i Eil THE STUDY OF MEDICINE. BY JOHN MASON GOOD, M.D. F.RS. F.R.S.L I MAY 29 1900 UM. l\ FIVE VOLUMES. VOL. V, FIFTH AMERICAN EDITION. REPRINTED FROM THE LAST LONDON EDITION, GREATLY IMPROVED AND ENLARGED, Netos¥ot1i: PRINTED BY J. & J. HARPER, FOR COLLINS AND HANNAY, COLLINS AND CO., AND O. A. ROORBACH, --PHILADELPHIA, JOHN GRIGG, TOWER AND HOGAN,—BOSTON, RICHARDSON & LORD, AND HILLIARD, GRAY, LITTLE, & WILKINS 1827. CLASS V. CLASS V. GENETICA. DISEASES OF THE SEXUAL FUNCTION. ORDER I. CENOTICA. AFFECTING THE FLUIDS. II. ORCASTICA AFFECTING THE OKU ASM. III. CARPOT1CA. AFFECTING THE IMPREGNATION. CLASS V. PHYSIOLOGICAL PROEM We now enter upon the maladies of that important function by Class V. which animal life is extended beyond the individual that possesses ciafs'ic° it, and propagated from generation to generation. To this division narae' of diseases the author has given the classic name of genetica, from ytiwvuu, "gignor," whence genesis (ymirig,) " origo," " ortus." In almost every preceding system of nosology, the diseases of this Tahs|gdl0s," function are scattered through every division of the classification, the system and are rather to be found by accident, an index, or the aid of the mattered memory, than by any-clear methodical clue. Dr. Macbride's classi- {^{j fication forms the only exception I am acquainted with ; which, entire however, is rather an attempt at what may be accomplished, than Macbride the accomplishment itself. His division is into four orders ; general made an and local, as proper to men, and general and local, as proper to rimpSifica- vvomen ; thus giving us in the ordinal name little or no leading idea {jon; of the nature of the diseases which each subdivision is to include, attempt or any strict line of division between them ; for it must be obvious alone' that many diseases commencing locally very soon become general, and affect the entire system, as obstructed menstruation ; while others, as abortion, or morbid pregnancy, may be both general and local. Under the present system, therefore, a different arrangenjbnt is Ordinal di- chosen, and one which will perhaps be found not only more strict to der the pre the limits of the respective orders, but more explanatory of the lead- ^ng£nent ing 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 oirder is applied the term cenotica (wv«t««) from xevaxr/s, " evacuatio," " exinanitio," to the second, orgastica fayectTiH*) from *>£y,«£«/, •t irrito," " incito," and especially libidinose ; and to the third, <;ar- roTiCA (KttgTroTtxx) from khokos, " fructus." Before we enter upon these divisions, it will perhaps prove advan- tageous to pursue the plan we have hitherto followed upon com- inencing the preceding classes : and take a brief survey of the gisne- the'genentf ral nature of the function before us. under the following heads ;: [J^ prrt°f-t function. CL. V.] PHYSIOLOGICAL PROEM. Class V. f TUE MACHINERY BY WHICH IT OPERATES. II. THE PROCESS BY WHICH IT ACCOMPLISHES ITS ULTIMATE Machinery of the gene- rative function. Generation effected in two ways. Theory of epigenesis, what. Plants pro- pagable both by offsets and eggs or seeds. The lowest class of animals propagable in both ways also. Illustrated. In these cases no distinction of sex. In others of the same class ex- amples of both male and female organs in the same individu- als, as in monoicous plants. Hence hei- m aphro- dites. Fasciola or fluke. Helix hor- tensis or garden snail. Curious process of intercourse. 111. THE DIFFICULTIES ACCOMPANYING THIS PROCESS WHICH STILL REMAIN TO BE EXPLAINED. 1. 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 generation, by a system of organs contrived for this express purpose, and regu- lated 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 lead- ing principle of what has been called the theory of epigenesis. Many plants are propagable by offsets, and all plants are supposed 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 polype is well known to multiply by bulbs or knobs thrown forth from dif- ferent parts of the body, and the hirudo viridis, or green leech, by longitudinal sections, which correspond with the slips or suckers of plants. In these cases we meet with no distinction of sex ; the same indi- vidual being capable of continuing its own kind by a power of spon- taneous generation. In other animals of the worm class we trace examples of the organs of both sexes united in the same individual, 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 hermaphro- dites, evincing a complexity of sexual structure which is not be found i|i 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 late- rally. The helix hortensis, or garden-snail, is hermaphrodite, but incapable of breeding singly. In order to accomplish this, itis 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 im- pregnated. The manner in which this amour is conducted is singu- lar and highly curious. They make their approach by discharging several small darts at each other, which are of a sharp form, and of a horny substance. The quiver is contained 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 '■xha.usted : when the war of love is over and its consummation sue- PHYSIOLOGICAL PROEM. [cl. v. ceeds. The increase is by eggs which are perfectly round and Class v. about the size of small peas. cheery °f There are some animals in which a single impregnation is capable ,he sene" r j ■ 1 ' ,■ • • , „ ... ralive of producing several generations m succession : we have a familiar function. example of this in the common cock and hen ; for a single copula- ^'J."!™. tion is here sufficient to give fecundity to as many eggs as will con- "on suffi- stitute a whole brood. But the same curious fact is still more ob- sc.meTni. vious in various species of insects, and especially in the aphis (puceron ™*]s for or green-plant louse) through all its divisions, and the Dapbnia Pulex duction of of Moller and Latreille (the monoculus Pulex of Linneus.) In generations both these a single impregnation will suffice for at least six or seven in succes- generations ; and in both these likewise, we have another curious Aphis, pu- deviation from the common laws of propagation, which is that in the j;°™n °[ant warmer summer months the young are produced viviparously, and in louse. the cooler autumnal months oviparously. It is also very extraordi- Vamtyain nary that in the aphis, and particularly in the viviparous broods, the the m°de offspring are many of them winged, and many of them without wings tion. or distinction of sex : in this respect making an approach to the fpr™?,0^ working-bees, and still more nearly to the working-ant, known till of viviparous, late, by the name of neuters. parous"" For the generative process which takes place in these two last w°™ed kinds we are almost entirely indebted to the nice and persevering others ' labours of the elder and the younger Hiiber ; who have decidedly ^^wlth- proved that what have hitherto been called neuters are females with out dis- undeveloped female organs, and therefore non-breeders ; but whose sex- organs, at least in the case of bees, are capable of developement pronceer^t,v,e by a more stimulating or richer honey, with which one of them, among bees selected from the rest, is actually treated for this purpose by the eredTy the general consent of the hive on the accidental loss of a queen-bee, e,der and or common bearer of the whole, and in order to supply her place. Htiber. 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 ensure 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 the beginning of the autumn. The impregnation of the queen-bee is produced by a process too curious to be passed over. It was conjectured by Swammerdam 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 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 this 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 8 cl. v.] PHYSIOLOGICAL PROEM. Class V. I. Ma- chinery of the genera- tive func- tion. Procreation among fishes. Male or- gans in the squalus 01 shark. Young in some spe- cies of this genus pro- duced vi- viparously. Produced in the same manner in the blenny. Fishes in general have no external sexual organs or sexual connexion. Ordinary mode of increase. Spawn, or hard roe. Sperm, milt or soft roe. Still pair- ing observ- able in many kinds. Illustrated. Salmon. 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; but he has had repeated proofs of the former. She begins to lay her eggs, for the bee is unquestionably oviparous, forty-six hours after impregnation, and will commonly lay about three thousand 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 lay- ing which consist of drones' eggs alone. Of the mode of procreation among fishes, in consequence 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 species by spawn or eggs hatched externally, but in one or two viviparously, 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 ray ; when the male shortly afterwards passes over the sperm 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 connexion can be traced among the greater number of the class of fishes, something like pairing is often discerni- nible among many of those that have no visible organs of copula- tion : for if we watch attentively the motions of such as are kept in ponds, we shall find the sexes in great tumult, and apparently strug- gling 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 shallowness for the purpose, are well known to unite in digging a nest or pit in sand, of about eighteen inches in depth, into which the female casts her spawn, and the male immediately afterwards ejects his milt; when the nest is covered over with fresh sand by a joint exertion of their tails. PHYSIOLOGICAL PROEM. [cl. v. i) The salmon, the sturgeon, and many other marine fishes, seek out Clas9 V. a fresh-water stream for this purpose : and their navigations are often chinery of of very considerable length before they can satisfy themselves, or fhe senera_ obtain a proper gravelly bed. The salmon tribe sometimes make tion. a voyage of several hundred miles, cutting their way against the Defers1' most rapid currents, leaping over floodgates, or up cataracts of an encounter- astonishing height: in their endeavour to surmount which they often spawning fail, and tumble back into the water; and, in some places are, in tIme• consequence, caught in baskets placed in the current for this purpose. The power of fecundity in fishes surpasses all calculation, and Fecundity appears almost incredible. A single herring, if suffered to'multiply calculable." unmolested, and undiminished for twenty years, would show a pro- Jn'theVcr1- geny greater in bulk than the globe itself. This species, as also the ring. pilcard, 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 S'»?uiar that of fishes. Early in the spring the male is found upon the back among of the female in close contact with her, but there is no discoverable f'°s'i: communication, although this contact continues for several days ; nor can we trace in the male any external genital organ. After the animals quit each other, the female seeks out some secure and shallow water, in which, like the race of fishes, she deposit.es 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 deposites his sperm, which soon constitutes a part of the glutinous matter itself. The result is a fry of minute tadpoles, whose evolutions into the very different form and organization of frogs, is one of the most striking curiosities of natural history. In the Surinam toad (rana Pipa) this process is ^^ varied. The female here deposites her eggs or spawn without any Surinam. attention to order ; the male takes up the amorphous mass with 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 into tadpoles, which are perfected and burst their imprisonment in about three months. But a volume would not suffice to point out all the singularities exhibited by different animals in the economy of procreation. It is singular^ worth while, however, to notice how variously some of the organs tne 01gang of generation are situated in many tribes. In the female Ijbellula, «f genera- or dragon-fly, the vagina is placed on the upper part of the belly many tribes. near the breast. In the male spider the generative organ is fixed ordragon\ on the extremity of an antenna. In the female ascaris vermiculans, gy^ ^ or maw-worm, the young are discharged from a minute punctiform der. aperture a little below the head, which appears, therefore, to con- £«««_ «titute the ascarine vagina. In the snail we find this organ placed laris, or near the neck, in the immediate vicinity of the spiracle which serves worm. for its lungs. The taenia SoZiKm, or tape-worm, throws forth its S"^ go Vot,. V.__2 ]mrn' nr 10 CL. V.j PHYSIOLOGICAL PROEM. young from the joints. So some plants bear flowers on the petiole* or edges of the leaves instead of on the flower-stalk. In like manner, while the mammae in the human kind are placed on the chest, and made a graceful and attractive ornament, in all quadrupeds they are placed backward, and concealed by the thighs. In the mare, the teats, which are two, are inguinal; in the horse, they are singularly placed on the glans penis. The testes of most animals that possess this organ, and procreate only once a year, are extremely small during the months in which they are not excited. Those of the sparrow, in the winter-season, are scarcely larger than a pin's head, but in the spring are of the size of a. hazel-nut. In man this organ, before birth, or rather during the early months of pregnancy, is an.abdominal viscus : about the seventh month it descends gradually through the abdominal ring into the scrotum, which it reaches in the eighth month. And if this descent do not take place anterior to birth, it is accomplished with difficulty, and is rarely completed till the seventh or eight year. Sometimes, indeed, only one testis descends under these circum- stances, and occasionally neither. There is a set of barbarians at the back of the Cape of Good Hope who appear to be very generally monorchid, or possessed of only a single testis ; and Linneus, believing this to be a natural and tribual defect, has made them a distinct variety of the human species. Mr. Barrow has noticed the same singularity : but it is doubtful whether, like the want of a beard among the American savages, this destitution is not owing to a barbarous custom of extir- pation in early life. It is generally admitted that the productive power of man is greatly impaired, if not totally lost, by a retention paired by a 0f both testes in the abdomen, as in this situation they are seldom retention of ' . . J . the testes completely developed. Mr. Hunter imagines never ; andZacchias and Riolan concur with him. Mr. Wilson met with one case of this kind in which the generative power was perfect: and M. Fodere boldly affirms that persons thus incompletely formed are most remarkable for their vigour, thus strangely impeaching the ordinary course of nature. Yet in the erinaceus or hedge-hog genus, and a few other quadrupeds, they never quit the cavity of the abdomen. In the cock, whose penis is dichotomous or two-pronged, they are situated on each side of the back-bone. It has been made a question among physiologists whether the seminal fluid is secreted by the testes at the moment of the demand, fluidwn'eth- or gradually and imperceptibly in the intervals of copulation, and byu"tes- l°dged in the vesiculaE seminales as a reservoir for the generative tesatthp power to draw upon, The latter is a common opinion, (t is, dOTnTn'd'or however, opposed, and with very powerful arguments, by Swam- merdam and Mr. John Hunter. The secretion found in the vesiculje seminales, is different from that of the testes in the properties of colour and smell ; those of the former being yellow and inodorous Class V. I Ma- chinery of the genera- five func- tion. tape- worm : as in some plants. Mammae in quadru- peds. Teats in the mare inguinal. Where placed in the horse. Testes very small, when un- employed, in animals that pro- create only once a year. Illustrated in the sparrow. Original seat and progress in man. Whether tribes na- turally m norchid. Productive power of man im- in the ab- domen. Yet in the erinaceus or hedge- hog never quits the abdomen. Where seated in the cock. Seminal impercep- tibly and gradually deposited in the vesi ciiiBsemi- those of the latter whitish, and possessing the odour of the orchis- ThTi'atter root, or the down of chesnuts. On the dissection of those who SorTopW have naturally or accidentally been destitute of one testis, the vesi- nion: cula of the one side has been found filled with the same fluid, and buto|>- "' PHYSIOLOGICAL PROEM. [cl.\. 11 as largely as that of the other ; and consequently the fluid on the Class V. vacant side must have been supplied by a secretory action of the chhfeVy of vesicula itself. There are no organs of generation that differ so ^five fuiic- much in their form and comparative size in different animals as these tfoiT "" vesicular bags : in the hedge-hog they are twice as large as in man, ]sZime<- and in -many animals they are utterly wanting. They are so in the dam and J- dog, which continues for a very long time in a state of copulation, on That and in birds, whose copulation is momentary. They are, moreover, f°™djj wanting in most animals whose food is chiefly derived from an ani- Vesiculai mal source, though not in all, as the hedge-hog, to which I have differ" wide- just referred, is an example of the contrary. ly in form Mr. Hunter hence concludes that the vesiculas seminales are not different' seminal reservoirs but glands secreting a peculiar mucus, and that Hedge-hog. the bulb of the urethra is, properly speaking, the receptacle in Domestic" which the semen is accumulated previous to ejection. Of the Buds. actual use of these vesicular bags, he confesses himself to be igno- p0es"dVyUj." rant, yet imagines that in some way or other they are subservient Hunter to to the purposes of generation, though not according to the common PeCfeungSa conjecture. fluid diB- T c ■ . -i • -ii tinct from in a tew rare instances the uterus and vagina are said to have semen. been found double. Dr. Tiedemann informs us that he has met ya1""* and with two instances of this monstrosity. The organs constituting one sometimes of the cases are preserved to this day in the Heidelberg Museum. The individual had been pregnant in one of the sets, and the uterus is here larger than on the opposite side which is of the ordinary size. The woman reached her full time, but died nineteen days after delivery. The ovaria are to the female what the testes are to the male, °varia: They were formerly, indeed, called female testes, and furnish, on the called part of the female, what is necessary toward the production of a \l^^ progeny. They are, in fact, two spheroidal flattened bodies, How con- enclosed between the folds of the broad ligaments by which the with the uterus is suspended. They have no immediate connexion with uterUB- the uterus ; but near them the extremity of a tube, which opens on either side into that organ, hangs with loose fimbriae in the cavity of the abdomen, into which it communicates the fimbrial end. This Fallopian tube is called the Fallopian from the name of its discoverer.* At the age of puberty, the ovaria acquire their full growth, and continue to weigh about a drachm and a half each till menstruation ceases. They contain a peculiar fluid resembling the white of eggs, once ^P°ra supposed to be secreted by the glandular structure of various small what! bodies imbedded in them, which have been denominated corpora lutea. By some early writers this fluid was contemplated as aThes^c,e- female semen, forming a counterpart to the semen of males; but it these or- has since been held, and the tenet is well supported by anatomical *£"£ j£„ facts to be a secretion of a different kind, thrown forth in conse- ture. quence of the excitement sustained by the separation of one or more of the minute vesicles, which seem to issue from them as their J°^e0\ nucleus or matrix, and which are themselves regarded by the same the c-a- k Fallop. Obseir. Anaf. 19". iZ CL. V.J PHYSIOLOGICAL PROEM. to which subject' Class V. school as the real ovula of subsequent fetuses chirferV of however, we shall advert presently. the genera- It ig sinj,ular to contemplate the very powerful influence wnicu «£ the secretion, or even the preparation for secreting the seminal fluid, ^fluence but still more its ejection, produces over the entire system ^ *•» On the perfection, and a certain and entonous degree ot disten- STn the tion, of the natural vessels, apparently producing an absorption of the e"onoam fluifl when at rest' the sPirits>tne vlgouri aml tne general. health ot iiiusuated. man depend. Hence, antecedently to the full elaboration of the sexual system, and the secretion of this fluid, the male has scarcely any distinctive character from the female: the face is fair and beardless, the voice shrill, and the courage doubtful. And when- ever in subsequent life, we find this entonous distention relaxed, we find at the same time langour, debility, and a want of energy both in the corporeal and mental functions. And where the supply is entirely suppressed or cut off by accident, disease, or unnatural mutilation, the whole system is changed, the voice weakened, the beard checked in its growth, and the sternum expanded : so that the male again sinks down into the female character. These changes occur chiefly where the testicles are extirpated before man- hood ; but they take place also, though in a less degree, after- wards. In like manner, during the discharge of the seminal fluid in sexual commerce, the most vigorous frames of the stoutest animals become exhausted by the pleasurable shock : and the feeble frames of many of the insect tribes are incapable of recovering from the exhaustion^ and perish immediately afterwards ; the female alone surviving to give maturity to the eggs hereby fecundated. The same effect occurs after the same consummation in plants. The stoutest tree, if superfructified, is impaired for bearing fruit the next year ; while the plants of the feeblest structure die as soon as fruc- tification has taken place. Hence, by preventing fructification, we are enabled to prolong their duration ; for by taking away ths styles and stigmas, the filaments and anthers, and especially by plucking off the entire corols of our garden-flowers, we are able of annuals to make biennials, and of biennials triennials. In many animals during the season of their amours, the aroma of the seminal fluid is so strong, and at the same time so extensive in its influence as to taint the flesh ; and hence the flesh of goats at this period is not eatable. Most fishes are extremely emaciated in both sexes at the same time, and from the same cause, and are equally unlit for the table. Stags, in the rutting season, are so ex- hausted as to be quite lean and feeble, and to retire into the recesses of the forest in quest of repose and quiet. They are well known to be totally inadequate to the chase ; and hence, for the purpose of maintaining a succession of sporting, they are sometimes castrated, in which state they are called heaviers. If the castration be per- tain ff°W formed while the horns are shed, these never grow again ; and, if caseation while the horns are in perfection, they are never shed. drilled The male and female rein-deer (cervus Tarandus) ordinarily aPellBherf.y cast their horns every year in November. If the male be castrnted. f.-icidisr E fleets from its discharge in the stoutest animals; in the feeblest: in the stoutest plants : in feebler plants. Aroma in Sorno ani- mals pecu- liarly strong in the breed- ing season, mid flash not eata- ble. A like ef- fect in fishes. Singular exhaustion in stags. Horns PHYSIOLOGICAL PROEM. [ex. v. IS tiie horns will not grow after he is nine years old ; and the female Class v, instead of dropping her horns as usual in November, retains them, LnerVof it gravid, till she fawns, which is about the middle of May. In this lnc «enera- case the usual stimulus necessary for the operation of exfoliation Tot*™' is transferred to another part of the system. And for the same rea- fnZTeh.- son we often find that a broken bone in a pregnant woman will dKer-e" secrete no callus, and consequently not unite, till after child-birth. b/tt?7. In the former case the roots of the horns are affected by sympathy with the general sexual system, of which, indeed, they may be said to form a part, and by their superior size are discriminative of the male sex. In the human race, the strong deep voice, characteristic of manhood, is rarely acquired, if castration be performed in infancy. There is no animal, perhaps, but shows some sympathetic action Association of the system at large, or some remote part of it, with the genital ".il^SST organs, when they are in a state of peculiar excitement. The tree- with the frog (rana arborea) has, in the breeding season, a peculiar orbicular when in a pouch attached to its throat; the fore thumb of the common male Vehement toad is at the same season affected with warts : and the females of illustrated' some of the monkey tribes evince a regular menstruation. frog1? tree" II. The process by which the generative power is able to accom- coinmon plish its ultimate end, is to the present hour involved in no small moiTkey- degree of mystery ; and has given rise to three distinct and highly u'cenero- ingenious hypotheses that have a strong claim upon our attention. "ve Pr°- and which we shall proceed to notice in the order in which they have involved in appeared. mystery: rnu C. \ • Dul nas 1 he first and most ancient of these consists in regarding the fetus given rise in the womb as the joint production of matter afforded in coition by pup'uiaT both sexes, that of the male being secreted by the testes, and that of hyp°f"eses the female by the uterus itself, or some collateral organ, as the ovaria. Fetus plo- which last, however, is a name of comparatively modern origin, and fruiter* derived from a supposed office which was not contemplated among mixture of the ancients. To this hypothesis has been given the name of female3 se-d EPIGENESIS. mina.' fiui<'; The seed or matter afforded by the female was regarded by Hip theory of pocrates, Aristotle, and Galen, as the menstrual blood or secretion, Female518' which they supposed furnished the substance and increment of the generative fetus, while the male semen furnished the living principle : Empe- expiaYnedW docles, Epicurus, and various other physiologists contending, on the c'rya|^sPai,d contrary, that the father and mother respectively contributed a semi- Aristotle, nal fluid that equally co-operated in the generation and growth of ^i the fetus, and stamped it a male or a female, and with features more *?m,jn * How GX™ closely resembling the one or the other according as the orgasm of plained by either was predominant at the time, or accompanied with a more ^1^^' copious discharge. In the words of Lucretius who has elegantly Epicurus. compressed the Epicurean doctrine : features _, ,. . , . , how ac- Et multebre oritur patrio de semme sociura ; counted Maternoque mares exsistunt corpore cretei. for. Semper enim partus duplici de seruine constat: Atque, u 14 vl. v.j PHYSIOLOGICAL PROEM. opinion. Class v. The distinction of sex, however, was accounted for in a different "ve'prT*" manner by Hippocrates, who supposed that each of the sexes pos- lex'and sesses a strong and a weak seminal fluid : and very ungallantly as- feluTres serted that the male fetus was formed by an intermixture of the couufed robuster fluids of the two sexes, and the female by that of the more for by imbecile. Lactantius, in quoting the opinion of Aristotle upon this te'sPandra" subject, adds, fancifully enough, that the right side of the uterus is the £™°™ proper chamber of the male fetus, and the left of the female : a be- IjO in III 6II** r i it* *£* /""* 4 tary of hef which is still prevalent among the vulgar in many parts ot ureat Lactmtius Brita,n But he addg that if tjie ma\e-) or stronger, semen should by mistake enter the left side of the uterus, a male child may still be conceived ; yet, inasmuch as it occupies the female department, its voice, its face, and its general complexion will be effeminate. And, on the contrary, if the weaker, or female, seed should flow into the right side of the uterus and a feinale fetus be begotten, the female will exhibit many signs of a masculine character, and be inordinately vigorous and muscular.* The one or The doctrine of epigenesis under one modification or another, the" doc- continued to be the leading, if not the only hypothesis of the day till trinespo- the beginning of the sixteenth century, when, in consequence of the 8Ie"«rix! more accurate examinations and dissections of Sylvius, Vesalius, teenthcen Fallopius, and De Graaf, the organs which had hitherto been regarded which time as female testes, and so denominated, were now declared to be re- liwtead1"? positories of minute ova, and at length named ovaria by Steno in tester, were 1667.f We now therefore enter upon the second of the three hypo- deposifo-aS theses above alluded to, which derives the fetus from rudiments fur- r.iet °fva' msnei' by the mother alone. This hypothesis was originally advanced and hence by Josephus de Aromatariis, as flowing from these anatomical dis- "vITria. coveries, but was chiefly brought into notice by Swammerdam and Hence an Harvey, who established the doctrine of omne ab ovo. Observing a tiiesTs yP° cluster of about fifteen vesicles in each of the female ovaria, appa- ^vesufe3" rentty filled with a minute drop of albuminous yellow serum, and rudiments perceiving that they appeared to diminish in number in some kind of from the"1" proportion to the number of parturitions a woman had undergone, it mother was conceived by these physiologists that such vesicles are inert This hypo- eggs or ovula, containing miniature embryons of the form to be 'rated.'"118 afterwards evolved, one of which, by the pleasurable shock that darts over the whole body, but in an especial degree through this organ, during the act of copulation, is instantly thrown into a state of vital activity, detached from the common cluster, and in a short time passes into the uterus through the canal of the Fallopian tube which spontaneously enlarges for the purpose ; where its miniature germ is gradually unfolded and augmented into a sensible fetus, Features of partaking of the form and figure of the parent stock. The elementary accoumed animalcule, it was farther asserted by Harvey, may be occasionally for by the impressed with a resemblance in its features to the father from the shock eivin i . ■ , . . , . . . ^ to the electric impulse given in the genial act to everv portion of the solids tom'durir^ and fluids of the body' and of consequence to the fluid contained in brace™"it the ovlda tnfcmselves : but, reasoning from the length of the vagina * Be Opificio Dei. Cap. sir. j Elem. Myologies Specimen, p. lir PHYSIOLOGICAL PROEM. [ex. v. Id in cows and many other animals, and an occasional dissection of the Class V. human subject soon after coition, he contended that the male semen twe pro!ra" never did, nor indeed could, enter the uterus, and of course could b^„ deni. not add any thing to the embryon in its evolution. e<> that the Leewenhoeck and Hartsoeker, however, upon a more accurate men%*!uid anatomy of the uterus immediately after copulation, discovered not eLver rench only that the projected male semen could enter its cavity, but actu- or .d.; bdj ally did thus enter, and in some instances, which fell within their e^yoVh! notice, had clearly ascended into the Fallopian tubes. And now a i;«evoia- new doctrine was started, and one altogether opposite to the theory The con- of Harvey. Upon the principle of the former, the father had no gre*}*,°D' immediate connexion with his own child ; he could not bestow upon l-. wen- it a particle of his own matter, and the whole production was the HansoeiU; operation of the mother. But, in consequence of this later discovery, "J^ej"^'at it was contended that the entire formation was the work of the father, .t could and that the mother, in her turn, had nothing to do with it: that ^Fano- every particle of the propelled fluid was a true and proper semimum, ^'dn^e' containing in itself, like the ovulum of the female upon the hypothesis luaiiy did of Harvey, a miniature of all the organs and members of the future £xtremG fetus, in due time to be gradually evolved and augmented ; and that »nd most the uterus, and possibly the ovulum, into which some one of these I™. male semina or seminia is almost sure of being protruded in the act ;juonce£ i • • i_ ■ r i l. druwn irom of generation, offers nothing more than a nest in which the nomun- twin hypo- culus or rudimental fetus is deposited for warmth and nutriment. ^'t'Ur^6 And as the former hypothesis appealed to the natural economy of °r^en™e oviparous animals during the period of im-ubation, that of worms and that the'" tadpoles was appealed to by the latter : and a very considerable de- j^^ gree of life and motion was supposed to be discovered and proved diate con- by the aid of good magnifying glasses in the simple fluid of the male "v"h°hiB semen, insomuch that not less than many millions of these homun- ^[^{jjj^ culi, or unborn manikins, were pointed out as capering in a diameter „f the not greater than that of the smallest grain of sand, each resembling °^ed the tadpole in shape Lelappius, indeed, a celebrated pupil of Lee- that the wenhoeck, advanced farther ; for he not only saw these homuncular was the tadpoles, but pretended to trace one of them bursting through the ™* °fa*e tunic by which it was swaddled, and exhibiting two arms, two legs, j^™1**' a human head, and heart. more to do Such was the dream of the popular philosophy on the subject of with ;t.than generation indulged in at the period we are now adverting to, and a nest. which continued for upwards of a century. It is truly astonishing to ^^ reflect on the universality with which this opinion was accredited, and w'jMwjde how decisively every anatomist, and indeed every man who pretended ^n-es to the smallest portion of medical science, was convinced that his »™nenCTk children were no more related, in point of generative power to his ^cuiino. own wife than they were to his neighbour's. It was in vain that txllra'vear. Verheyen denied the existence of animalcules in the seminal fluid, f»«^mf and undertook to demonstrate that the motion supposed to be traced hypothec there, was a mere microscopic delusion : it was in vain to adduce re^g, the fact of an equal proportion of paternal and maternal features in almost every family in the world, the undeviating intermixture of fea- tures in mules, and other hybrid animals, and the casual transfer of I 16 Class V II. Genera tive pro- cess. Hypothesis of DurTcn forming a re-ediii..n of the hy- pothesis of epigenesis Organic molecules what. CL. V.]_ PHYSIOLOGICAL PROEM. Explained. Sex and features how ac counted for by liuffon. maternal impressions to the unborn progeny when suddenly fright- ened in the earlier months of pregnancy. The theory, as it was triumphantly called, of generation ab animalculo maris, was still confidently maintained; and the mother, it was contended, had nothing to do with the formation of her own offspring, but to give it a warm nest and nourishment. At length arose the celebrated and indefatigable Buffon, who was not inattentive to the facts before him, nor to the absurdities to which some of them had led. He readily accredited the miscroscopic motion pointed out by Leewenhoeck in the floating bodies of male semen, and which Spalanzani has since persuaded himself he has detected not only in this fluid but in various others of an animal origin ;* but instead of admitting them to be animalcules, he regarded them as primordial monads, molecules organiques, of a peculiar activity, existing through all nature, and constituting the nutrient elements of living matter : and upon this principle he founded not indeed a new hypothesis, but a new edition of that of epigenesis, with so much accuracy, and, in his view of the subject, important matter, as very nearly to entitle it to the character of an original plan. Like the speculations to which it succeeded, it soon acquired a very high degree of popularity. All organized beings, and hence plants as well as animals, according to the doctrine of M. de Buffon, contain a vast number of these active molecules in every part of their frames, but especially in the generative organs of both sexes, and the seed-vessels of plants, in which they are more numerous than in any other parts. These organic primordia afford nutrition and growth to the animal and vegetable fabrics ; and, as soon as these fabrics are matured, and consequently a smaller proportion of such molecules are requisite, their surplus is secreted and strained off for the formation of vegetable and animal seeds. The existence of ovula, in the female ovaria, impregnated and detached at the time of conception, is by this hypothesis declared to be a chimasra, and their passage -into the uterus asserted to be contrary to all observation and fact. The ovaria are once more regarded as female testes receiving, like those of the male, the surplus of the organic molecules of the body, and secreting them, like the latter, for the common purpose of generation. The seminal liquor thus secerned in the male and female frames are, in the act of coition, projected simultaneously into the uterus, and, becoming intimately blended there, produce, by a kind of fermenta- tion, the first filaments of the fetus, which grow and expand like the filaments of plants. To render such combination of seminal fluids productive, however, it was contended that their quantities must be duly proportioned, their powers of action definite, and their solidity, tenacity, or rarefaction symphoneous ; and the fetus, it was added, would be either male or female, as the seminal fluid of the man or woman abounded most with organic molecules, and would resemble either the father or the mother, according to the overbalance of the respective elements contributed by each parent. * Opuscoli de Fisica, Animale, Vegitabile, &c. Vol. if. 8vo. Milan. 