ATHRIX. BALDNESS. 7. -------- AREA. AREATED HAIR. 8. -------- DECOLOR. DISCOLOURED HAIR. SPECIES I. TRICHOSIS SETOSA. Brfstlg ptafr. HAIRS OF THE BODY THICK, RIGID, AND BRISTLY. This is the hystriacis or porcupine hair of Plenck. It is in fact a stiff corpulency of hair produced by a gross or exuberant nutriment, and has been sometimes limited to the head, sometimes to other organs, and sometimes common to the body. The remarks already offered will sufliciently account for its production. In the fifth volume of the Philosophical Transactions, we have an extraordinary example of hair of this kind being thrown off and renewed every autumn, like the horns of the deer, and various other quadrupeds. The affection was also hereditary, for five sons exhibited the same morbid state of the hair.* * See also Samml. Mec). Wahrnemung. Band. iv. p. 249. CE. IX.-SP. 11.] KXCLKNKNT FUNCTION. 449 SPECIES 11. TRICHOSIS PLICA. fatten f^afr. HAIRS VASCULARLY THICKENED; INEXTRICABLY HARLED AND MATTED BV THE SECRETION OF A GLU 1TNOHS FLUID FROM THEIR ROOTS. This disease affords a sufficient proof by itself, if other proofs were wanting, of the vascularity of the hairs. Vauquelin ascribes it to a superfluous excretion of the fluid that nourishes them, but there must be something more than this. there must be also an intumes- cence or dilatation of the vascular tunic of the hairs, since their capacity is always augmented, and in some cases so much so as to permit the ascent of red blood; in consequence of which they bleed when divided by the scissors. Most authors ascribe it to uncleanliness, which is no doubt the ordinary exciting cause, though there seem to be others of equal efficiency. It is also very generally affirmed to be contagious, and I had hence added this character to the disease in the volume of Nosology. But, as Dr. Kerckhoffs strenuously maintains the con- trary after a very minute attention to the complaint in Poland itself, and more especially after having in vain endeavoured to inoculate first himself, and then two children, from the matter issuing from the bulbs of hair pulled for this purpose from a boy who was suf- fering from it in the most loathsome manner, I have here with- drawn the symptom. Dr. Kerckhoffs reduces plica to a much simpler principle than it has hitherto been described under, and strips it of many of the most formidable features by which it has been characterised; par- ticularly its connexion with hectic fever or any idiopathic affection of the brain.* He regards it as a mere result of the custom com- mon among the lowest classes of the Polonese, of letting the hair grow to an immense length, of never combing, or in any other way cleaning it, and of constantly covering the head with a thick wool- len bonnet or leathern cap. And hence, says he, while the rich are in general exempt from the disease, it is commonly to be met with among the poor alone, who wallow in tilth and misery, and particularly among the Jews, who are proverbially negligent of their per-ons. He contends, in consequence, that it is no more endemic to Poland than to any other country; and that nothing more is necessary to effect a cure than general cleanliness, and e\ci*ion of the matted hair. • Observations .Medicates, P;ir Jos. Kom. Louis Kuu-khoris, "Medicine de TAi- mee, iic. See Med. Trans. Vol. vi. Art. in. VOL. iv. 57 450 ECCRITICA. [CL. VI.-OR. HI. The first person he saw labouring under this disease, and he gives the case as a general specimen, was a boy from fifteen to eighteen years old, in a miserably poor village in the neighbour- hood of Posen : most offensively filthy, lying in a dark hole, and stinking (puant) beside the beasts. He had black hair, very long, very coarse and braided into thick plaits of a twelvemonth's standing. His head was covered with grease, his brain was greatly affected, and he was complaining of terrible head-aches. The medical practi- tioner that attended him opposed a removal of the hair from a vul- gar belief that the common outlet of morbid humours being thus cut off, such humours would flow rapidly to the brain and produce apoplexy or some other cerebral affection. At length he consent- ed that after a brisk purge the process of cutting the hair should commence, but only to be proceeded in by degrees. The length of two fingers was therefore first removed; and this producing no mischief, it was again shortened to the same extent two days after- wards : and in this manner the whole was cut off in about twenty days. After this the patient was allowed to comb his head a little and wash it with milk; a few bitters and other tonics were pre- scribed for him, and he was very shortly restored to perfect health. Admitting Dr. Kerckhoffs' explanation of this disease to he cor- rect, it is somewhat singular that the same explanation has never hitherto been given by the most intelligent and most celebrated Polish, or even German physicians; as it is also that the disease should be unknown in other countries where the hair is, in like manner, suffered to grow without cutting, and where as little atten- tion is paid to cleanliness. Hence Sinapius,* and numerous other writers deny uncleanliness to be the only, or even the ordinary cause. They contend for a predisposition in the habit, and affirm that under such predisposi- tion any local accident, .and a variety of affections in remote organs, may become exciting causes. In the Ephemera of Natural Curi- osities is a case in which it seems to have been produced by a wound in the head.j Vehr relates another in which it followed, to- gether with jaundice, upon a suppression of catamenia for three months.J It is also occasionally a sequel of several of the varie- ties of psoriasis. Cutting off the hair, however, though generally supposed to exas- perate the disease, or to lead to some secondary evil, does not ap- pear to produce these effects; and hence Vicat recommends the use of the scissors whenever the hairs bleed.§ It is far better with Dr. Kerckhoffs to use them beforehand. Though the disease has been usually confined to the hair of the * Paradoxa Med. I Dec. ii. Ann. n. Obs. 1. X Diss. Icterus fuscus cum Plica Polonica, ^Tc.'Fr. 1708. * Memoiie sur la Plfcjue Polonoisc Lausanne, 1775. "iL. IX.-SP. II.] EXCERNENT FUNCTION. 151 scalp, it has occasionally appeared in other quarters, as in the beard, the cuticle, and even the pudendum: authorities for which are quot- ed in the volume of Nosology. From the great afflux of fluids, and even of blood to the head, during this disease, it is often accompanied with hemicrania, or some other cephalalgic affection. SPECIES III. TRICHOSIS HIRSUTIES. JBvtvaneoun Utatr. GROWTH OF HAIR IN EXTRANEOUS PARTS, OR SUPERFLUOUS GROWTH IX PARTS COMMON. The most frequent example of this misaffection is that of bearded women. In a few instances the female beard has even been brist- ly, thus uniting the present with a preceding species. Hippocrates ascribed hirsuties under this form to a deficient menstruation,* whence it is occasionally met with in young women. This cause is admitted generally in modern practice ; but one of the most strik- ing cases in a young woman, that has ever occurred to the present author, was accompanied with an habitual paramenia superflua, under which the patient at length sunk at about forty years of age. In like manner a beard has sometimes been found on boys,t and in a few instances on infants.^ Hair has often also sprouted forth from organs whence it does not grow naturally ; which, however, in most instances, can be ac- counted for without any great difficulty by bearing in mii.d a re- mark offered in the opening of the present genus, I mean that " the roots or bulbs of hairs are founJ over the entire surface of the body, though they only vegetate in particular parts." \ ,?t Amatus Lusitanus has given us an example to j\fL.»:.i li.is expla- nation will not apply, for in this the exotic hairs givw on ihe tongue,§ as the feathers of the toucan grew n,aurally. Lriniii and Rose found the heart covered in th. same maiiner.ll ' Epidem. Lib. vi. S.ct. 7. Scliurig, Parthi-nologia, p. 185. Dresd. 1729. 4to. t Paullini, Cent. in. Obs. 64. X Eph. Nat. Cur. Dec. II. Ann. iv. Obs. 163. Ap. 203. » Cent. VI. Cur. 65. || Pr. Hist de Anitomenis Messenii hirsuto corde, Paris, 1525. Pr. listens historiam cordis villosi, Leips. 1771. 452 ECCRITICA. [CL. VI.-OR. III. Of organized animal substances hair, however, seems to be ori- ginated more easily than any other: and this too without having, at least in many cases, any apparent bulb or root to shoot from. We had lately occasion when treating of paruria stillatitia, to notice their discharge from the bladder as constituting one of the causes of this complaint. So in malis gordii* they have been apparently solicited by friction, from different parts of the body of an infant with seeming relief to his distress. And under the genus eccyesis,! numerous examples have been given of their formation in various internal organs. It is on this account the hair and beard are said by writers of graver authority occasionally to grow for some time after the death of every other part of the body; of which examples may be found in Heister,! and Camerarius.§ SPECIES IV. TRICHOSIS DISTRIX. iForug |£afr. HAIRS OF THE SCALP WEAK, SLENDER, AND SPLITTING AT THEIR EXTRE- MITIES. This is a common affection, and depends upon a deficiency in the supply of proper nutriment from the bulb or root of the hair, in consequence of which the upper part of the tube becomes arid and brittle, and splits into minute filaments, as already explained in the introductory remarks to the present genus. Its cure is to he ac- complished by cutting the hair short, and stimulating the roots by irritant pomatums, unguents, or oils. * Vol. iv. p. 441. t Vol. iv. p. 168. ^ Heist. Compend. Anat. $ Camerar. Memorab. Cent, vi, p. 47. 6E. IX.-SP. V.] EXCERNENT FUNCTION. 453 SPECIES V. TRICHOSIS POLIOSIS. CBrras=nafr. HAIRS PREMATURELY GRAY OR HOARY. The specific term poliosis is a Greek derivative from t«a«;, " can- didus," " canus,"—" white or hoary " The general principle of this diseased appearance has been ex- plained in the introductory remarks to the present genus. The colour of the hair is derived from the rete mucosum, which secretes a very compound material for this purpose, a part of the occasional ingredients of which are iron, sulphur, lime, a grayish-green, and a blood-red oil. In the silvery white or glossy hair of young persons, the nutritive matter is, perhaps, the rete mucosum in its purest and most uncoloured state. Gray hair is produced in two ways. In one there is no colouring material whatever, except apparently a small portion of the sulphur; and in this case the hair is directly hoary, or of a yellowish or rusty white. In other circumstances the rete mucosum or nutriment of the hair, from causes already explained under the genus parostia, is loaded with calcareous matter, but deficient in its proper oil; and hence the hair is somewhat whiter, but of a dead hue, harsher, and coarser, very brittle, and apt to fall off from the roots. White hair, probably produced by the former of these means, has been found occasionally in every stage of life ; and Shenck gives a case in which it appeared on birth.* It has sometimes been trans- mitted hereditarily :t and, in one or two instances, seems to have taken place from terror,! the spasm of the capillaries of the skin extending to the bulbs of the hair, which no longer communicated a supply of the ordinary pigment. It has for the same reason fol- lowed upon an obstinate cephalaea,§ and is said to have occurred after death.|| ' I.ib. i. Obs. 3. tx Stuckio. I Eph. J\ at. Cur. Dec. ii. Ann. I. Obs. 69. X Camerar. Memor. Cent. n. N. 14. Doute, Ergo Canities a timore, Paris, 1657. ♦ Journ. des Sc;avans, 1684. || Eph. Nat. Cur. Dec. n. Ann. 1. Obs. 69. 454 ECCRITICA. [CL. VI.—OR. III. SPECIES VI. TRICHOSIS ATHRIX. DECAY AND FALL OF THE HAIR. The general principle of this defect has been so fully detailed under the preceding species, and in the introductory remarks to the pre- sent genus, that it is not necessary to add any thing further. This affection of the hair is the alopecia of Sauvages and other modern nosologists, but not that of Celsus and Galen, which is a variety of the next species. Alopecia is a Greek term derived from «A»5m| " vulpes," a fox, this animal being supposed to lose its hair and become bald sooner than any other quadruped The Ara- bian writers named it from the same source daus-saleb, literally " morbus vulpis." The species admits of the following varieties: x Simplex. Hairs of the scalp of a natural hue; Bald-head. gradually dying at the bulbs, or loosened by a relaxation of the cu- taneous texture. C Calvities. Hairs grey or hoary : baldness chief- Bald-crown. ly on the crown of the head; and confined to the head. Mostly com- mon to advanced age. y Barbfe. Decay and fall of the beard. Bald-beard. 1 The first variety is the deflivium capMlorum of Sennert. What- ever tends to give an established relaxation and want of tone to the cutaneous vessels become* a cause of this affection: and it is hence a frequent sequel upon fever- of v irious kinds It is also found as a symptom >n t ibes, phth sis porrigo, and mpetigo. General tonics and cold haihiiig form 1'ie must pronrting treat- ment where it is an dioj a.hie, affecinn : and where it is a seconda- ry compi.i.nt it must foaow the fortune of the disorder that gives rise to it. The second variety proceeds from a can^e precisely opposHe to the preceding. Here the cutaneous secernents, instead of being too loose and relaxed are too dry and rigid: there is little nutriment afforded to the roots or bulbs of the hair, whence they become arid and brittle, particularly at the extreme point of the head or crown, and are perpetually breaking off at thieir origin. The cause of the whiteness or hoariness of the hair has been explained under the preceding species. Other causes than that of old age are noticed i,K. IX.-SP. VI.] EXCERNENT FUNCTION. 455 by pathologists, and have no doubt a foundation; as terror, which has sometimes operated very rapidly, insolation or exposure of the head to the rays of the sun, unlimited sexual indulgence,* cephaUea, and worms.t This affection is far more common to males than to females; it is asserted by many writers that it never occurs in eunuchs,}; and by Schenck that it never takes place in any persons before the use of sexual copulation; and hence ought not to exist in bachelors; and, provided the remark be well founded, on which I cannot speak from my own knowledge, might be employed as a test of their con- tinence. The most promising remedies are to be sought for in an external application of warm animal oils, and oily aromatic essences, as la- vender-water. Baldness of the beard is not a common defect: but examples of it are referred to in the volume of Nosology. SPECIES VII. TRICHOSIS AREA. &reatcfc i£afr. PATCHES OF BALDNESS WITHOUT DECAY OR CHANGE OF COLOUR IN THE SURROUNDING HAIR ; EXPOSED PLOTS OF THE SCALP GLABROUS, WHITE AND SHINING ; SOMETIMES SPREADING AND COALESCING, RENDERING THE BALDNESS EXTENSIVE. This species is taken entirely from Celsus, who gives two varieties of it almost in the following words: x Diffluens. Bald plots of an indeterminate Diffluent areated hair. figure ; existing in the beard as well as in the scalp : ob- stinate of cure. Common to all ages. £ Serpens. Baldness commencing at the oc- Serpentine areated hair. ciput, and winding in a line not exceeding two fingers1 breadth, to each ear, some- * Gilibert. Adversus Pract. Prin. Merlct. Diss. Ergo si Salacitate Cilvities. Paris, 1662. t Paulini Lanx Sat. Dec. iv. Obs. 9. t De Moor, Di?s. in Hipp. App. vi. 2* L. B. 1736. Schenck. L. i. Obs. 10. 456 ECCRITICA. [CL. VI.-OR. III. times to the forehead : often terminating spontaneously. Chiefly limited to children. The first variety forms the true alopecia of the Greeks, of which I have spoken already, and is so denominated by Celsus, Galen, and other Greek and Roman writers. The second is called by them ophiasis from o0/j a serpent, in consequence of the serpentine direc- tion in which the disease trails round the head. Dr. Bateman has described this species under the name of porri- go decalvans, while he admits that the surface of the scalp offers no porriginous or other eruption whatever, but " within these areae is smooth, shining, and remarkably white." " It is probable, howev- er, he adds, though not ascertained, that there may be an eruption of minute achores about the roots of the hair, in the first instance, which are not permanent, and do not discharge any fluid." It must be obvious to every one that this fall of the hair has no connexion whatever with porrigo; depending upon a partial operation of the causes that we have already noticed as giving rise to the two pre- ceding species of poliosis and athrix. A frequent shaving of the entire scalp, with affusion of cold wa- ter, and the use of stimulant liniments, as a solution of two drachms of the oil of mace in three or four ounces of alcohol, will some- times be found to produce a fresh crop of hair: though, in most instances, all applications are equally unavailable. SPECIES VIII. TRICHOSIS DECOLOR. HAIR OF THE HEAD OF A PRETURNATURAL HUE. As the hair receives its tint from the pigment communicated to the bulbs by the rete mucosum, whatever varies the character or colour of this material, will vary also the colour of the hair. Some of the causes of such variation we shall have to notice under the en- suing genus; but there are others which are not so easily explain- ed. From the rete mucosum, we have already seen that the hair obtains iron and sulphur, as also the blood-red oil which is procured by digestion from the red hair, which forms a third constituent, since it does not seem from the experiments of Vauquelin, that this is a result of the iron. The grayish-green oil which this ex- cellent chemist has been also able to extract from black and other GE. IX.-SP. VIII.] EXCERNENT FUNCTION. 457 dark kinds of hair is another distinct principle : and, from an ex- cess or deficiency, or a peculiar combination of the colorific con- stituents, we are able to account for some of the extraordinary hue- which the hair is occasionally found to exhibit, though others seem to elude all explanation. The chief varieties they display are the following: x Caerulea. Of a blue colour.* € Denigrata. Changed from another colour to a black.T r<$,) is a term common to the Greek writers, and employed to express a coloured or spotted surface of any kind. The genus is new, but it seems called for. Like the last it consists of blemishes, many of which cannot always either be cured or even palliated; but, as all these are morbid affections, the nosolo- gical system that suffers them to pass without notice is imperfect. Many of them, however, are not of serious consequence. The following are the species that belong to it: 1. EPICHROSIS LEUCASMUS. VEAL-SKIN. 2.---------SPILUS. MOLE. 3.---------LENTICULA. FRECKLES. 4. --------- EPHEL1S. SUN-BURN. 5. --------- AURIGO. ORANGE-SKIN. 6. --------- P03CILIA. PVE-BALLED SKIN 7.---------ALPHOSIS. ALBINO-SKIN. SPECIES I. EPICHROSIS LEUCASMU*. srea^Sfcfit. WHITE, GLABROUS, SHINING, PERMANENT SPOTS, PRECEDED BY WHITE TRAN- SITORY ELEVATIONS OR TUBERCLES OF THE SAME SIZE ; OFTEN COALES- CING AND CREEPING IN A SERPENTINE DIRECTION J THE SUPER-INCUMBENT HAIRS FALLNG OFF AND NEVER RESPROUTING. This is the vitiligo, or veal-skin of Willan, so called from the veal- like appearance which these spots produce on the general colour of the surface. It is common to the different parts of the body, but chiefly found about the face, neck, and ears. The term leucasmus (xivxxvpog,) importing whiteness, is merely employed instead of vitiligo to avoid confusion as Dr. Willan has used vitiligo in a sense different from that of Celsus, t)r of any one who preceded him. GE. X.-SP. II-] EXCERNENT FUNCTION. 459 The size of these spots vary considerably, from that of a large pin's head to that of a shilling or half-a-crown. The blank and morbid whiteness remains through life, and seems to show that the patches are no longer possessed of red blood-vessels, and that the white hue of the rete mucosum alone is visible in their respective areas, exhibiting a pure white, only differing from that of death in being glossy from the action of a living principle. SPECIES II. EPICHROSIS SPILUS. BROWN, PERMANENT, CIRCULAR PATCH; SOLITARY; SOMETIMES SLIGHTLY ELEVATED, AND CRESTED WITH A TUFT OF HAIR. The specific term, from o-t/A»s u macula," has been long in use. The blemish is common but unimportant. We have had much of late to observe concerning the rete muco- sum, and in the ensuing species shall have again to refer to this material. We have already remarked that it is a substance which forms the second or middle of three laminae that constitute the external integument. It is improperly called either rete or mucosum, for it is neither a net-work, nor a mucous material, being in effect nothing more than an adipose secretion of a peculiar kind, which, when black, has a considerable resemblance to the grease that is interposed between the axles and wheels of our carriages. It is the common pigment or colouring principle of the skin, and hence differs very considerably in hue, as is sufficiently obvious in the respective individuals of the same country, but still more so in those of remote regions ; giving a white or fair hue to the inhabitants of the south side of the Caucausus and their probable descendants the great body of Europeans, a black to the negroes of Africa, an olive hue to the Mongo-Tartar race, a brown to the islanders of Australasia, and a red to the native tribes of North America. In temperate climates, and in its purest state, it is a clear glossy white, and when reddened under a delicate cuticle, by the minute and innumerable arteries that are distributed over the surface of the body, it gives that rich but dainty tone of colour which constitutes beauty of complexion. It sometimes happens, however, that persons who are perfectly fair in their general complexion, from an equal diffusion of this substance in its utmost purity, have a few small spots of a lighter or deeper brown in the face, limbs, or body, from an occasional dash 460 ECCRITICA. [CL. Vl.-OR. 111. of brown in the rete mucosum, produced by causes which it is impossible to unravel: and which, as we shall show presently, in other persons extends over the entire surface, and is consequently intermixed with the whole of the secretion : and it is this occa- sional dash that constitutes a spilus or mole. In treating of trichosis? we observed that chemical analysis has proved that the hair, and consequently the rete mucosum which supplies it with pigment, is possessed of a certain portion of iron : and it is possible that a concentration of this mineral substance in the coloured part may constitute the colorific material. Be this as it may, we perceive, wherever these coloured spots exist, there is a greater tendency to increased action than elsewhere ; and hence, we often find a slight elevation, and increased closeness of structure, and not unfrequently an enlargement of the natural down into a tuft of hairs. ^ If this reasoning be correct, alkaline lotions, (and all soaps are of this character though not sufficiently strong for the present purpose,) should form the best cosmetics. But the spots are rarely removea- ble by any means, and the less they are tampered with the better. These differ essentially from naevi or genuine mother-marks, inasmuch as the latter are produced by a distention of the minute blood-vessels of the skin, so that those which should contain only colourless blood, admit the red particles, and hereby exhibit stains of different shapes and ranges, and of different shades of crimson or purple, according to the quantity of red blood that is hereby suffered to enter, or the nature of the vessels that are distended. SPECIES III. EPICHROSIS LENTICULA. jfFrccfclrs. CUTICLE STIGMATISED WITH YELLOWISH-BROWN DOTS, RESEMBLING MINUTE LENTIL SEKDS ; GREGARIOUS J OFTEN TRANSITORY. Lenticula is more generally written in modern times lentigo ; it is here given as it occurs in Celsus. The root is the Latin term lens a lentil-seed. The Greek word for which is Qxxtx ; and this, with- out a diminutive termination, was also applied to the same blemish, when the spots were of a larger size. Its causes are various : most commonly it is produced by an ex- posure to the rays of the sun : but it frequently arises without any such exposure, and is sometimes transmitted hereditarily. The mode by which the colorific rays of the sun operate in the production of this effect we shall explain under ephelis or sun-burn, forming the next species. Where the remote cause is constitutional GE. X.-SP. III.] EXCERNENT Ft NCTION. 461 it is probably a result of the same colorific material as that to which we have just referred spilus or mole, existing in the rete mucosum, and operating more diffusively, though in much smaller patches. How it comes to pass that this middle layer of the exterior integu- ment should at any time be thus interruptedly charged with a co- loured pigment so as to form the freckled appearance which con- stitutes the present cuticular blemish, it is not easy to say, but that it has a remarkable tendency to do so is obvious, not only from the present and preceding species, but still more so from the very strik- ing and singular patch-work which constitutes epichrosis pcecilia or the sixth species of the genus before us: where we shall be again under the necessity of touching upon the subject. Freckles most frequently are found on persons of fair complex- ions and red hair; and, as we have already observed, that this hue of the hair is produced by a peculiar pigment derived from the rete mucosum, which gives rise to a blood-red oil that ascends into the hair-tubes, we have an additional reason for ascribing the brown, or reddish-brown freckles of the skin to a supertibundance of the same pigment in the same adipose layer. Freckles are often transitory. They occur in many instances in great abundance in pregnant women, and disappear after lying-in, sometimes, indeed, in the latter mbnths of pregnancy. Riedlin affirms, but upon what authority 1 know not, that they are a fore- sign of a female offspring.