1776. PHYSIOLOGICAL PROEM [ex. v, 17 It is obvious, from this brief view of the subject, that Buffon in the P.1-*53 v- planning of this hypothesis did nothing more than avail himself of uve pto-' the anatomical facts of Yesalius, De Graaf, and Harvey, and the GceSneral supposed discoveries of Leewenhoeck, to revive in a new form the remarks. doctrine of the Greek schools, and especially that of Epicurus. The subject, however, was offered to the world in plausible arguments and captivating eloquence, and had soon the good fortune to meet Buffon with powerful and enlightened supporters in Maupertuis and Need- bylMau- ham, who added some improvements, but of no very great impor- jjjj^hnm'- tance, to several of i\L de Buffon's tenets ; while Haller and Bonet opposed by strove hard to revive the hypothesis of a female generative power or Bonet "who that of evolution alone, as first established by Harvey ; or rather to endeuvom- erect an edifice somewhat similar to it, out of the crumbling ruins of vive under the primary building; in doing which they appealed to the phasno- f|J|eh'Lf0,fm mena of the vegetable creation with considerable research and some thesis" of fe- degree of success. But this revived hypothesis, notwithstanding, i™?ion7but has never been very generally followed ; and is now almost, if not ™th hltlc altogether, relinquished even in Germany. In like manner, there are several physiologists, who have endea- Attempted voured to improve upon the hypothesis of Buffon, of whom it may 'mem^upon be sufficient to mention Dr. Darwin and Professor Blumenbach. Buffon; The alterations, however, are little more than verbal, and conse- menuach quently of no great importance, and chiefly relate to the subordinate an.d Dar" doctrine of organic molecules. For the term organic molecules Darwin's Darwin prefers that of vital germs, which he assorts into two kinds, m0°n.lfica or rather maintains are thus formed by nature, as being secreted or vital provided by male or female organs, whether animal or vegetable ; fy"™! for in the philosophy of this writer, the two departments tread closely upon each other. In this subdivision of germs, however, the term molecule is still retained, but limited to the female character or de- partment : the vital germs or particles secreted by the female organs Molecules of a bud or flower, or the female organs of an animal, being by Dr. tlve'pro™'1" Darwin denominated molecules with formative propensities ; while wehDaStties' those secreted from the male organs of either department are called Fibriis fibrils with formative appetencies. To the fibrils he assigns a higher ^/p™.a" degree of organization than to the molecules. Both, however, we tites what. are told, have a propension or an appetency to form or create ; as we are told also that " they reciprocally stimulate and embrace each other and instantly coalesce ; and may thus popularly be compared to the double affinities of chemistry." In the view of Professor Blumenbach, matter is divided into two Biumen- kinds, possessing properties essentially different from each other, nfficatiom these are organized and unorganized : unorganized matter is endued °nrf™nor- with a creative or formative power throughout every particle ; and ganized organized matter with a creative or formative effort, a nisus forma- N*""for. thus, or bildungstrieb,* as he calls it, a principle in many respects "jj^*"8,0I similar to that of gravitation, but endowing every separate organ, as striebDe" soon as it acquires structure, with a vita propria. From the first he what traces the origin of the world in the simple and inorganic state of * Uber den Bildnngstrieb, 8yo. Getting. 1791, Vol. \.—3 18 Class V II. Gene- rative pro- cess. Remarks cf Hunter. Much phi- losophical trifling in these spe- culations Positions sufficiently established by the facts and disco- veries as- certained. First, male semen communi- cated to the uterus at first or soon after- wards. Secondly, the uterus also se- cretes a peculiar tluid, pro- bably the basis of the subsequent mem- branen. Thirdly, Fallopian tubes a me- dium of communi- cation be- tween the uteius and the ova- ries : the supposed vesicles of the latter real ovula, conveyed by this me- dium to the uterus. Fourthly, the cervix of the uterus from this lime be- comes closed, so that no second fetation can uke place. Form ition of caduca; or uterine ovum com- pleted ir. about a -??!: eftf CL. Y.j PHYSIOLOGICAL PROEM. the mineral kingdom ; from the last the rise of vegetables ami animals. n It is only necessary to add farther a remark of Mr. John Hunter 3, that in plants of all kinds, the seed, properly so called, is produced by the female organization, while the male gives nothing more than the principle of arrangement; and that the same operation and prin- ciples take place in many orders of animals.* In all these attempts to improve upon the older speculations, there is a great deal that cannot but be regarded as philosophical nugse. The physiological experiments that have been made, and the anato- mical facts that have been discovered, since the days of Harvey, and particularly during the last half century, though they leave the doc- trine of generation still surrounded with many difficulties, have suffi- ciently established the following positions : First that, in all ordinary cases, the male semen enters into the uterus at the time of coition ; and that in those cases in which it does not or cannot enter immediately, from the extreme length of the vagina, as in some quadrupeds, or from a greater or less degree of imperforation of the vaginal passage, it is conveyed there soon after- wards in consequence of its proximity of situation. Secondly, that the uterus itself, worked up at this time to the highest pitch of excitement, secretes also some portion of a peculiar fluid, the female semen of the Epicurean philosophers, with which the male semen combines, and which is probably the basis of the membranes soon afterwards prepared for the fetus. Thirdly, that the Fallopian tubes at this period become rigid-; their fimbria) embrace the ovaria : and consequently form a direct channel of communication between the ovaria and the uterus ; that what were formerly supposed to be vesicles are real ovula; and that one of them, detached by the momentary shock or excitement. bursts from its nucleus or matrix, enters into one of the open mouths of the fimbriae of the Fallopian tube, and in consequence, into the tube itself, by which it is conveyed to the uterus ; an effect, however, which does not seem to take place during the act of coition, since the ovulum is seldom found, even in the Fallopian tube, till some time afterwards : and that, as soon as the ovulum has thus escaped, the lips of the wound hereby made in the side of the ovary are closed by an external cicatrix, and indented with a small cavity, which forms what is meant by a corpus luteum. Fourthly, that the cervix of the uterus is, from this time, closed ia its canal towards its upper part, so as to prevent a second fetation by the introduction of fresh male semen ; while the internal surface of this organ becomes lined with a fine coagulable and plastic lymph, being probably the fluid secreted at the moment of intercourse • which assumes a thin membranous form, and has been called tunica caduca or decidua, and constitutes the uterine ovum or egg of the fetus ; this important part of the process seeming to take place about a week after the time of copulation. In the rabbit Mr. Cruikshank has found it as early as the fourth day. * Animal Economy, p. £5. PHYSIOLOGICAL PROEM. [cl. v. H) Fifthly, that, for the better protection and nutrition of the fetus, Class v. the walls of the uterine ovum are multiplied ; and that hence, while uveproce'es. the tunica caduca itself possesses a du plicature, which is called ^cual m" tunica reflexa, there aie also two other membranes by which the Fifthly, decidua is lined, denominated chorion and amnion, both which are Sf othe?" filled with peculiar fluids ; the fluid of the chorion occupying the associate space between itself and the amnion which it surrounds ; and the branes. fluid of the amnion occupying the whole of the interior which is dis- tended with it like a bladder. Sixthly, that the medium of connexion between the fetus and the sixthly, mother is the umbilical chord and the placenta into which it is dis- diurJTof tributed ; the former consisting of an artery from each of the fetal connexion iliacs, and a vein running to the fetal liver, twisted spirally and sur- the child rounded by a common integument; and the latter consisting of two m"/^^ parts, an uterine or spongy parenchyma, derived from the decidua, umbilical and a fetal parenchyma consisting of a great multitude of exquisitely piawnta! beautiful knotty flocculi that cover the chorion, and constitute not only an organ of nutriment, but, as was first ingeniously supposed by Sir Edward Hulse, of oxygenation. Seventhly, that about the third week, or as soon as the uterine Seventhly, ovum is thus prepared for its reception, we can trace the first vestige tes^ge'of of the embryon, oval in its shape and resembling a minute bean or l,,e em.''ry- kidney, swimming in the fluid of the amnion, and suspended by the about the umbilical chord which has now shot forth from the placenta. From afterim-ek this reniform substance the general fjgure pullulates, the limbs are pregnation, protruded, and the face takes its rise. shape re- III. The chief difficulties that have been felt as accompanying"^0™^ these positions and the general doctrine that flows from them, are cuities that the following: ™™*v First, as to the mode by which the male semen is conveyed to the the above ovulum in the Fallopian tube. Secondly, the occasional existence of corpora lutea in the ovaria of virgins, or of those who, from misformation, have been incapable of indulging in sexual commerce. Thirdly, the occasional detection of a,, full-sized fetus in the uterus without any placenta, umbilical chord, or mark of an um- bilicus. The first of these difficulties was earliest started, as we have £jr,tyd^t already observed, by Dr. Harvey, who contended that in the case of of the as- cows, whose vagina is very long, as well as in various other cases, J^maie the semen cannot possibly reach even the uterus; and that hence semen to there is no reason to suppose it ever reaches it. It was not then known that impregnation commences in the Fallopian tube, and that it must also reach this canal as well ; which, by Harvey would have been received as an objection still more triumphant. By what means the ejected semen is conveyed into the uterus, we Examined ■' J , , i . and rephe« do not, indeed, very clearly know even to the present hour ; but t0. that it is so conveyed and even in animals in which the male organ can by no means come in contact with it, has been proved by incon- trovertible facts. Mr. John Hunter killed a bitch in the act of copu- lation, and found that the semen was then existing in the cavity of 20 ex. v.i PHYSIOLOGICAL PROEM. the uterus, in his opinion carried there per saltum. Now it it reacli the uterus there can be no difficulty in conceiving that it may also reach the Fallopian tubes, which by one end open into the uterus ; sucked in, perhaps, as supposed by M. Blumenbach, by the lattei organ during the thrilling orgasm of the moment. Leewenhoeck and Hartsoeker seem, indeed, to have removed the difficulty alto- gether, by having, in some instances, detected the seminal fluid in iat the Fallopian tubes themselves. And there seems great reason to believe that it has, occasionally, entered the ovarium, and even pro- duced impregnation in that organ instead of in the uterus, where an obstruction has been offered to the descent of an ovulum into the fimbrial openings of the tube, after its detachment: for we cannot otherwise readily account for the formation of fetuses in the ovarium; facts, however, well known to occur, and of which Mr. Stanley has given a singular instance of late,* and Dr. Granville a still more ex- traordinary example, the last fetus at its examination appearing per- fect, and four months old.t The second difficulty is also capable of a plausible answer, but not quite so satisfactory as the preceding : Examined There can be no doubt that the ovarium is directly concerned in an rep le ^ great Dusuiess of generation: for it is well known that the opera- tion of spaying or excising the ovaries corresponds in females to that of castration in males. It takes off, not only all power of production, but all desire. And, in a recent volume of the Philosophical Trans- actions, there is the case of a natural defect of this kind in an adult woman, who, in like manner, had never evinced any inclination for sexual union, and had never menstruated: and who on dissection was found, with the deficiency of ovaria, to have the uterus only of the size of an infant's, a very narrow pelvis, and no hair on the pubes.J It seems, also, perfectly clear that in conception an ovum does really descend from the ovarium into the uterus within a few days after sexual intercourse has taken place: in proof of which it will be sufficient to quote the following curious historical fact from Sir Eve- rard Home,§ who appears to have traced its path very accurately: Case in ex- " A servant maid, twenty-one years of age, died of an epileptic fit «on, from seven days after coition, there being circumstances to prove that she Home.) could not have seen her lover after the day here adverted to, nor for many days before. The sexual organs were submitted to dissection: the right ovarium had a small torn orifice upon the most prominent part of its external surface, which led to a cavity filled with coagu- lated blood, and surrounded by a yellowish organized structure : its inner surface was covered with an exudation of coagulable lymph. A minute spherical body, supposed to be an ovum, was concealed in. the cavity of the womb among the long fibres of coagulable lymph which covered its inner surface, and especially towards the cervix. This supposed ovum was submitted to the microscopical powers of M. Bauer, who has made various drawings of it, and who detected * Med. Trans. Vol. vi. Art. xvi. t Phil. Trans. 1820. p. 101. i Vol. for the year 1805. p. 226. § Id, isn, p. 252. PHYSIOLOGICAL PROEM. [cl. iv. 21 in it two projecting points which are considered as the future situations Class v. of the heart and brain." cuities ac- What exact period of time the ovum demands to work its way fn5™^ny" down the tube into the uterus, has not been very accurately ascer- subject of tained. That it does not descend at once is admitted on all hands : ^','meani and there can be no doubt that in different kinds of animals a different descent of period is requisite. Mr. Cruikshank, whose experiments were con- to the ute- fined to rabbits, ascertained that in this species the ovum demanded pureC"s°eiy for its journey about forty-eight hours. In the case just alluded to, ascertained. seven days had elapsed, and consequently a period perfectly sufficient seems to have been given for the purpose, and there can be little doubt that the minute body observed in the cavity of the uterus was a genuine impregnated ovum that had completed its travels. But whence comes it'to pass, if the copulated perculsion, felt ^rhe"rcae through every fibre, be the cause of the detachment of ova or ovula lutea in from the ovaria, that examples should be found of a like detachment, ^nl'^'no and consequently of a formation of corpora lutea in cases where no j^"1^0" copulation has ever taken place ? Of the fact itself there is no ques- red. tion. " Upon examining," says Sir Everard Home, •• the ovaria of £/el,f,enoVt several women who had died virgins, and in whom the hymen was question. too perfect to admit of the possibility of impregnation, there were not ed*emp' only distinct corpora lutea, but also small cavities round the edge of the ovarium, evidently left by ova that had passed out at some former period, so that this happens during the state of virginity ."* Professor Accounted Blumenbach has met with similar examples ; and they have endea- 9UpPo3nion voured to account for it, first, by supposing that the females thus ^'^y circumstanced must have been of a peculiarly amorous disposition, duced by and at particular times morbidly excited by a venereal orgasm origi- ™p0a\% cl. v.] PHYSIOLOGICAL PROEM. Class V. III. Diffi- culties ac- company- ing the sub- ject of ge- neration. and Cu- vier. Indirect support from an- other cu- rious fact. Origiu of this mem- brane ex- plained. Does not afford much sup- port to the common conjecture Third diffi- culty : growth and support of fetus where no placen- ta or umbi- lical chord. What is the substi- tute on such occa- sions ■? This singu- lar fact tri- umphantly appealed to by the advocates for the doc- trine of epi- genesis, as overthrow- ing the doctrine of .ivnlntion. with vesicles of great size." In neither of these cases, however, do we meet with ovula actually detached, and still less with corpora lutea. Add to which, that not only corpora lutea, but detached ovula, and even imperfect fetation, have at times been found in the ovaries of infants often or twelve years of age, who can scarcely be suspected of any such erethism: a very curious instance of which we shall have to quote from Dr. Baillie, under the genus Proeotia.* I am aware that the same explanation has been adopted by M. Cuvier, indeed it is difficult to adopt any other, but direct facts in support of it are as wanting in him as well as in the authorities just referred to. There is an indirect fact appealed to, however, by the last, which is well worth noticing for its curiosity, whatever degree of bearing it may have upon the present question. After observing that a corpus luteum is not positive evidence of impregnation, he adds, nor does the existence of a decidua in the uterus constitute better evidence of the same, since it has sometimes happened that at each period of painful menstruation the excitement of the uterine vessels has produced a perfect decidua not to be distinguished from that belonging to an ovum. The present author has never met with a case of this kind, but of the fact itself there seems no doubt: Mor- gagni has given one striking instance of it in his day,t and Mr. Stan- ley another in our own. J To explain the origin of such a membrane under such circumstances is by no means difficult, as it follows upon the common principle by which other membranous or membrane-like tunics are produced in other hollow organs in a state of peculiar irri- tation, of which some curious examples have already been offered under diarrhoea tubularis.§ The peculiar character of the mem- brane 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 investigation. 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 oxygene from the mother by means of the placenta and umbilical chord, is founded upon the occa- sional 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 umbilical chord, or even the trace of an umbilicus. Admitting the course just glanced at to be the ordinary provision of Nature, what is the substi- tute 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, triumpbantly appeal to these curious 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 generally cut the question short by a flat denial of such monstrous aberrations. * Class v. Ord. 11. Gen. 11. Spec. n. of the present volume T De Sed. et. Caus. Morb. En. j Mcrl T™ 5 Vol. i. p. 252. I Med. Trans. Vol. yi. Art. yvi. PHYSIOLOGICAL PROEM. |cl. v. £3 There is little of the true spirit of philosophy in either conduct. Class v. Admitting the existence of such cases, they just as much cripple the cuit.es'ac- one doctrine as the other ; for, granting the explanation which is f^/Kb- usually offered by the former, the ordinary machinery of a placenta ject of ge- and an umbilical chord, become immediately a work of supereroga- ThTiact tion: a bulky and complicated piece of furniture to which no impor- '^ **Us tant use can be assigned, and which the overloaded uterus might be some ofy well rid of. lhe'r °pp°~ nents But, on the contrary, to deny the existence of well established and Difficulty accumulated facts, merely because we cannot bend them to our own ""« which- speculation, is still weaker and more reprehensible. The kangaroo, ***r <£"* opossum, and wom-bat, all breed their young without either placenta correct. or navel-string. The embryons are enclosed in one or more mem- p^ty ob- branes, which are not attached to the coats of the uterus, and are i*cl u"Phj- supplied with nourishment^ and apparently with air from a gelatinous iy. p ' u matter by which they are surrounded. Hoffman gives us the case ^ofe8^1. of a fetus born in full health and vigour, with the funis sphacelated pbiiosophi- and divided into two parts* Vander Wiel gives the history of a of the6"'0 living child exhibited without any umbilicus, as a public spectacle ;t ^"e^'be- and in a foreign collection of literary curiosities is the case of a hare cause no which was found, on being opened, to contain three leverets, two of **'n' 0'fathe them without a placenta or umbilical vessels, and the other with both.t occurrence. Ploucquet has coliected a list of several other instances in his Initia § 0fUiheU '°M but, perhaps, the most striking example on record is one which oc- facti curred to the present author in December 1791, an account of which he gave to the public in 1795.il The labour was natural, the child, striking scarcely less than the ordinary size, was born alive, cried feebly once occurred' or twice after birth, and died in about ten minutes. The organiza- t0 lhe 11 i ■ , i ■ /■ . • present tion, as well external as internal, was imperfect in many parts, author. There was no sexual character whatever, neither penis nor puden- dum, 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 placenta, 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 attached to the child. No hemorrhage or even discoloration followed its removal from the uterus. In a quarter of an hour after- wards a second living child was protruded into the vagina and deli- vered 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 state- ment. On the present occasion, however, it is not necessary to fol- * Op. de Pinguedine. t Observ. Cent. post. J Commerc. Litera. Norimberg. § Initia Bibliothecae, Medico-Pract. et. Cliirurg. Tom. m. p. 554. 4to. Tubing. 1794. ,.*,.. - || Case of Preter-natural Fetation, with observations: read before the Medtcn Societv of London, Oct. 20, 1794. ■j* cl. v.j PHVSIOLOGICAL PROIvY. Class V. ]ow up the amorphous appearances any further, as they are alrea luitiestc- before the public, except to state that the stomach, which was na company- tura^ wag half filled with a liquid resembling that of the amnios. je?,1" This subject has been brought forward, and will be found ably SK," discussed in the earlier volumes of the Edinburgh Medical Essays, forme. iy by Professor Monro and Mr. Gibson.* The latter, giving full credit wkh'nuch to the few histories of the case then before the world, endeavours abi ny ,nd verv ingeniously to account for the nutriment of the fetus by the fenfiiTin liquor aumii, which he conjectures to be the ordinary source of sup- rnVrgh mo- ply. and not the placenta. The chief arguments are that the era- dica. es- bryon is at all times found at an earlier period in the uterus than in sup^-ited the placenta itself; which does not appear to be perfected till two by bibsou. or t)iree inoilths 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 parturition ? 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 vivipa- rous animals when first born ; and that it diminishes in its volume in proportion to the growth of the fetus. Opposed by To these arg-uments 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 becomes 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 unsatisfactory cases at that time brought forward, than to perplex ourselves with facts di- rectly 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 discussions 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 explana- tion. But, after the history just given, and the references to other cases by which it may be confirmed, this, is not necessary on the pre- sent occasion. r"ssu!n tii ** *s s'ngu^ar that the subject of aeration, which forms another doctrine of difficulty in discussing the question, is not dwelt upon on either side, no[ad°vnert- notwithstanding the ingenious conjecture of Sir Edward Hulse, that ed to. the placenta might be an organ of respiration as well as of nutrition, * Vol. i. Art, xni. Vol. n. Art. is. x. xi. See also Dr. Flemine's paper. Phil. Trans. Vol. xlix. 1775—6. p. 254. PHYSIOLOGICAL PROEM. [vl. v. had at this time been before the public for nearly half a centurv ; Ciass. "V- and it shows us how slow the best founded theories not unfrequently cuiuefaV are in obtaining the meed of public assent to which thev are entitled ?omManJ'\ from the first. ' ^|f These, however, are only a few of the peculiar difficulties that otSif- still accompany the subject of generation, to whatever doctrine we Acuities of attach ourselves. There are others that are more general, but equally ne?au,nd inexplicable. The whole range of extra-uterine fetuses is of this JE^'j. character ; often formed and nourished and developed without either cabTe!xp' a placenta or an amnios, and yet sometimes advancing, even in the re- ^fetuses mote cavity of the ovarium, and perfect in every organ, to the age of at d(?veioped least four months, of which we have already offered an example. A pke'ema or great part of the range of amorphous births defy equally all mental aTo^ou, comprehension; particularly the production of monsters without hirthofva- heads or hearts, some of whom have lived for several days after equally "un birth ;* others consisting of a head alone, wholly destitute of a Hi™ui' trunk, and yet possessing a full developement of this organ ; a spe- cimen of which was lately in the possession of Dr. Elfes, of Neuss, on the Rhine :f and others again, the whole of whose abdomen and thoracic viscera has been found transposed.! Nor less inexplicable is the generative power of transmitting pe- Transmis- culiarities of talents, of form, or of defects in a long line of heredi- Knu'dJ?" tary descent, and occasionally of suspending the peculiarity through fe?lB>or a link or two, or an individual or two, with an apparent capricious- narkieS"11 ness, and then of exhibiting it once more in full vigour. The vast [aton8™6" influence which this recondite, but active power possesses, as well generation. over the mind as the body, cannot, at all times, escape the notice of the most inattentive. Not only are wit, beauty, and genius propa- gable in this manner, but dulness, madness, and deformity of every kind. Even where accident, or a cause we cannot discern, has produced Further a preternatural conformation or singularity in a particular organ, itlHuBtrate'1, is astonishing to behold how readily it is often copied by the gene- rative 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 foundation in every age and country for the family name, as in that of Varro, Valgius, Flaccus, and Plautus at 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 de- scended in a direct line for many generations in various countries. Hence hornless sheep and hornless oxen produce an equally hornless offspring, 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 hinder parts of one or two of the nations at the back of the Cape of Good Hope, of which examples have been furnished to us in our own island. * See for examples and authorities the author's volume of Nosology, p. 538. t Hufeland, Journal der Practischen Heilkunde. Apr. 1816. 1 t Samson, Phil. Trans. 1674. Vol. V._4 20 cl. iv."j PHYSIOLOGICAL PROEM. Class V. How are we, moreover, to account for that fearful host of diseases cuitie^'ac- gout, consumption, scrofula, leprosy, and madness, which, originating company- perhaps in the first sufferer accidental Iv, are propagated so deeply jeftof!"-" and so extensivelv that it is difficult to meet with a family whose Tranlmis Mood is totally free from all hereditary taint ? By what means this sion of predisposition may be best resisted it is not easy to determine. But u'y'whVt as there can be no question that intermarriages among the collateral transnmiBs-ch branches of the same family tend more than any thing else to fix and s.ons may multiply and aggravate it, there is reason to believe that unions be- opposed. tween total strangers, and, perhaps, inhabitants of different countries, form the surest antidote. For admitting that such strangers 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 ana- logies to render it probable that in their mutual encounter the one wisdom of may even destroy the other by a specific power. And hence, nothing sirainuof can De wiseri on physical as well as on moral grounds, than the divine and restraints which divine and human laws have concurred in laying on iawsaon marriages between relations : and though there is something quaint intermar- ant| extravagant, there is something sound at the bottom, in the fol- tween near lowing remark of the sententious Burton upon this subject: " And aunlntre- surely," says he, " I think it has been ordered by God's especial medy pro- providence, that, in all ages, there should be, once in six hundred Burton/ 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 Sar- matia, 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 infirmities, which by our lust and Severe law intemperance we had contracted."* Boethius informs us of a dip- ex™ence'n ferent and still severer mode of discipline at one time established in in scot- Scotland for the 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."+ * Anatomy of Melancholy, Vol. i. Parti. Sect. n. p. 89. 8vo, t Dc Vetenrm Scotorum Moribtis, Lib. i. CLASS V. GENETICA, ORDER I. CENOTICA. DISEASES AFFECTING THE FLUIDS. 5IORBID DISCHARGES ; OK EXCESS, DEFICIENCY OR IRREGULARITY OF SUCH AS ARE NATURAL. This order, the name of which is derived from Galen, and has been orDESr l explained already, is designed to include a considerable number of Scope of diseases which have hitherto been scattered over every part of a the order' nosological classification, but which are related to each other, as being morbid discharges dependent upon a morbid condition of one or more of the sexual organs. The term employed might have been medorrhcetica but that medorrhcea, as a genus, has been already employed by Professor Frank, of Paris, in a somewhat dif- ferent, and, as it appears to the author, peculiarly indistinct sense ; as combining, under a single generic name, what seems to be a medley of diseases with no other connexion than locality, or conti- guity of organs, as mucous piles, fistula in ano, leucorrhcea, clap, gleet, syphilis, phimosis, paraphimosis, and what was formerly called hernia humoralis, by him named epidydimitis, the orchitis of the present system. The genera under this order are five, and may be thus expressed: I. PARAMENIA. MLSMENSTRUATION. II. LEUCORRH03A. WHITES. III. BLENNORRHOJA. GONORRHOEA. IV* SPERMORRH03A. SEMINAL FLUX. V. GALAGTIA. MISLACTATION. CL. V GENETICA. GENUS 1. PARAMENIA. IWISMENSTRTJATION, MORBID EVACUATION OR DEFICIENCY OF THE CATAMENIAL FLUX. Gen. I. Origin of generic term. Catamenia] incorrectly regarded as blood: since it has hardly any property in common with it. How dis- tinguished by J. Hun 11 y Cruik- sliank. Further illustrated. Nosologi- cal confu- sion from not attend- ing to this distinction. Particularly in Sauvagei \..i Cu'.ieu. Paramenia is a Greek term derived from vnp* " male" and ftjj* " mensis." The genus is here limited to such diseases as relate to the 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 property 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 menstruation, serum or blood is intermixed with it, and extruded either from atonic relaxa- tion or entonic action of the menstrnal 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 action 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. Cruik- shank supposes it to be thrown forth 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 pro- lapse, both of the uterus and vagina, given by Mr. Hill, of Dumfries, in the Edinburgh Medical Commentaries. In this case, the os tineas 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 speaking, 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 hjemorrhagia, and will be so found in the present system in which it occurs in Class hi. Order iv. This remark applies directly to Sauvages; and quite as much so to Cullen, who, in his attempt to * Vol. iv. j., 91, ul. v.] SEXUAL FUNCTION. [oki>. i. 29 simplify, has carried the confusion even further than Sauvages. Few Gen< l: diseases, perhaps, of the uterus, or uterine passage can be more dis- Mism^n"'" tinct from each other than vicarious menstruation, lochial discharge, 8,ruatio" and sanious ichor ; yet all these, with several others equally unallied, are arranged by Sauvages 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 leucorrhoea or whites, abortion, and the mucous fluid, secreted in the beginning of labour from the glandulae Nabothi at the orifice of the womb, and hence vulgarly denominated its show, or appearance. Menstruation maybe diseased from obstruction, severe pain in its Specific di secretion, excess of discharge, transfer to some other organ, or ces- morbid ° sation; thus offering us the five following species, accompanied with m°n"tru'1 distinct symptoms: 1. PARAMENIA OBSTRUCTIONS. OBSTRUCTED MENSTRUATION. -?.b {"_ i-,, -ii • i struction;* ob the menses, by Professor Frank quaintly denominated amenor- Emansio. rhoea* tiruncularum, it i3 necessary to observe that when the growth onhf" menses- * Pe Cur. Horn. Morb. Ejrit. Tom. vi. Lib. vi. Part in. 8vo. Vienna, l&M. 30 CL. v.J GENETICA. [oKU. i- Ge\. I. SrEc. I. / P. ob- struclionis Emansio. Retention of the menses. Physiology Sexual or- ganization when per- fected, by what and with >\ hat result. Menstrual discharge. Its charac ter. Erroneous view of Cullen. Sympathe- tic affection with the uterus at this time often ma- nifested in remote parts. Catame- uia why thrown off monthly rather than it other of the animal 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 Monio contended for the former effect; Dr. Cullen, with apparently more reason, for the latter. And this last turn it seems to take for the wisest of purposes ; I mean in order to prepare for a future race by perfecting that system of organs which is imme- diately concerned in the process of generation ; and which, during the general growth of the body, has remained dormant and inert, to be developed and perfected alone when every other part of the frame has made a considerable advance towards 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 accumulation of nervous and sangui- neous 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 mamma?; 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 dis- charge, 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, consequently, the economy of menstruation as a periodical hemorrhage. " I suppose," says he, " that in conse- quence 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 hemorrhage, 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 conco- mitant 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. J We cannot explain the reason why this fluid should be thrown off 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 Mat. Med. Vol. u. p. 587. 4to. f Salmuth, Cent. ill. Obs. 1 a Act. Nat. Cnr. Vol. in. App.p, 168. "•.v.J SEXUAL FUNCTION. Jord. i. 31 recurrence of intermittent fevers. It is enough that we trace in 9EN- L this action the marks of design and regularity ; and, after the estab- A™'.1' lishment of a habit by a few repetitions, there is no difficulty in ^ructioni3 accounting for the intervals being of equal length. Retention The time in which the secretion, and consequently the discharge, senses. commences, varies from many circumstances ; chiefly, however, from periods not those of climate, and of peculiarity of constitution. In warm climates stunTproof menstruation appears often as early as eight or nine years of apje— °[ f^'S" c l ,.1 1 i «• i « i , obvious : lor Here tlie general growth of the body advances more rapidly than and a habit in colder quarters, and the atmosphere is more stimulant. In tern- by'Jepeti-'1 perate climates it is usually postponed till the thirteenth or fourteenth •jon- year, and in the arctic regions till the nineteenth or twentieth. firesrt'app°ear- In all "climates, however, when the constitution has acquired the ™™ varia" age in which it is prepared for the discharge, various causes, from "s.1'1 observes Dr. Gulbrand, may accelerate its appearance. Among hot'ciV" these we may mention any preternatural degree of heat or fever, or m,a|^r?teen any other stimulus that quickens the circulation. Mauriceau relates or fourteen a case in which it was brought on suddenly by an attack of a tertian JntcT'and intermittent: and in like manner anger or any other violent emotion nineteen or of the mind, has been found to produce it as abruptly. The de- arctic re, pressing passions, as fear and severe grief, conduce to the same f^neraiiv end though in a different way: for here there is rather uterine con- accelerated gestion than increased impetus, in consequence of the spastic chill dents.0' of the small vessels on the surface, which lessens their diameter. Inordinate exercise, or a high temperature of the atmosphere, has in like manner a tendency to hurry on the menstrual tide ; and hence its appearing so early in tropical regions. Dr. Gulbrand, indeed, Sometimes • tw • • X l f -i • u f ,, by a difler- conceives that even an increase in the elasticity or weight of the enCe in the atmosphere is sufficient to produce a like effect, and refers to a elasticity curious fact in proof of this. In an hospital, to which he was one of the at- of the physicians, he tells us that a very considerable number of the raost,,iere' female patients were suddenly seized with catamenia ; which was the more remarkable because several of these had, for a considerable time, laboured under a suppression of that discharge, and had been taking emmenagogues to no purpose ; while others had only been free from their regular returns for a few days. On inquiring into the cause, the only one which could be ascertained was a very great augmentation in the weight or pressure of the atmosphere, the mer- cury in the barometer having attained a height at which it had never been observed at Copenhagen before; though he does not state the point it had actually reached.* It is possible that other general Hence the causes may sometimes operate to a like extent; and hence this sometimes disease is said, by Stoll and other writers, to be occasionally epi- *p$emica<. demic.t Still much depends upon the idiosyncrasy : some girls are of a Much dc- more rapid growth than others of the same climate; and in some [heidiosyn- there is a peculiar sexual precocity or prematurity of orgasm that w'^nundet hurries on the discharge before the general growth of the body would pregnancy is reported to have c- * Dc Sanguifluxu Uterino. 8ro. Hafn. r"Trpd nt Rat. Med. P. Hi. p. 48. Saminl. Med. Wahrnehm. ix. B. p. 401, GENETICA. [otu>. Gen. I. Spec. I. a P. ob- btructionis Kmansio. Retention m" the menses. nine years of age. Duration of the dis- clmrge. (Quantity secreted. Ultimate term. Retention not always >l disease. Sometimes prevented by structu- ral defect. Sometimes by consti- luiional tardiness lias occur- red for the first time at seventy. Hence re- tention only a dis- ease when the body is disordered in conse- quence hereof. Description of symp- toms when the system suffers. Fatient sometimes thought to be in a decline. lead us lo expect it; of which Pecklin gives an example in a girl ot seven years of age who, in the intervals, laboured under a leucor- rhcea.