* Cosmetics are of less avail in this than in the ensuing species, but those we shall have there occasion to notice may be tried under the species before ns SPECIES IV. EPICHROSIS EPHELIS. SbuiMmrn. CUTICLE TAWNY BY EXPOSURE TO THE SIN : OFTEN SPOTTED WITH DARK FRECKLES, CONFLUENT OR CORYMBOSE ; DISAPPEARING IN THE WINTER. Ephelis (i^i|A*«,) is a term of Celsus as well as the name appropriat- ed to the preceding species : and its real meaning ;s " sun-burn'" or " sun-spot"—" vitium faciei solis ustione." In Celsus however, the term is used in a much wider sense, and applied to blemishes which have no connexion with sun-burning. It is here restrained to its proper signification. The sun in hot climates, or very hot summer seasons, has a ten- dency to affect the colour of the skin in a two-fold manner. First by a direct affinity of its colorific rays, or those of light, with the oxygeneof the animal surface, and particularly with that of the rete mucosum, in consequence of which a considerable part of the oxy- * Lin. .M.-.I. 1695. p. 393. 462 ECCRITICA. [CL. VI.-OR. III. gene is detached and flies off, and the carbone and hydrogene, with which it was united, being freed from its constraint, enter into a new combination, and form a more or less perfect charcoal, accord- ing to the proportion in which they combine. And, secondly, by the indirect influence with which the colorific rays of the sun, or those of heat, produce upon the liver and excite it to a more abun- dant secretion of bile, possessing a deeper hue, and which is more copiously resorbed into the system. That a certain proportion of bile is resorbed at all times is clear from the colour of the urine and the stain which the perspirable fluid gives to clean linen: and that this proportion is greater in hot summers than in cold winters. and particularly in intertropical climates, is well known to even one who has attended to the subject. These then are the ordinary causes of that effusive brown -tain of the skin, which we denominate sun-burn. But whether the deeper spots or freckles, which so often accompany a sun-burnt skin be owing to an equal action of either of these causes, and particu- larly of the first, upon the rete mucosum, or to an extrication of any colouring matter, as of iron, for example, existing in the rete mucosum itself, and unequally distributed, is beyond our power to determine. Either cause is sufficient tc produce such an effect, though perhaps the real cause is the latter: and we have already seen that, in the distribution of this adipose layer over the surface, and its connexion with the cuticle and the cutis, there is a frequent obstruction to a free flow of whatever colouring material may exist in it, which is in consequence accumulated in spots or patches in- stead of being equably diffused. As sun-burn is chiefly occasioned by an inordinate separation of oxygene from the other constituent principles of the rete mucosum with which it was united, the most rational cosmetics, in this case, are those which have a tendency to bleach the skin, by containing a considerable proportion of some vegetable or mineral acid. Hom- berg's cosmetic, which has long been in vogue on the Continent, is a dilute solution of oxymuriate of mercury with a mixture of ox- gall. Hartmann's which has also been in high estimation, consists of a simple distillation of arum-root in water. This forms a very pungent lotion, and its object is to dilute or wash out the brown pigment by exciting an increased flow of perspirable fluid towards the surface, and to carry off a part of it by an increased action of the cutaneous absorbents. Spirit of lavender or any of the essential oils dissolved in alcohol may be employed for the same purpose : and some have used a diluted eau de luce which is also useful as an alkaline irritant. In Schroeder's Pharmacopoeia there is a prepara- tion for the same purpose which we should little expect, and the virtues of which are not very likely to be tried in the present day: it is entitled aqua stercoris humaui: but in former times dung of all kinds was a standard article in almost every Materia Medica, and there are few diseases for which it was not recommended by some practitioners; occasionally, indeed internally as well as externally. The general intention was that of obtaining a very pungent vola- GE. X.-SP. V.] EXCERNENT FUNCTION. 463 tile alkali; but this we are able to do at present by far less offen- sive means. When the hands are deeply discoloured they may often be bleached by exposing them to the fumes of sulphur. In drupaceous fruits, and especially those of a fine cuticle, as apples, we sometimes meet with spots and miscolourations of the same character as moles, freckles, and sun burn ; the causes of which we do not always know, though we can sometimes trace them to small punctures in the cutis by birds and insects. SPECIES V. EPICHROSIS AURIGO. ©rangr=«Sfeiit. CUTICLE SAFFRON-COLOURED, WITHOUT APPARENT AFFECTION OF THE LIVER, OR ITS APPENDAGES ; COLOUR DIFFUSED OVER THE ENTIRE SURFACE : TRANSIENT: CHIEFLY IN NEW-BORN INFANTS. This orange hue of infants, and which is occasionally to be met with in later periods appears, as Dr. Cullen observes, to depend either on bile, not as in the usual manner excreted, but received into the blood-vessels and effused under the cuticle, or on a peculiar yellow- ness of the serum of the blood distinct from any connexion with bile.* Sauvages has rightly distinguished between this disease, as a mere cutaneous affection, and proper jaundice. In him it occurs under the name of ephelis lutea, an improper name, however, as the affection is not an ephelis or sun-burn; while the jaundice of infancy he calls aurigo neophytorum, which ought rather to be icte- rus neophytorum. It may in general be remarked that while the sclerotic tunic of the eyes as well as the skin is tinged with yellow in the genuine jaundice of infants, the former retains its proper whiteness in aurigo. Whence the serum derives the yellow hue it so strikingly evinces on some occasions, except from the bile, it is difficult to determine. That a certain proportion of bile exists constantly in the blood in a healthy state is manifest, as we have already observed from the colour of the urine, and the tinge given to linen by the matter of insensible perspiration : and that this proportion varies in different climates, and different seasons of the year, without producing genu- ine jaundice, we have observed also. And hence, infants under particular circumstances, may be subject to a like increase with a like absence of icteritious symptoms. But what those circumstances are, do not seem to be clearly known. We see nevertheless that whatever rouses the system generally, and the excretories peculiar- Synops. Nosol. Med. Gen. sci. 5. 464 ECCRITICA. [CL. VL-OR. III. ly, readily takes oft* the saffron dye: and hence it often yields to a few brisk purges, and still more rapidly to an emetic. SPECIES VI. EPICHROSIS POECILIA. llgc=JlaUetr Sfetn. CUTICLE MARBLED GENERALLY, WITH ALTERNATE PLOTS OR PATCHES OF BLACK AND WHITE. Pcecilia (vomXtx) is a term of Isocrates, from woixtXtg, t; versicolor" " pictus diversis coloribus;" whence Pcecile the porch or picture- gallery of the Stoics at Athens. The species is new to nosological classification ; but the morbid affection has been long known to physiologists, and ought to have had a niche in the catalogue of diseases before now. This affection is chiefly found among negroes from an irregular secretion or distribution of the pigment which gives the black hue to the rete mucosum. In Albinoes, as we shall have occasion to observe presently, this pigment is entirely withheld, and the matter of the rete mucosum seems to be otherwise affected ; in the species before us it is only irregularly or interruptedly distributed. What the cause of this interrupted distribution consists in we know not; but in several of the preceding species of the present genus, and particularly in moles and freckles, we perceive a striking tendency to such an effect; and if we turn our attention to the animal and vegetable world around us, we shall observe it springing before us in a thousand different ways, and giving rise to an infinite diversity of the nicest and most elegant cutaneous tapestry. It is in truth, as the author has already remarked in the volume of Nosolo- gy, to the partial secretion or distribution of this natural pigment that we are indebted for all the variegated and beautiful hues evinced by different kinds of animals and plants. It is this which gives us the fine red or violet that tinges the nose and hind-quarters of some baboons, and the exquisite silver that whitens the belly of the dolphin, and other cetaceous fishes. In the toes and tarsal membrane of ravens and turkeys, it is frequently black : in common hens and peacocks, gray : blue in the titmouse, green in the water hen, yellow in the eagle, orange in the stork, and red in some spe- cies of the scolopax. It affords that sprightly intermixture of co- lours which besprinkle the skin of the frog and salamander. But it is for the gay and glittering scales of fishes, the splendid metallic shells of beetles, the gaudy eye-spots that bedrop the wings of the butter-fly, and the infinitely diversified hues of the flower-garden that nature reserves the utmost force of this ever-varying pigment, and sports with it in her happiest caprices. In some cases, a diversified colour of the skin appears to be he- reditary among mankind Blumenbach gives an example of a GE. X.-SF. VI.] EXCERNENT FUNCTION. 465 . Tartar-tribe, whose skin was generally spotted like the leopard's.* Individuals thus motley coloured are commonly called pye-balled negroes, or are said to have pye-balled skins. The Medico-Physical Society of New York, has lately published a case communicated by Dr. Emery Bissel, in which a man of the Brotherton tribe of Indians, ninety years of age, had been gradually becoming white for the last thirty years of his life. The first ap- pearance of this change was a small white patch near the pit of tbe stomach, soon after an attack of acute rheumatism ; which was shortly accompanied with other white spots in the vicinity that enlarged and at length intermixed. And the spread of the white hue continuing to range over the whole body, the original colour was only visible, at the time of writing, on the forehead, and fore- part of the face and neck, with a few small patches on the arm. The skin, as it became while, was of a fine clear tint, and had nothing of the dull earthy appearance, or the livid hue observed in albinoes. Whence it should seem that not merely the black or dark-coloured pigment had been absorbed and carried off, but that a fair, whitish, and glossy rete mucosum, like that secreted under the cuticle in white men, had taken its placet This extraordinary change, however, is sometimes produced far more rapidly : for in the American States a black man has in a few instances bad the whole of the colouring pigment carried off in the course of a severe fever, and has risen from his bed completely transformed into a white man. Biichner, on the contrary, relates (he case of a white man who, on recovery from a like disorder, had his face tinged with a black hue, doubtless from a morbid secretion of a pigment the skin had never before elaborated. A course of nitrate of silver, continued internally for some weeks. has often produced a deep tawny and uniform discolouration of the skin approaching to a black, being deepest in the parts most ex- posed to the light. Fourcroy, Butini, Reimarus, and many other writers, have given cases of this change ; and Dr. Roget has lately published another instance in tbe Transactions of the Medico- Chirurgical Society. Plenck asserts that he once saw a man with a green face, the right side of bis body black, and the left yellow, produced by a previous disease: and Dr. Bateman informs us, -' that, subsequent to the pe- riod of his publication, Dr. Willan had observed a variety of pity- riases in children born in India and brought to this country, which commenced in a partially papulated state of the skin, and terminat- ed in a black discolouration with slightly furfuraceous exfoliations It sometimes affected half a limb, as the arm or leg; sometimes the fingers or toes."