* And hence chiefly we are able to account for those very early and marvellous stories of pregnancy in girls of not more than nine years old, which, if not well authenticated, and from different and unconnected quarters, might justify a very high degree of skepticism.! The efflux continues from two to eight or ten days ; and the quan- tity thrown forth varies from four to ten ounces in different indivi- duals : the monthly return running on till the fortieth or fiftieth year, and sometimes, as we shall have occasion to observe hereafter, to a much later period of life. It is not always, however, that a retention of the menses to a much later date than sixteen, or even twenty years of age constitutes disease : for sometimes it never takes place at all, as where the ova- ries are absent or perhaps imperfect; or where, instead of precocity in the genital system, there is a constitutional tardiness and want of stimulus; under which circumstances it appeared for the first time, according to Holdefreund, in one instance at the age of seventy :J and in another, that fell under the care of Professor Frank, it never appeared either in a condition of single or married life, nor had the patient at any time any lochial discharge, though she had produced. three healthy children.§ It is only, therefore, when symptoms take place indicating a disordered state of some part or other of the body, and which experience teaches us is apt to arise upon a retention of the menstrual flux, that we can regard such retention as a disease. These symptoms, as already stated in the definition of the disorder, consist chiefly in a general sense of oppression, languor, and dys- pepsy. The languor extends over the whole system, and affects the mind as well as the body: and hence, while the appetite is feeble and capricious, and shows a desire for the most unaccountable and innutrient substances, the mind is capricious and variable, often pleased with trifles, and incapable of fixing on any serious pursuit. The heat of the system is diffused irregularly and is almost always below the point of health: there is, consequently, great general inactivity and particularly in the small vessels and extreme parts of the body. The pulse is quick but low, the breathing attended with labour, the sleep disturbed, the face pale, the feet cold, the nostrils dry, the intestines irregularly confined, and the urine colourless. In some instances there is an occasional discharge of blood, or a blood- like fluid from a remote organ, as the eyes, the nose, the ears, the nipples, the lungs, the stomach, or even the tips of the fingers, giving examples of the fourth species. There is also, sometimes, an irri- table and distressing cough ; and the patient is thought to be on the verge of a decline, or perhaps to be running rapidly through its stages. * Lib. i. Obs. 24. t Haller (Gottl. Eman.), Blumenbach. Bibl. i. p. 558. Schmid, Act. Helvet iv L>. 167. Eph. Nat. Cur. Dec. in. Ann. ii. Obs. 172. X Erzaklungen, No. 4. :> De r„r. Horn. Morb. Epit. Tom. vi. Lib. vi. Part m. 8vo. Vienna, 1821. '.i»\.j SEXUAL FUNCTION. [okd. i. So A decline, however, does not follow, nor is the disease found fatal, Gen-, i. although it should continue, as it has done not unfrequently, for a £E„v ' many years : for if the proper discharge do not take place, the con- aructiouid stitution will'often in some degree accommodate itself to the mor"bid Retention circumstances that press upon it, and many of the symptoms will mfem^„. become slighter or altogether disappear. Most commonly, however, Yet decline when the patient is supposed to be at the worst, probably from the follow'0 increased irritation of the system peculiarly directed to the de- jh°eua^tl,e faulting organs, a little mucous or serous discharge, with a slight continue show of colour is the harbinger of a beneficial change, and is soon yearT.a"y succeeded by the proper discharge itself: though it often happens that System the efflux is at first not very regular either as to time or quantity, acc^mmo But this is an evil which generally wears away by degrees, and is ^0atlnbei,selt diminished with every recurrent tide. morbid All the symptoms indicate that retained menstruation is a disease DUensc" of debility ; and there can be little doubt that debility is its primary sometimes cause—a want of energy in the secernent vessels of the uterus that gradually prevents them from fulfilling their office, till the increase of irrita- p^To bility, from the increase of general weakness, at length produces a be at the sufficient degree of stimulus, and thus momentarily supplies the Manifestly place of strength. The system at large suffers evidently from ofduebiiuv sympathy. which is Yet menostation may take place from a suppression op the menses \ll*™^A. after they have become habitual, as well as from their retention in ^ypcaVB_e- early life, which constitutes the second variety of the disease. structionis The causes of this form are for the most part those of the pre- gjjwji^'.0" ceding, and consist in a torpitude of the extreme or secernent vessels sion of tiie of the uterus produced by anxiety of mind, cold, or suddenly sup- cause" pressed perspiration ; falls, especially when accompanied with terror, mostly or a general inertness andflaccidity of the system, and more particu- ceding va- larly of the ovaria. Hence the disease may exist equally in a robust May exist and plethoric habit and in the midst of want and misery. In the last equally m case, however, it is usually a result of weakness alone ; and on this and deU- account it is sometimes found as a sequel upon protracted fevers. cate framc- As this modification of the disease occurs after a habit has been fj™?*?™ t • t *-v ■ i necessarily established in the constitution, its symptoms differ in some degree different from those we have just contemplated. And, as it occurs also both 0rf the pre°- in a state of entony and atony, the symptoms must likewise differ ^'"S^ according to tiie state of the constitution at the time. If, however, why.' the frame be at the time peculiarly weak and delicate, the signs will ^ntiaiiy not essentially vary from those of the first variety, only that there will ^^'.v be a greater tendency to head-ache, and palpitation of the heart. habits. If the habit be plethoric, and, more particularly, if the cause of f^P^ suppression take place just at the period of menstruation, or during nic habit. its efflux, a feverish heat and aridity of the skin usually make their appearance, the face is flushed and the eyes red, the head is oppressed and often aches, with distressing pains down the back, occasionally rt-lieved by a hemorrhage from the nose. As the principle which should guide us in the mode of treating *£»£«|it both these varieties, will also extend to the ensuing species, it will postponed be most convenient to defer the consideration of it till that species ^Ve',.-* Vol. V.—5 that pre- .'. I iiENETICA [OKU. Gen. 1 Sr ec. II. ,i P. ob- ►mictionis Suppressio. S ippresaion of the ing spe- ■-, and bus passed in review before us. We shall then be able to see how far a common process may apply, and to contrast the few points in which it will be necessary to institute a difference. All these, indeed, have by many writers, and especially by Dr. Cullen, been included under the term amenorrhcea, which Professor Frank has lately employed in a still wider sense, so as to embrace not only those three distinct forms of impeded menstruation, but chlorosis as well.* SPECIES II. PARAMENIA DIFFICIL1S. LABORIOUS MENSTRUATION. Gen. I. Spec. II. How dis- tinct from the preced- ing species. Quantity of .1 ':*ch.iiio loo small : iiml pain* nboutthe loins Secretion ,uiemiix< d «ub blood AJjoining, organs in- fected. Hope of a i'mnily pro- hibited. Often chro- nic, and only termi- nates with ihe period of men- struation itself. Occasional formation of uiem- i'sne-life' i .'ATAJ1ENIA ACCOMPANIED WITH GREAT LOCAL PAIN AND ESPECIALLY' IN TIIE LOINS ; PART OF THE FLUID COAGULABLE. In the preceding species the regular efflux is altogether prevented, as we have already observed, by a torpitude of the secerning vessels of the uterus, perhaps of the ovaries also. In the species before us there is no actual suppression, but the quantity thrown forth is for the most part too small, and attended with severe and forcing pains about the hips and region of the loins, that clearly indicate a spas- modic constriction of the extreme vessels of the uterus. The secre- tion is hence extruded with great difficulty, and is sometimes perhaps of a morbid character : while from the force of the action the mouths of some of the vessels give way, and a small portion of genuine blood becomes intermixed with the menstrual discharge, forming coagula in the midst of an uncoagulating fluid, and thus drawing a critical fire of distinction between the two. The spastic action., thus commencing in the minute vessels of the uterus, not only spreads externally to the lumbar muscles, but inter- nally to the adjoining organs of the rectum or bladder, in many instances, indeed, to the kidneys ; and hence an obstinate costive- ness, and suppression of urine are added to the other symptoms, and increase the periodical misery; the frequent return of which embitters the life of the patient, and effectually prohibits all hope of a family : for if impregnation should take place in the interval, the expulsory force of the pains is sure to detach the embryon from its hold, and to destroy the endearing promise which it offers. These pains generally recur at the regular period, bufoften anticipate it by a day or two, and rarely cease till a week afterwards. The disease, moreover, is peculiarly obstinate, and in some instances has defied the best exertions of medical science, and has only yielded to time, and the natural cessation of the discharge. We have frequently had occasion to observe, and especially under croup, and tubular diarrhea, that where hollow and mucous organ? * De Car. Horn. Morb. Epit. Tom. vi. Lib. »j. Part m. 8ro. Vienna, 1821. - i.. v.j SEXUAL FUNCTION. |okd. i. C,:, labour under a certain degree of irritation, a portion of gluten is often fiF>f-' thrown forth with the morbid secretion that takes place on the sur- j.„rt,i1',.,i,il" face, and the result is the formation of a new membrane or membrane- dirhcuu. like substance that lines the cavity to a greater or less extent: the menstrua- nature of this substance being regulated by the nature of the organ in0anierini, in which it takes place. This remark applies particularly to the uterus is in other under the influence of the irritation we are now speaking of; and, defpccu'-' li:ir irrita- tion. consequently, a membrane very much resembling the decidua, or that naturally elaborated by the uterus on impregnation, has been Membrane occasionally formed and discharged in fragments,* during the vio- tTieXcwTia lence and forcing pain of laborious menstruation. And sometimes of ""!'»•;-' , i -i-i nation. the protrusive agony has been so severe as to occasion a displace- ment, or retroversion of the uterus, which has been found forced down, enlarged, with the fundus thrown backward, and the indu- rated mouth facing the lower edge of the symphysis pubis, t Cold, mental emotion, local injury from a fall, and above all, a ordinary peculiar irritability of the uterus itself, are the common causes. The cure of all the forms of paramenia, we have thus far noticed, ^'^ is to be attempted first, by increasing the tone of the system in procc««. general, and next, by exciting the action of the uterine vessels, where they are morbidly torpid, or relaxing them where they are in pain from spasmodic constriction. Both the last, however, are subordi- nate to the first; for if we can once get the system into a state of good general health the balance of action will be restored, and the organs peculiarly affected will soon fall into the common train of healthful order. To give strength and activity to the circulation is generally Particular attempted by tonics : to give local action, by stimulants. Both Jr Spec!.' i. these should be employed conjointly in the two forms of the first °d^esnr.uc' species. The astringent tonics, however, are supposed, and appa- struation rently with good reason, to be injurious, and in many instances to toS™' extend the retardation or diminish the flow where there is any ap- pearance. Myrrh has long been a favourite medicine, but its power does not appear to be very considerable in mismenstruation, though it undoubtedly acts as a stimulant in phthisis, and has at times, in highly irritable habits, produced haemoptysis. The metallic tonics Mjjja>lic are those on which we can chiefly depend; and of these the principle that have been employed are iron and copper. The first requires less care than the second, and has hence been more frequently re- curred to as the safer. It has been given under a great variety of forms, but that of the sulphate, or green vitriol, is one of the best, and most readily obtained. It is often tried, in union with myrrh ; J^™"' and, where symptoms of dyspepsy exist, and especially acidity in the stomach, the two have been united with the fixed alkali, a combina- ^dhb°£d tion which makes the celebrated draught so well known by the name alkali. of its inventor, Dr. Griffiths. Iron is, by some writers, supposed to show an astringent, and by §™ £„£, others, an aperient power. In different constitutions it may be said >pp»enti>< ,, ,. . ,, , , andatother * Morgagni de Sed. et Caus. Morb. Ep. xlviii. 12. Denman, Medical * acts and timei Observations, 1. 12. t ma aperient. + Dr. J. Robertson. Edin. Merl. and Sure. Journ. No. 73. :J6 UKNETICA. OKU. I. Gen I. Spec. II. Paramenia ilifficilis. Laborious menstrua- tion. Treatment. Prepara- tions of copper uncertain. Tinctura \eneris lolalilis. Cuprura aminonia- M\m. Chalybeate mineral waters and their usual roncomi- !iinlB.*""tt» Cold sea- bathing. Stimulants general and local. Character of general stimulants. to operate both ways. *< If for example," says Dr. Cullen, a re- tention of menses depends upon a weakness of the vessels ot the uterus, chalybeate medicines, by invigorating the force of the ves.scl> may cure the disease, and thereby appear to be aperient: and on thecontrary in a menorrhagia, when the disease depends upon a laxity of the extreme vessels of the uterus, iron exhibited, by re- storing the tone of these vessels, may show an astringent opera- tion."* The preparations of copper labour under two disadvantages: they are essentially more astringent than many of the other metals, and at the same time more uncertain in their effect. They are, perhaps, more soluble in the stomach than any other metallic preparations, wherever there is a sufficient proportion of acid for this purpose: but as the quantity of acid in this organ is constantly varying, their effect must vary also. Dr. Fordyce advises to avoid cupreous prepa- rations when the intention is to strengthen ; but when we attempt to lessen irritability he observes that they are extremely useful; and hence, their advantage in epilepsy and plethoric hysteria. It is, how- ever, a just remark of Dr. Saunders, that all solutions of metals are sedative and ease pain, or, in other words, take off irritability, pro- vided the solution be not too strong. The old tinctura veneris vola- tilis, consisting of one drachm of filings of copper infused in twelve drachms of water of ammonia, is one of the simplest and best prepa- rations of this metal, and forms a good substitute for the cuprum am- moniacum, or c. ammoniatum of the Edinburgh and London Phar- macopoeias. Boerhaave directs us to begin with three drops as a dose, and gradually to increase it to twenty-four. The chalybeate mineral waters have also been used with consider- able success, and the more so as with these are usually conjoined the advantages of travelling, change of air, and a new stimulus given to both the mind and body by novelty of scene, novelty of company, amusing and animating conversation, and exercise of various kinds. With these may also be combined, in the intervals of the menstrual season, and particularly before the discharge has appeared, the u.-t of cold, and especially of sea-bathing. An unnecessary apprehension of catching cold by the employment of this powerful tonic has been entertained by many practitioners : with proper care I have never known it occasion this effect; and it should only be relinquished where no reactive glow succeeds to the chill produced by immer- sion, and the system is hereby proved to be too debilitated for its use. The stimulants to be employed under the first species, in conjunc tion writh a tonic plan, arc those that operate generally and locally. The general stimulants should consist of those that do not exhaust the excitability or nervous power of the frame, but rather by the mo- deration of their effect, and the constancy of their application, sup- port and augment it. Exercise, which we have already recom- mended, will in this view also be of essential service ; as will likewise be uniform warmth ; and hence, the warmth of a mild climate, and * Mat. Med. Vol. 11. p. 22. 4to. '■'«• V-J SEXUAL FUNCTION. [oRD. i. 3^ n generous diet with a temperate use of wine. Hence also the Gen. r. benefit of friction and electricity applied directly to the hypogastric p"™"" and lumbar regions.* difficiiis. As the depressing passions produce the disease, the elevating menstrua' passions have been often known to operate the best and speediest T°ektment cure. It has sometimes suddenly yielded to a fit of joy,| and, in one Friction" ' instance, from the violence of the emotion, to a fit of terror. J We triclty!"" can hence easily see how it may be induced by disappointed love, Som5'bmes and removed by a return of hope and a prospect of approaching the' eie-y happiness.^ vatingpns- ',1 . •> . . . ,,.,.,. sions: and Ihe stimulants operating locally in this disease are known by the especially name of emmenagogues. In the old writers the catalogue of these o?hope?rn is very numerous. Those that are most worthy of notice consist of StimuIants .• 111 • ,» operating the warmer gums and balsams, as guaiacum, assafoetida, turpentine, locally. and petroleum; castor, and the more irritating cathartics, as aloes o^mi"7 and black hellebore. The last is, in most cases, too stimulant upon nBted em the whole range of the intestinal canal, though at one time in high gog^s. favour as an emmenagogue. Aloes is a very valuable medicine. gum"nand Dr. Adair gave it in combination with cantharides; but in this form f»aisaras: it will often be found to produce a troublesome irritation on the rec- catmuii?,. turn or bladder, rather than a salutary stimulus to the vessels of the %*{"]}m uterus. The juniperus Sabina,or common savine, is also a valuable medi- J"n!Peru,i , • . i • i ii-ii • i • Sabina or cine, as being both stimulant and slightly aperient, and operating not savine. only locally but upon the system at large. It may be given in pow- der, extract, or essential oil: of the powder, the dose varies from a scruple to a drachm twice or three times a-day : of the extract from half a scruple to half a drachm ; and of the essential oil from two to four drops. Dr. Home thought highly of it, and M. Herz has praised it in equal terms.II The former declares that by employing the scruple doses three times a-day he succeeded in three out of five cases. But the most favourite emmenagogue in his hands was the ^?uia root of the rubia Tinctormn or madder. Of nineteen cases, of w hich Madder. he gives an account, fourteen, he tells us, were cured by it. From half a drachm to a drachm was prescribed twice or oftener daily. Dr. Home asserts that, in this quantity, it produces scarcely any sen- sible operation, never quickens the pulse, nor lies heavy on the sto- mach ; yet that it generally restores the discharge before the twelfth day from the time of its commencement. IT The present author has Contradic never tried it; he has been deterred by the very different, and even countsof contradictory accounts of its effects upon the constitution which have itBdviri.ue*R been given by different writers of high authority. While Dr. Home found it thus beneficial in cases of obstructed menstruation, Dr. Parr tells us that it produced a cure in excessive menstruation, but in the former disease effected no change whatever.** From its tinging the * Alberti. Diss, de Vi Electric* in Amenorrhoeam, sen Catameniorum obstruc- tionem. Goett. 1764. Birch, Considerations of the Efficacy of Electricity in Fe- male Obstructions, &c. Lond. 1799. t Medicin Wochcnblatt, 1782. p. 416. J Waltber, Thes. Obs. 37. i Eph. Nat. Cur. Dec. i. Ann. ix. x. Obs. 58. || Briefe, n. p. 5. f Clinical Experiments, Histories, &c. 8vo. 1780. ** Mod. Diet. Vol. it. in verb. p. 624. .;,«, ce.v.j GENETICA. LuUu-'- Ce». I. urine of a red colour it has been supposed to be a powerful diuretic. pf'men,; but even this quality it has beet, incapable of supporting : and yet, in ditneiii.'. the opinion of Dr. Cullen, this seems to be its only pretension to the mrt.rT character of an emmenagogue.* Given freely to brute animals, Dr. !*°" , , Cullen tells us that it always disorders them very considerably, and n^iT' appears hurtful to the system. Its direct virtues do not, therefore, servediy seem to have been in any degree ascertained ; but let them be what depute0 they may, it has deservedly fallen into disrepute as a remedy for any misaffection of the uterus. Aihamanta The athamanta Meum, or spignel, which once rivalled the reputa- L^gneV. ti°n °^ 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. iodine. It is very probable that in cases of weak action, and especially when combined with a strumous diathesis, the pills or tincture of iodine, as we shall have occasion to notice them when treating of bronchocele, may be attended with beneficial effects. Dr. Coindct regards this medicine indeed as one of the most powerful emmena- gogues we possess ; and even accounts for its advantages in bron- chocele from the sympathy which the uterus and the thymus manifest for each other :| but the present author cannot yet speak of its result in mismenstruation from his own practice. This part of the subject must not 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 employed with unques- Spurred tionable success. This is spurred rye, or rye vitiated by being in- iwription fested with the clavis or ergot, a parasitic plant which we have of its pow- already had occasion to notice as producing a powerful effect on the tmn. whole system, and especially on the nervous part of it, and the abdo- minal 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 some- thing smaller than this, it excites that pestilent fever which the French denominate mal des ardens, and in the present work is described under the names of pestis erythematica ;% while in a quantity still smaller and long continued, it seems to spend itself almost entirely on the extremities as being the weakest part of the body, and to produce that species of gangr^ena, 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 minute quantities. * Mat. Med. Vol. 11. p 663 4to. edit. comp. with p. 38, of the same t Archives Generates de Medicine, &c. in Rem I Vol. ill. CI. m. Ord. in. Gen. iv. Spec, i ; Vol. m. C\. in. Or for. The prime object should be to quiet irregular local irritation, palliative wherever necessary, by gentle laxatives, moderate opiates, or other treatment- narcotics, and to prevent any incidental stimulus, mental emotion, or 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 costiveness pre- vented 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 Bleeding the head feel oppressed and vertiginous, six or seven ounces of ^indulged. 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 mammas that constantly associate in the changes of the Mamma; uterus, and constitute a direct part of the sexual system, are at this "taw of ir- time, also, not unfrequently in a state of considerable irritation ; and "tation ' * ' J. . .... lrom sym- if a cancerous diathesis be lurking in the constitution, such irritation patiiy: and is often found sufficient to excite it into action. And hence, the easfonaiTy period before us is that in which cancers of the breast most fre- cancers. quently show themselves. From the natural paresis into which this important and active stock of system is hereby thrown, a certain surplus of sensorial power seems powera to be let loose upon the system, which operates in various ways. jj®rnedbaynfC~ The ordinary and most favourable mode is that of expending1 itself scattered over the 4t> CL. v.] GENETICA. [ORD. I. Gen. I. Upon the adipose membrane generally, in consequence of which a SenYa' larger portion of animal oil is poured forth, and the body becomes ceaJsaa'tion«. plump and corpulent. The most unfavourable, next to the excite- So"ofment of a cancerous diathesis into action, is that of irritating some the menses, neighbouring organ, as the spleen, or liver, and thus working up a different" distressing parabysma or visceral turgescence ; or deranging the soTetimes order of the stomach, and laying a foundation for dyspepsia. generally and pro- ^,.,,,^1^,,, ducing cor- pulency. Sometimes L°3S# GENUS II. tumid liver or other LEUCORRHCEA. WHITES. MUCOUS DISCHARGE FROM THE VAGINA, COMMONLY WITHOUT INFEC- TION ; DISAPPEARING DURING MENSTRUATION. Or^ln'of1' ^HE term leucorrnoea fr°m **»*«?» " white," and f«v, " to flow," the generic is apparently of modern origin ; as it is not to be found in either the term. Greek or Roman writers ; and seems first to have been met with in Bonet or Castellus. rhlg?a alba ^his *s tne Menorrhagia alba of Dr. Cullen, so denominated ofCuiien. because he conceives the evacuation to flow from the same vessels as the catamenia ; as also that it is often joined with menorrhagia, Source of or succeeds to it. Its source, however, is yet a point of dispute ;* charge a Stoll,t Pinaeus, and various other distinguished writers have ascribed dis'putef ^' n^e Cullen, to the uterus. But as it occurs often in great Probably abundance in pregnant women, in girls of seven, eight, and nine botiVem years of age,J and even in infants, it has been supposed by Wedel,§ vaevix ofd an(* mos* w"ters °f tne present day, to flow from the internal the uterus, surface 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 SQme other diseased indication, and sometimes the vagina, during the prevalence of this malady. || Frank affirms that he has occasionally, on dissection, traced it issuing from the Fallopian tubes. IT In the case narrated by Mr. Hill, of Dumfries, and noticed under the preceding genus, it was evidently confined to the vagina alone.** * Rat. Med. P. vn. p. 155. t De Notis Virginitatis, Lib. I. Prob.S. X Heister, Wahrnemungen, B. n. N. 128.—Hoechstatter, Obs. Med. Dec. iv Cas. I. Schol. § Diss. De Fluore albo. Jen. 1743. || De Sed. et Caus. Morb. Ep. xlvii. Art. 12. 14. 16. 17. 18. 19. g7. Ep. txii' Art. 14. "" IT De. Cur. Horn. Morb. Epit. Tom. y. p. 177. Mannh. 8»o. 1792. ** Edinb. Med. Comment, iv. p. 91. i;l. v.J SEXUAL FUNCTION. [ord. i. 47 From its frequency in Sweden, Riedlin conjectures it to be Gen. II. endemic there :* but this can hardly be allowed, and there are more rh^a."' obvious causes to which such frequency may be referred. sahHo be When first secreted it is bland and whitish, but differs in colour endemic, and quality under different circumstances, and hence affords the sufficient01" three following species : Qualities' 1. LEDCORRHC3A COMMUNIS. COMMON WHITES. 2.----------NABOTHI. LABOUR-StlOW. 3. SENESCENTIUM. WHITES OF ADVANCED LIFE. SPECIES I. LEUCORRHCEA COMMUNIS. COMMON WHITES. THE DISCHARGE OF A YELLOWISH-WHITE COLOUR, VERGING TO GREE.V This species is the fluor albus of most writers ; the medorrhcea Gen. II. fceminarum insons of Professor Frank. It is found in girls antece- p™^}' dently to menstruation, or on any simple local irritation in the mid- bus of most die of life, and hence also, as just observed, during pregnancy. It is nescViption. said in the Berlin Transactions to be occasionally contagious :| 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 Causes. asserted also to have done on a suppressed catarrh ;| and dullness or suppressed perspiration of the feet.§ Local irritations, moreover, are frequent causes. And hence one reason of its being an occa- sional concomitant of pregnancy ; as also of its being produced by pessaries injudiciously employed, by voluptuous excitements, and uncleanliness. It is said at times to exist as a metastasis, and Produceu particularly to appear on a sudden failure of miik during the period t!fsime ai of lactation ; a failure which may be set down to the list of suppressed discharges.il Jensen gives a singular case of leucorrhoea that alter- Has alter- nated with a pituitous cough. 11 It is most frequently found among other com the weakly and delicate of crowded cities and humid regions, of a $"*l' cachectic habit, and who use but little exercise ; especially about chiefly the age of puberty, or who being married, have borne too numerous a family, or been pregnant in too quick a succession. It is also found among the barren, those who cruelly forbear to suckle their own offspring, or who menstruate too sparingly.** It is usually accompanied with a sense of languor, and a weakness Symptom grass. * Lin. Med. 1695. p. 164. t Act. Med. Berol. Dec. 1. Vol. v. p. 85. I Act. Enid. Lips. 1709, p. 376—Raulin, Sur les Fleurs blanches, p. 329. S Act. Nat. Cur. Vol. vm. Obs. 38. f\ Astruc, De Morb. Mulier. Lib. i. cap. 10. If Prod. Act. Havn. p. 160, • - J. P. F.aak,De Cur. Horn. Morb. Epit. Tom. v. p. 176. 48 cl. v.j GENETICA. [orjj. r r.EK. II. Spec. I, Leucor- rhoea com- munis. Common whites. How dis- tinguisha- ble from blenor- rhcea, Constim- tional mis- chief, when violent. Medical treatment. Local re- medies. Injections of warm water or diluted so- lution of acetate of iead. Other as- tringent injections. or pain in the back. And if it become chrome, or of long conti- nuance, the countenance looks pale and unhealthy, the stomach is troubled with symptoms of indigestion, the skin is dry and feverish, and the feet edmatous. The discharge, in its mildest form, is slimy, nearly colourless, or of an opaline hue, and unaccompanied with local irritation. It afterwards 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 appears 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 of distinguishing the discharge of whites from that of blenorrhosa, 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 irritation extends through a considerable part of the meatus urinarius, so as to pro- duce a considerable pain in making water; symptoms which are not found in leucorrhoea. 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. Where 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 ;* by abortion or miscarriage, where there is pregnancy ; and by barren- ness, where no pregnancy has occurred. When it acts on the system at large, it has given rise to cutaneous eruptions of various kinds ;| and is said to have introduced tabes and hectic fever,f dropsy, scirrhus, and cancer.§ The cure is often difficult : but it is of no small importance to be, from the first, fully acquainted with the nature of its cause and character^ for the proper means to be pursued will mainly depend upon this. And hence it will often be necessary to examine the organs themselves, or to intrust the examination to a nurse on whose judgment we can fully depend. If the cause be uncleanliness, a lodgement of some portion of a late menstrual flux, or any other actuating 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 debility and relaxation produced by a severe labour or miscarriage, forming no uncommon causes : as they are also no uncommon effects. Other astringent injections have, often been tried, as green tea, a solution of alum, or sulphate of zinc, a decoction of pomegranate * Boehman, Diss, de Prolapsii et Inversione Uteri. Hal 1745 t Klein. Interpreti Cliniciw, p. 112. j Hippocr. Apb. Sect. v. 9 Kauhn, Surles Fleurs blanches. Tom. i. passim.—Frank, ut snpr. p. 182 ix. v.J SEXUAL FUNCTION. |oki>. i. 4U bark, or a solution of catechu. All these are sure to be of service Gen. II. as tending to wash away the discharge, and keep the parts clean ; Leucor- and in many cases they will also succeed as astringents ; nor is it *®aig°0'"" always easy to determine which is to be preferred, for in some cases common one answers the purpose best, and in others another. Treatment. Sir Kenelm Digby recommended a local application of the fume Fume oi of sulphur,* which may be communicated in various ways ; and so su p'" far as this has a tendency to change the nature of the morbid action, by originating a new excitement, it is worthy of attention; but ^*"b h 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, Treatment. 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 Disease of- .... j ten trou- mnumerable. Acids have been taken internally m as concentrated biesome a state as possible, but rarely with much success. The sulphuric n°?eob9tl" acid has been chiefly depended upon : and, in the form of the eau de General ■^» . , .... , J „ ... • 1 i> • •.. c remedies Rabel, which is that of digesting one part to three of spirit of wine, Acid3. it was at one period supposed to be almost a specific. The com- pound, however, has not been able to maintain its reputation, and has long since sunk into disuse. Emetics have been found more useful, as operating by revulsion, Emetics. 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 Purgatives. 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 this purpose is sulphate of magnesia. Small doses of calomel have been given daily with the same view, but they have not succeeded in general. Heister, however, recommended mercury in this disease Mercury so even to the extent of salivation ;| yet this is a very doubtful remedy, duc^sln- and even under the best issues purchases success at a dear rate. A vation- spontaneous salivation has sometimes indeed effected a cure ;§ 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. j^j™1, 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 gene- ]^ata of rally, and have a peculiar tendency to influence the secretion of mucous mem°-U3 membranes, as the terebinthinate preparations, particularly camphor, ^^ balsam of copaiba, and turpentine itself: and there is reason to nate pe- believe that the second of these has often been useful. It has some- TirTcturTof times been employed in combination with tincture of cantharides : ««£*• * Medic. Experiment, p. 65. f Icter. Spasmodic. Vol. i. ; Wahrnemungen. Band. n. $ Eph. Nat. Cur. Dec. hi. Aim. re. x. Obs. 140. Vol. V.—7 5p cl. v.] GENETICA. _[0K1»-1' Gen. II. Spec. I. Leucor- rhoea com- munis. Common whites. Treatment. Astringents, Putentilla anserina : ot wild tansey. Alum. Kino. Rhatany root. Best gene- ral treat- ment. 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 tansey, (Potentilla anserina, Linn.) was at one time in high favour ; it was particularly recommended by M. Tournefort, 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. The rhatany root is much better entitled to a trial in the form of a decoction, as already recommended in atonic paramenia superfua: though, from its warmth, united with the quality of astringency, it is a still more promising remedy in the leucorrhoea of advanced life. Upon the whole, the best general treatment we can recommend is a use of the metallic tonics, and especially zinc and iron in con- junction 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 Tun- bridge or Cheltenham. SPECIES II. LEUCORRHCEA NABOTH1. LABOUR-SHOW. THE DISCHARGE SLIMY, AND MOSTLY TINGED WITH BLOOD. Gen. II. Spec. II. Synonyms. Where usually found. Probable source. In this species the fluid is secreted by the glandulre Nabotln situate on the mouth of the uterus, whence the specific name. It is the leucorrhoea JSabothi of Sauvages, and the haemorrhagia 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 pro*- cess, has now commenced, and that the pains of chila-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 nam* of a haemorrhage, as given by Dr. Cullen. though blood from .'.; SPECIES I. BLENORRHGEA SIMPLEX. SIMPLE URETHRAL RUNNING. SIMPLE INCREASED SECRETION FROM TIIE MUCOUS GLANDS OF THE URETHRA. This definition is given in the words of Dr. Fordyce, and is suffi- Gen. III. ciently clear and expressive. In effect, the efflux proceeds from E^xtiom mere local irritation, unaccompanied by contagion, or virulence of any simple io- kind, and is chiefly found in persons in whom the affected organ is tion. in a state of debility ; the occasional causes of irritation being vene- causes. real excess, too large and indulgence in spirituous liquors, cold, topical inflammation, too frequent purging, violent exercise on horse- back, to which various authors add transferred rheumatic action ;* and occasionally, according to Mr. John Hunter, transferred irrita- tion of the teeth.t The matter discharged is whitish and mild, producing no excoria- tion, pain in micturition, or other disquiet. It is the mild gonorrhoea of many writers, the gonorrhoea pura of Dr. Cullen ; and usually yields without difficulty to rest, emollient injections, and very gentle nnd cooling purgatives. SPECIES II. BLENORRHGEA LUODES. CLAP. MUCULENT DISCHARGE FROM THE URETHRA OR VAGINA, INTER- MIXED WITH SPECIFIC VIRUS : BURNING PAIN IN MICTURITION : PRODUCED BY IMPURE COITION : INFECTIOUS. This is a disorder of far greater mischief and violence than the Gen, III. preceding, and in contradistinction to it has been very generally f*"|j;JJ* denominated the virulent or malignant gonorrhoea. It is the gonor- called vim rhcea impura of Cullen. malignant The disease was for many years supposed to be a local effect of ^nwrhcea. that poison which, when communicated to the system, produces sy- posed to be philis. It is in truth received in the same manner, and by the same ™p^Bct of organs—its medium of conveyance being that of cohabitation with How fat^it an infected person. We arc chiefly indebted to Mr. John Hunter tTth'syphi- lis. * De Plaigne, Journ. de Med. Tom. lxxiv.