{ * De G» <., .is Hum. varictate nativ:!. ' Journ. <:i Science and Ait?, NY. ; ti. ■■>. 3?o X Cutaneous P -; .iscs, p. 4'" VOL. iv. 5Q itii; ECCRITICA. [CL. VL-OR. III. SPECIES VII. EPICHROSIS ALPHOSIS. ^IhtuO'Sfetn. CUTICLE DULL WHITE : PUPILS ROSY : SIGHT WEAK, AND STRONGEST IN THE SHADE. This species occurs not among negroes only, as commonly sup- posed, but among the inhabitants of Europe as well, and affords us the two following varieties : x iEthiopica. Hair white and woolly: irids white. Negro albino. Found among negroes. £ Europea. Hair flaxen and silky. Found among European albino. Europeans and other white na- tions. The first of these varieties is by far the most striking, on account of the greater change in the colour of the skin, and the peculiar contrast it forms with the general cast of the negro-features. The name of albino was first employed by the Portuguese, and applied to such Moors as were born white, or rather who continued so from the time of birth, for the children of negroes have little discolouration on birth, nor for several weeks afterwards, and who, on account of this morbid hue, were regarded as monsters: and the term has since passed into our own and most other languages of the world. In these persons, however, there were other pecu- liarities observed besides the hue of the skin, for their hair, in all its natural quarters, was equally white, the iris of the eyes white, and the pupil rose-coloured. This whiteness of the surface, how- ever, is not the clear and glossy tint of the uncoloured parts of the European frame in a healthy state, but of a dead or pallid cast, something like that of leprous scales. The eyes, in consequence of the deficiency of their natural pigment, are so weak that the in- dividuals can hardly see any object in the day, or bear the rays of the sun ; though under the milder light of the moon, they see with great accuracy, and run through the deepest shades of their forests with as much ease and activity as other persons do in the brightest daylight. They are also said to be less robust than other men; and to sleep through the day and go abroad at night: both which last facts are easily accounted for, for the weakness of their sight, and the discomfort of the sun-beams to their eyes. It was at one time a subject of inquiry whether these persons were a distinct variety of the human race, or merely instances of an occasional aberration from the ordinary laws that govern the human fabric: and the former opinion derived some support from its being found that male and female albinoes, who not unfrequently intermarried, being rejected by the rest of the world, produced an offspring with the same imperfections as their own. CE. X.-SP. VII.] EXCERNENT FUNCTION. 4b # The question, however, has long been sufficiently set at rest. since albino children have been found produced in most parts of the world, and from parents of all tribes and colours, black and olive-hued, and red and tawny: and, since the subject has been more closely attended to, from white parents or inhabitants of Eu- rope, as well as black or copper-coloured Africans. It is the appearance of the characteristic albino-signs in Eu- ropean children, that constitutes the second of the two varieties before us. These signs are a dull or unglossy white diffused over the body, with white or flaxen hair, white irids and red pupils. The disease is rare, but we have had at least eleven examples described by different authorities to the present time. Two by de Saussure, four by Buzzi, one by Helvetius, one by Maupertius, and three by Dr. Traill. It is singular that all these are males ; and still more so that the female offspring of the same families were, without an exception, destitute of the albino degeneracy. The three described by Dr. Traill were part of a family of six, the daughters of which were in every respect unaffected. How far this disorder is in Europe capable of being produced hereditarily as abroad is not known ; nor, indeed, does there yet appear to have been an opportunity of forming an intermarriage between a male and a female of this kind, as not a single female has yet been dis- covered possessing the imperfective formation. The same delicacy of constitution that distinguishes the foreign or negro albino, distinguishes the European, of which we ma: form an estimate from Dr. Traill's account of one of the three we have already alluded to. " The oldest of these albinoes," says he, " is nine years of age, of a delicate constitution, slender, but well formed both in person and in features: his appetite has al- ways been bad; he frequently complains of a dull pain in his fore-. head: his skin is exceedingly fair; his hair flaxen and soft; his cheeks have very little of the rose in them. The iris and pupil of his eyes are of a bright-red colour, reflecting in some situations an opaline tinge. He cannot endure the strong light of the sun. When desired to look up, his eye-lids are in constant motion, and he is incapable of fixing his eyes steadily on any object as is ob- served in those labouring under some kinds of slight ophthalmia, but in him is unaccompanied by tears. His mother says that his tears never flow in the coldest weather, but when yexed they are shed abuudantly. He goes to school, but generally retires to the darkest part of it to read his lesson.—His disposition is very gentle ; he is not deficient in intellect. His whole appearance is so re- markable that some years ago a person attempted to steal him, and would have succeeded in dragging him away, had not his cries brought him assistance."* The disease consists altogether in a defective secretion of the rete mucosum, which is not only without the colouring constituent * Nicholson's Journ. Nat. Phil. Feb. 1808. 468 ECCRITICA. [CL. VL-OR. HI. principles that naturally belong to it, and particularly its power of affording a black pigment, but seems to be also untempered or im- perfectly elaborated in other respects, judging from the dullness or deadness of the white hue it gives to the surface of the body, in- stead of the life and glossiness it diffuses in a state of perfect health. That this cutaneous layer is not altogether wanting is clear, since in such case the red vascularity of the cutis would be conspicuous through the deiicate transparent cuticle, in albinoes peculiarly delicate, and tinge the surface with a red instead of a white colour. It is to this imperfection in the secretion or elaboration of the rete mucosum that the delicacy or feebleness of the general frame is in all probability to be ascribed, though we may be at some loss in determining how such an effect is produced by such a cause. That the flaxen hue of the hair, and the whiteness of the irids is derived from the same source, admits, however, of no doubt, and the opiuion long ago expressed by Professor Blumenbach,* that the red colour of the pupils in the two adult albinoes, whom he had examined at Chamouni, was equally owing to the want of the usual black pigment, has since been confirmed by M. Buzzi of Milan, who has had an opportunity of dissecting an albino, and has proved that the pigmentum nigrum of the choroid coat, and also that portion of it which lies behind the iri>, and is called uvea, were totally want- ing.? We have observed, under the preceding species, that other animals are as richly supplied with a rete mucosum as. mankind, and that they are indebted to it for their respective colours: and, as there can be no reason why they may not at times endure a like deficiency, we have reason to expect a priori that they may occa- sionally exhibit proofs of the same complaint. In accordance with this reasoning, M. Bulmenbach has traced this affection in many tribes, and especially in white dogs, owls, and rabbits and Dr. Traill has lately observed a case of the same disease in a young sparrow which he accidentally shot. This seems to have been a perlect albino, with red eyes, pale reddish beak and neck, snow- white plumage, of a satin gloss on the head, neck, wing-coverts, and back. The nest from which it issued contained another young sparrow of the common colour; and when the albino bird quitted the nest, which it was seen to do a few days before it was shot, it was instantly attacked by fifty or sixty common swallows, and obliged to take refuge in a tree.J * Med. Bibl. n. 537. i Disspitnzioue storico-anatomica sopia una varieti. particolare de nomini bianchi, &c. Milan, 1734. Le Cat, Trait-.- de la Couleuv de la p?au humaine. t Edin. Phil. Journ. No. iv. p. 390. [469] GENERAL INDEX. The Numerals indicate the Volume ; tbe Figures the Page. The Classes and Orders are distinguished by Small Capitals ; and the Genera by Italics. A. \bortion, iv. 122 Abscess, how distinguished from Apo- stem, ii. 163 of the breast, ii. 137 Absence of mind, iii. 108 Abstraction of mind, iii. Ill Absorbent system, physiology of,' iv. 187 whether veins are absorb- ents, iv. 191 general effects (< win the union of this and the secernent sys- tem, iv. 195 Absorption in cataract, iii. 151 Acari malis, iv. 4:M Acaius dysenteric, ii. 304 cutaneous, iv. 438 Acid bath, i. 257 formic, in indigestion, i. 116 uric, produced more copiously from animal than vegetable food, iv. 333 oxalic, predominant principle in diabetic urine, iv. 332 Acidum abietis, i. 348 Acoroides resinifera of New Holland, i. 113 Acrotica, iv. 357 Acrotism, iii. 260 Acrostismus, iii. ib. .Edoptosis, iv. 102 vaginae, iv. 105 vesicae, iv. ib. utfii, iv. 102 complicata, iv. 106 polyposa, 107 .Esthetica, iii. 133 jEmUis volaticus, iv. 370 iEthusa Cynapiuiu, or fool's parsley, i. 141 \fter-pains in labour, iv. 165 Agallochum, or lign-aloes, i. 113 Agenesia, iv. 88 impotens, iv. 89 dys-spermia, iv. 91 iucongrua, iv. 94 Agria, iv. 376 Agrypnia, iii. 308 excitata, iii. ib. pertaesa, iii. 310 Ague, ii. 65 quotidian, ii. 68 tertian, ii. 70 quartan, ii. 71 irregular, ii. 72 complicated, ii. 73 has raged in high grounds, while low have escaped, ii. 77 treatment of, ii. 78 Ague-cake, i. 279 Air, average of inspired, in a minute, i. 301 expired, i. 301. 304 whether secreted by organs, iv. 286 Albino-skin, iv. 466 Algor, iii. 187 Alimentary canal, i. 2 comparative length of, i. 4 Diseases of, i. 9 Alkekengi, or winter-cherry, iv. 307 Alopecia, iv. 427. 456 Alphabets, why thpy differ in different languages, i. 335 mostly derived from the Phenician, i. ib. Devanagari, and some others not, i. 336 Alphos, iv. 391, 392 Alphosis, iv. 466 Alusia, iii. 93 elatio, iii. 94 hypochondrias, iii. 99 Alysrous, iii. 314 470 GENERAL INDEX. Alyssum, iii. 252 Amaurosis, iii. 154 varieties, iii. ib. Ambition, ungovernable, iii. 83 Ainmoniaco-magnesian phosphate of the bladder, iv. 339 Amnesia, iii. 124. 126 Anal hemorrhage, ii. 466. 468 Anaphrodisia, iv. 89 Anas cygnus, i. 294 olor, i. ib. Anasarca, iv. 245 serosa, ii. 319 Anemone pratensis, iii. 146 Anelus, ii. 65 quotidianus, ii. 68 tertianus, ii. 70 quartanus, ii. 71 erraticus, ii. 72 complicatus, ii. 73 treatment of, ii. 78 Aneurisma, ii. 592 varieties, ii. 593 Anger, ungovernable, iii. 84 Angelica, i. 215, 216 Angina polypoea, ii. 234 • Anhelation, i. 362 Animals, lower orders, propagable both by offsets and seeds, iv. 6 Animation suspended, iii. 367 Anthracia, ii. 424 pest is, ii. 426 rubula, ii. 445 Anthrax, ii. 193 Antigua fever, compared with Bulam, ii. 103 Antimony, glass of, cerated, ii. 310 Antipathia, antipathy, iii. 315 sensilis, iii. ib. insensilis, iii. 316 Anxiety, ungovernable, iii. 88 corporeal, iii. 312 Aphis humuli, i. 197 Aphtha, ii. 390 Aphrodisiacs, of little avail, iv. 90 Aphonia, i. 318 elinguium, i. 319 atonica, i. 322 suidorum, i. 324 Aphoria, iv. 97 impotens, iv. 97 paramenica, iv. 99 impercita, iv. 100 incongrua, iv. 101 Aphis, iv. 7 Aphelxia, iii. 107 socors, iii. 108 intenta, iii. Ill otiosa, iii. 112 Appetite, morbid, i. 71 canine, i. 72 depraved, i. 80 Apocbysis, iii. 148 Apostema, aposteme, ii. 163 how differs from abscess, ii. 164 commune, ii. 164 psoaticum, ii. 175 hepatis, ii. 176 Empyema, ii. 178 Vomica, ii. 181 Apoplexia, apoplexy, iii. 394 entonic, iii. 402, 40C atonic, iii. 404 sanguine, iii. 401 serous, iii. ib. Aqua regia bath, i. 257 obscura, iii. 149 serena, iii. ib. Arctium Lappa, ii. 590 Ardor, iii. 187 Area, iv. 455 Areca oleracea, i. 3. 211. 