—Richter, Chir. Bibl. B. iv. p. 608. —Ponteau, (Euvres Posthumes. i. t Natural Historv of the Teeth. ?4 Gen. HI. Spec. II. Bloiior- llicen luodos. Clap. Distinctive symptoms. CL. V. GENETICA. [orl). I Such symptoms not gene- rally ac- knowledged in France. Lagnean's hypothesis examined and replied Simulated symptoms of syphilis may per- haps, though rarely, spring from gonorrhoea. As ihey do from ->ther local irri- tants. Some of these dis- tinctions. for having pointed out the distinction ; and there is now scarcely an individual in our own country who has any doubt upon the subject, though there are several who conjecture that it has been derived from the syphilitic venom changed and softened in its virulence by an introduction into different constitutions. These conjectures are harmless, but they have little ground for support. That it is a dis- ease specifically different from syphilis, is clear from the following fact. Its appearance did not commence till more than a hundred years after that of syphilis ; it will continue for months without any syphilitic symptoms, which are rarely, indeed, found connected with it; and where such symptoms have shown themselves, there has been full evidence of a new and different infection or strong ground for suspicion : the matter of chancre, the pathognomic symptoms of syphilis, when introduced into the urethra has been found not to produce clap, and the matter of clap inserted under the skin, has been proved not to produce syphilis : the common course of mercury which is the only specific cure for the' latter, is a very inconve- nient, and dilatory way of treating the former ; while the local plan by which the former is conquered with great speed and ease, pro- duces no effect on the latter. It is singular, therefore, that the old and erroneous doctrine of their being one and the same disease should still maintain its ground in France, as it appears to do from M. Sainte-Marie's late treatise, as well as various others, on this sub- ject.* M. Lagnean, indeed, although he acknowledges that clap or go- norrhoea may have a different origin from syphilis, still endeavours to prove the identity of the former and chancres in the greater number of cases, from the fact that various females have been infected with both complaints by the same man, and various men by the same fe- male.j But this will go no further than to show that the individual communicating both complaints was infected with both at the same time. What is so common as porrigo galeata or scalled-head co- existing with itch ; or dysentery with bilious fever, measles, or any other epidemic that may be prevalent together with itself? It is very possible, indeed, that in a few habits or idiosyncrasies of great acritude, the matter of gonorrhoea may produce chancres or other local sores, or even be followed by constitutional symptoms very closely mimicking those of syphilis : for, when treating of this last disease; we shall have to show that such mimickry of■ symptoms fre- quently takes place from other impure and local irritants, and with so near a resemblance as to be distinguished with great difficulty from the disease it seems to copy. We have already pointed out the distinctive characters of the malady before us and syphilis ; and it is sufficient to observe further that the anomalous symptoms, if they ever follow upon genuine clap, occur not in the ordinary course of its march, but as extreme exceptions to its established habits : and are not to be found once in ten thousand examples. Some of these facts indeed were known to physiologists and rea- * M6thode pour gnerir les Maladies Veneriennes invgterees, &c. Paris, 1818. t Expose des Symptomes de la Maladie Venerienne. Paris, 1815. ll. v.J SEXUAE FUNCTION. [ord. i. 55 soned from even before the time of Mr. John Hunter : and hence Gen. III. Baglivi contended that virulent gonorrhoea, as it was then called, uienor- may be produced by other acrimonies than the syphilitic,* while Zel- ^a luo" lcr, towards the close of the seventeenth century affirmed that it may ciap. originate in either sex without contact ;| and Stoll in the middle of J"""na*"n the eighteenth, that it proceeds from various causes of which syphilitic before the • ■ J. r • 1 I /> T-v r>l /• L t!mU °* contagion is one.J It is due to the merits of Dr. blefour to observe j. Humer. that he made the distinction between syphilis and gonorrhoea, the ground of his inaugural dissertation at Edinburgh in t767, which was nineteen years before the publication of Mr. Hunter's celebrated work. It is not easy to account for the primary appearance of this or of Pathology. any other specific poison : but we see daily that most, perhaps all, mucous membranes, under a state of some peculiar morbid action, have a tendency to secrete a" virulent and even contagious material of some kind or other ; the particles of which are in some instances highly volatile, and capable of communicating their specific effect to organs of a like kind ; and of propagating their power by assimilation, after having been diffused to some distance through the atmosphere, which does not at all times readily dissolve them ; though, agreeably to a general law we have formerly pointed out, the more readily the purer the constitution of the atmosphere.§ We have a manifest ^°tM1^Teed proof of this in the muculent discharge of dysentery, in canine catarrh, discharge or the muculent affection in the nostrils of dogs, which is vulgarly te°™.dysen' called distemper, and in the glanders, possibly also in the farcy, of «««•, horses. And although that species of catarrh which we name influ- danders: enza, is probably a miasm rather dependent on some intemperament farcy: of the atmosphere itself for its origin, than on the temperament of the individual who suffers from it; yet this also becomes a contagion in its progress, and is communicable in consequence of such new pro- perty, from individual to individual, after a removal into fresh and very remote atmospheres by travelling :|| whilst nothing can be more J^^.. highly contagious than the discharge from the mucous glands of the tunica conjunctiva in purulent ophthalmy, although possibly the matter of this contagion dissolves rapidly in the atmosphere, or is not sufficiently volatile to float in it; whence a direct contact is necessary for the production of its effect. In like manner, leucorrhoea, as we have already observed, has |^or sometimes seemed to be contagious ; for I have occasionally found a kind of blenorrhoea produced in men, accompanied with a slight pain in the urethra, and some difficulty in making water, upon cohabitation with women who, upon inspection, had no marks what- ever of luodic blenorrhoea, or clap ; and, in some instances, indeed, were wives and matrons of unimpeachable character. The disease before us, however, has symptoms peculiar to itself, Jj£,*f* and undoubtedly depends upon a specific virus. The chief of these j^°™ t cific virus * De Fibre. Motice, &c. t Diss, de Gonorrhoea utroque sexu, Tubing, 1700. t Prelect, p. 104. § Vol. u. Carol. 9. p. 85. || See Catarrhus eptdemicus of this work, Vol. n. CI. m. Ord. n. keu. ix ^nec. n 56 cl. v.j GENETICA. [ORD. 1. Gen. III. Srcc. II. Blenor- rhoea luodes. Clip. Symptoms described. Disease less severe in women than in men and why. Interval from the time of infection. Gonor- rhea sicca. Puriform fluid thrown forth, does not proceed from an ulcer: symptoms are described in the definition. They are generally pre- ceded by a troublesome itching in the glans penis, and a general seiw! of soreness up the whole course of the urethra : soon after which the discharge appears, on pressing the glans, in the form of a whitish pus oozing from its orifice. In a day or two it increases in quantity, and becomes yellowish ; and, as the inflammation augments, and the disorder grows more virulent, the yellow is converted into a greenish hue, and the matter loses its purulent appearance, and i* thinner and more irritant. The burning or scalding pain that takes place on making water is usually seated about half an inch within the orifice of the urethra, at which part the passage feels peculiarly straitened or contracted, whence the urine flows in a small, inter- rupted stream : the lips of the urethra are thickened and inflamed, and a general tension is felt up the course of the penis. This last symptom is sometimes extremely violent, and accompanied with involuntary erections ; at which time, as the fraenum, in consequence of the inflammation, has lost its freedom of motion, the penis is incur- vated with intolerable pain. It is to this state of the penis, in which it bears some resemblance to a hard, twisted cord, that the French have given the name of ohordee. Under these circumstances we often meet with a troublesome phimosis, either of the strangulating, or incarcerating kind ; in consequence of the increased spread of the inflammation. Sometimes it extends to one or both groins, in which case the glands swell and buboes are often formed ; some- times it reaches to the bladder, the surface of which pours forth a cheesy or wheyey fluid instead of it3 proper lubricous secretion, which is communicated to the urine ; and sometimes the testes parti- cipate in the inflammation, become swollen and painful, and excite a considerable degree of fever. In women, the chief seat of affection is the vagina ; but as this is a less sensible part than the urethra, the pain is seldom so pungent, except when the meatus urinarius and the nymphae associate and participate in the inflammation. The disease appears at very different intervals after infection, according to the irritability of the constitution. The usual time is about the fourth or fifth day. But it has shown itself within the first twenty-four hours, and has sometimes continued dormant for a fortnight. Domeier lays down the time from the fourth to the four- teenth day.* Plenciz fixes it after the tenth-t Sometimes by the violence of the irritation the secretion is absorbed as fast as it is effused : so that only a very small discharge takes place, while the other symptoms are peculiarly exasperated. To this state of the disease some practitioners have applied the very absurd name of gonorrhma sicca. . . .. It was at one time imagined that the puriform fluid which is usually poured forth in considerable abundance, proceeds from an ulcer in the urethra : but it is now well known, as we have already had occasion to observe frequently, that it is not necessary for an * Fragmente iiber die Erkenntnis venerischer Krankheiten. Hanov. 17«n r Acta, et Observationes. Med. p. 139. ul. v.J SEXUAL FUNCTION. [ord. i. 57 ulcer or an abscess to exist for the formation of pus, and the dissec- Gen. III. tion of persons who have died while labouring under this disease, Btenor- ' have sufficiently shown that the secretion is thrown forth from the Thce?- internal membrane of the urethra, chieCy at the lacunae, without ciap. * the least appearance of ulceration, or even, in most instances, of c^ted ftom eXCOriation. the internal The cure, in the present day, is simple ; for the venereal clap, oTthe"re- like the venereal pox, appears to have lost much of that virulence cJ£ti and severity of character, by passing from one constitution to process another, which it evinced on its first detection. Rest, diluent drinks, the preset and an antiphlogistic regimen will often effect a cure alone. But it daJiand may be expedited by cooling laxatives, and topical applications. The remedies employed are of two kinds, and of very opposite Twociasses characters ; stimulant and sedative. Both, also, are used generally diesT"6" and locally ; with a view of taking off* the irritation indirectly by ^nd seda- exciting a new action ; or directly, by rendering the parts affected tive: torpid to the existing action, and thus allowing it to die away of its generaify own accord. Many of these medicines, indeed, as well the local ?n*"• <■ Gen. III. fivc or six times a day, in the quantity of a dessert-spoonful, or about BienoCr-"' three drachms, as well in the ensuing as in the present specie?, rhcea during which time all heating aliments are to be carefully abstained* ciap08' from. The cure, we are told, is entirely completed in two or three days, the ardor urinae first ceasing, and the discharge again becoming viscid. A slight diarrhoea is sometimes produced, with a flush- ing in the face, and sense of heat in the palms of the hands, and the soles of the feet. In a few instances, Mr. Crawfurd tells us, inflamed testicles have supervened, an affection which yields easily to the common treatment.* This plan has of late been extensively made successful use 0f at home. Mr. Broughton has given us a result of fifty trials Broughton. under his own eye: and of these he tells us that he cured forty-one in less than a month ; that five were relieved ; one was cured, bitf relapsed; and three failed. He affirms that it does not disagree with the stomach, is more easily admissible than balsam of copaiba, and is not attended with the evils of injections. He employed the medicine two or three times a day ; giving of the powder, from two drachms to half an ounce, and of the wine or tincture from a drachm to half an ounce for the dose.t stimulants There is no necessity, however, for subjecting the constitution to focaiiy. so severe a discipline ; for the stimulant process, and particularly that of astringent stimulants, when employed locally, succeeds ordina- sa!t*llic r*^ m a ^ew C'a^s w^^out any trouble. These consist chiefly of metallic salts in solution, as the muriate, and sub-muriate of mercury, the former in the proportion of three or four grains to eight ounces of water:—sulphate of zinc, sulphate of copper, ammoniacal copper, and the acetated solution of lead. The astringent property of most of these, under due management, instead of being found mischievous, gives a check to the morbid secretion, at the same time that it acts as a direct tonic and rapidly restores the irritated mouths of the exhalants to their healthy and proper action ; and this, too, Solution of without the inconvenience of a secondary inflammation. A slight solution of alum alone, indeed, in the proportion of one or two grains to an ounce of water, has, for this purpose, been often em- Suiphato of ployed with sufficient efficacy; though the present author has bole ar- reason to prefer the sulphate of zinc, which he has usually combined menic. "witli bold armenic in the proportion of one scruple of the former and two of the latter to half a pint of water. And he can venture to say that, through a pretty extensive course of practice for upwards of thirty years, he has never known this composition to fail; and has never perceived it produce any of the inconveniences of strict- ure or swelled testicle which were so much but so groundlessly apprehended when the stimulating and astringent practice was first introduced. The addition of the bole may to some practitioners appear trifling, but it adds to the power of the zinc, probably by giving an in- creased body to the solution without diminishing its stimulant effect which would certainly follow by using oil or mucilage in its stead! Sr °' T SU,p^ate of c°PPer » more ^ritating than that of zinc, and, in a strong solution, is more likely to produce inflammation ; and it is t Tr^^c°LihlFTT Cnbeb^&c. Ediiib. Med. and Journ. No. lhi. p.S2 T Irans. of the Medico-Chur. Soc. Vol. «n. Part i. 1822. P ul.v.] SEXUAL FUNCTION [ord. i. ed stric- tures. on this account chiefly that the author has confined himself to the 9EN# m latter. It is in effect, by an analogous practice, that several modi- uifno*- fications of purulent ophthalmy, and particularly that of infancy, is [niEa most successfully subdued, as we observed when treating of this ciap.' disease. It is almost unnecessary to add that the utmost cleanliness by cleanliness. frequent washing should be maintained from the first appearance of the disease. Where the complaint, however, is improperly treated with stimu- spasmodic lants, and particularly astringent stimulants, or where it has continued tions'dis- too long before application for medical assistance, the whole range {j^01 f£°vm', of the urethra, or some particular parts of it, are apt to become so gariy caii- irritable as to excite spasmodic contractions, which commonly pass under the name of strictures, without being so in reality ; and, as we have already observed, this irritation in some cases, extends to the interior surface of the bladder, and even thickens it. We have Their ori- often had occasion to remark that in fibrous structures and canals Counted the most sensible parts are their extremities; and this remark for> tt"d re- is particularly applicable to blenorrhoea, for the portions of the tion. urethra which suffer most from irritation are the interior membrane of the glans and the prostate, particularly the latter, in consequence of its direct connexion with the bladder as well as the urethral canal. On this account, when a patient once labours under spasmodic constrictions from the disease before us, whatever other parts these may exist in, the introduction of a bougie will be almost sure to prove that there is also a constriction in the prostate. Generally Commence speaking it will be found to originate here, and to occur in other [ate,"arid*9 parts of the canal from sympathy. But the case will often be re- ef.tend e» , ,,..,..- •■ - i •, otnerpart?. versed, and while the irritation originates in some other part, or in the Tins rui« bladder, it is by sympathy with these that the prostate itself is affected, aii^e011 Mr. Abernethy has pointed out this double source of spasmodic versed. constriction in the prostate, in the clearest manner possible ;* and Bougie the remarks he has offered upon the propriety of employing or with- available, holding the bougie as an instrument of cure cannot be too deeply "beWirsed. imprinted on every student's mind : the general principle of which is to persevere in its use wherever it appears to blunt the sensibility ; and to pass it as high up the urethra as can be accomplished with this effect, if possible indeed through the prostate into the bladder ; but in every instance to desist where a second or third trial of the instrument gives more pain than the first, or to content ourselves with passing it as high as it can be done without any such symptoms of increased irritation, and there stopping short: and only making an occasional trial when we have reason to hope that the morbid sensibility has still further subsided. M. Ducamp seems to think n^nc€,°e^*' that little benefit is, in any case, to be derived from the use of bougies Ducamp. on wounds ; and that suffering them to remain in the urethra is sure to increase the irritation.! But his attention has been ch.efly * Surgical Observations ©u diseases of the Urethra, p. 194,8vo. 1810. _ t Traitfi des Retentions d'Urine par le R4trecissement de HJrethre, &c. Pans, 8vo, 1812. GO cl. v.j GENETICA. [om>. j. Gen. hi. directed to callosities in the canal; and will be better entitled to BienoCr-IL notice when we come to treat of constrictions of this kind as n rhrea cause of strangurv.* modes. Clap. SPECIES III. BLENORRHCEA CHRONICA. GLEET. SLIMY DISCHARGE FROM THE MUCOUS GLANDS OF THE URETHRA, WITHOUT SPECIFIC VENOM OR INFECTION : SLIGHTLY IRRITATING : CHRONIC. s EN' m* This species is a frequent sequel upon a clap that has been ill- May be a ' managed, or has lasted long, and produced an obstinate local debi- theU°ro°f "ty' **ut ** ex^sts a^so independently of clap, and is occasioned by ceding or strains, excess of venery, and other causes of weakness. The dis- dis>t'aTeary charge is, for the most part, a bland and slimy mucus not accom- Natureof panied with inflammation, apparently proceeding from a morbid cifaigX relaxation of the mucous glands of the urethra, and at times, like other discharges from debilitated organs, accompanied with and kept up by irritation, and especially irritation produced by a stricture in the urethra properly so called, or a diseased state of the prostate gland. aeneraiiy In common cases, the disease yields to the local tonics and astrin- io'cais l° gents recommended under the preceding species, but it is sometimes means peculiarly irritable, and bids defiance to all the ingenuity of the hilt some- medical art. A. Castro gives an instance of its having continued cuTaruT for eighteen years.! intractable. The stimulants ordinarily employed have consisted of copaiba or stimulants, some terebinthinate or resinous balsam in the form of injection; tincture of ipecacuanha, as recommended by Schwediaur; infusion of cantharides, a favourite remedy with Bartholin ; or a blister applied to the urethra, as advised by Mr. John Hunter and several other writers. bougies of The bougie may here be used, for the most part more fearlessly advantage tnan m ^ precetjmg species. Its own simple stimulus, if employed B°rrT a^'with re&ularly once or twice a-day, has often proved sufficient; and where irritants; this fails it may be rendered more active by being smeared with tur- demandg pentine, mercurial ointment, or camphorated liniment; or armed caution, with nitrate of silver, where there are strictures that require it. Even in this species, however, it is a valuable remark of Mr. John Hun- ter, that, before we have recourse to any powerful acuants, we should well weigh the degree of irritability of the patient's constitution; for we may otherwise run a risk of exciting a violent local inflamma- tion, or of extending the irritation to the testes or the bladder. Should Vol. v. Cl. vi. Ord. n Gen. m. Spec. hi. t De Morb. Mill. p. 6fl cl. v.J SEXUAL FUNCTION. [ord. i. bi such an issue unfortunately occur, one of the most salutary injections <*en. HI- we can employ is a solution of the extract of hyoscyamus in water. Bk>norrha?a Even in chordees, which resisted the influence of opium, Mr. Bell chronica. asserts that he has found this medicine advantageous in the quantity it great of from one to three grains at a time, and repeated three times "J""^^ a-day or oftener. Or we may have recourse to a warm hemlock how to bo poultice, applied every night, and made sufficiently large to cover the whole of the periuaeum, testes, and penis. I have known this succeed in taking off an habitual irritation, and with it effectually suppressing the discharge, on the third application, in two instances of more than a twelvemonth's standing ; and this after stimulants of all kinds, and narcotics of many kinds, and particularly opium, had been tried in succession. The leaves were here employed in a fresh state. Nisbet gives an instance of cure, produced by a fresh infec- tion : but this is not a remedy to be recommended either medically or morally. In women this disease is often mistaken for leucorrhoea; we have In women pointed out the distinctive character under the last species. Yet the fimes mis- mistake is not of essential consequence, as the same treatment will [^"r^a. often effect a cure in both. As the vagina, however, is less irritable than the urethra, gleet in females is a less frequent and a less trouble- some complaint than in males. GENUS IV. SPERMORRHCEA. SEMINAL FLUX. INVOLUNTARY EMISSION OF SEMINAL FLUID WITHOUT COPULATION. The generic name is derived from e-wetpa, "sero," " semino;" Gen. IV whence aspermus, "void of seed," gymnospermus, "having the °,J)*ineofic seed naked,"—a term well known in botany ; and hence also nume- name. rous other derivatives of the same kind. Gonorrhoea, which is a why em- direct synonym, would have been retained as the name for this genus, stead of go- as it is retained by Linneus, SagaT, and Frank, but from the con- »»«"««»• fused signification in which it has been employed by Sauvages and Cullen; and from its being usually, though most improperly, applied in the present day to blenorrhoea luodes. The genus offers two varieties as follow: 1. SPERMORRHCEA ENTONICA. ENTONIC SEMINAL FLUX. 2. ----■ ■■ ■----- ATONICA. ATONIC SKMTNAL FLUX. B2 CL. V.j GENETICA. j ORD. I Gen. IV. Spec. I. Necessity of an habi tual subju- gation of the pas- sions. Effects of libidinous indulgence. Sometimes originates from a cor- poreal cause. In such case how to bo treated. SPECIES I. SPERMORRHCEA ENTONICA. ENTONIC SEMINAL FLUX. INVOLUNTARY EMISSION OF PROPER SEMEN WITH ERECTION ; MOSTLY FROM AN INDULGENCE OF LIBIDINOUS IDEAS. The usual cause is assigned in the definition, and it very strikingly points out the influence which the mind bears upon the body, and the necessity of subjecting the passions to the discipline of a chaste and virtuous deportment ; since, as there is no passion more debas- ing than that of gross lust, there is none more mischievous to the general health of the body. It leads the besotted slave straight for- ward to every other sensuality, and, by becoming at length an estab- lished and chronic disease, stupefies the mind, debilitates the body, and is apt to" terminate in hectic fever and tabes. This affection sometimes originates in the body itself: in a local and urgent erethism, produced, as Forestus conjectures,* by a super- abundant secretion of seminal fluid in a constitution of entonic health and vigour. And, as in the former case, the body is to be chastised through the mind, in the present the mind is to be chastised through the body: particularly by purgatives and venesection, a low diet and severe exercise. If, however, the patient be single, as is commonly the case, the pleasantest as well as the most effectual remedy is to be sought for in marriage. Gbn. iv. Spec. II. Singular examples from Sau- vages. SPECIES II. SPERMORRHCEA ATONICA. ATONIC SEMINAL FLUX. INVOLUNTARY EMISSION OF A DILUTE AND NEARLY PELLUOID SEMINAL FLUID ; WITH LIBIDINOUS PROPENSITY BUT WITHOUT ERECTION. Of this species Sauvages gives us two curious examples: one from Deidier, in which the patient was an exemplary monk, who shrunk with horror at the idea of this involuntary self-pollution, as he regarded it: the other a case in his own practice, in which the patient, a most religious young female, was, as he affirms, driven almost to madness under the same erroneous contemplation of the disease. From his having included a female under this genus, it * Lib. xjcvj. Obs. n. i l. v.] SEXUAE FUNCTION. [ord. i. 6*3 should seem that Sauvages inclined to the theory of epigenesis ; or Gen. IV* that which supposes the male and female to contribute* equally a sperm'or- seminal fluid in the act of procreation. It is probable that some rh(Eaa at0" local irritation is the usjual cause. Professor Deidier himself Atonic suspected this in the first of the above cases ; and referred it rather fleu'xmaI to a calculus in the bladder, sympathetically affecting the prostate gland, than to any idiopathic disease of the vesiculae seminales, or the testes. The pious monk found himself most relieved by scourging his legs: a blister applied to the perinseum would probably have re- lieved him still more effectually. The fluid is a thin degenerate secre- Natnre of tion, apparently from the vesiculae seminales, rather than semen itself. ,,1?e £uia + It is sometimes found intermixed with blood; and in this case we have the further irritation of a wound or ruptured vessel. The most ordinary common cause of this miserable disorder is a previous life of unre- ca^se• strained concupiscence: and under this debility, hereby produced, the morbid discharge is peculiarly apt to flow upon the mere muscu- lar excitement that takes place on evacuating the rectum ; and hence follows hard Upon a Stool.* toymen*. A cure should be attempted by the daily use of a bidet of cold sea-water, or of early bathing in the sea, and the internal use of metallic tonics. The bowels should be kept lax, but the warm and irritating purgatives should be carefully abstained from. Blistering the perinaeum, or making a seton in it has occasionally been found serviceable : as has also a local use of electricity. GENUS V. GALACTIA. MISLACTATION. MORBID FLOW OR DEFICIENCY OF MILK. This includes the greater part of those affections, treated of by sL_. 7. Dioscorides, under the name of sparganosis, which, however, in his Svnonyms> arrangement embraced, as we observed under phlegmone mammje,* many complaints that have little or no connexion with each other, and particularly one of the species of bucnemia, or tumid-leg : so that it has been necessary to break up the division and allot to its different members their proper positions. Galactia is a Greek term, from yec*x, u lac," whence yxXetKTtKog, °"g>n of " lacteus." It occurs in Einneus and Vogel for the genus now n'.me6"** before us, which by Sauvages and Sagar is written galactirrhcea, ^j^ff literally " milk-flux," in a morbid sense of the term. The author thora what: has preferred galactia as more comprehensive than galactirrhasa, so * Art. Med. Berol. Dec. i. Vol. iv. p. 70.—WetCjman Dc Po'httione, &c. Goetf 1712. t Vol. n Cl. in. Or' ii, C-n, .'. Sn 64 cl. v.j GENETICA. i.' Gen. V. ag to allow the idea of a depraved or detective, as well as of a j£: superabundant secretion of milk : all which are equally entitled to tion- lie comprised under one common head, as excess, deficiency, or other how far irregularity of arterial action in fever. Hitherto, however, from an frfln gaiac- opposite fault to that of Dioscorides, these affections have been tiQ- separated from each other by many nosologists, and carried to dif- ferent heads, sometimes to different orders, and occasionally to dif- ferent classes ; whence the student has had to hunt for them through every section of the nosological arrangement. It has already been necessary to make the same remark respecting many of the species of paramenia ; and various other instances will occur to us in the ensuing orders of the class we are now explaining. The flow of mUk may become a source of disease as being out of season, defective in quantity, vitiated in quality, transferred to an improper organ, and as discharged from the proper organ but in the male sex. These differences will furnish the present genus with five distinct species as follows : I. GALACTIA PH.EMATURA. 2. -------- DEFECTIVA. 3. -------- DEPRAVATA. 4. -------- ERRATICA. 5. -------- VIRORUM. PREMATURE MILK-FLOW. DEFICIENT MILK-FLOW. DEPRAVED MILK-FLOW. ERRATIC MILK-FLOW. MILK-FLOW IN MALES. SPECIES I. GALACTIA PREMATURA. PREMATURE MILK-FLOW. EFFLUX OF MILK DURING PREGNANCY. GKN. V. Spec. I. Physiologi- cal re- marks. Sympathy with the womb con- tinues after child-birth. Advantage of a wet- nurse living with her husband. The mammae which maintain the closest sympathy with the ovaria, and uterus, and in most animals possessing them, are placed in their direct vicinity, and which in truth are as much entitled to the cha- racter of a sexual organ as any organ of the entire frame, participate in the developement of the generative function from the first stimulus of puberty. It is then that the breasts assume a globose plumpness, and the catamenial flux commences: when pregnancy takes place, and the uterus enlarges, the breasts exhibit a correspondent increase of swell; and when, shortly after child-birth, the lochial discharge ceases, and the uterus takes rest, the lacteal discharge is secreted and poured forth in immediate succession. The sympathy continues, however, even after this rest has commenced, for one of the most effectual means of increasing the flow of milk from the breasts is a slight excitement of the uterus as soon as it has recovered its tone : and hence the mother of an infant living with her husband, and her- self in good health, makes a far better nurse and even requires a less stimulant regimen than a stranger brought from her own family and l. v.J SEXUAL FUNCTION. [obp. i. 65 secluded from her husband's visits. Of this, indeed, many of the Gbn- v- rudest and most barbarous nations, but who are not always inatten- Gaiaetia ' tive to the voice of nature, have the fullest conviction : insomuch pwmatura. that the Scythians, according to Herodotus, and the Hottentots in milk-flow. our own day, irritate the vagina to increase the flow of milk in their Uluslrated' cows and mares. It sometimes happens, however, that this stimulus of sympathy is h«w pro- carried to excess even during pregnancy, and that the lactiferous rauaeturety!" ducts of the mammae secrete milk from the ultimate branches of the arteries sooner than it is wanted. If the quantity thus separated be small it is of no moment; but if it be considerable some degree of Why pre- debility is usually produced with restlessness and pyrexy. And hence mMtan Galen observes, that a premature flow of milk indicates a weakly indication child;* and the collections of medical curiosities contain various iychild. cases, in which it has appeared to be injurious.! Sauvages gives an instance in which a pint and a half was poured forth daily, as early as the fifth month. Where the constitution is peculiarly robust, even this may for some time be borne with as little mischief as menstrua- tion during pregnancy: but in ordinary cases the system must be weakened by so excessive and unprofitable a discharge. There is another instance noticed in the volume of Nosology in which a pint and a half was poured forth daily at the fifth month. The morbid irritation, however, may generally be taken off by Medical venesection, and, if this should not succeed, by a few doses oftreatmcn aperient medicines, which have the double advantage of lowering the action in the affected organ, and exciting a new and revulsive action in an organ that is usually more manageable. It has sometimes happened that a like precocity has occurred in This pre young virgins, and that these also have secreted and discharged milk ^met/mea from the proper organ. In many cases this has occurred as a sub- in y.ouns stitute for the catamenial flux which has been retained or suppressed Cause,' and at the time ;{ but more generally it has proceeded from entonic J^"'^ plethora, or a morbid erethism of the sexual organs at the period of puberty ;§ and is to be removed by a reducent regimen, bleeding, and purgatives, as just pointed out. On the other hand we have occasional instances of a supply of ^k;fldow milk, in women considerably advanced in life, and who have long women ceased to bear children, and even to menstruate. Thus a woman ™*°Jd™ of sixty-eight, is stated by Dr. Stack, in the Philosophical Transac- bearchii- tions, to have given suck to two of her grand-children ;|| and another menstruate. of eighty, in a Swedish Journal, is said to have performed the same illustrated. office. IT In most of these cases the antiquated nurses have consisted Action ac- of married women, who had many years before reared families ofcomx,ed for- their own, and whose lactiferous organs were therefore more easily re-excited to the renewed action, than if they had never suckled. * Fragm. ex Aphor. Rab. Mois. p. 34. t Act. Nat. Cur. Vol. iv. Obi. 66. | De la Corde, Ergo Yirgo, menstruis deficientibus, lac in mammis habere potest ? Paris, 1680. § Hippocr. Aph. Sect. r. § 39. Vega, Comment, in Hippocr. Aph. ▼. § 89. I| Vol. xli. Year 1799. 141. r. rarr m ikfl'" inquires, with some decree of quaintness, whether this organization in'maieT 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 disease. interesting The following, from Captain Franklin's Narrative of his Journey uiustration tQ tne shores 0f the Polar Sea, is a beautiful exemplification of what Franklin. Dr. Parr refers to; and I cannot consent to alter the forcible and seaman-like simplicity of the style in which the story is told. u A young Chipewyan had separated from the rest of his band for the purpose of trenching beaver, when his wife, who was his sole com- panion, and in her first pregnancy, was seized with the pains of labour. She died on the third day after she had given birth to a boy. The husband was inconsolable, and vowed, in his anguish, never to take another woman to wife ; but his grief was soon in some degree absorbed in anxiety for the fate of his infant son. To preserve its life he descended to the office of a nurse, so degrading in the eyes of a Chipewyan, as partaking of the duties of a woman. He swaddled it in soft moss, fed it with broth made from the flesh of the deer ; and, to still its cries, applied it to his breast, praying earnestly to the Great Master of Life to assist his endeavours. The force of the powerful passion by which he was actuated produced the same effect in his case as it has done in some others which are recorded: a flow of milk actually took place from his breast. He succeeded in rearing his child, taught him to be a hunter, and, when he attained the age of manhood, chose him a wife from the tribe. The old man kept his vow in never taking a wife for himself, but he delighted in tending his son's children ; and When his daughter-in-law used to interfere, saying, that it was not the occupation of a man, he was Wont to reply, that he had promised to the Great Master of Life, if his child was spared, never to be proud like the other Indians.—Our informant (Mr. Wenkel, one of the association) added, that he had often seen this Indian in his old age, and that his left breast, even then, retained the unusual size it had acquired in his occupation of nurse."* * P. 157. 4to. Lond. 1825. CLASS V. GENETICA. ORDER II. ORGASTICA. DISEASES AFFECTING THE ORGASM. ORGANIC OR CONSTITUTIONAL INFIRMITY, DISORDERING THE POWER, OR THE DESIRE OF PROCREATING. The ordinal term orgastica, is derived from o^yxa " appeto Class V. impatienter ; proprie de animantibus dicitur, quae turgent libidine." o^^or Scapul. Orgasmus is, hence, used by most writers for salacity in ordinal general; though by Linneus it is employed in a very different sense,tei being restrained to subsultus arteriarum. The following are the genera which appertain to this order : I. CHLOROSIS. II. PRiGOTIA. III. LAGNESIS. IV. AGENESIA. V. APHORIA. VI. £>DOPTOSIS. GREEN-SICKNESS. GENITAL PRECOCITY. LUST. MALE STERILITY. FEMALE STERILITY. GENITAL PROLAPSE. BARRENNESS. GENUS I. CHLOROSIS. GREEN-SICKNESS. « PALE, CHLORID COMPLEXION ; LANGUOR ; LISTLESSNESS; DEPRAVED APPETITE AND DIGESTION : THE SEXUAL SECRETIONS DEPRAVED OR INERT, ESPECIALLY AT THEIR COMMENCEMENT. Chlorosis is a derivative from %***. or #*«», " herba virens ;" <*en. *• whence, among the Greeks, x*etigxftxrii" viror," " pal- generic" lor ;'* evidently applied to the disease,like our own term green-sick-term< ness. from the pale, lurid, and greenish cast of the skin. 72 GL. v.j UENET1CA. [ORD. II. Gen. I. Chlorosis. Green- sickness. General causes. Whether love-sick- ness ever cause: Retained menses and dyspepsy during pu- berty the most com- mon causes: and hence a)! these affections sometimes blended or confounded by nosolo- srists. According to Sauva- ges occurs in infancy. but the cases are thoBB of dyspepsy only. The causes of this disorder are numerous ; one of the most fre- quent is menostation, retained or suppressed catamenia; another is excessive menstruation ; a third, inability of obtaining the object ol 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 developementof the sexual system and the energy ot its secretions is at this time interfered with. Dr. Parr makes it a question whether love-sickness or an ungratified longing for an object of desire is ever a cause ; but the examples are too numerous to give countenance to any doubts upon the subject ;* and pining, eager, ungratified 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 foundation 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 oi 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 complaints that some nosologists have merged it altogether in the first, and others in the second. Dr. Cul- len, so far as relates to his opinion, is an example of the former. Dr. Young, so far as it 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, praetor illam quae retentionem menstruorum comitatur, agnos- cere vellem"—he still continues chlorosis in all the editions of this work as a distinct genus from amenorrhoea, or paramenia obstruc- tionis, 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 pre- valent opinion, but there are various reasons for thinking it is quite as naturally connected with amenorrhoea." Professor Frank has more lately directly arranged it as a subdivision or variety of this last compla nt.t Chlorosis is often, indeed, not only connected with amenorrhcea, but a consequence of it. Yet few writers have felt themselves able to adopt this view 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 ver^e, set down one species under the name of chlorosis infantum. This, however, is to generalize the term too widely, and to make it include all cases marked by indigestion, and a chlorid countenance. Yet 1 cannot but concur with those authors who contend that chlorosis is by no means uncom- * Pauarol. Jatrolog. Pentech. in. Obs. 14.