21* Malabar Nut, i. 106 Arnica, i. 157 montana, iii. 432 Arqua, iii. 149 Arsenic, in intermittents, ii. 86 in rheumatism, ii. 335 in consumption, ii. 510 in career, ii. 544 in nerve-ache, iii. 195 in rabies, iii. 251 in chorea, iii. 296 in epilepsy, iii. 364 in leprosy, iv. 399 Artemisia santonica, i. 215 Arteries and veins, ii. 7 Arthrocace, ii. 620 Arthrosia, it. 324 acuta, ii, 326 chronica, ii. 332 Podagra, ii. 335 Hydarthrus, ii. 358 Arthritis, ii. 324 Articular inflammation, ii. 325 Arum in hemicrania, iii. 328 Ascaris lumbricoides, i. 200 vermicularis, iv. 10 Asclepias, gigantea, ii. 572 Ascites, iv. 276 Aspalathus canariensis, i. 93 Asphyxia, iii. 367 varieties of, iii. 368 how related to acrotismus, iii. 260 Asphyxy, iii. 367 Aspleniura ceterach, as a diuretic, iv. 305 Asthma, i. 370 siccum, i. 375 humidum, i. 378 nervous, i. 375 Athamanta oreoselinum, as a diuretic. iv. 305 GENERAL INDEX. 471 Athamanta Meum, iv. 40 cretensis, iv. 305 Atheroma, iv. 212 Atmosphere contaminated with febrile matter, sometimes affects birds, ii. 48 Atriplex foetida, iii. 349 Atrophia, atrophy, ii. 475 Aura epileptica, iii. 360 podagrica, ii. 348 Aurigo, iv. 463 Auruin fulminans, ii. 378 Avarice, ungovernable, iii. 18 Azote necessary to animal nutriment, i. 3 B. Bacher's pills, iv. 249 Baker's itch, iv. 401 Baldness, iv. 448. 454 Balfour, his hypothesis of sol-lunar in- fluence, ii. 56 Ballismus, iii. 297 Balsamum carpathicum, iv. 305 hungaricum, iv. ib. Banana, i. 3 Barbadoes-leg, ii. 320 Barbieis, iii. 303 Bark, Peruvian, history of, ii. 81 Barrenness, iv. 97 of impotency, iv. ib. of mis-menstruation, iv. 99 of irrespondence, iv. 100 of incongruity, iv. 101 Bastard-pox, ii. 563 Beating, sense of, in the ears, iii. 169 Bee, economy of, iv. 7 Beet, i. 3 Beetle, larves of, intestinal, i. 204 grubs intestinal, i. ib. Bella donna in cataract, iii. 153 amaurosis, iii. 155 Belly-ache, i. 120 dropsy of, iv. 276 Benat-allil (Arab.) ii. 385 Beras (leprosy,) iv. 388. 391. 395 Berat (leprosy,) iv. 388. 391 Beriberia, Beribery, iii. 303 origin of the name, iii. ib. Bex, i. 342 humida, i. 344 sicca, 349 convulsiva, 354 Bezoar, ) ^ 186 Bezoardus, ) spurious, i. 187 Bichat, his hypothesis concerning the mind, iii. 28 Bildungstrieb, iv. 18 Bile, use of, i. 244 Bilious remittent fevers, ii. 91. 93. 104.. Bimariy kodek (Pers.) iv. 79 Birds, singing, vocal avenue, i. 294. imitative, i. 295 Bismuth, oxyde of, in indigestion, i. 110 Black disease, i. 362 leprosy, ii. 570 vomit, i. 266.—ii. 102 water, i. 84 Bladder, prolapse of, iv. 102 vermicules discharged from, iv. 309 stone in, iv. 347 inflammation of, ii. 269 Bladder-bougies, i. 238 Bladdery fever, li. 402.—iv. 309 Mains, iv. 406. 414 Blear-eye, ii. 288 Blebs, water, iv. 407 BlenorrhcEa, iv. 55 simplex, iv. 56 luodes, iv. ib. chronica, iv. 62 Blood, how affected by inspiration, i. 300 modena hue of, how produced, i. 301 scarlet hue, how produced, i. ib. 305 intrinsic properties of, ii. 21 moving powers of, ii. 11 sulphur of, ii. 22 iron of, ii. ib. 23 colouring matter of, ii. 23 red particles of, ii. 24 transmits mental and corporeal taints to subsequent generations, ii. 26 why supposed to be alive, ii. ib. Bloody flux, ii. 300 Blow-fly, larves of, intestinal, i. 207 Blue-boy, ii. 602 Blushing, cause of, ii. 8 Blush inflammatory, ii. 200 Boak (common leprosy,) iv. 388. 391. 393 Boerhaave, his doctrine of fevers, ii. 30 Boil, ii. 192 Boletus laricis, iv. 361 Boinbus, iii. 169 Bones, contortion of the, iv. 222 Bonus Henricus, i. 237 Borborygmus, i. 89 Botium, iv. 209 Botts intestinal, i. 203 Bowels, inflammation of, ii. 256 Brain-fever, ii. 215. 219 Brain, inflammation of, ii. 214 nature of, ramifications and sub- stitutes, iii. 6 of man compared with animals, iii. 10 generally admitted to be a gland, I iii. 21 472 GENERAL INDEX. Bread-fruit tree, i. 3 Bread-nut, i. ib. Breast-pang, suffocative, i. 393 acute, i. 394 chronic, i. 400 Breeze or gadfly larves, i. 204 Breslaw remittent fever, ii. 110 Bright spot leprous of the Hebrews, what, iv. 388 Broken-wind, i. 370 Bronchial polypus, ii. 237 Bronchitis, ii. 233 Bronchocele, iv. 209 Bronchus, ii. 290 Brosimum alicastrum, i. 3 Brown, his doctrine of fevers, ii. 30 Brown-study, iii. 108. 112 Bubo, ii. 188 Bubukle, ii. 197 Buccal pouch in monkeys and other ani- mals, i. 4 Bucnemia'ii. 316 sparganosis, ii. 317 tropica, ii. 320 Bulam fever, ii. 99 its relation to the Antigua fever and others, ii. 103 Bulge-water tree, i. 211 Burdock, ii. 590 Bursa Fabricii in birds, i. 5 C. Cabbage-tree, i. 3. 211. Cachexies, ii. 450 Caddy-fly larves, intestinal, i. 207 Cadmia of Gaubius, iii. 295 Cajeput-tree, i. 57 Calcareous earth, formed or secreted by all animals, i. 164 Calculus renal, iv. 340 vesical, iv. 340. 347 intestinal, i. 188 urinary, iv. 338 its various kinds, iv. 339. 348 Caligo, iii. 146 Callus, iv. 445 Calor mordicans in typhus, ii. 129 Calvities, iv. 454 Camphor, its sedative power against the irritation of the bladder by canthari- des, iv. 307 Cancer, ii. 533 common, ii. 534 whether contagious, ii. 536 ascribed to vermicles, ii. 537 in various parts, ii. 539 Cannabis sativa, i. 256 Capsicum, in indigestion, i. 113 Carbuncle, ii. 193 escar, ii. 194 Carbuncle berry, n. io. Carbuncled face, ii. 197 Carcinus, ii. 533 Vulgaris, ii. 534 Cardamine pratensis, ii. 245. 351 the sisymbrium of Diofco- rides, iii 351 Cardiogmus, ii. 593 Carditis, ii. 248 Caries, ii. 612 of the spine, ii. 614 Carminatives, i. 91 Camevaletto delle donne, of Baglivi. iii. 290 Carpotica, iv. 169 Caruncula, caruncle, iv. 443 Cams, iii. 366 Asphyxia, iii. 367 Ecstasis, iii. 382 Catalepsia, iii. 385 Lethargus, iii. 390 Apoplexia, iii. 394 Paralysis, iii. 414 Caryophyllata, i. 237 Cusmunar, in indigestion, i. 113 Cutatausis, ii. 576 ebriosa, ii. 577 Catalepsia, catalepsy, iii. 385 Catamenia, origin and progress, iv. 32. Cataphora, iii. 391 Cataract, iii. 148 Catanacid, iii. 148 vaiieties, iii. 149 Catarrh, ii. 299 Catarrhus, ii. ib. communis, ii. 291 epidemic us, ii. 293 caninus, ii. 296 vesicae, iv. 309 Catechu, i. 238 Catoche, what, iii. 388 Catochus, what, iii. 384. 388 lcow connected with tetaniu, iii. 221 Catotica, iv. 238 Cattu schiragaam, vermifuge, i. 219 Caum-,, ii. 117 its varieties, ii. 121 Causus, or burning remittent, ii. 10S Cellular substance of organs, iv. 183 Cenotica, iv. 29 Ctjihalcea, iii. 318 gravans, iii. ib. intensa, iii. 320 ! Hemicrania, iii. 323 pulsatilis, iii. 324 nauseosa, iii. 325 ! Cephalitis, ii. 214 , meningica, ii. 210 profunda, ii. 222 I Cerchnus, i. 317 Cesarean operation in labour, iv. 156 GENERAL INDEX. 473 Cevadilla, i. 211 Chaerophyllum sylvestre, i. 237 Chalasis, ii. 526 Chamomile, in indigestion, i. 115 Chancres, ii. 549 Charcoal-powder, its use in indigestion, i. 109 Chenopodium anthelminticum, i. 215. vulvaria, iii. 349 Cherry-laurel, i. 256 Chervil, i. 237 Chest, dropsy of, iv. 271 Chicken-pox, ii. 400 Child-bed fever, ii. 148 Chilblain, ii. 210 Chiggoe, Chiggre, iv. 437 Chivalry, iii. 94 Chlorine, iii. 253 Chlonosis, iv. 74 atonica, iv. 73 entonica, iv. 76 Chocolate, butter of, i. 237. 353 Choke-damp, iii. 368. 376 Xoxaf, i. 167 Xom», i. 167 Cholera, i. 167 biliosa, i. 168 flatulenta, i. 171 spasmodica, i. 172 epidemic, i. 171 Chololithus, i. 268 quiescens, i. 270 means, i. 271 Chorea, iii. 289 Chronic rheumatism, ii. 332 Chyle, its nature, i. 6 how produced, i. 150 Chylifaction, process of, i. 9 Chyme, i. 102 Chymifaction, process of, i. 6 Cicuta virosa, i. 141 Cinchona, history of, ii. 81 Cinetica, iii. 202 Circumligatura, ii. 189 Clap, iv. 56 CLASS I. Proem i. 1 Order i. i. 17 Ord. ii. i. 243 II. Proem i. 291 Ord. i. i. 309 .Ord. ii. i. 342 III. Proem ii. 5 Ord. i. ii. 27 ii. ii. 154 iii. ii. 363 iv. ii. 450 IV. Proem iii. 5. Ord. i. iii. 41 ii. iii. 133 iii. iii. 202 iv. iii. 307 v. Proem iv. 5 vol. iv. 60 CLASS V. Ord. i. iv. 30 ii. iv. 74 iii. iv. 109 VI. Proem iv. 183 Ord. i. iv. 199 ii. iv. 239 iii. iv. 357 Clavus, iv. 445 Climacteric disease, ii. 480 Climacterics, Greek what, ii. 480 Cloaca in birds, i. 5 Clonic Spasm, iii. 265 Clonus, iii. 265 pathology of, iii. 265 Singultus, iii. 268 Sternutatio, iii. 270 Palpitatio, iii. 272 Nictitatio, iii. 281 Subsultus, iii. 283 Pandiculatio, iii. 284 Clutterbuck, his doctrine of fever, ii. 30 Cobalt in consumption, ii. 510 Coffee, its use in asthma, i. 481 sick head-ache, iii. 330 Colchicum autumnale, how far a speci- fic in gout, ii. 356 useful in dropsy, iv. 254 Cold, general feeling of what, iii. 187 in the head, ii. 224 Ccei.iaca, i. 17 Colic, i. 120 of Poitou, i. 127 Colica, i. 120 cibaria, i. 135 constipata, i. 144 constricta, i. 145 flatulenta, i. 142 Collatitious organs of digestion, i. 5 Colon, valve of, i. 4 Coltsfoot in scrophula, ii. 532 Coma vigil, iii. 392 Comatose spasm, see Spasm. Combustibility of the body, ii. 576 Concoction, ancient doctrine of, ii. 31 Concretion, intestinal, i. 185 Conessi bark, ii. 315 Congestion, marks of, in typhus, ii. 133 Constipation, i. 148 Consumption, ii. 494 varieties, ii. 495 how far affected by agues, ii. 525 Contagion, what, ii. 43 impure atmosphere necessa- ry to its spread, ii. 51 laws of ii. 52 and miasm, identity of, ii. 296 Contortion of the bones, iv. 222 Convulsio, convulsion, iii. 345 varieties of, Hi. 346 474 GENERAL INDEX. Convulsio, puerperal, iv. 138 Copaiva, balsam of, i. 164.237 Coprostasis, r. 147 constipata, i. 148 obstipata, i. 151 Corns, iv. 445 Cornea opake, iii. 146 Corpora lutea, what, iv. 11 Corpulency, iv. 200 Coryza, i. 309 entonica, i. 310 atonica, i. 312 how related to catarrh, ii. 290 Costiveness, i. 147 Couching the eye, iii. 151 Cough, i. 342 of old age, i. 344 hooping or convulsive, i. 354 Country-sickness, iii. 86 Cowhage, i. 214 Cow-pox, ii. 394 its varieties, ii. 396 whether produced by grease in the horse's heel, ii. 399 Crab-louse, iv. 436 Crack-brained wit, iii. 94. 96 Cramp, iii. 211 Crampus, iii. ib. Craziness, iii. 42 Credulity, iii. 124. 128 Crepitus, i. 89 Cretinism, iv. 231 its relation with rickets, iv. 223 Crimping of cod-fish, iii. 23 Crinones, iv. 441 Crisis, febrile doctrine of, ii. 54 of Hippocrates, ii. 55 referred to the heavenly bodies, ii. 56 Cross-birth, iv. 146 Crotophium, iii. 260 Crotophus, iii. ib. Croton Tiglium as a hydragogue, iv. 247 Croup, ii. 233 acute, ii. ib. chronic, ii. 237 Crusta lactea, iv. 422 Cubebs, iv. 60 Cucumber-suppositories, i. 238 Cullen, his doctrine of fever, ii. 30 Cutaneous vermination, iv. 434 Cyauia, ii. 601 Cycas circinalis, i. 3 Cyrtosis, iv. 222 Rhachia, iv. 223 Cretinismus, iv. 230 Cystic oxyde or calculus, of the bladder, iv. 339 Cystitis, ii. 269 D. Dal fil (Arab.), ii. 320. 568 Dance of St. Vitus, or St. Guy, iii. 289 Dandelion, i. 256 iv. 305 Dandriff, iv. 385 Dans saleb (Arab.) iv. 454 Dartus darsis, iv. 409 Darwin, E. his doctrine of fevers, ii. 30 Day-mare, i. 391 sight, iii. 137 Deaf-dumbness, i. 324 speech maintained and how, i. 325 Decay of nature, ii. 480 Decline, ii. 487 Defluxioq, ii. 290. 335 Delirium ferox, ii. 219 mite, ii. 219 Delivery premature, its advantages at times, iv. 158 origin of the practice, iv. 159 Demulcents, their nature and how they act, i. 352 Dentition, economy of, i. 19 Dentrifices, i. 36 Depression in cataract, iii. 151 Derbyshire-neck, iv. 207. 209, 210 Despair, iii. 89 Despondency, iii. 89 Destitution of urine, iv. 298 Devonshire colic, i. 127 Diabetes, iv. 311 aquosus, iv. 312 insipidus, iv. 312. 335 mellitus, iv. 311, 312 different hypotheses to ac- count for its symptoms, iv. 315 Diabetes, sugar secreted by various or- gans as well in a state of health as of sickness, iv. 324 Diarrhaa, i. 152 fusa, i. 153 biliosa; i. 154 mucosa, i. 156 chylosa, i. 157 Lienteria, i. 159 serosa, i. 160 tubularis, i. 162 gypsata, i. 164 urinary, iv. 311 Diary fever, ii. 58 Dictamnus albus, i. 215 Digitalis, how far useful in phthisis, ii. 519 in dropsy, iv. 253. 273 Digestion, process of, i. 6 hypotheses concerning, i. 8 Digestive Fuhctiok, i. 1 Organs, i. 1 | GENERAL Dinus, iii. 330 Diplopia, iii. 144 Dipsacus, iv. 311 Dipsosis, i. 67 avens, i. 69 expers, i. 70 Dirt-eaters of West Indies, i. 82 Distemper of dogs, ii. 296 Division of the symphysis of the ossa pubis in impracticable labour, iv. 153 Dizziness, iii. 330 Dodders, iv. 434 Dolichos pruriens, i. 214 Doronicum Pardalianches, i. 157 Dotage, iii. 130, 131 Dracunculus, iv. 440 Drivelling, i. 57 Drop serene, iii. 154 Dropsy, iv. 238 * cellular, iv. 244 of the head, iv. 260 spine, iv. 269 chest, iv. 271 belly, iv. 277 ovary, iv. 281 fallopian tube, iv. 283 womb, iv. 284 scrotum, iv. 285 head (acute) ii. 215.217 urinal, iv. 311 Drowning, death from, iii. 371 Dry gangrene, ii. 610 Dumas, his hypothesis concerning the mind, iii. 28 Dumbness, i. 318 elingual, 319 Dysenleria, ii. 300 how far connected with fever, ii. 301 or contagion, i;. 302 simplex, ii. 303 pyrectica, ii. 307 Dysenteric fever, ii. 307 Dysentery, ii. 300 Dyspepsia, i. 100 phthysis, i. 104 Dysphagia, i. 58 atonica, i. 62 constiicta, i. 59 1 globosa, i. 63 uvulosa, i. 64 linguosa, i. 65 Dysphagy, i. 58 Dysphonia, i. 326 susurrans, i. 327 puberum, i. 329 itnmodulata, i. 331 Dysphoria, iii. 312 simplex, iii. 313 anxietas, iii. 314 Dyspnaa, i. 362 chronica, i. 364 INDEX. 476 Dyspnoea, exacerbans, i. 368 Dys-spermia, iv. 91 varieties, iv. 92 Dysthetica, ii. 450 E. Ear-ache, ii. 224 Earthbone calculus of the bladder, iv. 339 Ecchymoma lymphatica, ii. 317 Eccritica, iv. 199 Eccyesis, iv. 168 ovaria, iv. 170 tubalis, iv. 173 abdorflinalis, 173 Ecphlysis, iv. 406 Pompholyx, iv. 407 Herpes, iv. 408 Rhypia, iv. 414 Eczema, iv. 415 Ecphronia, iii. 42 Melancholia, iii. 56 Mania, iii. 64 Ecphyma, iv. 442 Caruncula, iv. 443 Verruca, iv. 444 Clavus, iv. 445 Callus, iv. 445 Ecpyesis, iv. 416 Impetigo, iv. 418 Porrigo, iv. 420 Ecthyma, iv. 423 Scabies, iv. 429 Ecstasis, Ecstacy, iii. 382 Ecthyma, iv. 428 Ectropium, ii. 288 Eczema, iv. 415 Edematous inflammation, ii. 203 Effluvium, human, ii. 42. 51 marsh, ii. 42 Elatio, iii. 94 Elephantia, ii. 567, 568 Elephantiasis, ii. 566.—iv. 390. 396 Arabica, ii. 570 Italica, ii. 573 Asturiensis, ii. 575 Elephant leg, ii. 320 how differs from elephan- tiasis of the Greeks, ii. 320 Elephant-skin, ii. 566 Elephas, ii. 566. 568 Elf-sidenne, i. 388 Ellis, his hypothesis of respiration, i. 381.—ii. 12 Emaciation, ii. 472 Emansio mensium, iv. 31 Empassioned excitement, iii. 79 depression, iii. 85 Etnpathema, iii. 77 entonicum, iii. 79 476 GENERAL INDEX. Empathema, entonicum, laetitiae, phi- lautiae, superbiae gloriae famis, ira- cundiae, zelotypiae, iii. 79 atonicum, iii. 85 varieties, iii. ib. inane, iii. 92 Emphlysi; ii. 386 Miliaria, ii. 386 Aphtha, ii. 390 Vaccinia, ii. 394 Varicella, ii. 400 Pemphigus, ii. 402 Erysipelas, ii. 406 Emphyma, iv. 205 Sarcoma, iv. 20G Encystis, iv. 212 Exostosis, iv. 214 Emphysema, iv. 288 cellulare, iv. 290 abdominis, iv. 292 uteri, iv. 295 Empresma, ii. 212 Cephalitis, ii. 214 Otitis, ii. 224 Parotitis, ii. 225 Paristhmitis, ii. 227 Laryngitis, ii. 231 Bronchitis, ii. 233 Pneumonitis, ii. 237 Pleuritis, ii. 245 Carditis, ii. 248 Peritonitis, ii. 249 Gastritis, ii. 252 Enteritis, ii. 256 Hepatitis, ii. 260 Splenitis, ii. 267 Nephritis, ii. 286 Cystitis, ii. 269 Hysteritis, ii. 270 Orchitis, ii. 272 Emproslhotonos, iii. 221 Empyesis, ii. 411 Variola, ii. 411 Emrods, i. 233 Enanthesis, ii. 366 Rosalia, ii. 366 Rubeola, ii. 379 Urticaria, ii. 384 Encanthis, iv. 443 Encystis, iv. 212 Enecia, ii. 116 Cauma, ii. 117 Typhus, ii. 123 Synochus, ii. 145 English melancholy, iii. 102 mercury, i. 237 Entasia, ii. 207 Priapismus iii. 207 Loxia, ii. 208 articularis, iii. 210 Systremma, iii. 211 Trismus, iii, 213 Entasia, Tetanus, iii. 220 Lyssa, iii. 228 acrotismus, iii. 260 Enterica, i. 17 Enteritis, ii. 256 adhaesiva, ii. 256 erythematica, ii. 259 Enterolithus, i. 274 Bezoardus, i. 276 Calculus, i. 278 Scybalum, i. 283 Enuresis, iv. 333 Epanetus, ii. 91 mitis, ii. ib. malignus, ii. 93 Hectica, ii. 112 Causus, ii. 108 asthenicus, ii. 110 flavus, ii. 98 Ephelis, iv. 461 Ephemera, ii. 58 mitis, ii. 59 acuta, ii. 61 sudatoria, ii. 62 Ephialtes, i. 388 vigilantium, i. 391 nocturnus, i. 392 Ephidrosis, iv. 359 profusa, iv. 360 cruenta, iv. 361 partialis, iv. 362 discolor, iv. 363 olens, iv. 363 arenosa, iv. 365 Epian, ii. 446 Epichrosis, iv. 458 Leucasmus, iv. 458 Spilus, iv. 459 Leuticula, iv. 460 Ephelis, iv. 461 Aurigo, iv. 463 Poecilia, iv. 464 Alphosis, iv. 466 Epigenesis, theory of, iv. 13 Epilepsia, Epilepsy, iii. 356 varieties of, iii. 357 Epinyctis, iv. 408 Epistaxis (nasal haemorrhage,) ii. 460 468 Ergot, iv. 40 Erosion of the skin, ii. 211 Eructatio, Eructation, i. 89 Eruptive fevers, ii. 363 Erysipelas, ii. 406 oedematosum, ii. 409 gangrenosum, ii. 409 pestilens, ii. 428 Erysipelatous inflammation, ii. 204 Erythema, ii. 200 oedematosum, ii. 203 erysipelatosum, ii. 204 gangrenosum, ii. iu6 GENERAL INDEX. 477 Erythema, resiculare, ii. 207 Pernio, ii. 210 Intertrigo, ii. 211 why ulcerative rather than phlegmonous, ii. 202 mercuriale, ii. 210 volaticum, iv. 370 Essera, or Eshera, iv. 375 Esophagus, i. 4. Esthiomenos, iv. 410 Everted eye-lid, ii. 289 Evolution spontaneous in labour, iv. 150 Exangia, ii. 592 Aneurisma, ii. 592 Varix, ii. 598 Cyania, ii. 601 ExAKTHEMATICA, ii. 363 Exanthem, ii. 363 rash, ii. 366 ichorous, ii. 386 pustulous, ii. 411 carbuncular, ii. 424 Exawthesis, iv. 366 Roseola, iv. 366 Excernent system, physiology of, iv. 183 Excitability of Biown, what, ii. 39 Exra'caria Agallochuin, i. 113 Excrescence, cutaneous, iv. 442 Excrescence genital, iv. 102 Exfetation, iv. 168 ovarian, iv. 170 tubal, iv. 173 abdominal, iv. 173 Exormia, iv. 367 Strophulus, iv. 369 Lichen, iv. 371 Prurigo, iv. 379 Milium, iv. 383 how distinguished from Ec- thyma, iv. 367 Exostosis, iv. 214 Expectorants, i. 346 in what way they act, i. 346 Extra-uterine Fetation, iv. 168. See Exfetation Eye-lids, twinkling of the, iii. 281 Fainting, iii. 339 from various odours, iii. 339 Fainting-fit, iii. 341 Falling-sickness, iii. 356 Falling down of the womb, iv. 102 False inspiration, iii. 94. 96 False conception, iv. 178 Fanaticism, iii. 94. 98 Fasciola, i. 202. 210. iv. 6 Fasting Ion j; or chronic, i. 77 woman of Tctbury, i. 79 Fat, formed from bile, i. 13.—iv. 201 Fatuity, iii. 123 imbecility, iii. 124 irrationality, iii. 130 Febrifuges possess some property not yet ascertained, ii. 89 Febris lenta nervosa, ii. 127 dysenterica, or nova, of Syden- ham, ii. 302 rubr i of Heberden, ii. 367 Felon, ii. 199 Fern, male, i. 217 Fetation extra-uterine, iv. 168. See Exfetation Fetus has been born alive at four months, iv. 122 may live at seven, iv. 122 Feu volage, iv. 370 Fevers, ii. 27 difficulty of defining, ii. 27 genera in the present work, ii. 28 proeguminal cause, what, ii.29 procatarctic, ii. 29 exciting cause, ii. 29 proximate, ii. 29 remote, ii. 42 chief hypotheses of, i'. 30 by what agents excited or in- fluenced, ii. 46 diary, ii. 58 sweating, ii. 62 intermittent, ii. 65 remittent, ii. 91 yellow, ii. 98 Bulam, ii. 99 paludal, ii. 99 seasoning, ii. 99 jungle, ii. 99 ardent, ii. 108 continued, ii. 116 inflammatory, ii. 117 imputiid continent, ii. 117 continued, ii. 117 sanguineous continued, ii. 117 hysterical, ii. 127 nervous, ii. 127 putrid, malignant, jail, camp, hospital, ii. 129 synochal, ii. 145 puerperal, or child-bed, ii. 14- peritoneal, ii. 148 eruptive, ii. 363 miliary, ii. 386 bladdery, ii. 402 Fibrinous calculus of the bladder, iv. 340 Fibre, nervous, iii. 8. 21 irritable, iii. 20 Fibrous substance of organs, iv. 183 Ficus, iv. 443 Fidgets, iii. 313 Fievre matellotte, ii. 99 478 GENERAL INDEX. Filaria, iv. 439 Filix mas, i. 217 Fish-skin, iv. 402 Flavours, how influenced at different times, and under different circum- stances, iii. 180 Flatulency, i. 89 Flatus, i. ib. Flea-bite, iv. 437 Flesh-fly, larves of, intestinal, i. 207 Flexibility of the bones, iv. 219 Flooding, iv. 128. 164 Fluids, sexual diseases affecting the, iv. 29 Fluke-worm, i. 202.—iv. 6. found in the liver, i. 275 Fluttering of the heart, iii. 272 Flux, i. 152 bloody, ii. 300 of aqueous urine, iv. 333 Food, small quantity often demanded, i. 78 water sufficient food for some ani- mals, i. 78 air sufficient, i. 71 Fool's parsley, i. 141 Folly, iii. 130 Forgetfulness, iii. 124, 125 singular examples of, iii. 127 Fragile vitreum, iv. 217 Fragilitas ossium, iv. 217 Fragility of the bones, iv. '217 Frambcesia, ii. 445 Fraxinella, i. 215 Freckles, iv. 460 Fret, ii. 211 Frogs, singular procreation of, iv. 9 Frost-bite, ii. 210. 607 Fundament, falling down of, > . „.„ prolapse of, ) Fungi, a common cause of surfeit, i. 141 springing up nightly in gangre- nous limbs, i. 199 Fungus haematodes, ii. 613 Furunculus, ii. 192 Fusible calculus of the bladder, iv. 339 G. Gadfly larves, i. 204.—iv. 440 Galactia, iv. 66 praematura, iv. 67 defectiva, iv. 69 depravata, iv. 71 erratica, iv. 72 virorum, iv. 73 Gallantly romantic, iii. 94 Gall-bladder, wanting in many animals, i. 245 Le Gallois, his experiments, iii. 24 Gall-stone, i. 268 passing of, i. 271 Ganglion, iv. 212 Ganglions of the brain, what, iii. 12 Gangrcena, ii. 603 sphacelus, ii. 604 ustilaginea, ii. 608 necrosis, ii. 610 caries, ii. 612 Gangrenous inflammation, ii. 206 Garden-lettuce, ii. 242 Gasses, inhalation of, i. 385 Gastric juice, discovery of, i. 9 quantity of, i. 9 quality of, i. 9 other powers, i. 9, 10 Gastritis, ii. 252 adhaesiva, ii. 256 erythematica, ii. 259 Generative function, iv. 5 machinery of the, iv. 6 process of, iv. 6 different hypothe- ses of, iv. 15 difficulties accom- panying the subject of eeneratien, iv. 18.20 GENETICA, iv. 29 Geoffroya, i. 211 Geum urbanum, i. 160 Ginseng, whether an aphrodisiac, iv. 90 Glanders in horses, ii. 297.—iv. 58 Glaucedo, iii. 147 Glaucosis, iii. 147 Gleet, iv. 62 Glottis, i. 291 air how rendered sonorous in, i. 292 capable of supplying the tongue's place, i. 296 Gluttony, i. 72 Goa^le-eye, iii. 160 Goggles, iii. 160 Goitre, iv. 209 Gonorrhoea, iv. 55 Gordius, intestinal, i. 205 cuticular, iv. 441 Gout, ii, 335 origin of term, ii. 335 its varieties, 337 how far refrigerants may be em- ployed, ii. 344, 345. 347 reputed specifics, 352 compression and percussion, ii. 357 Granulation, ii. 169 Grass-hopper, wart-eating, iv. 444 Gratiola officinalis, iv. 255 Gravedo of Celsus, ii. 291 Gray hair, iv. 448. 453 GENERAL INDEX. 479 Great-pox, u. 549 Green-sickness, if. 74 Grief ungovernable, iii. 89 Grocer's Itch, iv. 419 Grog-blossoms, ii. 198 Groundsel, its use in sickness of the stomach, i. 99. 280 Gryllus verrucivorus, its power in de- stroying warts, iv. 444 Guinea-worm, iv. 439 Gum, yellow, of New Holland, i. 113 of infants, i. 261 Gum-boil, ii. 184 Gums, excrescent, i. 47 scurvy of, i. 47 Gutta seu Juuctarum dolor, ii. 335 obscura, iii. 149 serena, iii. 149 Gymnastic medicine, ii. 520.—iii. 297 H. HAiMATICA, ii. 27 Haemoptysis, ii. 462. 468 Haematemesis, ii. 464. 468 Haematuria, ii. 464. 468 Hamorrhagia, ii. 456 entonica, ii. 457 atonica, ii. 467 Hair-worm, intestinal, i. 205 cutaneous, iv. 441 Hair, morbid, iv. 446 matted or plaited, iv. 449 gray, iv. 453 bristly, iv. 448 Hallucination, iii. 93 Hanging, death from, iii. 371 Hardness of hearing, iii. 165 Hare-brained passion, iii. 92 Harmattan, ii. 45 Harvest-bug, iv. 438 Head, dropsy of, iv. 260 Head-ache, iii. 318 stupid, iii. ib. chronic, iii. 320 sick, iii. 325 throbbing, iii. 324 spasmodic, iii. 325 Hearing, how far it exists in different animalsy iii. 15 Hearing, morbid, iii. 1K2 acute, iii. 164 hardness of, iii. 165 perverse, iii. 166 double, iii. 168 illusory, iii. 168 varieties of, iii. 269 Heart, organization of, ii. 6 how far it may leap for joy, ii. 7 fluttering of, iii, 272 throbbing of, iii. 272 Heart burn, i. 83 ache ungovernable, ii. 89 Heat, general feeling of, how produced, iii. 187 Heat-eruption, iv. 415, 416 Hectic fever, ii. 112 Hertica, ii. 112 Hedge-hyssop, iv. 255 Helix hortensis, iv. 6 Hellebore, how far a specific in gout, ii. 356 black, as a hydragogue, iv. 249 Hcmeralopia, iii. 135 Hemicrania, iii. 323 Hclminthia, i. 195 alvi, i. 200 erratica, i..20o podicis, i. 203 Hemiplegia, iii. 418 Hemorrhage, ii. 456 entonic or active, ii. 457 varieties of entonic, ii. 457 atonic, ii. 467 varieties, ii. 468 Hemorrhoids, i. 233 Hemp seeds, in jaundice, i. 256 Hen-blindness, iii. 139 Hepatitis, ii. 260 acuta, ii. 260 chronica, ii. 265 Herb bennet, i. 160 Hermaphrodites, iv. 6 Hernia humoralis, ii. 272 carnosa, iv. 208 Herpes, iv. 408 Hesitation in speech, i. 332 Hiccough, iii. 268 Hirsuties, iv. 451 Hirudo viridis, iv. 6 Hirudo sanguisuga, intestinal, i. 208 Hives, ii. 400 Hoffmann, his doctrine of fevers, ii. 30 Holy fire, ii. 209 Home-sickness, iii. 86 Honey-dew, what, i. 197 Hooping-cough, i. 354 Hordeolum, ii. 191 Horns, never grow after castration, iv. V 13 Horse hair-worm, intestinal, i. 205 Horse-leech, intestinal, i. 208 Hour-glass contraction of the womb. iv. 165 Human Understanding, Locke's Essay on, examined and eulogized, iii. 33 analysis of, iii. 34 Humoral opacity of the eye, iii. 147 Hunger, sensation of, how accounted for, i. 67 Hydarthrus, ii. 358 Hyderus (diabetes.) iv. 311. 335 480 GENERAL INDEX. Hydra, iv. 6 Hydrargyria, i. 51.