—Ephem. Nat. Cur. Dec. n. Ann. ix. Obs. 114. t De Cur. Horn. Morb. Epitom. Tom. vi. Lib. vi. Par. in. 8ro. Viennw. 1821. i'L. v.J SEXUAL FUNCTION. [ord. ii. t3 mon among females who have no interruption of the menstrual flux: Gen. I. though a derangement of some kind or other in quantity, quality, or Green0-*8' constituent principles appears to be always connected with it; and ™=kHe8s- is for the most part the cause or leading symptom. There is even adult Kfe ground for carrying the term, with other authors, still further, and occJirT applying it to green-sick boys as well as green-sick girls, for reasons ^hera no which will be offered in their proper place. uo'n'ofThe For the present, it is sufficient to characterize chlorosis as a fl,^strual dysthesis or cachexy, produced by a diseased condition of the sexual though je- functions operating upon the system at large, and hence most com- sW^e- mon to the age of puberty, in which this function is first called forth fangement by the complete elaboration of organs that have hitherto been inert tSty orquar and undeveloped. " A certain state of the genitals," says Dr. Cul- Sworot'ic len, and the remark will apply to both sexes equally, is " necessary h<>y^ to give tone and tension to the whole system ; and, therefore, if the ctenlcter. 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-SICKNEsS '2.--------ATONICA. ATONIC GREEN-SICKNESS- SPECIES I. CHLOROSIS ENTONIC A. ENTONIC GREEN-SICKNESS. HABIT PLETHORIC; PAIN IN THE HEAD, BACK, OR LOINS ; FREQI E_\l PALPITATIONS AT TIIE HEART ; FLUSHES IN THE FACE ; PULSE FILL, TENSE, AND FREQUENT. Chlorosis has been commonly confined to the second or atonic Gen- *• species. But the symptoms and mode of treatment of the disease, Necessary' as it appears in a vigorous, florid, and full-bosomed country-girl, ^ifst/h1icstig°[)ne, overflowing with health and hilarity f and in a delicate, pale-faced, cies from emaciated town-girl, debilitated by an indulgence in a course of ^fn|#n" luxurious indolence from her infancy, seem to justify and even demand a distinction. In both cases there is want of energy of mind, great irregularity ^™l?ee in the mental functions, and often a high degree of irritability in the nervous system, clearly proving a very extensive disturbance of the general balance. But they differ in the symptoms enumerated in the JJJgw, 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 Desc^i..- Vol. V—10 ?4 Gen. I. Spec. I. Chlorosis errionica. Entonic green-sick- ness. Pathology. CL. V.J GENETICA. [ORD. II. May termi- nate in the atonic spe- cies- Medical treatment. 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 i.« 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 morbid accu- mulation of living power ; the fabric is satiated or overloaded ; 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 plants there is no efficient de- velopement 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 maturity of the system in females as well as in males, depends upon a develope- ment of the sexual organization in all its powers, and a certain 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 maturity for want of this appropriate stimulus. And if such an effect may occur where there is no concomitant source of excite- ment, 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 irritation 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 venesec- tions will be found necessary: cooling, rather than heating and irri- tant 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 subdued, a plain diet. regular exercise, and sober hours, will easily accomplish the rest '■>••*.] SEXUAL FUNCTION. |»ki». n. ;r, SPECIES II. CHLOROSIS ATONIC A. ATONIC GREEN-SICKNESS. MABIT DEBILITATED ; GREAT INACTIVITY AND LOVE OF INDULGENCE ; DYSPNffiA ON MOVING ; LOWER LIMBS COLD AND EDEMATOUS, ESPE- CIALLY AT NIGHT ; PULSE QUICK AND FEEBLE. In conjunction with the above specific symptoms, there is, in this Gen. I. division of the disease, the same want of energy of mind, and fickle- f Je^ffi*n ll' ness of temper, and corporeal irritability which we have already character. 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 chiefly sober retreats of rural life, marked by simple meals, healthful acti- among the vity, and early hours; but to the gay and glittering routine of town j,"^^' indulgences, and midnight parties, and hot unventilated atmospheres; victims of the havoc of all which is to be seen in the pale, but bloated counte- iffe.,ona nance, the withering form, emaciated muscles, and departing symme- try 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 sacrifice of her person for one half 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 Sometimes sources of exhaustion, have so much constitutional debility and relax- by°a^natu- ation, as to be incapable of bearing the double load of growth and «i debility. sexual developement without manifesting a considerable degree of sickliness in all their functions. In both these cases the disease is probably produced by a chemical Probably a imperfection or want of elaboration in the blood itself, so as not to imperftc- keep pace with the expansion and irritability of the sexual organs ; b,^nintbe and consequently so as not to afford them a pabulum sufficiently rich this species. and ripe for secretion. Here, therefore, bleeding and purgatives would only add to the Medical evil; and it behooves us even from the first to employ a strengthening treatment- and tonic plan, and to extend it through all the departments of diet, exorcise, and medicine : the whole of which, however, mav be col- 76 CL. V.J GENETICA. ORD. II. Gen. I. Spec. II. Chlorosis atonica. Atonic green-sick- ness. Treatment. How far chlorosis may exist in males. Generally admitted among Eastern writers : and the idea adopt- ed by va- rious Euro- pean au- thors. lected from what has already been observed on the genus parame- nia. It is probable that the internal use of iodine either in the form of pills or tincture, amounting to about half a grain to a dose, might in many cases of this modification of the disease be found a very useful stimulant as well as tonic, and prove even of more general service than in simple emansion of the menses. The same kind of debility which prevents the full developement of the sexual organization and a secretion of the sexual juices in grow- ing girls prevails, not unfrequently, in growing boys ; and especially when about the age of puberty the growth is rapid, and outruns 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 occasion- ally been applied to males as well as to females at this unsettled period of life. In the volume of Nosology I have remarked that it is frequently so applied in the East, and especially among Persian writers, who accordingly expressed one subdivision of the disease by the name of bimariy hodek or morbus puerorum. Bonet has followed the oriental extension of the term, and has given instances 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 characters of this malady except that which is peculiar to the female sex. He was treated like the others, and recovered under the use of carbo- nated iron and aloes."* It is on this account that the definition 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 character 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. * Medico.Chir. Trans. Vol. iv. p. 140. "-v.] SEXUAL FUNCTION. [ord. ir. T GENUS II. PRGEOTIA. GENITAL PRECOCITY. PREMATURE DEVELOPEMENT OF SEXUAL ORGANIZATION OR POWER. The generic term prosotia or prceotes is copied from Theophras- Gen# il tus, and derived from v^m, "praemature." It is, however, pecu- liarly applied to premature semination. The genus, as embracing both sexes, comprises the two following species: 1. PR030TIA MASCULINA. MALE PRECOCITY. -•-------FEMININA. FEMALE PRECOCITY. SPECIES I. PRCEOTIA MASCULINA. MALE PRECOCITY. PREMATURE DEVELOPEMENT OF SEXUAL ORGANIZATION IN MALES. Both the mind and body advance in their ordinary career, by slow Gen. II. and almost imperceptible steps to maturity ; faculty after faculty, and ®PEC:*■ function after function puts forth, acquires strength, and becomes pathology. perfected. But it occasionally happens that this ordinary course is Precocity departed from, and that the whole system as well mental as corporeal, dentil and or, which is still more frequent, that particular powers or organs, corporeal push forward with incredible rapidity. The admirable Crichton, as he p°" is commonly called, and others pre-eminently gifted in the same exten- sive way, afford instances of the first of these remarks : 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 precocity should sometimes exhibit itself in the developement of sex- o^aniza- ual organization and power : and that from a peculiar degree of localtion- 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 erection. It is not necessary to dwell upon instances of exemplification, Exempiifi- which may be traced in great numbers in the writings of physiologists catlon* «ho have been curious upon this subject. Those who are desirous i& CL. V. (iKNETICA. [ord. II, Gen. II. 0f doing so, may turn to the Journal des Scavans for 1688, and Uw Philosophical Transactions for 1745. In the former, Boiset 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 onlv a few years since, in a boy who was exhibited by his friends for money to medical practitioners in this metropolis; and may be found, together with various others, minutely described in the first volume of the Medico-Chirurgical Transactions. With respect to moral, or even medical treatment, nothing can be worse than this very common practice of a public exposure when- ever 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 exami- nations, and the polluting tide that exhausts and debases the body, is at length accompanied, even though it should not be so at first, with a polluting pleasure, that in a still greater degree exhausts and de- bases the mind. An occasional application of leeches to the seat of affection,cooling aperients, a cool, loose, and unirritating 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 occasions : and, by pro- ducing 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 puberty. Spec Proeotia maaculina Male pre- cocity. Mischief of a public exposure of the person under these circum- stances. Remedial treatment. SPECIES II. PRGEOTIA FEMININA. FEMALE PRECOCITY. PREMATURE DEVELOPEMENT OP SEXUAL ORGANIZATION IN FEMALES. Gen. II. Under the species of obstructed menstruation, we have observed General11" tnat tn*s secreti°n which commonly affords a proof that the sexual physioiogi- organization is developed, and its function completed, takes place marks". 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.* ThePraeient There is hence no difficulty in conceiving that, under the influ- readily ence of the same kind of local erethism we have noticed in the accounted preceding species, the sexual organization in females may acquire a similar precocity to that in males. And so complete has been the Waltber. Thes. Obs. 40. ol. v.J SEXUAL FUNCTION. [ord. h. 79 developement occasionally, that we have numerous and well authenti- Gen. II. cated instances of pregnancy itself occurring at the early age of nine p"^ "' years, on which we shall have to remark more fully in the introduc- 'eminina. tory observations to the third Order of the present Class, when treat- precocity. ing of morbid impregnation. This foremarch of nature should be timely checked, for it will ™e mor- otherwise assuredly lead to a very great debility of the system in position To general, and is usually found to stint the stature, and induce a pre- checked- 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 not always always seem to be connected with any cupidinous orgasm, or at least ^.th any1 it has occurred under circumstances that render it extremely difficult cupidinous to entertain any such idea. One of the most singular instances of Exempli- this kind is a case of extra-uterine fetation communicated by Dr. fied' Baillie to the Royal Society, and published in their Transactions 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 Example peculiar irritation had been excited to the rudimental process of an exv a" imperfect conception, and that it had, in consequence, been separated from its niche, and a corpus luteum taken its place. In the Physio- logical Proem to the present Class, we have observed that such changes are occasionally met with in mature virgins whose organs have offered ample proof of freedom from sexual commerce, 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 desire, and that such feeling has been a sufficient excitement to produce 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 cause. * Phil. Trans. Vol. lxxix. p. 71. 80 cl. v.] GENETICA. \o*d. u. GENUS III. LAGNESIS. LUST. INORDINATE DESIRE OF SEXUAL COMMERCE, WITH ORGANIC TURGES- CENCE AND ERECTION. Gen. III. Lagnesis is a derivative from teym, " libidinosus ;" " prceceps in ?erner?c°f venerem ;" and, as a genus, is intended to include the satyriasis term. and nymphomania of Sauvages, and later authors ; which, chiefly, if synonyms. not entn.giVi differ from eacn 0ther only as appertaining to the male or female sex, and in their symptoms do not, like the preceding genus, offer ground for two distinct species. The proper species belonging to this genus are the following : 1. lagnesis salacitas. salacity. 2.-------furor. lascivious madness. SPECIES I. LAGNESIS SALACITAS. SALACITY. THE APPETENCY CAPABLE OF RESTRAINT ; THE EXCITEMENT CHIEFLY CONFINED TO THE SEXUAL SYSTEM, Gen. hi. In a state of health and civilized society there are two reasons Spec. I. wnv mankind are easily capable of restraining within due bounds the cai re- animal desire that exists in their frame from the period of puberty till marks. tne mfjrmity 0f age. the one is of a physical, and the other of a moral ordinary kind. The natural orgasm of men differs from that of brutes in being causes of 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 inculcation of a principle of absti- nence and chastity in civilized life, form a moral cause of temperance that operates with a still stronger influence than the preceding, and lays down a barrier, which, though too often stealthily broken into, y.t, in the main, makes good its post and serves as a general check upon society. temperance. ci. v.J SEXUAL FUNCTION. [ord. u. SI As man rises in education and moral feeling, he proportionally rises Gen^ III. in the power of self-restraint; and consequently, as he becomes Lagnesis' deprived of this wholesome law of discipline, he sinks into self-in- ^In- dulgence and the brutality of savage life. And were it not that the Hence less very permanency of the desire, as we have already observed, torpefies lavage and wears out its goad, the savage, destitute of moral discipline, would >'fe: be at all times as ferocious in his libidinous career as brutes are in the season of returning heat ; when, stung with the periodical ™donn°nehe ardour, and worked up almost to fury, the whole frame of the animal lcWciass- is actuated with an unbridled force, his motions are quick and rapid, |ni°^als. his eyes glisten, and his nerves seem to circulate fire. Food is ne- glected ; 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 :* Nonne vides ut tota tremor pertentet cquorum Corpora, si tantum notas odor attulit auras ? Ac neque eos jam frtena virum, neque yerbera sjeva, Non scopuli, rupesque car*, atque objecta retardant Flumina, correptos unda torquentia montes.f The power of restraint, however, does not operate alike on all Jof£*»*v persons even in the same state of society, and under a common disci- obtained in pline. Period of life, constitution, and habit, produce a considerable "^p™ difference in this respect, and lay a foundation for the four following periods of varieties of morbid salacity : « Pubertatis. Salacity of youth. 0 Senilis. -------of age. y Entonica. -------of full habit. «r Assueta. -------of a debauched life. The first variety proceeds not so much from organic turges- «l. Sau- cence, as from local irritability : for it is chiefly found in relaxed and bertatis.* delicate frames, weakened by overgrowth, or a life of indolence and suabae^of indulgence. The action is new, and where, from whatever cause, iwhokgy. the irritability is more than ordinary, a degree of excitement is pro- fre^en°8irij duced which shows itself constitutionally or topically. If in the relaxed former way, hysteria or chorea, or some other nervous affection, is a very frequent effect: if in the latter, a high-wrought and distressing degree of appetency. It is under this state that females are said to be capable of separating ovula from their ovaries, and of forming corpora lutea without copulative perculsion, in the same manner as the ovaries of quadrupeds that are only capable of breeding in a cer- tain season of the year, exhibit, during their heat, manifest proofs ot excitement and especially of florid redness, when examined by dissec- tion I do not think the assertion concerning women is altogether established : but in the case of young men when entering upon, or emerging from pubescence, and of the relaxed and delicate tranw * See Crichton on Mental Derangement, n. p- 501, t Virg. Georg. Lib. in. 250. Vol. V.—1 1 frl CL. V.j GENETICA. [ORD. Gen. III. jUst noticed, nothing is more oPEC. I. _—j nnminol omicaiAn fliirincr a Remedial treatment. ,« L. Sala- citas seni- lis. aj» Causes „ common than involuntary erection ,ala[' and seminal emission during sleep, often connected with a tram ot citas puber- amorous ideas excited by the local stimulus, as we have already ob- saiacity of served under paroniria salax.* some^mes Jt is possiDle tnat this affection may occasionally be a resu t as is rarely the case however, the mind should at length Puror.6'3 become affected, it is rather by a transfer of the morbid irritation maanevss°.us 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 Wind suf- their maniacal ideas. In lascivious madness, on the contrary, this an «ten- ^ast symptom continues in its utmost urgency, all self-command is sionofthe broken down, the judgment is overpowered, the imagination en- ratheruian kindled and predominant, and the patient is hurried forward by the ofmorbid concupiscent fury like the brute creation in the season of heat, re- action, gardless 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. Pescrip- 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 con- nected 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 demand for a flow of milk, the fluid was repelled from the breasts with too little caution, and the uterine region, from the debility 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 degree 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. Sr°oducedes •Ir? SOme cases lt lias unquestionaDly proceeded from the perpetual by theCfric- friction of an enormous clitoris, making an approach, from its erec- enonrrnousn tion'to what Galen cal]s a female Papism. BQchner, Schurig,| clitoris. and Zacutus LusitanusJ give 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 n source of constant irritation. ureement In hot climates this kind of enlargement and elongation is by no frefuenun means uncommon, and, as it becomes a source of uncleanliness, as mates'" and W- aS of undue excitement, circumcision or a reduction of the clitoris at times re- to us proper size, has been often performed with advantage. The drcumc!^ same operation has been proposed for the case before us, and, in tataS* Mme™*nces, it has succeeded completely. » A young woman," performed says Mr. Uicherand," was so violently affected with this disease as cT& to.^ave ^course to masturbation, which was always accompanied Kr a Fr"se «missions15 a^ which she repeated so frequently as to > w. reduce hersetf to the last stage of marasmus. Though sensible of the danger of her situation, *he was not possessed of felf-command I62I.DeUu8'Adm8 Fascie''' Belol>Furw Ute*»*. Melajcholicus Effect™, Pari.. t Gyaacolog. p. 2.17. j Prax, Adnkt Jjibj ^ obg# 9J> UJ..V.J SEXUAL FUNCTION. [ord.ii. x» enough to resist the orgastic urgency. Her parents took her to Pro- Ges- hi« fessor Dubois, who, upon the authority of Levret, proposed an ampu- La^Ie'sis tation of the clitoris, which was readily assented to. The organ Furor. _ was removed by a single stroke of the bistoury, and all hemorrhage madness.1 a prevented by an application of the cautery. The wound healed easily, and the patient obtained a radical cure of her distressing affec- tion."* Where the cause cannot be easily ascertained we must employ a General general plan of cure. If there be plethora or constitutional fulness, venesection should never be omitted; and, in most cases, cooling lax- atives, 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 narcotics. Cam- phor, 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, Satyriasis. Vogel has arranged both satyriasis and nymphomania as species of mania. mania. But this is incorrect; the fury of the mind is merely symp- tomatic. Parr, on the contrary, has ranked it under lagnesis, to which, with great perversion, he applies the term hallucinatio eroto- mania or love-sickness, more properly a variety of empathema desi- derii, 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- Lo^e *'°k" citing cause, and its symptoms may be united with the complaint, casionai and even add to the general effect, of which the History of the Aca- *0r^re demy of Sciences affords an instance :f but in itself, it is, as we have cause. 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 \f™]°£" females: Bartholin gives an example of a hundred pollutions daily. pollutions daily. * Richerand, Nosograpliie Chirurgicale, &c. t Arm. 1764. p. 26. *•"> CL. V.] gi;m:tica. [ultn. 11 GENUS IV. AGENESIA. MALE STERILITY. INABILITY TO BEGET OFFSPRING. Ges. IV. The generic term is a compound from ot, negative, and ympiut. the*e°f- "to beget," and will be found to comprehend the three following t^nn.8"8'1 species, derived from impotency of power or energy ; an imperfect emission where the power is adequate; or an incongruity in the copulative influences or fluids upon each other. 1. agenesia impotens. male impotencv. 2.--------dysspermia. seminal mis-emission. 3.--------incongrua. copulative incongruity. A hke Among plants we sometimes meet with a like generative disability; sJmeUmes occasionally from imperfectly formed styles or stigmas, stamens or among anthers; sometimes from a suppression of farina, and sometimes plants. fI0m a tQtaj destitution of seeds; which last defect is common to bromelia Ananas; musa paradisiaca, or Banyan ; artocarpus incisa or bread-fruit tree; and berberis vulgaris or common ber- herrv. -SPECIES I. AGENESIA IMPOTENS. MALE IMPOTENCY. IMPERFECTION OR ABOLITION OF GENERATIVE POWER. Gen. IV, The species before us is, perhaps, more generally called by the The^n' -" nosologists anaphrodisia, though this last term has been used in very phrodisia different senses ; sometimes importing a want of desire, sometimes aiuiiors! inability, sometimes both ; and sometimes only a particular kind of inability resulting from atony alone. The third species has never, hitherto, so far as the author knows, been introduced into any noso- logical arrangement, although the reader will probably find, as he proceeds, sufficient ground for its admission. And even the first and second, closely as they are connected by nature, have rarely, if ever, been introduced before under the same common division, but been regarded as distinct genera belonging to distant orders or even cl. v.j SEXUAL FUNCTION. [ord. n. Bi classes, and arranged with diseases that have little or no relation to ^.^J,IVa them, of which numerous examples are given in the volume of Agenesia' Nosology. Milelmpo- Impotency in males may proceed from two very distinct causes, tency. showing themselves in very different ways, and laying a foundation for the following varieties : » Atonica. Atonic impotency. (3 Organica. Organic impotency. In the first of these there is a direct imbecility, or want of tone; ^*™~ produced chiefly by excess of indulgence, long-continued gleet, or atonica. a paralytic affection of the generative organs. It has also been AJ°enncy.m" occasioned by a violent contusion on the loins, or a fall on the ca°nmraon Under the two last causes a cure is often effected by time, and *<^rf local tonics and stimulants, especially cold-bathing : and the same when from process will frequently succeed where the weakness has followed fj*^.01 upon a chronic gleet: in which we may also employ the course of jury. remedies which have already been recommended for this complaint.! Where the impotency results from a paresis or paralysis of the J»™J*g.°r local nerves, or has been brought on by a life of debauchery, the case nearly is nearly hopeless. We have heard much of aphrodisiacs, but there )?$$£ is none on which we can depend in effects of this kind. Wine, ™£e«w.|h. which is the ordinary stimulant in the case before us, will rarely sue- ont a lhills. ceed even in a single instance, and where it has done so, it has in- creased the debility afterwards. It is, in truth, one of the most com- mon causes of the disease itself. Cantharides have often been employed, but in the present day cantha- they are deservedly distrusted, and flourish rather in proverbs than in practice. Their effect, as a local stimulant, shows itself rather on the bladder and prostate gland than on the testes, and as a general irritant in increasing the heat and action of the whole system, in which the testes may, perhaps, sometimes have participated. " They are," says Dr. Cullen, " a stimulant and heating substance, and I have had occasion to know them, taken in large quantity as an aphrodisiac, to have excited violent pains in the stomach, and a feverish state over the whole body."J Many of the verticillate plants, as mint and pennyroyal, have been Verfciiiate tried in a concentrated state for the same purpose, but with different, and even opposite effects, in the hands of different practitioners. To the present hour thev are supposed by many to stimulate the uterus specificallv. while they take off the venereal appetency in males. Upon sober and impartial trials, however, they seem to be equally guiltless of both : and may as readily be relinquished for such pur- N«to of poses as the nests of the Java swallow, which are purchased at a swa!loW, high price as a powerful incentive, and form an extensive article of commerce in the East. * Hildan. Cent. vi. Obs. 59. ! Art. Nat. Cur, Vol. v. Obs. 59. Mat. Med. lol. ii. p. 663 sions. 88 cl. v.J GENETICA, t^0- «■ Gem. IV. The best aphrodisiacs are warm and general tonics, as the stimu- «SA.Eim£i-lant bitters, and the metallic salts, especially the preparations of iron. tens nto- Ginseng, as an aromatic bitter, has a just claim to a further trial than Atonic im- it seems hitherto to have received. In China it has for ages been in B°csetnaCphro- high esteem, not only as a general restorative and roborant, but parti- disiacs to- cularly in seminal debilities. Dr. Cullen appears to have thrown it rerenf d'f~ out of practice by telling us that he knew " a gentleman a little ad- kinds, vanced in life, who chewed a quantity of this root every day for its pretfn- several years, but who acknowledged that he never found his venereal faculties in the least improved by it" This is no doubt true, but the merits of a medicine are not to be decided by a single experiment of so very loose a kind. Local Local irritants, in many cases, have undoubtedly been of use, as blisters, caustics, and setons. Electricity is said to have been still more extensively serviceable ; and friction with ammoniated oil or spirits, or any other rubefacient, is fairly entitled to a trial. Stinging with nettle-leaves (urtica urens) was, at one time, a popular remedy, and flagellation of the loins* or nates,t or both, still more so. The principle is the same, and we hence account for the success which is said to have attended all these in particular cases. (> a. impo- In organic impotency, forming our second variety, the chance of tens organ- succegg jg generaj]y hopeless. This proceeds from a misformation °orferieCim or misorl?arnzation of the parts, either natural or accidental: as an Causes. amputated, injured, or enormous penis, or a defect or destitution of the testes. Plater introduces brevity or exility of the penisj among the causes, but these evils are generally overcome by habit. An in- curvated, retracted, or otherwise distorted form is also mentioned by many writers, but these seem rather to belong to the ensuing species. An unaccommodating bulk of the organ seems to have been no un- common cause. § Schenck gives an instance of this kind in which the bulk was produced by the monstrosity of a double penis ;|| and Albinus relates a case of a divorce obtained against a husband, from inability to enter the vagina obpenem inormem.^ A similar litigation with divorce is recorded by Plater.** How far a It has been doubted whether a retention of the testes in the abdo- thoetes?es" men, or in the path of their descent, will necessarily produce impo- se iu°~ ter»cy. Swediaur distinctly affirms that impotency is not a conse- quence, and points out the importance of rightly distinguishing between a real and an apparent deficiency in respect to the one or the other of these two cases.ft * Meibom. de Flagrorum nsu in re Venerea. t Riedlin, Linn. Med. 1696. p. 6. I Observ. Libr. i. pp. 249. 250. 8 Schurig. Gyntecolog. p. 226. Wadel, Pathol. Sect. in. p. 11. H Obserr. Lib. iv. N. 2. 8. IT Dissert, de Inspectione corporis, forensis, in causis matrimoniaiibus fallacious et dubiis. Hall. 1740. ♦* Obserr. Lib. i. p. 250. tt Nov. Nosol. Syst. Vol. n. p. S5I. w.. v.j SEXUAL FUNCTION. I'okd. ii. 89 SPECIES II. AGENESIA DYSSPERMIA. SEMINAL MISEMISSION. IMPERFECT EMISSION OF THE SEMINAL FETJID. This is the dysspermatismus, or, as it is usually but incorrectly Gen. IV. spelt, dy-spermatismus of authors. The termination is varied, not [wp"rF" merely on account of greater brevity and simplicity, but in conformity matismus with the parallel Greek compounds, polyspermia, gymnospermia, author* aspermia, terms well known to every botanist, and the two former of which are elegantly introduced into the Linnean vocabulary. Imperfection or defect of emission proceeds from numerous causes, accompanied with some change of symptbms as appertaining to each, and hence laying a foundation for the following varieties : x Entonica. The imperfect emission proceeding from Entonic misemission. super-erection or priapism. p Epileptica. Rendered imperfect by the incursion of Epileptic misemission. an epileptic spasm produced by sexual excitement during the intercourse. y Anticipans. The discharge ejected hastily, prema- Anticipating misemis- turely, and without due adjustment. sion. $ Cunctans. The discharge unduly retarded from hebe- Retarding misemis- tude of the genital organs : and hence sion. not accomplished till the orgasm, on the part of the female, has subsided. e Refluens. The discharge thrown back into the vesi- Refluent misemission. culae seminales or the bladder, before it reaches the extremity of the penis. Of the? first, or entonic variety, examples are by no means ^AJ^seri uncommon. Dr. Cockburn gives an instance in a young noble tonica. Venetian, who, though married to a fine and healthy young lady, had |^° ■£. no seminal emission in the act of union, notwithstanding there was •»£ , a vigorous erection, whilst he could discharge very freely in his ^"mpii- dreams.* He was greatly afflicted, as were also his family, by such fied- a misfortune ; and as no remedy could be devised at home, the Venetian ambassadors resident at the different courts of Europe, were requested to consult the most eminent physicians in their various quarters. The case came in this manner under the notice of Dr. Cockburn, who, hitting accurately upon the cause of the retention. and ascribing it to the violence of the erection, or rather to the ple- * See a similar case in Marcel, Donat. Lib. it. Cap. 18, Vol, V.—12 yo ex. \.j GENETIC A. [ORD. n. Gen. IV. Spec. II. a A. Dys- spermia entonica. Entonic misemis- sion. Additional illustration. ,^A.»ys- spermia epileplica. Epileptic misemis- sion. Cause ex- plained. Exempli- fied. Celibacy adviseahle. Where married, abstinence at particu- lar periods. y A. Uys- spermiu anticipnns. Anticipat- ing mise- mission. General- cause and mode ot" treal- tn, nt. thora of the vessels of the penis, whose distention produced a tem- porary imperforation of the urethra, so that the powers which threw out the semen could not overcome the resistance, an effect which probably did not occur in dreaming, advised purgative medicines and a slender diet, which soon produced the desired issue.* I remember, many years ago, a healthy young couple who conti- nued without offspring for seven or eight years after marriage, at which period the lady, for the first time, became pregnant, and con- tinued to add to her family every year till she had six or seven chil- dren ; and in professional conversation with the father, he has clearly made it appear to me that the cause of sterility, during the above period, was the mordid 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 despaired 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 pre- disposed to epilepsy, are, for the most part, of a highly irritable habit; and wherever the predisposition exists, any accidental excite- ment, 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 embrace. 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.J Morgagni§ and Sinbalduslj 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 com- merce 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 ejaculatio intempestiva,^ and are equally entitled to this character : while the former is, by Schenck, denominated ejaculatio prematura.** The anticipating or premature variety evinces great nervous irrita- bility 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 I ffiiftiS: ML. P. leit Voh "'•Syspafcia E^ia> p- ««■ \ S^ajSTSJ?.^ P$K£ A?nbt 1T95 !1 °™**#* p. «4 "* Obserr. Lib. iv.Obs. 46. vx.v.j SEXUAL FUNCTION. [ord.ii. 91 power. In some cases, the afflux has been so quick as to take place Gen. IV. even before the vagina has been fairly entered. PEC' " The fourth or retarding variety forms a perfect contrast to ' a. 055- the preceding. It imports a sluggishness eitherof constitution or of cuncTans. local erethism, in consequence of which the seminal flow does not ^l^ls take place till the orgasm of the female has subsided, and fatigue, sion. perhaps disgust, has succeeded to desire. Here too, general tonics na*a.w and local stimulants offer the fairest chance of success ; and both M»«Jeof .j,,-,.. , . _'.. treatment sting-nettles* and flagellations,! as in some cases ot 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£ A- *?ys> M. Petit,j whose description has been copied by Sauvages. " It refluent. consists," he tells us, " in a reflux of the semen into the bladder or j^"""1 vesiculae seminales, on account of the narrowness of the urethra, in sion. consequence of which there is no semination during the interunion, du°ced^r° and the semen is afterwards discharged with the urine." This narrowness is common to those who have suffered from fire- vv.he,re quent blenorrhoeas, and have hence contracted strictures or scirrhous f0Und? "ndurations in the course of the urethral passage, or have the passage blocked up with indurated mucus. Deidier gives a case not very sa^ufJ.*rra unlike, consisting of a patient who laboured under a fistula opening Deidier. from the vesiculae seminales into the rectum ; in consequence 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 quan- tity of urine ; and hence his marriage was sterile.§ In all these cases the cure of the impotency must depend upon a Medical cure of the local cause of constriction. The dyspermatismus ure- lreatracn<" thralis, 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. COPULATIVE INCONGRUITY. 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 Gen. IV. the first two that have hitherto been noticed by nosologists : nor is The gp'ecie; there any preceding system that I am aware of, under Which even ~™- arrange- * Epta. Nat. Cur. Dec. n. Ann. v. APP. p 55. « hgp t Meibom, and Rtedlin, loc. citat. rWnlt r ' Memoires de 1'Acadamie de Chirtmrie, i. p. 434. * Tom. m. Consult, i. 9:2 cl. v.] CENETICA. (.<"«>• »■ separated the co-spe cies vory remotely. This spe- observa- tions and incidental liintg. Gen. IV. ^hese two have been introduced into the same subdivision. In almost Amnesia11' every instance, indeed, they have beon regarded as distinct genera ineongrua belonging to distant orders or even classes, and arranged with dis- Pncongrouy eases &that have little or no relation to them. Thus, in Sauvages, hitherto 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 dysspermatismus is carried forward to the third order of his ninth class. In Cullen these dis- eases occur, indeed, in the same class, a very improper one, that of locales, but under different orders of this class ; impotentia being arranged under the second order, with the morbid cravings of the alimentary canal, and some of those of the mind, as nostalgia ; and dysspermia being placed under the fifth order entitled epischeses or SUPPRESSIONS. The present species is, for the first time, so far ■ as the author fromdfciuea1 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 doctrine of conception, and has been already explained in the Physiological 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 pro-* priety of its introduction into the general register. Every one must have noticed occasional instances in which a hus- band 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 pro- geny. In all this there seems to be an incongruity, 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 medi- cal, have not often adverted to this subject, though it is appealed to and for the most part with approbation, by physiologists of all ages and countries. Sauvages, however, evidently alludes to and admits such a cause in his definition of disspermatismus serosus, which is as follows: " Ejaculatio seminis aquosioris, adeoque ad genesim inepti^ quae species est frequentissimum sterilitatis virilis princi- pium." 