—ii. 210 Hydrocele, iv. 285 Hydrometra, iv. 284 Hydrophobia, iii. 228 without rabies, iii. 229 Hydrops, iv. 239 cellularis, iv. 244 capitis, iv. 260 spinas, iv. 269 thoracis, iv. 271 abdominis, iv. 276 ovarii, iv. 281 tubalis, iv. 283 uteri, iv. 284 scroti, iv. 285 matellae, iv. 335 Hyoid bone, i. 291 Hypochondrias, iii. 99 its varieties, iii. 106 Hypochondrism, iii., 99 its varieties, iii. 101 Hypochyma, iii. 149 Hypochysis, iii. 149 Hysteria, iii. 352 fceminina, iii. 352 masculina, iii. 353 Hysterics, iii. 352 Hysteritis, ii. 270 simplex, ii. 270 puerperarum, ii. 271 I&J. Jaundice, yellow, i. 244 biliary, i. 247 gall stone, i. 251 spasmodic, i. 251 of infants, i. 261 black, i. 262, 263 green, i. 262, 263 Iceland liver-wort, ii. 517 Icterus, i. 244 cholcens, i. 247 chololithicus, i. 251 spasmodicus, i. 251 hepaticus„i. 259 infantum, i. 261 Icthyiasis, Icthyosis, iv. 402 Ideas, what, iii. 34 of sensation, iii. 34 reflection, iii. 35 objective and subjective, iii. 35 complex, iii. 35 association of, iii. 37 Idiotism, iii. 130, 131 Ignis sacer of Celsus, ii. 208 Jealousy, ungovernable, iii. 84 .limmerat (Arab.) ii. 436 Ileac passion, i. 121 Ileus, i. 121 Illusion, iii. 93 Imbecility, mental, iii. 124 Impetigo, iv. 413 Impostume in the head, ii. 184 Impotency, male, iv. 89 barrenness of, iv. 97 Impregnation, Diseases affect- ing the, iv. 109 physiology of, iv. 109 Inability to beget offspring, iv. 88 to conceive offspring, iv. 97 species of, iv. 88 Incarnation, ii. 169 Incongruity, copulative, iv. 94 Inconstancy, iii. 129 Incontinence of urine, iv. 333 Incubus, i. 388 Indian-pink, i. 219 Indigestion, i. 100 Inflammation, general, of Fordyce, ii. 119 edematous, ii. 203 erysipelatous, ii. 204 gangrenous, ii. 206 vesicular, ii. 207 of the brain, ii. 214 throat, ii. 227 kidneys, ii. 268 larynx, ii. 231 lungs, ii. 239 pleura, ii. 245 heart, ii. 248 stom..ch, ii. 252 bowels, ii. 256 liver, ii. 260 spleen, ii. 267 bladder, ii. 269 womb, ii. 270 testicles, ii. 272 eyes, ii. 273 iris, ii. 278 articular, ii. 324 Inflammations, ii. 153 pathology of, ii. 154 proximate cause of, ii. 154 remote causes of, ii. 15S healthy, ii. 158 unhealthy, ii. 158 adhesive, ii. 159 ulcerative, ii. 159 always tend to the sur- face, ii. 161 resolution of, what, ii. 162 suppurative, ii. 159.165 process of, ii. 166 Inflammatory fever, ii. 117 its varieties, ii. 121 blush, ii. 200 Inflation, iv. 288 GENERAL INDEX. 481 Inflation, cellular, iv. 290 tympanic, iv. 292 of the womb, iv. 295 Influenza, ii. 293 its order of recurrence, ii. 299 Insanity, iii. 42 pathology of, iii. 44 Insanity, proximate cause, iii. 52 whether more common to Eng- land than other countries, iii. 54 whether ah increasing mala- dy, iii. 55 Inoculation for cow-pox, ii. 396 small-pox, ii. 421 for plague, ii. 432 Insensibility of touch, iii. 189 complicated with insensibility of other senses, iii. 189 Inspiration, false, iii. 94 Instinct, what, ii. 26 Intellect, diseases affecting the, iii. 41 Intellectual principle, iii. 25 Intermarriages between near relations, wisdom of restraints divine and hu- man upon, iv. 26 Intermittent Fever, ii. 65 quotidian, ii. 68 tertian, ii. 70 irregular, ii. 72 complicated, ii. 73 treatment of, ii. 77 Intestines, organ of, i. 4 Introsusception, i. 123 Invermination, i. 195 Ionthus, ii. 195 Varus, ii. 196. corymbifer, ii, 197 Joy, ungovernable, iii. 80 Iris, inflammation of, ii. 278 (herpes,) iv. 412 Irk Medini (Guinea-worm,) iv. 439 Irrationality, iii. 130 Ischuria, iv. 301 Itch, iv. 429 baker's, iv. 401 complicated, iv. 430 grocer's iv. 419 pocky, iv. 430 rank, iv. ib. watery^ iv. ib. mangy, iv. ib. Itch-tick, iv. 438 Judam (Arab.), ii. 568 Juzam (Arab.), ii. ib. K. Kibe, ii. 210 Kidneys, inflammation of, ii. 268 Kin-cough, or kind-cough, i. 354 VOL. IV. 61 King's evil, ii. 527 Knife-eaters, i. 82 KOIAIA, i. 17 Kouba or kuba (Arab.), iv. 389 Krummholzohl, vermifuge, i. 213 L. Labour, morbid, iv. 130 atonic, iv. 132 unpliant, iv. 134 varieties of, iv. 135 complicated, iv. 139 perverse, iv. 146 varieties of, iv. 147 impracticable, iv. 151 multiplicate, iv. 160 sequential, iv. 163 premature, iv. 122 show, iv. 53 Lacerta aquatica, intestinal, i. 203 Lachrymose ophthalmy, ii. 275 Lacteals, organ of, i. 6 Lagnesis, iv. 82 Salactitas, iv. 83 Furor, iv. 86 Lallatio, i. 338 Lambdacismus, i. ib. Land-scurvy, ii. 581 Lappa, ii. 590 Laryngic suffocation, i. 360 Laryngitis, ii. 231 Laryngysmus, i. 360 stridulus, i. 360 Larynx, i. 291 of birds, i. 293 stridulous constriction of, i. 360 Lascivious madness, iv. 86 Laughing, how produced, i. 300 Lauro-cerasus, see Prunus Lawrence, his hypothesis concerning life and a living principle, iii. 30 Lax, i. 152 Lead, subacetate of in hemorrhages, ii. 470 Leech, intestinal, i. 205 Leg, tumid puerperal, ii. 317 of West Indies, ii. 320 Leipopsychia, iii. 337 Lenticula, iv. 460 Lentor of the blood, what, ii. 32 Leodonton Taraxacum, i. 256 iv. 305 Leontiasis, ii. 569 Lepidosis, iv. 383 Pityriasis, iv. 385 Lepriasis, iv. 387 Psoriasis, iv. 399 Icthyiasis, iv. 402 Lepriasis, iv. 387 Leprosy, iv. ib. 482 g Leprosy, Asturian, ii. 575 black, ii. 570 dull-white, iv. 341 dusky, iv. 391 Leprosy, nigrescent, iv. 391. 393 bright-white, iv. 391. 394 Lethargus, > .., 9Q Lethargy, $ varieties of, iii. 391 Leucasmus, iv. 458 Leuce, iv. 391 Leucorrhcea, iv. 48 communis, iv. 49 Nabothi, iv. 53 senescentium, iv. 54 Libellula or dragon-fly, singular posi- tion of sexual organs, iv. 10 Lichen (in botany) caninus, iii. 248 terrestris cinereus, iii. 248 in pathology, iv. 371 Lientery, i. 159 Life, various hypotheses concerning, iii. 27 weariness of, iii. 103. Lign-aloes in indigestion, i. 113 Limosis, i. 71 avens, i. 72 Cardialgia, i. 83 Dyspepsia, i. 100 Emesis, i. 94 expers, i. 76 Flatus, i. 89 Pica, i. 80 Lippitude, ii. 288 Li| pitudo, ii. 288 raping, i. 340 .' it/-:i I ii. 573 Pellagra, $ Pemphigus, ii. 402 Peripneumonia, ii. 239 Peripneumony, ii. 239 varieties, ii. 239 Peritoneal fever, ii. 148 Peritoneum, inflammation of, ii. 249 Peritonitis, ii. 249 propria, ii. 250 omentalis, ii. 251 mesenterica, ii. 251 Pernio, ii. 210 Pestis, ii. 426 varieties, ii. 426 Phacia, iv. 460 Phalaena pinsuinalis, larves of, intesti- nal, i. 207" Phasianus, mot-mot, i. 294 Pheasant, mot-mot, i. 294 Philautia, iii. 82 Phimosis, ii. 189 Phimotic phlegmon, ii. 189 Phlegmasia, ii. 153 Phlegmatia, dolens, ii. 317 Phlegmone, Phlegmon, ii. 182 Parulis, ii. 184 communis, ii. 183 auris, ii. 184 parotidea, ii. 185 mammae, ii. 187 Bubo, ii. 188 phimotica, ii. 189 Phlogistica, ii. 153 Phlogotica, ii. 153 Phlyct«nae, ii. 209 Phlysis, ii. 198 Phonica, i. 310 Phosphorus in typhus, ii. 143 gout, ii. 350 Phrenica, iii. 41 Phrensy, ii. 219 Phryganeagrandis, larves of, intestinal, i. 207 Phthiriasis, iv. 434 Phthisis, ii. 494 varieties, ii. 495 dyspeptic, ii. ib. Phyma, ii. 190 Hordeolum, ii. 191 Furunculus, ii. 192 Sycosis, ii. 192 Anthrax, ii. 193 Physalis Alkekengi, or winter-cherry, iv. 307 Physometra, iv. 295 Pian, ii. 445 <^* Piles, i. 233 ^ Pin of the eye, iii. 146. 155 Pin-eye, iii. 146. 155 Placenta, retention of, iv. 164 Plague, ii. 426 varieties, ii. 426 of Athens, ii. 427. 429. of London, ii. 429 of Morocco, ii. 431 of British army in Egypt, ii. 433 inoculation for, ii. 432 exposure to, diminishes its pow- er, ii. 440 influenced by state of the at- mosphere, ii. 441 Platalea Leucorodia (spoon-bill,) i. 294 Plethora, ii. 451 entonica or sanguine, ii. 453 atonica or serous, ii. 454 Pleuralgia, i. 401 acuta, i. 402 chronica, iv. 403 Pleurisy, ii. 245 spurious, ii. 331 Pleuritis, ii. 245 vera, ii. 245 GENERAL INDEX. 487 Pleuritis, mediastina, ii. 247 diaphragmatica, ii. 247 Pleurosthotonus, iii. 221 Plica, iv. 449 Pneumatic medicine, ii. 521 Pneomatica, i. 309 Pneumatosis, iv. 290 Pneumonica, i. 342 Pneumonitis, ii. 239 vera, ii. 239 maligna, ii. 243 notha, ii. 244 Podagra, ii. 335 its varieties, ii. 337 Pcecilia, iv. 464 Poison of viper as an antilyssic, iii. 259 Poliosis, iv. 453 Polyglottus, mocking-bird, i. 295 Polypus, i. 313 elasticus, i. 314 coriaceus, i. ib. uteri, iv. 107 vagina', iv. ib. Polysarcia, iv. 200 adiposa, iv. ib. Pompholyx, Pomphus, iv. 407 Pontine marshes, insalubrity of, ii. 90 Porphyra, ii. 578 simplex, ii. 580 haemorrhagica, ii. 581 nautica, ii. 535 Porrigo, iv. 421, 422 Portland powder, ii. 352 Pose, ii. 335 Power, nervous, iii. 21 sensific and motific, iii. 22 motific, or irritation of a lower description than sensific iii. 23 Pox, ii. 549 bastard, ii. 563 Precocity, genital, iv. 79 Pregnancy, morbid, iv. 113 from constitutional derangement, iv. 114 from local derange- ment, iv. 119 from miscarriage, ii. 122 proper period of, iv. Ill utmost extent al- lowed, iv. 112 Premature delivery, its advantages at times, iv. 158 Priapus, iii. 207 Pricking, general feeling of, iii. 186 Prickly-heat, iv. 372. 375 Pride ungovernable, iii. 82 Proctica, i. 220 Proctica, simplex, i. 220 spasmodica, i. 221 callosa, i. 227 Exania, i. 240 Marisca, i. 233 Tenesmus, i. 232 Preeotia, iv. 79 foeminina, iv. 81 masculina, iv. 80 Prolapse, genital, iv. 102 of the bladder, iv. 105 vagina, iv. 105 womb, iv. 102 Protuberant eye, iii. 158 Prunus Lauro-cerasus, i. 394 in fevers, ii. 87 Prurigo, iv. 379 Pruritus, iii. 186 Prussic acid, i. 278 Psellismus, i. 332 Bambalia, i. 332 Blaesitas, i. 334 Pseudocyesis, iv. 176 molaris, iv. 176 inanis, iv. 178 Psoas abscess, ii. 175 Psora, iv. 389. 399' Psoriasis, iv. 399 Psorophthalmia, ii. 287 Ptyalism, i. 49 Plyalismus, i. ib. acutus, i. 50 chronicus, i. 57 iners, i. 57 Pubis symphysis ossa, division of, in impracticable labour, iv. 153 Puerperal fever, ii. 148 epidemic, ii. 149 contagious, ii. 149 mania, iii. 65 convulsions, iii. 346 Pulex (Daphnia,) iv. 7 (Monoculus,) iv. ib. Pulex, iv. Pulsatilla nigricans, iii. 146 Pulse, doctrine, of, ii. 16 Pulse, why different in different ages, ii. 9 standard in adult life, ii. 16 infancy, ii. 17 advanced life, ii. 17 different kinds of, ii. 19 of Solano, ii. 20 of Bordeu, ii. 20 Pulselessness, iii. 260 Pulvis, antilyssus, iii. 249 Cobbii, iii. 251 Pupil, closed, iii. 152 double, iii. 153 five-fold, iii. ib. Purpura (Miliaria,) ii. 386 Purulent ophthalmy. ii. 280 488 GENERAL INDEX. Pus, a secretion, ii. 167, 168 Hewson's view, ii. 167 Hunter's, ii. 168. 171 use of, ii. 170. 173 Push, ii. 183 Pye-balled skin, iv. 464 Ptrectica, ii. 27 Q. Quartan ague, ii. 71 double, 73 treble, ib. duplicate, 74 triplicate, ib. Quas, Russian, ii. 591 Quinsy, ii. 227 varieties, ii. ib. nervous, i. 63 R. Rabid blood, as an antilyssic, iii. 252 Rabies, iii. 228 canine, iii. 235. 238 feline, iii. 235, 236 Rainbow worm, iv. 412 Raphania, iii. 300 Raptus nervorum, iii. 211 Rash txanthem, ii. 366 rose, iv. ib. gum, iv. 369 lichenous, iv. 371 pallid, iv. 371 pruriginous, iv. 379 millet, iv. 383 rainbow, iv. tooth, iv. 369, 370 wild-fire, iv. ib. ib. Rattling in the throat, i. 316 Rectum, stricture of, spasmodic, i. 221 callous, i. 227 Red-gum, iv. 369 Remittent fever, ii. 91 mild, ii. 91 malignant, ii. 93 autumnal, ii. 94 yellow, ii. 98 burning, ii. 108 asthentic, ii. 110 of Breslaw, ii. ib. Renal calculus, iv. 340 Respiration, effect of, on the blood, i. 300 Ellis's hypothesis, i. 301 quantity of air expired and Inspired in, i. 304 Rest-harrow as a diuretic, iv. ib. Restlessness, iii. 312 Retching, i. % Retension of the menses, iv. 31 secundines, iv. 164 Revery, iii. 107 of mind, iii. 108 abstraction of mind, iii. 107. Ill brown-study, iii. 107. 112 Rachialgia, i. 127 Rhachitis, iv. 223 origin of the name, iv. ib. Rheuma, how used formerly, ii. 335 Rheumatism, acute, ii. 326 whether co-exists with gout, ii. 325 articular, iii. 326 lumbar, ii. 330 of the hip-joint, ii. ib. pleura, ii. 331 chronic, ii. 332 Rhonchus, i. 316 stertor, i. ib. Cerchnus, i. 317 Rhus vernix, i. 358.—iii. 432 toxicodendrum, iii. 432 Rhypia, iv. 414 Richerand, his hypothesis concerning a living principle, iii. 28 Rickets, iv. 223 Ringing in the ears, iii. 169 Ring-worm, iv. 409. 412 scall, iv. 421. 424 Rosalia, ii. 366 Rose-rash, iv. ib. Rose-wood, i. 93 Roseola, iv. 366 Rosy-drop, ii. 197 Rot in sheep, cause of, i. 210 Rotacismus, i. 338 Rubeola, ii. 366 Rubia tinctorum, iv. 39 Rubula, ii. 445. Rubus Chamaemorus, ii. 590 Rumbling of the bowels, i. 89 Rumination, instances of in man, i. 94 Running at the note, i. 309 Rye, spurred, iv, 40 S. Saat (Hebr.), iv, 395 Sahafata (Arab.) Scall, iv. 399 Salacitas, ) . .„ Salacity, } ,v' *3 Saliva, analysis of, i. 49 Salivation, i. 50 Salmon, fecundity of, iv. 9 Sambucus Ebulus, iv. 248 nigra, iv. 248 Sancti Viti chorea, iii. 289 Sand, urinary, iv. 340 white, iv. 341 GENERAL INDEX. 489 Sand, urinary red, iv. 342 Sanguiferous system, machinery of, ii. 5 moving powers of, ii. 11 fluids of, iii. 21 Santonica, i. 215 Saphat (Hebr.) Scall, iv. 389. 395. 399 Sarcocele, iv. 208 Satyriasis furens, iv. 86 Scabies, iv. 429, 430 Scabiosa Indica, i. 211 Scale-skin, iv. 384 Scall, dry, iv. 399 humid, iv. 416 scabby, iv. 421 milky, iv. 422 honey-comb, iv. 423 Scalled head, iv. 422 Scandix cerefolium, i. 237 Scarabaeus, (beetle-grubs) intestinal, i.203 Scarlatina, ii. 366 Scarlet-fever, ii. ib. with sore throat, ii. 368. 371 Scelotyrbe, iii. 290. 297 Scented odours issuing from the bodies of animals, iv. 364 Sciatica, ii. 331 Scotodinus, iii. 334 Scotoma, iii. 334. 336 Scott's acid bath, in jaundice, i. 257 lues, ii. 558 Scrophula, ii. 525 Scurvy, ii. 578 land, ii. 581 petecchial, ii. 580 sea, ii. 585 Scybalum, i. 191 Sea-bear, i. 3 calf, i. 3 sickness, how produced, i. 99 worms, feed harmlessly on copper- bottomed ships, i. 139 Seasoning fever of hot climates, ii. 100 Secale cornutum, or spurred rye, i. 141 Secernent Ststem, diseases of, iv. 184 Secretions, furnished by different ani- mals, and often the same animal in different parts, iv. 197 sugar sulphur lime milk urine bile honey wax silk phosphorescent light air VOL. IV. 62 M97 Secretions,&c. electricity i furnished by plants > 198 equally diversified,) Secundines, retention of, iv. 164 Self-conceit, ungovernable, iii. 82 Seminal fluid, how secreted, iv. 10 powerful influence of, on the animal economy, iv. 12 flux, iv. 64 entonic, iv. 64 atonic, iv. 65 misemission, iv. 91 Senega, iv. 249 Seneka-root, i. 384 Sensation, Diseases affecting the, iii. 133 .. Sensation and motion, principle of, in. 19 whether a com- mon power, or from distinct sources, iii. 22 Senses, external, in different animals, iii. 13 whether any animal possesses more than five, iii. 17 Sensorial powers, diseases af- fecting jointly, ii. 307 Sentimentalism, iii. 94 Serpigo, iv Seta equina, intestinal, i. 205 Seville Orange Tree, iii. 295 Sex and features, how accounted for, iv. 14. 