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 Etmuller. Cullen expresses himself doubtfully upon this species," Dedysspermatismo seroso Sauvagesii," says he, » mihi non satis constat." Yet his own gonorrhoea laxorum, m the present system spermorrhcea atonica, and which he explain* " humor plerumque pellucidus, sine penis erectione, sed cum libidine m vigilante, ex urethra fluit," makes so near an approach to it General physiology. Dyssper- matismus serosus of Sauvages. Gonorrhoea says he, laxorum of - vL.v.} SEXUAL FUNCTION. [ord. n. dS that the physiologist who admits the one can find little difficulty in Gen. IV. admitting the other. The resemblance is, indeed, close and striking; Agenesia in the latter disease the individual labouring under it, emits involun- j" congrua. tarily, and without coition, or even erection, but with a libidinous inc'on-a lV sensation, a pellucid fluid, apparently of a seminal character, affirmed s""1?1 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 erec- tion, is poured forth during coition. In like manner, Forestus speaks of a proper gonorrhoea', or invo- Further luntary emission of seminal fluid, produced ex aquositate,* from too ,llu!rtrate ' watery a condition of the secretion: Timasus, of the same disease occasioned ex semine acri,] by a secretion of an acrimonious semen: and Hornung, of hysterics occasioned in married women who are sterile from an " immissio frigidi seminis :"f 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- Pathoiogi- hensive view of the subject, by supposing that the seminal fluid may ^atfdnT be secreted, not merely in a state of morbid diluteness, but, under applied to various modifications, even in.a state of health, of such a condition BpecMw*e as to render it inadequate to the purposes of generation in female ™*c*a cs" idiosyncrasies of certain kinds, while it may be perfectly adequate pointed in those of other kinds. In agricultural language, it supposes that out' the respective seed may not be adapted to the respective soil, how- ever sound in itself. So, Parr tell 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 Mode of 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 particularly the use of the bidet or local cold-bath. With these may be com- bined the warm and stimulant resins and balsams, as guaiacum, tur- pentine, copaiba ; and the oxydes of iron, zinc, and silver. Abstinence by consent, for many months, has, however, proved a more frequent remedy than any other, and especially where the inter* course has been so incessantly repeated as to break down the stami- nal strength: and hence the separation produced by a voyage to India has often proved successful. * Lib. xxvi. Obs. 12. t Cas. p. 188. t Cista. p. 467. 5 Opp. I. p. 120. || Spermatologia, p. 21. * Obserr. Rar. N. 10. ** Diss. Art. Anaphrodisia. 04 CL. v. tpu " fero," " pario," is a term in common use among the Greek writers. It is singular that the morbid condition it imports has no dis- tinct 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 has the genus any one species that expressly applies to female barrenness. The proper species belonging to it are the following :— 1. aphoria impotens. 2.------paramenica. 3.------impercita. 4.------incongrua. BARRENNESS OF IMPOTENCY. BARRENNESS OF MISMENSTRUATION. BARRENNESS OE IRRESPONDENCE. BARRENNESS OF INCONGRUITY. SPECIES I. APHORIA IMPOTENS. BARRENNESS OF IMPOTENCY. IMPERFECTION OR ABOLITION OF CONCEPTIVE POWER. Gen. V. This species runs precisely parallel with the same disease in males Spec. I. ajready described under agenesia impotens, and consequently offer? us the two following varieties : <* A. Impo- tens atoni- ca. Atonic barrenness. Causes, x Atonica. /3 Organica. Atonic barrenness. Organic barrenness. In atonic barrenness there is a direct imbecility or want of tone, 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 leucorrhoea, or paralytic affection of the generative organs. It has also been occasioned by violent con- tusions in the loins, or the hypogastric region, and by over-exertion in walking. «-'*.. v.j SEXUAL FUNCTION. [ord. ii. 95 The plan of treatment is to be the same as already laid down under gen. iv atonic sterility or impotency in males, yet it is seldom that any treat- tts"£ "; ment has afforded success under this variety. tens aton> Organic barrenness is produced by some structural hinderance Atonic or defect, whether natural or accidental. And this may be of vari- T/era™t ous kinds: for the vagina may be imperforate and prohibit not only (3 a impo- all intermission of semen, but an entrance of the penis itself. The ^ic™" ovaria may be defective, or even altogether wanting, or not duly J0'**™0 developed, or destitute of ovula ; or the fimbriae may be defective, causes. *" and incapable of grasping the uterus ; or the Fallopian tube may be obstructed, or impervious, or wanting ; in all which cases barrenness must necessarily ensue. In the case of an impervious vagina, how- Conception ever, unless there be a total occlusion, conception will sometimes inYnlra-"1 follow: for it has occurred where the passage has been so narrow as ^n°auff not to admit the penis ; and occasionally indeed, when, with the the occiu- same impediment, a rigid and unbroken hymen has offered an addi- total!'6 not tional obstacle, of which the medical records contain abundant exam- ples. Ruyset, gives us a singular case of a hymen found unbroken 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 Rut the us, is, in common cases, a sufficient bar not only to conception, but rarempleS to copulation. The author was lately consulted by a very amiable illustrated, 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 successful issue. The lady was reluctant to submit herself to the hands of a surgeon, and hence with equal courage and judgment became her own operator. The impediment was completely re- moved, and she has since had several children. In a few instances, however, this will not answer, for there is a Vngina it- natural narrowness or stricture, sometimes found in the vagina, times na- which cannot be overcome, at least without a severer operation than J,"1*"* "^ most women would be induced to submit to; that I mean of laying narrowed it open through the whole length of the contraction. A sponge tent, Jre* st"c however, gradually enlarged, or a bougie, has sometimes succeeded. Remediai cs • • * c v 1 .• c ■ ■ process. bung gives an account ot a dissolution ot marriage in consequence of an impediment of this kind.* * (lynaecolog. p. 223. 96 VL. V.J GENETICA. foRD. 11. SPECIES II. APHORIA PARAMENICA. BARRENNESS OF MISMENSTRUATION. fcrEN. V. Sfec. II. Menstrua- tion not absolutely necessary to impreg- nation. Explained. But a flow of caiame- nia neces- sary. where once established: and hence menosta- tion a cause of barren- ness : Difficult menstrua- tion a cause, and why. Profuse menstrua- tion a cause, and v.hy. CATAMENIAL DISCHARGE MORBIDLY RETAINED, SECRETED WITH DIFFICULTY, OR IN PROFUSION. It is not always necessary to impregnation that a female should menstruate: for we have already observed* that a retention of menses, 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 developement, or proper erethism of the ovaries, and menstruation is delayed 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 organs are in a condi- tion to elaborate this secretion, yet if such condition take place after marriage, impregnation may instantly succeed and prohibit or post- pone the efflux which would otherwise take place, j But where there is a manifest retention of the catamenial flux pro- ducing 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 accidentally commence, the very next paroxysm of distressing pain puts a total end to all hope by separating the germ from the uterus. 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 generally the case, intermixed with genuine blood, there is as little chance of conception as in difficult menstruation. The organs are too debili- tated for the new process ; and not unfrequently there is as little de- sire as there is elasticity. * Vol.V. Paramenia obstructionis, p. 32. t Class v. Ord. hi. Caxpotica, introductory remarks cl. v.J SEXUAL FUNCTION. [ord. n. 07 Having thus pointed out the general causes and physiology of bar- Gen. V. renness when a result of mismenstruation, it will be obvious that Aphoria"' the cure must depend upon a cure of the particular kind of morbid g^™™1' affection that operates at the time and lays a foundation for the dis- of mlsmen- ease, of all which we have already treated under the different species Mode''™' of the genus paramenia, and need not repeat what is there laid treatment. down. SPECIES III. APHORIA IMPERCITA. BARRENNESS OF IRRESPONDENCE. STERILITY PRODUCED BY PERSONAL AVERSION OR WANT OF APPETENCY. It is not perhaps altogether impossible, that impregnation should Gen. V. take place in the case of a rape, or where there is a great repug- impregna?' nancy on the part of the female, for there may be so high a tone oftion may constitutional orgasm as to be beyond the control of the individual uanderPa who is thus forced, and not to be repressed even by a virtuous recoil, xhe'effect and a sense of horror at the time. But this is a possible rather than possible an actual case, and though the remark may be sufficient to suspend particular a charge of criminality, the infamy can only be completely wiped ™drti°t£_ away by collateral circumstances. tion; but In ordinary instances, rude, brutal force is never found to succeed anZmo'sUy against the consent of the violated person. And for the same rea- t^j"18- son, wherever there is a personal aversion, a coldness, or reserve, in- Aversion, stead of an appetency and pleasure, an irrespondence in the feelings J""rnveeM'or of the female to those of the male, we have as little reason to hope prohibit for a parturient issue. There must be an orgastic shock, or per- ^whyr' culsion 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. So observes the first didactic poet of ancient Rome, addressing himself to the Generative Power, in the language not of the voluptuary but of the physiologist: —per maria, ac monteis, fluviosque rapaceis Frundiferasque domos avium, camposque virenteis. Omnibus incutiens blandura per pectora amorem, Ecftcis, ut cupide generatim secla propagant.* So through the seas, the mountains, and the floods, The verdant meads, and woodlands fill'd with song, Spurr'd by desire each palpitating tribe Hastes, at thy shrine, to plant the future race. * PeRer. Nat. i. 17. Vol.. V.—13 96 CL. v.J GENETICA [ORD. II. Gen. V. The cause is clear, and the effect certain, but it is a disease un- AphoVia1"' medicable by the healing art, and can only be attacked by a kind, impercita. assiduous, and winning attention, which, however slighted at first, of"renness will imperceptibly work into the cold and stony heart, as the drops of ife°nnceesnuf- rain work into the pavement. It should teach us, however, the folly ficient 0f forming family connexions and endeavouring to keep up a family the pnrfse°nrt name where the feelings of affection are not engaged on both sicks. species. Important ^^^^ lesson to be ,,1,*,**,: learnt from the above f et* SPECIES IV. APHORIA INCONGRUA. BARRENNESS OF INCONGRUITY. TIIE CONCEPTIVE POWER INACCORDANT WITH THE CONSTITUENT PRINCIPLES OF THE SEMINAL FLUID RECEIVED ON THE PART OF THE MALE. Gen. v. This species runs precisely parallel with the third under the pre- prKii'iIV* ceding genus agenesia incongrua, and the physiological and thera- with age- peutic remarks there offered will equally apply to the present place. nesia in- .. congrua in cause, ef- fect, and ___________________ mode of ^"^*—^m^^ treatment. GENUS VI. iEDOPTOSIS. GENITAL PROLAPSE. PROTRUSION OF ONB OR MORE OF THE GENITAL ORGANS, OR 01 EXCRESCENCES ISSUING FROM THEM, INTO THE GENITAL PASSAGE. IMPAIRING OR OBSTRUCTING ITS COURSE. ori*?nofL ■^DOPTOSis is a compound term from xthiov, " inguen," pi. « ' brane of its a virgin, who was from the first peculiarly troubled with a retention Thefirst °f u"nei accompanied with frequent convulsive movements. She modifica- soon fell a sacrifice to it, and it was on dissection that the state of trated."11 the tunic was clearly proved. M. de Sauvages queries whether on a recurrence of this case it would be most adviseable to make an opening into the protruding sac, or to extirpate it altogether. The second The second variety he tells us is chiefly found among women who have borne many children, or have been injured by blows or other violence on the lower belly. The protruding cyst produced by an inversion of the membrane drops down in the urinary passage to about the length of the little finger, and is sufficiently conspicuous between the labia. Solingen who met with a case of this kind, returned it by a probe, armed at the upper end with a piece of sponge moistened with an astringent lotion ; and afterwards endeavoured to retain it in its proper position by a bandage. SPECIES IV. ^EDOPTOSIS COMPLICATA. COMPLICATED GENITAL PROLAPSE. PROTRUSION OF DIFFERENT ORGANS COMPLICATED WITH EACH OTHER. Gen. VI. From the connexion of the uterus and the vagina with the bladder iv. a prolapse of either of the two former is often complicated with that of the latter, giving us the two following varieties : cl. v.] SEXUAL FUNCTION. [ord. ii. 103 x Utero-vesicalis. Prolapse of the uterus dragging Gbn. vi. Utero-vesical Prolapse. the bladder along with it. jEdoptosiB" Q Vagino-vesicalis. Prolapse of the vagina dragging g° ^"co*' Vagino-vesical Prolapse. the bladder along with it. ed genital prolapse. Under either of these conditions the bladder, being deprived of General the expulsory aid of the abdominal muscles, in consequence of its tion.8" dropping below their action, is incapable of contracting itself suffi- ciently to evacuate the water it contains ; and hence the patient is obliged to squeeze it with her hands or between her thighs. The causes and mode of treatment have been already described under the two preceding species. The present is the hysteroptosis composita of Sauvages. SPECIES V. iEDOPTOSIS POLYPOSA. GENITAL EXCRESCENCE. TOLYPOUS OB OTHER CARUNCULAR EXCRESCENCE IN THE COURSE OF THE GENITAL AVENUE. This is the polypus uteri, and polypus vagina of authors : but, Gen. VI. strictly speaking, they are less polypi than polypous concretions, synonyms' since the proper polypous is the fleshy excrescence of the nostrils, as already observed in the first volume.* The excrescences before us issue both from the uterus and the vagina, and hence form two distinct modifications as follow : x Uteri. Issuing with a slender root mostly Polypus of the womb. from the fundus of the uterus, and more or less elongating into the vagina. <3 Vaginas. . Issuing from the sides of the vagina Polypus of the vagina. broad and bulbous. The latter excrescences in an incipient state, and particularly ™8 ™tf-M when loose and flabby, are sometimes dispersed by stimulant and sometimes astringent applications, or a hard compress of sponge or any other **■»* elastic material: and, if this cannot be accomplished, they must be hints^ destroyed by excision or caustics. It is rarely that they have a neck 80metime8' narrow enough for the application of a ligature. SSluS Polypous excrescences of the womb, are, however, a disease ot nescr^>- much greater severity ; since the stomach suffers, in most cases, 010enri°e from sympathy, and consequently the general health, producing all polypous the symptoms we have already noticed under .edoptosts uteri: which eBil^ * Vol. i. p. S49. 104 CL. V.j GENETICA. [ORD. II. Gen. VI. Spec. V. ^Edoptosis polypoaa. Genital ex- crescence. Of all sizes and various consisten- cies. Shape. Mode of treatment. Cauliflow- er ex- crescence. last is not unfrequently a result, if the excrescence be of long con- tinuance, and of considerable weight and magnitude. They are of all sizes, and of various degrees of hardness, from that of a soft and yielding sponge to that of firm and substantial leather. Though they commonly grow from the fundus of the uterus, they have sometimes been found to sprout from its sides, and even its cervix, shooting down to different depths of the vagina, and occupying it more or less completely according to their extent. They are generally round in shape and compact in structure, inter- sected by membranes running in different directions. Sometimes, however, they are oblong, in which case they usually consist of a loose irregular texture with numerous interstitial cavities. Dr. Baillie, has given various examples of this diseased production in his tables of Morbid Anatomy.* They have been attempted to be removed in different ways, as by caustics, excision, laceration, and ligature. The last, however, is the only method unaccompanied with danger or uncertainty. Yet even this can rarely be had recourse to while the excrescence con- tinues in the womb ; and hence, the usual method is to defer the operation till, from its increase of size and weight, it has descended into the vagina, when the removal cannot be attempted too soon. They have sometimes dropt off spontaneously, the peduncle having probably decayed or shrivelled away. There is also a variety of excrescence which should not be passed without notice, and which from its peculiar form and feel is called the cauliflower excrescence. It arises usually from the surface of the mouth of the uterus, and spreads into the vagina, rarely or never into the cavity of the womb. To the finger it seems to be a portion of placenta, and consists of a mass of distended blood-vessels sur- rounded by a membrane through which oozes profusely the serous part of the blood, and scarcely ever, except when severely handled, the red globules. The tumour is not tender nor very sensible. The quantity of discharge is in proportion to the size of the tumour and the action of the uterine vessels. As the disease advances the sys- tem becomes weakened generally, dyspepsy taking the lead and dropsy closing the scene. The cause is seldom ascertainable. While the excrescence is small it -has often been successfully attacked by local bleedings which empty the vessels, by astringent injections, plugging up the vagina, and tightly bracing it with bandages carried round the loins.t * See especially Fascic. c. ix. Plate iv. 1. j Observations on the Diseases of Females, &c. by Ch. Mansfield Clarke. 8vo. 1821. CLASS V. GENETICA ORDER III. CARPOTICA. DISEASES AFFECTING THE IMPREGNATION. The ordinal term carpotica, is derived from xxfiros, " fructus," Class V. whence *«£?iwi$, " fruitio." Origin" of In the Physiological Proem to the present Class, we have taken a generic brief survey of the laws and general process of generation so far as e we are acquainted with them. Impregnation constitutes a part, and the most important part, of this wonderful economy ; and, from the changes that the body undergoes during its action, it can never be surprising that it should often give rise to various diseases. These Generaof diseases may be arranged under four genera, including, those Which acCoinpa- occur during the progress of pregnancy : those which occur during n^a™; the progress of labour ; conceptions misplaced ; and spurious at- tempts at conception ; the whole of which may be thus expressed : I. PARACYESIS. MORBID PREGNANCY. II. PARODYNIA. MORBID LABOUR. III. ECCYESIS. EXTRA-UTERINE FETATION. IV. PSEUDOCYESIS. SPURIOUS PREGNANCY. In the preceding Physiological Proem, we have shown that, inJJfgJS" order for impregnation to take place, it is necessary the semen ofp^expia- the male should pass from the vagina to the one or other of the j^p^na- ovaries by means of the Fallopian tubes which lay hold of the uterus tion. by their very fine and sensible fimbriae, or fringed extremities, with a sort of spastic grasp during the high-wrought shock of the embrace, and thus alone open a path-way for the semen to travel m. The two ovaries are not merely intended to supply the place of pair of each other, in the event of one being wanting or defective, but, like ova™, to the testes in men, they seem to increase the extent of the productive the pro. power, and enable a female to bear a larger offspring than she would Jjeuve^ do, if she were possessed of one ovary alone. Mr. John Hunter qUadru has put this to the test by comparing the number of young produced ^unrated by a perfect sow with those of a sow spayed of one ovary, both of g»»*. the same farrow, and impregnated by a boar of the same farrow also. The spayed sow continued to breed for four years, during which Vot.. V.—I4 106 C.t. V/j GENETICA Lord. Ul. Class V. Ord. III. Carpotica. Diseases affecting the impreg- nation. This cose does not Boem equally applicable to weraen. After impregna- tion the womb closed by a septum : and hence no possi- bility of superteta- fien. Superfeta- tion. Hence children born within a few months of each other real twins, conceived at the same time. Difference of kind of birth ac- counted for. Superfeta- tion may occur in certain circum- stance?. Women capable of breeding as soon as they men- iTT'iate : period she had eight farrows producing a total of seventy-six young. The perfect sow continued to breed for six years ; during the first four of which she also had eight farrows producing a total of eighty- seven young: and during the two ensuing years she had five more farrows producing a total of seventy-five young, in addition to those of the first four years.* So that, if we may judge from this single experiment, the use of two ovaries, in equal health and activity, enables an animal to breed both more numerously, and for a longer period of time, than the possession of one alone. Among women, however, the extent of fecundation does not seem to be much interfered with by the defect of a single ovarium, or its means of communication with the uterus, according to a paper of Dr. Granville read before the Royal Society, April 16, 1813, con- taining the case of a female whose uterus was found after death to have had but one set of the lateral appendages, and, consequently, a connexion with but one ovarium, and who, nevertheless, had been the mother of eleven children, several of each sex, with twins on one occasion. After impregnation has taken place, the membranes produced in the uterus form a complete septum, and consequently, a bar to the ascent of any subsequent flow of semen, so as to prohibit the possi- bility of two or more successive impregnations co-existing in any part of the uterus during the period of a determined gravidity. Children, indeed, have been born within a few weeks, or even months, of each other, and hence a colour has been given to the hypothesis that they may be conceived at different periods of a com- mon parturition, and such births have, in consequence, been distin- guished by the name of superfetations ; but we shall have occasion hereafter, when treating of a plurality of children, to show that it is far more probable that fetuses thus born in succession, however they may vary in size or maturity, are real twins, conceived at one and the same time, from the descent of a plurality of ovula into the uterus, instead of a single one, and that the difference of size or maturity depends upon some unknown cause in the dead or puny fetus, which has killed it or prevented its keeping pace with the other. If, however, a second connexion take place within a few hours of the first, and before the occluding membrane produced on impregnation be formed, a twin may be the result of this additional coition ; but the fetuses will in such case be parallel in their progress to perfection. M. Bouillon has given a curious example of this in a negress who at the usual time of pregnancy was delivered of two male children full grown, and of like proportions, but the one a negro and the other a mulatto. The mother, after long resistance, con- fessed that she had had connexion the same evening with a white and with a negro.t Women are in general capable of breeding as soon as they begin to menstruate, which is the ordinary proof that the organs of concep- tion are fully developed and perfected : and since this discharge, »<= * Animal Economy, p. 157. * Bulletin de la Faeulte. etde la Society de Medicine, &c. No. in. lfi2J; '.i. v.} SEXUAL FUNCTION. [ohd. hi. 107 we have remarked in the Proem just referred to, commences some- 5LAS8fv^' times in very early life, and particularly in hot climates, where it has cfrpotica.' occurred in girls of not more than nine years of age, so we have in- D«eases stances of conception and pregnancy having commenced as early, the imp'e^ Baron Haller* and Professor Schmidt,t concur in examples of J"f h°'nce pregnancy at nine years old : and the medical records confirm these sometimes singular histories by numerous instances of a like kind. J at nine '"^ Yet, though menstruation is the ordinary proof that the conceptive yearB of powers have acquired a sufficient finish and vigour for their proper illustrated. function, menstruation itself is not absolutely necessary for impreg- *0en not*" nation. As there are circumstances that hurry on this secretion absolutely before its ordinary term of appearance, there are others that delay it, foVlmpreg- insomuch that some women pass through a long life without men- ^""j,- struating at all, while others only begin after reaching an adult age, and others again not till the period in which it usually ceases. Now, it may happen that a woman whose peculiar habit produces a pecu- liar retardation of menstruation, may marry before this secretion takes place for the first time ; and, as we have just observed that she is able to breed as soon as ever she is able to menstruate, the former process may anticipate the latter, and postpone it till the term of pregnancy has been completed. " A young woman," E*en>Ks says Sir Everard Home, " was married before she was seventeen, and, although she had never menstruated, became pregnant: four months after her delivery she became pregnant a second time, and four months after the second delivery she was a third time pregnant, but miscarried: after this she menstruated for the first time, and con- tinued to do so for several periods, and again became pregnant. "§ There is much difference of opinion as to the period of pregnancy Dinefenof in the human female ; for while other animals seem to observe great concerning punctuality upon this subject, we meet with so many and such cop- }g°meXfCi siderable varieties in women, that legislators, as well as physicians, maiepreg- have not agreed in assigning a common term. Hippocrates rules it ^eCjldg. that we should admit the possibility of a child being born at ten ment both months, but not later, which is the common term assigned in the torsCanda book of the Apocrypha entitled Wisdom of Solomon ;|| while Haller Pby"cian«' gives references to women* who are said to have gone not only ten, but eleven, twelve, thirteen, and even fourteen months ;'most of Which, however, are of a suspicious kind. Twelve months, never- May theiess, is a term allowed by many physicians, as what may take twelve place under peculiar weakness or delicacy of health :1F and yet it is ^"jjjjj* a£" most probable that in all these the mother is mistaken as to the pro- some :sand per time of her conception, and imagines herself to have commenced circurn™ at pregnancy for some weeks or even months before it actually takes £^1*' place. The state of menstruation affords no full proof; for as con- of the case ception may occur without its appearance, so it may continue for ^"taj^* one. * Vide Blumenbach, Bibl. i. p. 558. t Act. Helret. iv. 162, txplaniec I Epb. Nat. Cur. Dec. m. Ann. 11. Obs. 172. § Phil. Trans- 1817, p. 258. || Chap. vii. 2. ft Biichner, Miscell. 1727, p. 170.—Enguin, Journ. de Med. Tom. lxi.—Bram- billa, Abhandl. der Joseph. Acad. Brand, i. p. 102.—Telmont de St. Journ. de Med. Tom. xxvii.—Ploucquet, Von. den physischen ErfordernisBen der Erfahigteit d>r Kitrder. p. 69. Treb. 8ro. 1778. 103 ex. v, GENETICA [OBI*. Ul. Class V. Ord. III. Carpotica. Diseases affecting the impreg- nation. In what sense a child said to be born after three years of pregnancy. In the Code Napoleon 300 days. Question of the Ban- bury peer- How dif- ferent pe- riods es- tablished by different legislators. Child may be legi- timate at five months, as deter- mined by the faculty of Leipsic. Ordinary calcula- tion of time in Britain, nine calen- dar months or forty weeks. Figure and position of uterus during pregnancy at different periods. many months or even during the whole term of pregnancy, though most commonly in a smaller quantity than usual. There is a singular case in the Histoire de l'Acad^mie des Sciences, of a living child born after what is said to have been three years of pregnancy.* Few reports of this kind are worth attending to, or entitled to any kind of explanation : but it has sometimes happened, and probably did so in this last case, that a woman conceits herself to be in a state of pregnancy, and has various symptoms that simulate it, for a twelvemonth or considerably more than a twelvemonth, and par- ticularly towards the cessation of the catamenia, instances of which we have had occasion to notice under the fourth genus of the present order, entitled pseudocvesis or spurious pregnancy : and if, after such a simulation continued for a year or two, the woman should fall into a state of real pregnancy, she may persuade herself at the close of the process that she has been pregnant for the whole of this time. By the Code Napoleon, the legitimacy of a child born three hun- dred days after a dissolution of marriage may be questioned. In our own country the law is to this hour in an unsettled state ; and much nicety of argument has frequently taken place ; of which an example was afforded in the famous question of the Banbury peer- age, upon a new raised distinction of access and generative access. There can be no doubt, however, that a considerable difference in duration may ensue from the state of the mother's health: for, as the fetus receives its nourishment from the mother, there is a proba- bility that various deviations from health may retard the maturity of the fetus. And it is, probably, on this account that different legis- lators have assigned different periods of legitimacy ; one of the shortest of which is that determined upon by the faculty of Leipsic, who have been complaisant enough to decide that a child born five months and eight days after the return of the husband, may be con- sidered as legitimate ; and that a fetus at five months is often a per- fect and healthy child. In the ordinary calculation of our own country the allowed term does not essentially differ from that in the Code Napoleon, for it extends to nine calendar months or forty weeks ; but as there is often much difficulty in determining the exact day between any two periods of menstruation in which semination has taken effect, it is usual to count the forty weeks from the middle of the interval before it ceases ; or, in other words, to give a date of forty-two weeks from the last appearance of the menses: and at the expiration of this term, within a few days before or after, the labour may confi- dently be expected. In the progress of pregnancy the size and figure of the uterus, as well as its position, change considerably. In an adult and unim- pregnated female, its length is about two inches and a half; its thickness one inch ; its breadth at the fundus something less than its length : and at the cervix about two lines. Before the end of the third month it has a tendency to dip towards the pelvis, at which Hist, de 1'Academic de* Sciences, 1753. p. 206 <*!>. v.J SEXUAL FUNCTION. [ord. ut. period it may be felt to ascend : during the seventh month it forma c»-ass v. a line with the navel; in the eighth month it ascends still higher, o!£t,2' reaching midway between this organ and the sternum ; and in the Diseases ' ninth it almost touches the ensiform cartilage; at the close of which, Sampler as though overwhelmed by its own bulk, it begins again to descend, uatlon> and shortly afterwards, from the irritation produced by the weight of the child, or, more probably, from the simple law of instinct, it be- comes attacked with a series of spasmodic contractions extending to the surrounding organs, which constitute the pains of labour ; Voting gradually increase in strength, enlarge the mouth of the organ, and Lu'j-pairrs. protrude the child into the world. The size of the child at this time varies considerably in different Size and individuals; and seems indeed to exhibit some diversity in different h7afthy°f " countries. Dr. Hunter, from observations made on some thousands ^'ed at """ of new-born and perfect children in the British Lying-in Hospital, found that the weight of the smallest was about four pounds, and of the largest eleven pounds two ounces, ordinarily however varying from five to eight pounds : whence, as also from his own observations, Dr. Clarke has calculated the average weight at seven pounds five ounces and seven drachms for male children, and six pounds eleven ounces and six drachms for female.* Dr. Merriman, however, gives Has reach- one instance in which the weight reached fourteen pounds : and Sir ■nd^fiftat? R. Croft another in which it reached fifteen pounds. On the conti- §t"n'dd*;d nent, the standard weight seems to be considerably less, for M. weight ap- Camus reckons it at not more than from five to seven pounds for feV/on^he France, and M. Roederer at from five pounds to six pounds and a Continent half for Germany. And consistently with this diminished scale M. Graeat'n Camus tells us that out of fifteen hundred and forty-one children Britain- examined by himself, the greatest weight was not more than nine pounds, of which there were only sixteen instances: while the Hos- pice de la Maternite at Paris, out of twenty thousand perfect births, a few only have reached ten pounds and a half, and none exceeded it. t At this time the standard length of the skeleton, according to M. Bedard, is eighteen inches, that of the spine seven inches and a quarter ; the former, at three months from conception, being only six inches, and the latter two inches and two-thirds. If the fetus be born before the completion of the seventh month, At whaj it has but a slender chance of surviving ; but there are a few well- nfaeiurePin- authenticated instances of its living when born earlier. Thus Dr. .^our il mtt' Norman gives a very satisfactory narration of a child born in 1815 at Paisley, between the fourth and fifth month ;J and Fortunis Liceli, who died at the age of twenty-four, is affirmed by Capuron to have been born at as early a period of pregnancy. In natural pregnancy, a strong hearty woman suffers little con- r° nstuial sidering the great change which many of the most important organs amutrong of both the thorax and abdomen are sustaining ; and in natural bs'£th. lit\le labour, though the returning pains are violent for several hours, and in e' there is little or no danger. But numerous unforeseen circumstances K» "ilita danger. * Phil. Trans. Vol. Lxxiv. But danc* t Medical Jurisprudence by J. Paris, M.D. and J. S. M. Fonblanque, Esq., Bar- rister at Law, Vol. II. p. 101, % Edin. Med. and Surg. Journ. Vol, xi. 110 cl. V.J GENETICA. [OBD. HI. OedSSIH may ariee from the constitution of the mother, the shape of the carpotica.' pelvis, the figure or position of the child, to produce difficulty, S%Z dan£er' and even death. the impreg- In describing the diseases which appertain to the wnoie 01 tms may0arise period, it is not. the author's design to do more than to take a gene-' from nume- ral pathological survey, so as to communicate that kind of knowledge cumstances. upon the subject which every practitioner of the healing art should serTeln- be acquainted with, even though he may not engage in the obstetric tended by branch of his profession. The minuter and more practical parts, in'des'crib' and especially those which relate to the application of instruments ingthedis- and the mechanical means of assistance, must be sought for in eu»aiDge.nce books and lectures expressly appropriated to this purpose, with which it is not his intention to interfere. GENUS I. PARACYESIS. MORBID PREGNANCY. THE PROGRESS OF PREGNANCY DISTURBED OR ENDANGERED BY TIIE SUPERVENTION OP GENERAL OR LOCAL DISORDER. Gen. I. The generic term i3 derived from irx^x, " male," and Kv»e-i<, " gra- eeneric°f viditas." The genus will conveniently embrace the three following term. species, according as the general system, or organs distinct from those immediately concerned, are disturbed ; as the sexual organs themselves are disturbed ; or as the fruit itself is disturbed and ex- truded prematurely ; 1. PARACYESIS IRRITATIVA. CONSTITUTIONAL DERANGEMENT OF PREGNANCY. 2,---------UTERINA. LOCAL DERANGEMENT OP PREG* NANCY. ?,. ———._—. ABORTUS. MISCARRIAGE. ABORTION. '■L.v.l SEXUAL FUNCTION foju>. nt. Ill SPECIES I. PARACYESIS IRRITATIVA. CONSTITUTIONAL DERANGEMENT OF PREGNANCY* PREGNANCY EXCITING DISTRESS OR DISTURBANCE IN OTHER ORGANS OR FUNCTIONS THAN THOSE PRIMARILY CONCERNED. The new condition of the womb operates upon the whole or dif- Gen. I. ferent parts of the system in various ways. We have frequently had various * occasion to observe that there is no organ whatever which exercises °rs*™> ef- • ICCttfu Ul- a more extensive control over the entire fabric than the uterus, with rectiy or the exception of the stomach ; and hence many parts are affected bDydithe0ctn*,w by sympathy during its new action, and particularly the brain and state of the the whole of the nervous function. But its change of shape, bulk, W( and position, operates mechanically on other organs and frequently produces serious mischief by pressure or irritation ; these organs are chiefly the stomach itself, the lungs, or the intestinal canal, and the veins of the legs. And hence the evils resulting from these causes, JmXu,^ may be contemplated under the following varieties : varieties: x Systatica. Accompanied with faintings, palpitations, convulsions, or other direct affections of the nervous system. & Dyspeptica. Accompanied with indigestion, sickness, and head-ache. y Dyspnoica. Accompanied with difficult breathing and occasionally a cough. ^Alvina. Accompanied with derangement of the alvine canal, as costiveness, diarrhoea, or hemorrhoids. i Varicosa, Accompanied with venous dilatation of the lower extremities. That the nervous system should often suffer severely, and in va- *".p- irri'a~ , . J ... -ii i iwa svsta- nous ways during pregnancy, will not appear singular to those who tica. have attended to the remarks we have already made concerning the aifmen'tsof close chain of sympathy that prevails between the brain and the pregnancy. sexual organs, from the time of the first developement of the latter system to their becoming torpid and superannuated on the cessation of the ^™^Baat catamenia. But indelicate hn bits, in which these nervous affec- ail times tions chiefly occur, there is another cause which is even more pow- ™xuai nr_ erful than the preceding ; and that is the demand of an additional s*ntsic;u^a"]v supply of sensorial power in support of the new process, and, con- in delicate" sequently, an additional excitement and exhaustion of the sensorium, oSwhat"1 persevered in without intermission, and increasing from day to day. account Thi M cl. v.] GENETICA [obd. m Gen: I. Spec. I. a P. irrita- tiva systa- tica. Nervous ailments of pregnancy. pitation, syncope, and convul- sions. Palpitation often an effect. Description of its course, which is frequently irregular. Pulsatory action sometimes confined to the heart: sometimes alternates with the larger arte- ries. Illustrated. Syncope or fainting often an effect Course and description. Exciting cause?. Remedial treatment Convulsions often an r-fftct. of course an irregularity in the flow, and particularly in the alter- nating pauses, of the sensorial current; hereby predisposing alike to palpitation of the heart, clonic spasms, and convulsions, accord- ing to the law of physiology laid down under the genus clonus,* to which the reader may return at his leisure. Fainting, as has also been previously shown under the genus syncope^ is dependent upon the same deficiency of action, rendered more complete, or more protracted in duration. Palpitation, in the case before us, is rarely attended with danger, but is often a most distressing symptom. It returns irregularly in the course of the day or night, but particularly after a meal, and very frequently on first lying down in bed. In the capricious state of the nervous system at this time, its return after meals does not seem to be so much dependent upon the nature of the food as upon the state of the stomach at the moment: it has recurred after a light and plain dinner, and been quiet after a more stimulant dinner ; and then for a few days has been most severe after the latter, and least so after the former; for a short time the digestion has gone on tran- quilly under both, and then again excited palpitation, and perhaps in an equal degree under both : nor has a total abstinence from solid animal food afforded any relief. The pulsatory action is some- times confined to the heart, sometimes alternates with the coeliac or some other arterial trunk in the abdomen, and sometimes with the temporal arteries. Not long ago the author was occasionally con- sulted by a lady then in her sixth month, who had been most griev- ously afflicted with this affection from the time of her beginning to breed, and who then continued subject to it till her confinement, none of the antispasmodics afforded much, if any, relief; camphor, in large doses, was found the best palliative ; the narcotics were all tried in vain ; opium maddened the head, and threw out a most dis- tressing lichenous rasb. The paroxysms usually continued from two to six or eight hours. Other irritations produced it, as well as those of the stomach, and especially any sudden emotion of the mind. Syncope or fainting occurs during any period of pregnancy, but chiefly in the stage of the first three months, and especially about the time of quickening. After this period the general frame acquires a habit of accommodation to the change that has taken place, and is less easily affected. It is ordinarily produced by more than usual exertion, exposure to heat, or any sudden excitement of the mind. It is sometimes of short duration, and the patient does not lose her recollection ; but in other instances it continues, for an hour or upwards. A recumbent position, pungent volatiles, sprinkling the face with cold water, and a free exposure to air with a moderate use of cordials, offer the speediest means of recovery. The extremi- ties, however, should be kept warm, and the friction of a warm hand be applied to the feet. One of the worst ailments that ever accompanies the process of gestation is that of convulsions. They may occur at any period of this process, and their exciting causes are not always manifest. The * Vol. iv. p. sas t M. sr>? cl. v.j .SEXUAL FUNCTION. |ord. m. IIS predisposing causes are general weakness or irritability of the ner- Gen. I. vous system, a constitutional tendency to epilepsy, or any other clonic a rf ^Jta! spasm, and entonic plethora. In all these cases there is a double «va systa- danger ; for we have to dread apoplexy from a rupture of blood- Nervous vessels in the head; and abortion or premature labour from an ailm„°{f °f extension of the spasmodic action to the uterus. No time, therefore, causes. is to be lost, and the remedial process must be as active as it is ^"fmeo1* instant. double: Bleeding must be had recourse to immediately, as well in the piexy; and atonic as in the entonic form of the disease. In the first, indeed, it ^ruon. is of itself an evil, for it will add to the general weakness ; but as Medical there is already, or, by a repetition of the fit, will unquestionably be, needing in a considerable determination to the head, and more especially as the a" ca?bs vessels in an atonic and relaxed frame yield easily as well to anas- atonic, and ^.omosis as to rupture, it will be a far greater evil to omit it. The bvuhtythe quantity'of blood, however, that it may be adviseable to abstract, quantity of must be determined by the concomitant symptoms so far as they relate BtracteVte to the head. Generally speaking, in weakly habits, the head is only '"J;*"^ affected secondarily, or by sympathy with the irritation of the uterus^ circum- where convulsions make their appearance ; and hence bleeding, in stances" such cases, is to be employed rather as a prophylactic than as an antidote : and it may be sufficient to confine ourselves to the opera- in weakly tion of cupping ; at the same time opening the bowels by an adequate sometimes repetition of some laxative. After this opium must be chiefly trusted l"™™s to, if the spasms still continue : and, on their subsidence, or in their opium af- interval, the metallic tonics should be introduced with the warmer te,war *' bitters. Where, however, the constitution is robust, and the convulsions J,"^0"5 have been preceded, as is often the fact in this case, by a tensive or bleeding even heavy pain in the head, vertigo, illusory corruscations before pSedw the eyes, or illusory sounds in the ears, the encephalon is itself the fainting; immediate seat of the disease, and the bleeding even in the first in- stance should be followed up to fainting, or at least till twenty ounces are drawn away, which it will frequently be necessary to repeat and some- within twenty-four hours afterwards ; and, if the practitioner be a j^tedT skilful operator, it will be better to abstract the blood from the jugular Jugular "'■'cln, as the good effect will be sooner felt. The hair should be best. shaved from the head, and ice-water or other frigid lotions be applied, F''sid aP* i /• rr«i 1 1 - • plications. and very frequent y enewed. 1 he bowels must at the same time Aperient* be purged vigorously, and dilute farinaceous food constitute the whole of the diet. Opium should be abstained from at least till the Opium to general strength is reduced to an atonic state, when if the paroxysm edftom^at should still return, it may be had recourse to in conjunction with J®*3* ^J1 antimonial powder or some other relaxant. is reduced* When, in despite of all this treatment, apoplexy has taken place, */pa,sy and is followed by a palsy of a particular organ, or of an entire side, tenconti- it will often be found that the paralytic affection will continue through "huro3ugh the whole course of the pregnancy, and entirely disappear afterwards, life. Sickness, heart-burn, and other symptoms of indigestion are B P »nta- still more common affections.than those of the nervous system we peptic!! have first noticed. These are chiefly troublesome in the commence- DSnpfj° ji ^OL. V.—15 rregnune'. 114 ul. v.J GENETICA. [owu. in. Gen. I. Sr-EC. I. 3 P. irrita- tiva dys- poptica. Dyspeptic ailments of prpgnancy. Thoir en use, pro- gress, and the cessa- tion of many of them, Moderate venesection or leeches lo (he epi- gastrium. Gentle lax- iitivos and cooling TCgimeu. Vomiiing seldom produces evil, though sometimes e nd angers tuiscar- viaee. -/P.irrita- nva dys- puoica. ;>yspnetic nilinents of pregnancy. Symptoms il escribed. Mode of iteatment. It' there be tough it rarely ter- minates in .onuurnp- tion, and whv. ment of pregnancy, and evidently prove that they proceed not from any mechanical pressure, either direct or indirect, against the coats of the stomach, but from mere sympathy with the new and irritable state of the uterus : for, as the novelty of this state wears away and the stomach becomes accustomed to it, the sickness and other dyspeptic symptoms subside gradually, and are rarely troublesome even when in the latter months of pregnancy the uterus has swollen to its utmost extent, from a length of three inches to that of twelve, and has risen nearly as high as the sternum. The head-ache which occurs as a dyspeptic symptom, is of a very different kind from that we have just noticed, and is rarely relieved by very copious bleedings; though the whole of these symptoms are occasionally mitigated by a loss of eight or nine ounces of blood from the arm, orthe application of leeches to the epigastric region as recom- mended by Dr. Sims, and M. Lorentz. Cloths wetted with laud- anum and applied to the pit of the stomach have also been found serviceable in various cases : but the most efficacious means con- sist in the employment of gentle laxatives, and a very light diet, to which may be added the use of the aerated alkaline waters or saline draughts, in a state of effervescence. The fluid discharged from the stomach on these occasions is usually limpid, thin, and watery ; but where there is much straining a little bile is thrown up at the same time. It is rarely that this kind of vomiting produces any serious evil ; though when it has become very obstinate, as well as very severe, it has sometimes endangered a miscarriage. The other symptoms of dyspepsy usually cease with this, and are rather disquieting than sources of any degree of alarm. They may often be palliated by some of the means already recom- mended under limosis, cardialgia,* and dyspepsia.! The chief symptoms of dysi'ncsa that become troublesome during pregnancy are occasional fits of spasmodic anhelation. These arc mostly common to those whose respiratory organs are naturally weak, or who are predisposed to hysteria. The paroxysms are of short duration and usually yield with ease to the warmer sedatives and antispasmodics. A dry and troublesome cough, however, is some- times combined with this state of the chest, that, if violent, endan- gers abortion, and has occasionally produced it. Bleeding will here also be adviseable as the first step in the curative process. Eight ounces of blood will suffice, but the depletion must be repeated at distinct intervals if the cough should continue unabated. Gentle laxatives should succeed to the bleeding and be persevered in as the bowels may require. And to these may be added the mucilaginous demulcents J already recommended in idiopathic cough, united with such doses of hyoscyamus, conium, or opium, as are found best to agree with the state of the constitution. There is little danger, nevertheless, of this cough terminating in consumption however troublesome and obstinate it may be in itself, for it is rarely that two superadded actions go forward in the constitution at the same time: and hence, as we already have had occasion to observe, whenever Vol. I. p. 121. H. 143. I Id. p. 3P9. ul. v.j SEXUAL FUNCTION. [ord.ui. 115 pregnancy takes place in a patient labouring under phthisis, the Gen. *• progress of the latter disease is arrested till the new process has run y n. irr'ita! its course.* tiva dvB~ t~» t/. pnoica. Derangements of the alvine canal, under some modification pyspnetic or other, accompany most cases of pregnancy, are often very distress- prcg^ncy"' ing, and by their irritation sometimes hasten on labour-pains before <* l?- >rrila- .1 • ,• x tiva alvina. their time. Aivi„6 These affections are of two very opposite kinds. In some in- aj.1cm®"I',8c"f stances the intestines participate in the irritability of the uterus, the peristaltic action is morbidly increased, and there is a troublesome diarrhoea. In others the larger intestines appear to be rendered £ia"|!®a- torpid partly by the share of sensorial power which is taken from them ness. in support of the new action, and partly by the pressure of the expanding uterus on their coats. In both cases piles are a frequent attendant, but particularly in the last The diarrhoea varies in different individuals from a looser flow of Treatment proper feces to a muculent secretion, or a dejection of dark-coloured "ha 1 / offensive stools, accompanied with a foul tongue and loss of appe- tite. The first modification requires no remedy, and may be safely left to itself. The second and third import a morbid action of the excretories of the intestines, and are best relieved by small and repeated doses of rhubarb with two grains of ipecacuan to each,| and afterwards by infusions of cascarilla, orange-peel, or any other light aromatic bitter. The costiveness must be carefully guarded against by such ape- J/*"^.','.' rients as are found upon trial to agree best with the bowels. Where nes*. acidity in the stomach is suspected, magnesia may be employed, and will often prove sufficient: but where this does not exist, the senna electuary, Epsom salts, or castor oil, will be found to answer much better. The piles will usually disappear as soon as the bowels are restored to a current state : and, if not, they should be treated ac- cording to the plan already laid down under proctica marisca. j Varicose dilatations of the veins of the lower extremities «.p-'"''.»" are a frequent, though not often a very troublesome accompaniment of cosa. pregnancy. They are chiefly found in women whose occupation ^e^,,, obliges them to be much on their feet. Where the affected veins pregnancy are first perceived to enlarge, the varicose knots may generally be palliate.i * prevented by exchanging the accustomed erect position for a recum- bent one, and using the legs but little. Where the varices are actually formed, the legs may be supported with a bandage drawn only with such moderate pressure as to afford sustentation ; for if carried beyond this we shall only endanger a worse congestion in some other part not equally guarded against. For the rest the reader may turn to exangia varix, in a preceding part of this work.§ Pregnancy may also take place during the existence of abdominal 'Jay be dropsy, or even give rise to it, and the general pressure and enlarge- ed'wu'h'aV, ment may be so considerable as to threaten suffocation. The ascites j]°™ic"al * Vol. in. Cl. in. Ord. iv. Gen. m. Spec. v. t Burns, principles of Midwifery, p. 154. J Vol. i. p. 269. $ Vol. in. CI. in. Ora by external violence, or a sudden emotion of the mind, venesection will-be the best remedy we can have recourse to, and afterwards thirty or five and thirty drops of laudanum in a saline draught witl two or three grains of ipecacuan. SPECIES III. PARACYESIS ABORTUS. MISCARRIAGE. ABORTION. PREMATURE EXCLUSION OF A DEAD FETUS FROM THE UTERl>. Gen. I. We have stated in the introductory remarks to the present order Spec. III. tnat the usual term of pregnancy is forty weeks, or nine calendar months. Within this period, however, the fetus may be morbidly ^IiBeahow expelled at any time. If the exclusion take place within six weeks distinguish- after conception it is usually called miscarriage ; if between six action, weeks and six months, abortion ; if during any part of the last three and pre- months before the completion of the natural term, premature labour! labour. Among some writers, however, abortion and miscarriage are used synonymously, and both are made to express an exclusion of the fetus at any time before the commencement of the seventh Fetus may month. At seven months the fetus will often live. It has been uYven born alive, in a few rare instances, at four months ;| and has as H0nheen rarely continued alive when born between five and six months.J born alive The process of gestation may be checked, however, from its ear- andcoiiti- "8st period : for many of the causes of abortion, which can operate nued alive afterwards, may operate throughout the entire term, and hence a fiveWand six miscarriage occurs not unfrequently within three weeks after im- m!scmS- pregnation, or before the ovum has descended into the uterus. In riage may this case the pains very much resemble those of difficult menstrua- anyUperio.i. tion; and with a considerable discharge of clotted or coagulated at0threemes D'00(^ tne tunica decidua passes away alone, having also some re- weeks, semblance to that imperfect form of it, which we have already auhat°p7 noticed as being produced in some cases of difficult menstruation, ""d. but exhibiting a more completely membranous structure. And here the ovulum escapes unperceived at some subsequent period, and is probably decomposed and incapable of being traced. Abortion m In later periods of pregnancy, abortion consists of two parts or perioT6" stages ; the separation of the ovum from the fundus of the womb, twoSsfagesf, a"a ils exPulsio" from the mouth. Sometimes these take place very aTexcfu-' * Vo1- '"■ Class in. Ord. iv. Gen. n. Spec. 11. t A. Reyes, Campus Elys. Quest. 90. p. 1164. ♦ Brouzet, sur l'Eduoation Medicinale des fciifanu. I. sion p. ST. "-• v.J SEXUAL FUNCTION. £ord. m. 119 nearly simultaneously, but sometimes several days or even weeks Gen. I. intervene ; so that the process of abortion may considerably vary in ?""; "J* its duration, and become exceedingly tedious. In several cases Abortus. I have known the ovum remain undischarged for upwards of six Jhlge*'" weeks, and, in one case, for three months after its separation, and Abortion. j i r>. .1 i . r. . r. r . 1 hese mav consequently alter the death of the fetus, comparing its size and ap- be simuita- pearance with the ascertained term of gestation. ™™te?' Through the whole of this period there is an occasional discharge ^0htenr^'.. from the vagina, and often temporary disquietudes, and even con- chaige tractile pains in the uterus. But both are of a very different kind ^A- from those which occur antecedently to the separation of the ovum, ring the in- The first pains are usually sharp and expulsory, with a free discharge a"docca- of clotting arterial blood; sometimes, indeed, in an alarming, though si„je^j(j8* rarely a dangerous profusion ; the last are dull and heavy, and the andVains: discharge is smaller in quantity, dark and fetid. We may also judge ^ $£*' of the detachment of the ovum, and consequently the death of the ,hose tha« fetus, by the cessation of those s) mpathetic symptoms which have separation. hitherto connected the stomach and the mammae with the action of 9th" dis" ,1 , ... . tinctive tne uterus ; as the morning sickness and the increasing plumpness symptoms. of the breasts, which, not unfrequently, are so stimulated as to se- crete already a small quantity of milk. On the separation of the ovum from the fundus of the uterus all these disappear; the stomach may be dyspeptic, but without the usual sickness, and the breasts become more than ordinarily flaccid. The ovum, when at length discharged, comes away very differently nescent of in different cases. Sometimes the whole ovum is expelled at once; theovum but more generally it is discharged in detached parts, the fetus first escaping with the liquor amnii, or descending with its own proportion of the placenta, the maternal proportion following some hours, or oven days, afterwards. And, where there are twins, one of the in pas"of fetuses, naked or surrounded with its membranes, is usually expelled alone, and the other not till an interval of several hours, or even a day or two ; the discharge of blood ceasing, and the patient ap- pearing to be in a state of recovery : so that it is difficult to determine whether or not there are twins in cases of early abortion. The canst* of abortion are very numerous ; and some of them Causes of are rather to be conjectured than fully ascertained. They may various depend upon the ovum itself, upon the uterus itself, or upon the kmds' uterus as affected by the nature of the maternal constitution, or acci- dental lesions. t% The imperfections observable in ova,'" remarks Dr. Der man, Cause? . /» i-iV- • i-i n i dependent ■'are of different kinds, and lound occasionally in every part; and opon tho there is usually a coisent between the fetus and the shell of the ovum, as the placental part and membranes may be called, but not always. For examples have occurred in which the fetus has died before the termination of the third m<>;:th. yet the shell, beirg healthy, has increased to a certain size, has remained till the expira- tion of the ninth month, and then been expelled, according to the genius and constitution of the uterus, though frequently it has been found to have undergone great changes, as, for instance, in many ■ ;t<=rs of hydatids."* * Practice of Midwifery. Edit. 5. p. 608. Pvo. ovum. \so CL. V. (iENE'HCA. [ORD. Ill Gen. I. Spec. HI Paracynsis Abortus. 3I^c;irri- ugo Abortion. (Jausc.n dependent upon tlio nature of 'he uterus. Causes COIliititU- tiunal or incidental. 3\tiscniriage apt to recur. (las recur- red up- wards of twenty times. Cause from plettioia whether entonic* or atonic. » It is remarkable," says the Same author, " that women who arc in the habit of miscarrying, go on in a very promising way to a cer- tain time, and then miscarry, not once, but for a number of times, in spite of all the methods that can be contrived, and all the methods that can be given : so that, besides the force of habit, there is some- limes reason to suspect that the uterus is incapable of distenumg beyond such size, before it assumes its disposition to act, and that it cannot be quieted till it has excluded the ovum. What I am about to say, will not, I hope, be construed as giving a license to irregu- larity of conduct, which may often be justly assigned as the imme- diate cause of abortion, or lead to the negligent use of those means that are likely to prevent it. But from the examination of many ova after their expulsion, it has appeared that their longer retention could not have produced any advantage, the fetus being decayed, or having ceased to grow long before it was expelled. Or the ovum has been in such a state as to become wholly unfit for the purpose it was as- signed 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 ate 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 cir- cumstances. 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 exertion of every kind is a cause not less obvious, as that of immoderate exer- cise in dancing, riding, or even walking; lifting heavyweights; great straining to evacuate the feces, or too frequent evacuations from a powerful purgative. Violent excitement of the passions, as 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. An-! 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 ;t Werlhoff, of five within two years ;| and Werlosclmig, of not less than eight in a single yt ar.§ YVolfius relates the history of a woman, who, in the whole course of her life, suffered twenty-two distinct abortions :ij and Schultz, that of another, who, in spite of every remedy, miscarried twenty-three times, and uniformly in the third month, probably from an indisnosi- tion in the uterus to become distended further, as sugge>ted 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* * Denman, ubi supra, p.'508. t Observationes, Lib. 11. p. 467. I Opp. hi. p. 718. $ De Curatiopibu* Verno-autumn. t>. 496 ! Lection. Memorab. p. 418 ' ..l. v.] riEXUAL JUNCTION. Loan. in. 131 '- being a largo vascular organ, is obedient to the laws of vascular Gen. I. action, whilst the ovum is more influenced by those regulating new p^cyc*"' formed parts ; with this difference, however, that new formed parts Abortus. or tumours are united firmly to the part from which they grow by all riage?r kinds of vessels, and generally by fibrous or cellular substance, whilst now en-' the ovum is connected to the uterus only by very tender and fragile tonic arteries and veins. If, therefore, more blood be sent to the maternal alfu.0™ 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 dis- ordered as to unfit it for continuing the process of gestation."* Now in atonic plethora, or that commonly existing in high and pli°}]'10arl°nic fashionable life, among those who use little exercise, live luxuriously, acts. and sleep in soft warm beds, although the action that accompanies the pressure is feeble compared with what occurs in the opposite state, the vessels themselves are feeble also, and their mouths and tunics are exceedingly apt to give way to even a slight impetus : 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 operation Mode of is still more obvious and direct. An increased flow of blood is here obv^usTn' forced urgently on the uterus, which participates irresistibly in the ent°.nic vehemence of the action ; so that if the vessels do not suddenly give p 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," observes M. Burns, " is especially 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 increased, 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 a temporary separation from the husband is indispensable."! The general treatment of abortion consists of two intentions, ^^I'ou that of preventing it when it threatens ; and that of safely leading embraces the patient through it when there is little doubt that it has taken tti^s'.n^t place. Uon'anTof The chief symptoms menacing abortion are transitory pains in the subsequent back or hypogastric region, or a sudden hemorrhage from the vagina. ma£tag0~ In all these cases the first step to be taken is a recumbent position, Preventive and when the patient is once placed in this state we should deiibe- ptoce rately examine into the nature of the cause. If there bo 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 + Principles of Midwifery, 3d. Edit. 8vo. p. 191. + Burns, ut supra, p. 19L Vol. V.—16 122 a,vj GIAETICA. toBP.m.' Gen. I. weakening. In every instance, except where plethora prevails, after pfracye1*"' abstracting blood, the next best remedy is a full dose of opium con- Abortus, sisting of thirty or forty drops of laudanum, or more if the symptoms r\ng"~ be urgent, and repeated every three or four months till the object is Treatment, obtained.* And where the system is so feeble or emaciated that bleeding is counter-indicated, 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 mus! limit our practice to the mineral acids and opium, and gently reliev- ing the bowels. Same pro- By this plan the pains originating from incidental causes ere often belong U checked, and the partial separation of the ovum that has commenced continued \e pUt a stop to. But the remedial process is thus far merely begun; iteTticcess. 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 any easy carriage. ca°tionKPio-" <-'0^ bathing, and especially cold sea-bathing, is of great impor- caiiy with tance ; and where these cannot conveniently be had, a cold hip ov rnjectwDg. 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. duf'To^be ^tne habit be peculiarly vigorous and robust, stimulants and soft- exchanged ness of bed-clothes must be carefully avoided, and the downy couch maurahss.rd be exchanged for a hard mattrass. But if the constitution be deli- a little cate and emaciated, two or three glasses of wine may be allowed eVd"tonthoW daily, and a course of angustura, columbo, or some other bitter Sexuai'' tonic should be entered upon. In either case, however, it is abso- eonnexion lutely necessary that sexual connexion should be abstained from for stai>nedb" ten days or a fortnight. UnUiter- ^ kas °^ ^ate Deen very much the custom to confine women of a rupted nse very delicate frame, and especially after they have once miscarried, beat'po"-m"to a recumbent position from the first symptom of conception through ture recom- the whole term of gestation. In a few cases this may be a right and mended by acjvantageous practice, but in the present day it is employed far too tion e"a-~ mdiscrimmatefy- Among the causes of abortion we have just enu- mined. merated there are many it can never touch, as where the ovum itself simeacases,is at fault, or there is a natural indisposition in the uterus to expand b>ucabfePto bey°ncl a certain diameter. In this last case, if we could be sure of othere:6 ° it, a tepid hip-bath employed every evening, about the time the tepid'hi'p-* abortion is expected, would be a far more likely means of preventing irfoie ukei •*'' ^°T W6 snomd act here as in all other affections where our object lobe use- y is to re*ax and take off tension, in which states we uniformly employ illustrated, warmth and moisture ; commonly, indeed, a bread and water poul^ tice. And hence, in the instance before us, one of the best appli- cations 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 * Aaskcw, Act. fin*. Med. Hafia, IVm, i, CL.V.J SEXUAL FUNCTION. [oiu>.iii. 123 swathe of folded linen. This should be worn through the whole Gen- ' night, and continued for a fortnight about the time we have reason paracy0bi6 to expect a periodical return of abortion from the cause now Abortus. ,, , , l Miseai- alluded to. riago. I was lately requested to join in consultation with an obstetric phy- treatment. sician upon the state of a young married lady of a highly nervous and Further irritable frame united with great energy and activity both of mind from "a case and body, who had hitherto miscarried about the third month ofjj1*^ gestation, by braving all risks, taking walks of many miles at a hasten mis- stretch, or riding on horseback for half the day at a time. She was carria""- 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 other- wise than to feed herself: and to continue in this motionless state for the ensuing eight months. Without entering into the immediate eause 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 dysphoria or restlessness. which would peculiarly vent itself on the organ of greatest irritation. But I 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 over- ruled, however, to persevere in the plan already adopted from tho 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 irri- table, fatigued, and dispirited ; and miscarried at about six weeks from conception, instead of advancing to three months as she had hitherto done. Even in the case of a delicate and relaxed frame, and of a mind 0^Jl' that has no objection to confinement, it is well worth consideration worth con- whether the ordinary means of augmenting the general strength and 8idcrins- elasticity by such tonics as are found best to agree with the system, and such exercises as may be taken without fatigue ; particularly any of those kinds of motion which the Greeks denominated aeora, as swinging or sailing, riding in a palanquin, or in a carriage with a sofa-bed or hammock,—which, as we observed on a former occa- sion,* instead of exhausting, tranquillize and prove sedative, retard the pulse, produce sleep, and calm the irregularities of every irri- table organ,—may not be far more likely to carry the patient for- ward 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 abortion, ^8* and that the symptoms are capable of being suppressed. But if the abortion paina, instead of being local and irregular, should have become ^u * Marasmus Phthisis. Yd. lit. Cl. m. Ord. iv. Gen. ui. Sp. v. 12-1 cl. v.j GENETICA. [<>«"■ in. Gen. I. regular and contractile before medical assistance is sought for, or r««e'"!' should have extended round the body, and been accompanied with Abortus!'" strong expulsory efforts, and parlicularl) if, in conjunction with riage"" those, there should have be^n a considerable degree of hemorrhage, Treatment our PrcvcnUV'c plan will be in vain, a separation has unquestionably '' taken place, and to check the descent of the detached ovum would be usele.-s if not mischievous. Even though the pains should havo ceased we can give no encouragement, tor such a cessation only affords a stronger proof that the effect is concluded. vybffutho If the discharge continue but in small quantity, it is best to let it smaihC?te take its course ; to confine the patient to a bed lightly covered with utt'^taV clothing, and give her five and twenty or thirty drops of laudanum. ' Bleeding is often had recourse to with a view of effecting a revulsion; it is uncalled for, however, and may do mischief by augmenting the weakness. Treatment But the practitioner often arrives when the discharge is in great m oodmg. aDunciance and amounts to a flooding ; and the patient is faint and sinking, and seems ready to expire. Symptoms To the inexperienced these symptoms are truly alarming, and, in but not" a few instances, sudden death appears to have ensued from the ex- often fatah haustion that accompanies them. But these are very uncommon cases, for it rarely happens that the patient does not recover in an Syncope it- 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 tho Cold ex- sudden interruption it gives to all vascular action. Cold, both ex- ■ntca,n|nd t<:rnal anu< 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 rung out in cold-water, or ice-water, should be applied to the lower parts of the body and renewed as its temperature becomes warm ; withholding the appli- cation, however, as soon as the hemorrhage ceases. injections Injections should, in this case, be desisted from; for the formation riesisted0 ° °f clots of blood around the bleeding vessels should be encouraged from, and as much as possible, instead of being washed away. And for this TheVagina reason it is now a common practice to plug the vagina as tight as jdngged. possible with sponge or folds of linen, or, what is better, a silk hand- kerchief, smeared over with oil that they may be introduced the more easily, and afterwards to confine the plug with a T bandage. This plan has been long recommended by Dr. Hamilton, and has been Opium in extensively followed with considerable success. Here, also, Dr. large doses: Hamilton prescribes large doses of opium as an auxiliary, beginning with five grains, and continuing it in doses of three grains every when given three hours, till the hemorrhage has entirely ceased. Opium, how- ™getou1i'yarever' is £ivcn with most advantage where the flooding takes place after the expulsion of the ovum ; for if this have not occurred its ad- vantage may be questioned, since it has a direct tendency to interrupt that muscular contraction without which the ovum cannot be ex- pelled. And it should be farther observed that where opium is had recourse to in such large doses as are above proposed, it must not be dropped suddenly, for flic most mischievous consequences would cl.v.J SEXUAL FUNCTION. [ohd. in. 125 ensue; but must be continued in doses gradually diminishing till it cGen\{; can at length be omitted with prudence. ParacyeBis' If the flooding occur after the sixth or seventh month, and the Abortus. debility be extreme, the hand should be introduced into the uterus nage. as soon as its mouth is sufficiently dilated, and the child turned and Treatment. brought away. And if, before this time, a considerable degree of only to bo irritation be kept up within the womb from a retention of the fetus degrees. y or any considerable part of the ovum after its separation, one or two JI|'(J'e'Jh,jJ£ fingers should also be introduced for the purpose of hooking hold of circum- what remains, and bringing it away at once Such a retention is be tuine'd often exceedingly distressing, the dead parts continuing to drop and away in membranous or filmy patches for several weeks intermixed a*™j. with a bloody and offensive mucus. And not unfrequently some f^'^'g. danger of a typhous fever is incurred from the corrupt state of the tention of unexpelled mass. In this case the strength must be supported with wheifdead. a nutritious diet, a liberal allowance of wine, and the use of the warm Th* bitters, with mineral acids. It is also of great importance that the be here uterus itself be well and frequently washed with stimulant and anti- utenisto' septic injections, as a solution of alum or sulphate of zinc, a decoction ' e washed of cinchona or pomegranate bark, a solution of myrrh or benzoin, iant andinu" or, what is better than any of them, negus made with rough port M"»»pfo 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 Summarv perfect quiet, and, where the pulse is full, venesection, are the chief raeiite.a 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 delivery 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 it has been weakened by a 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 whe- ther the application of warm cloths to the stomach and extremities might not be of more advantage ? for unless the extremities 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 allowance of a little cold negus. So that the utmost degree of judgment is necessary on this occasion, not only how far to carry the established plan, but on pecu- liar emergencies how far to deviate from, and even oppose it. We have said that the hemorrhage which takes place in abortions, J^™1"- howevcr profuse, is rarely accompanied w7ith serious effects. This, abortion however, must be limited to the first time of their taking place : for if dna"*ar8e in they occur frequently in the course of a single gestation, or form a as they in- habit of recurrence in subsequent pregnancies, the blood, from such rCca™'"<.,,. 126 cl. v.] GENETICA. 