17 Sexual fluids, diseases affecting, iv. 29 Shaking palsy, iii. 297 Shark, procreation of, iv. 8 Shingles, iv. 409, 410 Short-breath, i. 364 Sibbens, or Sivens, ii. 564 Sick head-ache, iii. 325 Sickness of the stomach, i. 94 Sighing, how produced, i. 300 Sight, in different animals, ii. Sight, morbid, iii. 134 night, iii. 135 day, iii. 137 long, iii. 140 of age, iii. 141 short, iii. 141 t skew, iii. 142 " false, iii. 143 Silliness, iii. 130 Silver, nitrate of, in epilepsy, iii. 365 power of producing a dark co- lour on the skin, iii. 365 Simarouba, ii. 315 Singing-birds, vocal avenue of, i. 294 bull-finch, i. 294 nightingale, i. ib. thrush, i. 294 tuneful manakin, i. 294 490 GENERAL INDEX. Singing-birds, vocal mocking-bird, i. 295 Singultus, iii. 268 Sisymbrium, iii. 351 Skin papulous, iv. 367 Slaughter-houses, exhalation of, in con- sumption, ii. 522 Slavering, i. 57 Sleeplessness, iii. 308 Sleep-disturbance, iii. 114 sleep-walking, iii.116 sleep-talking, iii. 115. 117 night-pollution, iii. 115 Small-pox, ii. 411 varieties, ii. 417 Smell, morbid, iii. 172 acrid, iii. ib. sex, age, and other qualities dis- coverable by it, iii. 174 obtuse, iii. 176 want of, iii. 177 illusory, whence, iii. 333 how far it exists in different ani- mals, iii. 14 Snaffles, ii. 296 Snail, procreation of, iv. 10 Sneezing, iii. 270 Snivelling, i. 311 Snuff-taking, why injurious, i. 106 Snuffles, ii. 296 Snuffling, i. 311 Soap, i. 256 Soins, ii. 591 Sol-lunar influence, Balfour's hypothe- sis of, ii. 56 Solid parts of organs, of what compos- ed, iv. 183 Solvents, biliary, i. 273 Somnambulism, iii. 116 Sore-throat, ii. 227 ulcerated or malignant, ii. 228 Soreness, general feeling of, iii. 184 Sounds, vocal, i. 337 guttural, i. 340 nasal, i. 338 lingual, i. ib. dental, i. 340 labial, i. 337. 339 imaginary in the ears, iii. 169 Sparganosis, ii. 317 Spasm, doctrine of, as applicable to fevers,- ii. 33 Spasm, constrictive, iii. 207 its species, iii. 207 clonic, iii. 265 its species, iii. 267 synclonic, iii. 287 its species, iii. ib. comatose, iii. 342 its species, iii. 342 Spawn, or hard roe, what, iv. 8 Speech, how produced, i. 292 inability of, i. 318 may be produced without a tongue, i. 319 Speechlessness, i. 318 Sperm, or soft roe, what, iv. 8 Spermorrhcea, iv. 64 Spider discharged from the anus, i. 208 Spigelia, i. 211. 219 Spignel, iv. 40 Spilosis, iv. 459 Spilus, iv. 459 Spina ventosa, what, ii. 614 Spine, dropsy of, iv. 269 Spirit of animation, of Darwin, ii. 39 Spitting of blood, ii. 462 Splanchnica, i. 243 Spleen, office not known, i. 13 not found below the class of fishes, i. 13 iii. 103 Splenalgia, ii. 267 Splenitis, ii. ib. Spoon-bill, i. 294 Spurred-rye, i. 141 iv. 40 Spurzheim, his hypothesis upon the na- ture of the mind, iii. 29 Squalus, procreation of, iv. 8 Squinting, iii. 160 varieties, iii. 161 St. Anthony's fire, ii. 406 varieties, ii. 407 St. Guy, Dance de, iii. 289 St. Vitus's Dance, iii. 89 Stahl, his doctrine of fevers, ii. 30 Stammering, i. 332 Staphyloma, iii. 158 varieties, iii. ib. Stays, tight, their mischievous effects, i. 404 Sterility, male, iv. 88 female, iv. 97 Slernalgia, i. 393 ambulantium, i. 394 chronica, i. 400 Sternutatio, iii. 270 Stertor, i. 316 Stiff-joint, muscular, iii. 210 its varieties, iii. 210 Stitch, i. 402 Stomach, organ of, i. 4 omnivorous power of, i. 3. self-digesting power of, i. 11. seat of universal sympathy, i. 14 inflammation of, ii. 252 Stone in the bladder, iv. 347 Stone-pock, ii. 196 Stoppage of urine, iv. 301 f.F.VERAL INDEX. 491 Strabismus, iii. 160 Stramonium, iii. 249 Strangury, iv. 306 spasmodic, iv. 307 scalding, iv. ib. callous, iv. 308 vermiculous, iv. 309 polypous, iv. 310 mucous, iv. 309 Stricture of the rectum, spasmodic, i. 221 Strophulus, iv. 369 Struma, ii. 525 vulgaris, ii. 527 Studium inane, iii. 112 Stupidity, iii. 124 Sturgeon, mode of procreation, iv. 9 Stuttering, i. 332 Sty, ii. 191 Subsultus, iii. 283 Sudor anglicus, ii. 62 Suffocatio stridula, ii. 233 Suffocation from asphyxy, iii. 368 from hanging or drowning, iii. 368 mephytic, iii. 376 electrical, iii. 379 from severe cold, iii. 380 Suffusio, iii. 149 scintillans, iii. 143 reticularis, iii. 143 Sugar in sacchrine urine, the proportion, iv. 314 Summer-rash, iv. 372. 375 Sun-burn, iv. 461 Superannuation, iii. 130, 131 Superfetation, iv. 162 Suppression of the menses, iv. 35 Suppurative inflammation, ii, 165 Surditas, iii. 169 Surfaces, internal, diseases af- fecting, iv. 239 Surface, external, diseases af- fecting the, iv. 357 Surfeit, i. 135 Suspended animation, iii. 367 Susurrus, iii. 169 Sweat, morbid, iv. 359 profuse, iv. 360 bloody, iv. 361 partial, iv. 362 coloured, iv. 363 scented, iv. ib. sandy, iv. 365 Swan, dumb, i. 294 musical, i. 294 Sweating-fever, ii. 62 whether Englishmen only subject to it, ii. 64 Sweet-spittle, i. 55. 59 Swimming of the head, iii. 336 Swine-pox, ii. 400 Swooning, iii. 337 varieties, iii. 339 Sycosis, ii. 192 Sympathies and antipathies, how form- ed in the mind, iii. 37 Synclonus, iii. 287 Tremor, iii. 287 Chorea, iii. 289 Ballismus, iii. 297 Raphania, iii. 300 Beriberia, iii. 303 Syncope, iii. 336 simplex, iii. 337 varieties, iii. 339 recurrens, iii. 341 Synizesis, iii. 152 Synocha, ii. 118 Synochal fever, ii. 145 Synochus, ii. 145 its varieties, ii. 146 Syrigmus, iii. 169 Syspasia, iii. 342 Convulsio, iii. 345 Hysteria, iii. 352 Epilepsia, iii. 35H Systatica, iii. 307 Systremma, iii. 211 T. Tabes, ii. 487 varieties, ii. 487 dorsalis, ii. 490 Tabor or Talbor, his early use of the bark in agues, ii. 84 Taedium vitae, iii. 103 Taenia Solium, i. 200 vulgaris, i. ib. generation of, iv. 10 Tarantismus, iii. 290 Tar, fumigation with, ii. 521 Tar-water, useful in indigestion, i. 109 Taraxacum, i. 256 iv. 305 Saraxis, ii. 275 Taste, how far it exists in different ani- mals, iii. 14. 178 Taste, morbid, iii. 178 acute, iii. 181 obtuse, iii. 180. 182 want of, iii. 180. 183 illusory, whence, iii. 333 Teats in the mare, inguinal, iv. 10 Teeth, tartar of, i. 45 transplantation of, i. 43 whether an extraneous body, i. 32 whether injured by sugar, i. 34 pretended, reproduced by jug- glers, i. 27 carious, i. 30 492 GENERAL INDEX. Teeth, deformity of, i. 41 Teething, i. 18 in adults, i. 25 in old age, i. ib. Tenderness, general external feeling of, how produced, iii. 184 Teneritudo, iii. 184 Tenesmus, i. 232 Tertian ague, ii. 70 double, J triple, > ii. 73 duplicate, ) Testes, diminish in the winter in many animals, iv. 10 where seated in the cock, iv. ib. Testudo, iv. 213 Tetanus, iii. 221 anticus, iii. 221 dorsalis, iii. 221, 222 lateralis, iii. 221 erectus, iii. 221. 223 Tetter, iv. 408 Therioma, iv. 410 Thirst, morbid, i. 67 immoderate, i. 69 sensation of, how accounted for, i. 67 Thirstlessness, i. 70 Throbbing of the arteries, iii. 275 heart, iii. 272 Thrush, ii. 390 its varieties, ii. 390 Tic, meaning of the term, iii. 194. 213 douloureux, iii. 193 Tick-bite, iv. 438 Tiglium seeds as a hydragogue, iv. 247 Tinea, iv. 422. 423 Toads, suckling in cancer, ii. 545 Tongue, speech not necessarily depen- dent upon it, i. 542 Tonquin powder, iii. 251 Tooth, derangement of, i. 17 wise, i. 25 Tooth-ache, i. 27 Tooth-edge, i. 39 Toothlessness, i. 43 ^^ Torpor, iii. 366 ^£| Touch, morbid, iii. 183 acute sense of, iii. 184 insensibility of, iii. 189 illusory, iii. 190 Trance, iii. 385 Transudation in dead animal matter, iv. 190 Trembling, iii. 287 Tremor, iii. 287 Trichechus Dudong, i. 3 Trichoma, iv. Trichocephalus, i. 200 Trichosis, iv. 446 setosa, iv. 448 Plica, iv. 449 Trichosis, Hirsuties, iv. 451 distrix, iv. 452 Poliosis, iv. 453 athrix, iv. 454 Area, iv. 455 decolor, iv. 456 Tripudatio, iii. 297 Trismus (entasia) iii. 213 varieties, iii. 215 maxillaris, iii. 193 dolorificus, iii. 193 Triton palustris, intestinal, i. 208 Tsorat of the Jews, what, iv. 388, 389. 394. 399 Tubba, ii. 447 Tubercle, ii. 190 j Tumid-leg, puerperal, ii. 317 I of West-Indies, ii. 320 Tumour, iv. 205 sarcomatous, iv. 206 fleshy, iv. ib. adipose, iv. ib. pancreatic, iv. ib. cellulose, iv. 207 cystose, iv. ib. scirrhous, iv. 207, 20S mammary, iv. 207 tuberculous, iv. ib. medullary, iv. ib. encysted, iv. 212 steatomatous, iv. ib. atheromatous, iv. ib. honied, iv. ib. ganglionic, iv. ib. horny, iv. 213 bony, iv. 214 osteous, iv. 215 periosteous, iv. ib. pendulous, iv. ib. exotic, iv. ib. Turgescence visceral, i. 273 Tussis, i. 342 Twinkling of the eye-lids, iii. 281 Twinning, congruous, iv. 160 incongruous, iv. 161 Twins, iv*160 Twitchings of the tendons, iii. 283 Tympanites, iv. 292 Tympany, iv. ib. whether ever an idiopathic affection, iv. 293 Typhomania, ii. 219.—iii. 392 Typhus, how far approximates yellow fever, ii. 50. 124 described, ii. 123 causes, ii. 124 how becomes contagious, ii. 124 extent and intensity of conta- gion, ii. 125 mild, ii. 127 malignant or putrid, ii. 128 GENERAL INDEX. 493 Typhus, specific properties of its mi- asm, ii. 124.132 septic power, distinct from its debilitating, ii. 132' copious bleeding, how far ad- visable, ii. 134 U &V. Vaccinia, ii. 394 its varieties, ii. 395 Vagina, prolapse of, iv. 102 Vapours, iii. 101 Variola, ii. 411 Varix, ii. 598 Varus, ii. 196 Vegetation promoted by animal dejec- tions, i. 8 Veins and arteries, ii. 7 Vena Medinenses, iv. 440 Venereal disease, ii. 547 Ventriloquism, what, i. 295 Vermifuges, 211 Vermis Medinensis, iv. 440 Vermination, cutaneous, iv. 434 Vertigo, iii. 331 origin of, iii. 332 Verruca, iv. 444 Vesicula seminales, iv. 11 differ in different animals, iv. 11 Vesicular inflammation, ii. 207 fever, ii. 402 its varieties, ii. ib. Viper, poison of, as an antilyssic, iii. 259 Vis insita, iii. 20 nervea, iii. ib. a tergo, hypothesis of, ii. 13 Viscus quernus, iii. 351 Vitiligo, iv. 387 Ulcer, ii. 615 depraved, ii. 616 callous, ii. ib. fungous, ii. ib. cancerous, ii. ib. sinuous, ii. 618 carious, ii. 620 Ulcus, ii. 615 incarnans, ii. 615 vitiosum, ii. 616 sinuosum, ii. 617 tuberculosum, ii. 619 cariosum, ii. 620 Vocal avenue, i. 291 Voice, how produced, i. 292 imitative, seat of, i. 295 whispering, i. 327 of puberty, i. 329 rough, i. 331 harsh, i. ib. Voice, nasal, i. ib. squeaking, i. ib. whizzing, i. ib. guttural, i. ib. palatiue, or through the nose, i. 331 immelodious, i. ib. Vomica, ii. 181 occult, ii. ib. open, ii. ib. Vomiting and purging, i. 167 of blood, ii. 464 i.96 Vomito prieto, ii. 99 Vomituritio, i. 96 Vomitus, i. ib. Voracity, i. 72 Uric calculus, iv. 344 Urinal dropsy, iv. 311. 335 Urinary calculus, iv. 838 Urinary sand, iv. 340 gravel, iv. 340. 344 Urine, earths, salts, and other princi- ples of, iv. 339 bloody, ii. 464 destitution of, iv. 298 stoppage of, iv. 301 saccharine, iv. 311 honeyed, iv. ib. incontinence of, iv. 333 unassimilated, iv. 336 erratic, iT. 337 Uroplania, iv. 337 Urticaria, ii. 384 Uteri procidentia, iv. 103 prolapsus, iv. ib. relaxatio, iv. ib. Uterine hemorrhage, ii. 465.468 W. Wakefulness, iii. 308 irritative, iii. 308 chronic, iii. 310 Walrus, i. 3 Wart, iv. 444 Water in the head, iv. 260 Water-blebs, iv. 407 Water-flux, iv. 311 Water-brash, i. 84 Water-pox, ii. 400 Water-hemlock, i. 141 Web of the eye, iii. 146 Weeping, how produced, i. 300 Wen, iv. 212 adipose, iv. ib. honied, iv. ib. horny, iv. 213 Wheal-worm, iv. 439 Whelk, ii. 195 White-gum, iv. 369. 371 494 GENERAL INDEX. White-swelling, ii. 358 Whites, iv. 48 Whitlow, ii. 199 Whizzing in the ears, iii. 169 Wild carrot, as a diuretic, iv. 305 Wind-cholera, i. 171 cholic, i. 142 dropsy, iv. 288 Winking, iii. 281 Winter-cherry, iv. 307 Wit, how it may exist without judg- ment, and hence in insanity, iii. 57 crack-brained, iii. 94. 96 Witlessness, iii. 130 Womb, inflammation of, ii. 270 falling-down of, iv. 102 retroverted, iv. 104 Worm-grass, i. 219 Worm, goose-foot, i. 215 Wormwood, i. 114 Worms, intestinal, their ability to resist digestion, i. 11 various species, i. 195 long round, i. 200 thread, i. 200, 201 tape, i. 201 broad tape, i. 202 END Worms, intestinal, maw, i. 203 erratic, i. 205 hepatic,.i. 275 vesical, iv. 309 Worm-seed, i. 211 Wry-neck, iii. 208 X. Xanthic oxyde of the bladder, iv. 339. Y. Yam, i. 3. Yawning, iii. 286 Yaws, iii. 445 Yellow fever, how far approaches ty* phus, ii. 50 description of, ii. 98 Z. Zaruthan, ii. 543 Zona, iv. 410 ignea, iv. ib. Zoster, iv. 409, 410 VOL. 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