1°kd. "i- Gem. I. frequent discharges, loses its proper crasis ; the strength of the con- Pmeyes"' stitution is broken down ; the sensorial fluid is secreted in less abun- Abonus. dance, perhaps in less energy : and all the functions of the system ritlgo"" are of consequence performed with a considerable degree of languor. Evu'effecu The increasing sensorial weakness produces increasing irritability : of frequent and hence slighter external impressions occasion severer mischief, abortions. anj ^ patjent 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 symp- toms is apt to terminate in dropsy. GENUS II. PARODYNIA. MORBID LABOUR. THE PROGRESS OF LABOUR DISTURBED OR ENDANGERED BY IRREGU- LARITY OF SYMPTOMS, PRESENTATION OR STRUCTURE. Gen. II. The generic term is a Greek compound from Kxpx, male, and «h» wfth^which or £hs,-ivcs, "dolor parturientis." All the different species of vivi- utero-ges- parous animals have a term of utero-gestation peculiar to themselves, pie'tes itself and to which they adhere with a wonderful precision. Among nates?r™" women we have already said that this term is forty weeks, being nine calendar or ten lunar months. Occasionally the expulsory 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 Supposed pointed out. Sometimes the weight of the child has been supposed fabour°f to f°rce it downwards at this precise period, and sometimes the pains on uterus has been supposed to contract, from its inability of expanding pietion'of any farther, and hence from an irritable excitement produced by the pregnancy, pressure of the growing fetus. By other physiologists it has been ascribed to the increasing activity of the child, and the uneasiness occasioned by its movements. But it is a sufficient answer to all these hypotheses to remark that a like punctuality 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 incontestibly proved than that a dead child, even though it may have become putrid, is commonly born after a labour as regular and natural in every part of the process as a c\bienorPpU" liv5n2 one \'* and hence we can only resolve it into the ordinary unsatisfac- law of instinct or of nature, like that which regulates the term of tory: and hence best resolved * Pnrt. of Midwifery, Bro. Edit. 5. p. 255. t>i>. v.j SEXUAL FUNCTION. jobd.iu. 127 menstruation, or assert still more intelligibly with Avicenna that, Gei*. n. u at the appointed time labour comes on by the command of God." Mo?b1 •J GENETICA. [ord. in. Gen. II. Spec. II. r P. im- jilastica. lacerans. Parturient laceration. Laceration of the fun- dus of the uterus may take place during any part of la- bour under particular circum- stances. Laceration of the cer- vix more common. Laceration of the vagi- na or peri- neum. Mode of treatment. Opium when al- lowable. If prolapse be threat- ened, the uterus to be support- ed during pains; and the patient avoid hear. inc; down- women,*' observes Mr. Burns, " are most liable 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 scirrhus 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 organ do not act in unison in every part; but the mischief more commonly commences in the cervix, when the head, or the shoul- 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 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 laxer, softer, and more compilable. In all such cases also an emollient injection several times repeate-l, .vill 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 ab- stinent till the parts have yielded and the tension and irritation sub- sided, for before this, every application of the fingers will only in- crease 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 the 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 pur- pose of allaying the irritation and taking oft 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 bo 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 artu- * Principles of Midwifery, 8vo. 3d. Edit. p. 361. ul. v.J .SEXUAL FUNCTION. [oed. hi. 133 ally protruded into the vagina, a reduction must be instantly attempt- Gen. II. ed ; and if this cannot be done, no time should be lost in passing the } pEfra.n* hand through the cervix, as soon as, without force, it can be suffi- pin«>ca ciently dilated for this purpose, and delivering the child by turning. Parturient Laceration generally takes place suddenly, though, in irritable lracfatj°!1* habits, cramps or other spasmodic affections are often previously com- lapse a re- plained of in different parts of the body. Mr. Burns has well de- bSfn'J!,^, scribed the symptoms that succeed : " When this accident does hap- *"eJep^?d pen the woman feels something give way within her, and usually be turned suffers at that time an increase of pain. The presentation disap- awdayr.ousht pears more or less speedily unless the head have fully entered the Laceration pelvis, or the uterus contract spasmodically on part of the child, as cur^sud- happened in Bechling's patient.* The pains go off as soon as the f^'h child passes through the rent into the abdomen : or if the presenta- sometimes tion be fixed in the pelvis, they become irregular and gradually de- C^cramps. cline. The passage of the child into the abdominal cavity is attend- General ed with a sensation of strong motion of the belly, and is sometimes 0f symp-0" productive of convulsions."? lupuireof It is not necessary to make a distinction between the parts in the womb. which the laceration takes place : for whether it be in the fundus lactation or cervix of the womb, or in the vagina, except where, as just ob- tbesame, served, the position is fixed in the pelvis, the part presented instantly the body or disappears, and the child slips imperceptibly through the chasm "ve0:mb0or,h" into the hollow of the abdomen, sometimes with a hemorrhage that the vagina. threatens life instantly, but sometimes with little or even no he- morrhage whatever. This accident will not unfrequently occur towards the close of a Sometimes labour that promises fair. It is not many years ago, when the pre- towards the sent author, at that time engaged in this branch of the profession, c'<»e of a was requested with all speed to attend, in consultation, upon a lady gooTpro- in Wigmore Street, who was then under the hands of a practitioner Exemoii- of considerable skill and eminence. She had for about eight hours tied. 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 clear- ed the os uteri and was resting on the perinreum, 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 surprised 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 ascertained that a large laceration had taken place in the uterus, commencing 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 antece- dently there were no means of determining. It is usual, under these child in circumstances, to follow up the child with the hand through the rup- ^*£™ ture into the abdomen, and to endeavour to lay hold of the feet, and followed J up into the mother's * Haller, Disput. Tom. m. p. 477. t Burns, at supra, p. 362. 134 cl. v.] . GENETICA. l°*v- ™- Gen. II. Spec. II S P. ira- plastica faeerans. Parturient laceration. body and brought away by the feet. Life conti- nues usu- ally about twenty- four hours after the accident. Sometimes longer Twenty- sixth day. Three montha. A few raro accounts of a natural cure of the uterus, and a continu- ance of the ex-fetus in the abdo- men for many years or thiough life. Where the child can- not be fol- lowed up, the case must be left, or the Cesarean operation be per- formed. withdraw it by turning. The hemorrhage had alarmed the practi- tioner, and this had not been attempted ; and at the time of the au- thor's arrival, which was about an hour and a half afterwards, the attempt was too late, for the pulse was rapidly sinking, the breath- ing interrupted, and the countenance ghastly, yet the patient had not totally lost her self-possession, and, being informed of her situa- tion, begged earnestly to be let alone, and to be suffered to die in quiet. Where there is little or no hemorrhage, the life usually continues 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 women, who, after being delivered, lingered for three months : and a few marvel- lous 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 ;t 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 the violent contraction of the uterus between the os uteri and the rent, we have nothing to propose 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 instances 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.|| * Tom. li. p. 326, t Mem. de Paris, 1773. t Epta. Nat. Cur. Dec. i. Ann. in. Obs. 12. 5 Id. Dec. u. Ann. vm. Obs. 134. || Progres de la Medicine, 1698, 12mo.—Abhandlung der Konigl. Schwed. Acad 1744.—Hist, de 1'Acad. Royale des Sciences, 1714. p. 29. 1716. p. 82. w*v.J SEXUAL FUNCTION. Lord, in, 135 SPECIES III. PARODYNIA SYMPATHETICA, COMPLICATED LABOUR. 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 Gen. ft,« the stomach, there is no organ that holds such numerous ramifications f "J^J*1, of sympathy with other organs as the womb : and we hence find the ra.ge of progress of parturition disturbed, and what would otherwise be natu- bc?w,eeSy ral, converted into a morbid labour by the interference of various the nt«ru* other parts of the body, or the faculties which appertain to them, organse' The whole family of varieties which issue from this source are j^soni the extremely numerous : but the three following are the chief: species of disease. « Pathematica, Accompanied with terror or other mental emotion. /3 Syncopalis. Accompanied with fainting. y Convulsiva. Accompanied with convulsions. In the pathematic variety, the joint emotions which are usually a p. gym. operative upon a patient's mind, and especially on the first labour, ptlllemau- are bashfulness on the presence of her medical attendant, and appre- «. hension for her own safety. There is not a practitioner in the world tedTith but must have had numerous instances of a total suspension of pains ^"{-jj,, on his first making his appearance in the chamber. And in some and henca cases the pains have been completely driven away for four and twenty pafn'slierc- hours, or even a longer term. J".y som^ There is nothing extraordinary in this, for two powerful morbid tireiy driven actions are seldom found to proceed in the animal frame simulta- B^pfainxa, neously ; 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 Duty of the familiarize himself to his patient before his assistance is required, and r,e}a"ji„I,lt<> °cca- of apoplexy. It is against this, indeed, that all practitioners, how cause. much soever they may disagree upon other points, most cordially ^"c^ l^a endeavour to guard, though it rarely happens that effusion in the brain, be guarded and some of its results, do not take place in spite of all their exertions. aEainst" The first step is to open a vein and bleed copiously, from a large Medical orifice, till the patient faints : and if the operator be expert, the best copjow"*" vein to make choice of is the jugular: the hair should be imme- bleeding, diately removed from the head, and lotions of cold water, pounded ice, the jugular or the freezing mixture, produced by dissolving three or four different ^"'head sorts of neutral salts in water at the same time, be applied all to be kept over it by wetted napkins changed for others as soon as they require chl1 e ' the least degree of warmth. At the same time a purgative injection Purgative?. 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 circum- Tbi* plan stances, though its extent, and particularly in regard to blood-letting, sounder must be regulated by the strength and energy of the patient. The Nation.0"1' local mode of treatment seems to be somewhat less decided. Local It may happen that at the attack of the fits, the os uteri is merely "latme'nt. beginning to open, or that it is of the diameter of a crown piece, but j^'j;*^ peculiarly rigid and undilatable. There are practitioners who, in to bo cau- this case, confine themselves to the depleting plan, and only wait for w°"ched. the advance of the labour : but, in the state of the uterus we are now J™!e»*u_ contemplating, they may have to wait for some hours before the Lriy^fgid, labour is so far advanced as to render them capable of affording any {£„{;££ manual assistance whatever, while the fits are, perhaps, recurring handmust every quarter of an hour, and threatening fatal mischief to the brain. DutqXV And in this case I cannot but warmly approve of the bolder, or rather Jg^" a the more judicious advice of Dr. Bland, who, after a due degree of0fiauda- •lepletion, recommends a full dose of opium, for the purpose of ^ ™,st Vol. V.—lR 130 cl.v.J CJEiNETiCA. L"* Gen. II. allayin" the nervous irritation generally, and particularly that of the Sfec. III. utcrus°wi,ich is the punctum saliens of the whole. A few hours' patheS. rest may set all to rights, if no vessel have thus far given way in the paSEriSn?' head: for when the next tide of pains returns, it will commence convui- under very different circumstances in consequence of the reducent Treatment, course of medicine that has been 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. . commonly, But this is not the common course which the uterus takes under thewhote these circumstances ; for, in by far the greater number of cases, the las'dVnd wno'e OI* this organ, the cervix as well as the fundus, is so exhausted the mouth in the general contest, as to be more than ordinarily relaxed and fataMe'?1 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 ter- minate in a few minutes. But unfortunately this muscular exertion, instead of being concentrated, is distracted and erratic, and wander- ing 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 .^tate of harmonious action. This state This may be easily ascertained by introducing the hand on a return pabieyofa" of the paroxysm, when the uterus will be found to contract, indeed, ceruined Dut wlt^ a tremulous undetermined sort of force, perfectly different from what it does at any other time. The ob- The necessary practice in this case should appear to be obvious dy Sn this6" ano< without doubt: the medical attendant seems imperatively called baaekti uPon to introduce his hand into the os uteri, as soon as it is suffi- membranes, ciently open for him to do so without force, to break the membranes and bring if not broken already, lay hold of the child's feet, deliver by turning, away tho and thus put an end to the convulsions at once, and, consequently, to the fatal effects which seemed to await the mother as well as the child. Such the f Such was the practice recommended by Mauriceau upwards of a Siauriceau, century since : "La convulsion," says he, "fait souvent perir la vv.eHunter, mere et l'enfant* si la femme n'est pas promptement secourue par ;nd Low-' Vaccouchement, qui est le meilluer remede qu'on puisse apporter a l'une et a l'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 olaosedab k°tn wou^ otherwise have unquestionably perished. Some forty RPoPe°deeter,y years after the publication of M. Mauriceau's work, Professor Roe- waidfby derer of Coettingen called this practice in question, and recom- Ross. mended 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 * Traite de.^ Maladies des Feuimes grosses. Tom. i. 23. 4(n Paris iT»1 v Llemcnta Art is Obstetrics?. Aph. 679. Goet. 1769. 8m. I '^- sympathe- tica. Complicat- ed labour. Treatment Question further examined. General •conclusion. Gen. II. an(J plastic instrument of the band, may supersede the use of Spec. III. , nd rougher, and less manageable tools of art. Parodynia ™g^ o^ mo* important part of the question is as to the actual degree of danger which is induced by convulsions; and to determ me this, nothing more seems necessary than to put the whole upon tne footing of an impending apoplexy. It is possible that no ettusion in the brain may have taken place at the time when the depleting plan has been carried into execution, but if the paroxysms should still recur, 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 patient 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 paroxysm is over, accompanies her through the remainder of her labour, 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 incon- testible 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 requested 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 ad- mitted 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 suffered to take its course. Expulsory pains followed at intervals, but the convul- sions 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 pelvis, it was determined to deliver her by the forceps, which was applied accordingly; and in about an hour afterwards a dead child was brought into the world, whose appearance sufficiently proved that it had not been long dead. 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 consi- derable hopes of recovery. On the second day, however, in conse- quence of the accession of milk-fever, the convulsions returned, immediately followed with stertor and insensibility, and on the ensuing day she died apoplectic. To reason from a single instance, whether successful or unsuc- cessful, is often to reason wrong. Yet it is difficult to avoid con- striking il« I titration. How far a general issue may bf> drawn cL.v.i SEXUAL FUNCTION. [ord. in. 141 jecturing that if immediate delivery had here taken place as soon as Gen.ii. the sanguiferous system had been duly emptied, and when the state Parody*"' of the uterus was so favourable for a trial, two lives might have been sympathe- spared, both of which were lost under the course pursued. It is true uompiicat- the fits returned with the milk-fever, but had the brain been less Treatment. injured, there would have been far less danger of such return. The from a sin- cases of Dr. Smellie and of Dr. Perfect concur in justifying such a t'LTu5-' conjecture : and the following passage of Mr. Burns should be com- ^or'0;r™jw mitted to memory by every student and every practitioner. " But by various this is not all," adverting to the necessity of a free depletion, " for a^smoE the patient is suffering from a disease connected with the state of Perfect, the uterus, and the state is got rid of by terminating the labour. Even when convulsions take place very early in labour, the os uteri 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, although 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 pos- sibly do it without violence. There is, I am convinced, no rule of practice more plain or beneficial. Delivery does not, indeed, always save the patient, or even prevent the recurrence of the fits, but it does not thence follow that it ought not to be adopted."* SPECIES IV. PARODYNIA PERVERSA. CROSS-BIRTH. LABOUR IMPEDED BY PRETERNATURAL PRESENTATION OP THE FETUS OR ITS MEMBRANES. In the ordinary course of gestation the fetus is rolled up into as GEN* lb small a compass as possible with the breast uppermost, and the head Natural ' dependent, the legs incurvated and the arms folded : the placenta position of rises from some part of the fundus, and the umbilical cord hangs at the womb. perfect ease in loose folds, or is sometimes turned loosely round the body, thus forming an ellipse whose longer axis corresponds to the longer axis of the uterus. Why the head rather than the breast, or J^lsposi' indeed any other part of the fetus should so uniformly constitute the commo-s point of presentation, we know not, excepting that it is by far the ^HvSJ°r. most commodious point for delivery; and we can hence only resolve and depen- it into one of those striking laws of nature which are ever aiming at an instm"- accomplishing the best ends by the best means, and afford an un- jj'f^ of * Principles of Midwifery, p. 359. Sd Edit. 8vo. 1811. 142 cl. v.J UENETICA. [ord. in. Gen. II. Spec.IV. Parodynia perversa. Cross- birth. Morbid deviations from this position. varying and unequivocal proof of design united with benevolence and power. Here, however, as in every other part of the animal economy, we meet with occasional deviations from the ordinary course of nature, and deviations which are always productive of evil. Tor it some- times happens, from incidental causes that are totally concealed from us, that some other part of the child is lowermost or presents itself instead of the head; or that the placenta rises in an unfavourable part of the womb, or that the navel-string hangs down below the head and is constantly in danger of being strangled as the child passes through the sharp bones of the pelvis: and hence we have the following varieties of morbid condition offering themselves to us under the present species : et Faciei. |3 Natium. y Pedis. ^ Brachialis. e Transversalis. £ Funis prolapsi. » Placenta?. Presentation of the face. ---------- of the breech. ----------of one or both feet. ----------of one or both arms. ----------of the shoulder. Prolapsed navel-string. Presentation of the placenta. Present work not designed to instruct in the ma- nual or ar- tificial ope- rations of the obste- tric art: but merely to take a view of the conditions in which they will lie found necessary: and to offer general re- marks. Presenta- tion of the child un- known be- fore the time of labour: and not positively to be spo- ken of till the mem- branes have broken- Explained. Hence ap- prehensions of pregnant women drawn from imaginary tokens un- founded : As it is by no means the object of the present work to instruct in the manual or artificial operations of the obstetric art, the author must limit himself to pointing out the different morbid conditions in which such operations will be found necessary. Their nature, mode of accomplishment, and effective instruments are only to be learnt by works written professedly on this subject, or, which is infinitely better, by an attendance on lectures, and such initiatory practice as the obstetric schools afford. A few general or incidental remarks are all that the author can undertake to add to the above table of morbid presentations. There is no mode of determining what may be the presentation of a child before the commencement of labour, and even at that time it is most prudent for a practitioner to speak with some hesitation on the subject till the membranes have actually broken, and the position is fully decided. For though the real presentation is often suffi- ciently ascertainable through the membranes themselves, and parti- cularly on the natural descent of the head, yet it has occasionally happened that, on the breaking of the membranes, the head has re- ceded and the shoulder or some other part taken its place; and there are cases in which the opposite and more fortunate change has oc- curred of a recession of a presenting shoulder and a descent of the head in its stead.* There is hence no foundation for those apprehensions which are often entertained by pregnant women respecting the misposition of the child, drawn from some peculiar symptom or feeling which she has never been conscious of on former times,, as a singularity in the shape of the abdomen, a sense of the child's rising suddenly toward? '' Toerj, Hist. Part. p. 90.—Burns, ut supra, p. 292. ll. v.J SEXUAL FUNCTION. [ord. m. 143 the stomach, or a numb or painful uneasiness in one leg more than in Gen. 11. another. These, and hundreds of other anomalous sensations have pffod,mT' occurred in cases where the presentation has at last been found perversa. natural, and the labour has proved highly favourable ; while on the MrthT contrary it is very rarely, when a cross birth is detected, that it has ^jr^a8"" been particularly apprehended by any precursive tokens whatever, present in" And the mind of the timid may hence be comforted in the midst of ^"n't"-91 all the peculiarities on which they are accustomed to hang with daily ,ion and i absent in dldrill. - preternatu- It will rarely be found necessary to have recourse to any mecha- '^ h . nical instrument in any of the varieties we have enumerated above; means and in some of them, as the breech and foot-presentations, the expul- Ceesa'yn?n sory powers of nature generally are sufficient alone, at least till the aDy °? the head descends into the pelvis : at which time it will be found neces- presenta-0 sary, whenever the arms he over the head, to introduce a finger or !ion be\ ,11,1 ° longing to two and gently draw them down. this species. Where the face presents, or any other part of the head than the Face pre- vertex, it was formerly the custom to deliver by turning, but a skil-sentatl0n- ful practitioner of the present day is commonly able, by a dexterous pressure of one or two fingers against particular parts of the head, and especially if attempted in an early stage of labour, to give the organ a right direction without introducing the hand. On the presentation, however, of a shoulder or of one or both arms, shoulder or it will be expedient to turn as soon as pos$ibl< ; or, in other words, ^a^ion. as soon as the mouth of the womb is sufficiently dilated for this pur- pose. It is singular that, while under the old practice, delivery by the feet was often endeavoured in face-cases, attempts were made in arm and shoulder-cases to bring down the head and reduce the labour to a natural course. This it seems has been done and may be done, but with so much fatigue and exhaustion to the patient as to run the risk of incapacitating her for any subsequent efforts, if she do not even fall a sacrifice to a flooding as in a case related by Dr. Smellie. It is to the successful exertions of Pare and Mauriceau that the better practice of the present day has obtained a triumph over all Europe. Yet, in justice to the obstetric practitioners of ancient Greece, it should be observed that the modern method i? little more than a revival of their own which unaccountably sunk into disfavour : for we are told by iEtius, that Philomeles discovered the method, at that time in common use. of turning and delivering children by the feet in all unnatural presentations. Where, however, the child is small,or of premature birth, it may sometimes be taken away without changing the presentation : for the obstetric writers abound in ex- amples of delivery effected under such circumstances by pulling down the arm and drawing the head into the vagina.* It sometimes happens that the shoulder is so far advanced into the Spontane- pelvis before the arrival of the practitioner, or from the vehement "i'0ntn°Iu force of the uterus, that it is impossible to raise or move the child ^]d" by the utmost power of the operator : and the state of the case • Gardner, Med. Comment. Vol. y. 307.—Bandelocque. Sect. 1530.—Burns, ut <'ipra, SO" 144 cl. v.j GENETICA. i^u. ui Gen. II. seems to leave the woman without any hope of relief. At this very pfrod'ml" moment, however, and by these very means the wise and benevolent perversa, law of instinct or of nature is interposing to the relief that is de- Mr?"" spaired of. This wonderful process, though occasionally noticed by earlier writers, and foremost of all perhaps by Schoenheider, in the Copenhagen Transactions,* was first fully illustrated and explained by Dr. Denman, who distinguished it by the name of a spontaneous Nature of evolution. His explanation is best given in his own words : "As tionhexV-olu to the manner in which this evolution takes place, I presume that niained. after the long continued action of the uterus, the body of the child is brought into such a compacted state, as to receive the full force of every returning action. The body in its doubled state being too large to pass through the pelvis, and the uterus pressing upon its in- ferior extremities, which are the only parts capable of being moved, the latter are forced gradually lower, making room, as they are pressed down, for the reception of some other part into the cavity of the uterus which they have evacuated, till, the body turning as it were upon its own axis, the breech of the child is expelled, as in an original presentation of that part: and consequently is delivered by To what nature at the time she least expected it." Dr. J. Hamilton, how- stances ever, has justly observed that this evolution can only take place limited. where the action of the uterus can produce no exertion on the pre- senting part, or where that part is so shaped that it cannot be wedged in the pelvis : and he might have added where the woman is in full strength and the uterus is capable of exercising a strong expulsory power. And hence, it is a chance that should never be trusted to or suffered to interfere with the common practice of delivering by the feet wherever this can be accomplished. in ail these In all the above cases it is a general rule and one of great impor- witers to tance, to suffer the water of the amnios to accumulate towards the rateU™nd nec^ of the womb as largely as possible, and to leave the membranes the mem- unbroken as long as may be. beTeftt0 A presentation of the funis is another difficulty often of considerable as'ion^as moment in the progress of labour : for it is obvious that by a check to may bl.°B the pulsation, either actually taking place or being greatly endangered JontationT m every Pain by tne violent pressure of the head or of any other part against the mouth of the uterus, or afterwards against the sides of the pelvis, and consequently against the funis itself, the fife of the child is in imminent hazard, and without the exercise of considerable skill, may inevitably be lost. If it be possible to return the pro- lapsed part of the funis round the head as it is descending, or to hook it against the hand or some other part so as to keep it clear of pres- sure, this ought to be done by all means. But if this be impossible the child must be turned, as soon as turning is practicable from the dilated state of the os internum: or if the head should have reached the pelvis before the accident takes place, the labour must be acce- lerated by the patient's using her utmost efforts during every pain ; and, if she be too much exhausted for concentrating her strength, i', ■mist be quickened by the use of the forceps. But if the pulsation * Act. Havn. Tom. n. Art. xxin. u^v.j SEXUAL FUNCTION. joitn. m. 14o in the chord have already ceased, and we have hereby a proof that Gen. 11. the child is dead already, the labour is to be suffered to take its p^ody.!.!' natural course. pervorsa. It sometimes happens, however, that after the child is turned and Head does' the head does not follow the body so speedily as could be wished ^jy^.! from the patient's being greatly exhausted,—and the same frequently low the occurs in breech cases, in consequence of the protracted length of IhTbo'dy^ the labour in this presentation,—there is still a considerable danger inu|°°geJf to tlie navel-string, from its pressure between the child's head and the exhaustion pelvis. This should be remedied as much as possible by giving the n°cr*lor ee" funis full play between the pains. But it frequently occurs, in spite Hence the of the utmost caution, that the pulsation is suspended, and the child danger": is born in a state of asphyxy, and apparently lifeless. children The common practice in this case is to tie the navel-string as bom in a quickly as possible, remove the child from the mother to the warmth p^yxy.f as of the fire-place, and endeavour to stimulate the lungs into action by The com_ breathing forcibly into the mouth while the nostrils are closed, ticotodi- , Friction with a warm hand, and with the conjoint aid of some pun- funf3jm3rae. gent volatile, is at the same time applied actively to the chest; and diately, if this do not succeed the nostrils arc attempted to be roused with "t1muTant ammonia, or the fauces with a tea-spoonful of brandy and hot water, t71OHm8eby to excite sneezing or coughing. All this is well; but there is aThisprae- great, and, I am afraid, not unfrequently a fatal error in thus sepa- neouTso rating the navel-string and removing the child from the mother, <« as «- • . I*ite9 to di- While it continues united it has two chances of recovery, that of the viuing the action of the lungs and that of the re-action of the umbilical artery. f"rnel8t^pi. By removing it from the mother we allow it but one chance, and ration. that, in my opinion, the feeblest. The expansion of the lungs is alto- nio'n °£! gether a new process^ and, like other new processes, does not always pladinj^g. take place with great promptness, even where the child is in full life uated. and vigour, and the umbilical artery in regular pulsation ; for it is sometimes half a minute or double this time before the child begins to cry, which is the first proof of its respiring. But the flow of the blood through the umbilical artery is an established habit, and, like all other habits, has a powerful tendency to recur if we give it time and favour; and must derive an additional tendency from the stimulus of the posterior placental vessels which are still pulsating, and ope- rating wjjh a vis a tergo. Of the various cases of asphyxy on birth which I have witnessed, by far the greater number have proved fatal when treated in the former way, and successful when treated in the latter : and the explanation here given will readily account for the difference. The placenta itself may, also, form a preternatural presentation, t^en8°nfta and add much to the difficulty and the danger of labour. We have placenta. said that this rises ordinarily from some part of the fundus of the Uterus, though it may originate from its sides, or from some other quarter, for there is no quarter of the womb which may not become its source. Hence it occasionally takes its rise more or less over the mouth of the womb ; and while this part of the womb continues quies- cent, it produces no more inconvenience there than any where else. But the moment labour commences, or even, in the latter months of ,, Vor.. V.—IP Gen. II. Srr.clV. Purodymu mci versa. > 'ros-birth l,X. v.j GENETICA. |(>Kl>. Ill- fJnnatural labours proportion ably, but few. Their re- spective averages. nartuntion, when any cause whatever irritates the mouth of he womb, and in any degree puts it upon the stretch, some ot the placental vessels must necessarily become ruptured and a hemorrhage ensue. So long as this is -mall in quantity, and does not frequently return, it will be sufficient to enjoin quiet, a recumbent position, and that the bed be not heated with a profusion of blankets. But if the hemorrhage be considerable, whether before the full time of labour, or on its accession, or in any part of it, there is no perfect safety but in delivery, and hereby giving the ruptured vessels an opportunity of closing their mouths. The difficulty is less than a young practitioner might at first expect: for he may be sure, from the hemorrhage itself, that the os uteri is both dilated and dilatable, since if this did not give way neither would the vessels which produce the hemorrhage. Upon the whole, the proportion of unnatural deliveries to natural is but few ; and of these it is pleasing also to reflect that the more they are connected with difficulty or danger, the more rare is their occurrence : insomuch that comparing the statements of Professor Magele, of Heidelberg,* with those of several of the most eminent accoucheurs of our own country, as Dr. Bland and Dr. Merriman, we may calculate that a breech case may be expected about once in fifty times ; a foot case once in eighty ; and the more dangerous presentations of the arm. breast, or funis =carcelv twice in five hun- dred births SPECIES V. PARODYNIA AMORPHICA. IMPRACTICABLE LABOUR. t-ABom impeded by mis-configuration of the fetu THE MATERNAL PELVIS. OR OP l*EN. II. Spfc. V. In natural labour mu- tual adap- tation of the bead and the pelvic pas- sage. This mu- tual adap- tation sometimes interfered with by the figure ol the child's bead, or the mater- nal pelvis, bo much so as to render a passage impractica- ble In natural labour the size of the head is adapted to the diameter of the pelvis it has to pass through : in some children, indeed, th» head is rather larger than in others, or has a difference of shape; and we meet with a like difference in the area of the pelvis : and these circumstances may prolong the labour, though the expulsory powers of the mother will ultimately triumph over the resistance. But it unfortunately happens that the head is sometimes so enlarged by monstrosity of structure, hydrops capitis, or some other disease. or that the maternal pelvis is so deformed in its make, that the child cannot pass through the passage, and delivery becomes altogether impracticable. There is, however, an intermediate state between the natural size of the pelvis with a head of a natural size applied to it, and that of absolute impracticability from the utter inaccordance of the head to * HphersicM der Vorfalle in f!or G. H. F,ntl,;n!;tB!r«anstalt 711 Hpirlelberp, &c. 1819 u.. v. j .> E A L A L F UN CTiON [okd. rii. I tf the opening ; in which, though the most violent and best directed Gen. II. pains of the mother may not be sufficient to produce expulsion, this prfrodynil' object may be effected by the assistance of instruments co-operating amorphica. with the natural efforts. biePiabou£ What space of pelvis is absolutely necessary to enable a living Jo^g" child, at its full time, to pass through it, has not been very accurately sometimes settled by obstetric writers, some maintaining that this cannot take SatX-03 place where the conjugate diameter is less than two inches and a {jj^jj, n half, though it may, till we reach this degree of narrowness ; and practicable others that it cannot take effect under three inches. The dif- Xm.Tay ference in the size of the head in different children on their birth, b0 obtained and of the thickness of the soft parts within the pelvis in different ofmocnani- women, may easily account for this variation in the rule laid down. J;",!,,1,"81'11" It is clear, however, from the acknowledgment of both parties, Necessary that if the dimension of the pelvis be much under three inches, o^the*161 delivery cannot be accomplished without the loss of the child : and pelvis. it is also clear that if the head be much enlarged beyond the natural size from any cause whatever, it cannot pass even through the ordi- nary dimensions, thus giving us the two following sources or vari- eties of difficult labour from an amorphous cause. et A fetu. The fetus deformed by a preternatural magnitude ol head, or some other morbid protuberance. (3 Pelvica. The pelvis contracted in its diameter by natural de formity, or subsequent disease or injury. It is by no means easy to determine what is the actual measure- Thejud? rnent of the hollow of the pelvis in a Jiving woman, and particularly moreim rluring the time of labour : and hence, how useful soever it may be fi^"8^. to be acquainted with what ought to be its precise capacity as taken rocr moas under other circumstances, the judgment must chiefly determine pXhfin6 as to the practicability or impracticability of the passage from a every sepa- • ■aim attention to the individual case at the time, and particularly ra where the difficulty proceeds from the form of the child rather than from that of the mother. If, in well weighing the circumstances, the J™0,^, question remain doubtful, the patient should be allowed to proceed to proceed with her natural exertions alone, or such only in addition as the alubt^I in hands may be able to afford, till the strength is considerably ex- "?eBtiU hausted, and the mind participates in the depression of the body. ofbCd^and And if, at this time, as will probably be the case, the head has de- J^jf^JS scended so low as to be in contact with the perinaeum, and an ear then * use can be felt, it would be imprudent to delay any longer assisting her o^Vfor'" with the vectis or the forceps. ceP*- But the case may not be doubtful, and the passage may be so £»tthe much contracted as to render all attempts to accomplish delivery by not adm.t the hands or the ordinary instruments totally ineffectual from the "^ ,P""ho first. In this situation other means must be resorted to, or the ^£, even mother and the child must both perish, worn out by fatigue, and mcnt8. perhaps rendered gangrenous in the points of contact from irritation ind inflammation. Tbo moans thjit present themselves to the practitioner on this in this «a»c • ■■-■' i • ^no tncojjg 148 CL. V.j GENETICA. [OKU. Gen. H. Spec. V. Parodynia nmorphica. Impructi ca- ble labour. to be re- sorted to arc three- fold: a reduction ot the head : a division of the sym- physis : or the Ce- sarean sec- tion. Reduction of the head by the pcr- torntor. This to be employed without hesitation where the head is morbidly enlarged: and on what grounds. Put the pelvis may l>c so de- formed us to tender delivery even in this way im- practicable. Hence some other plan must bo pursued. Division of the sym- physis of the ossa pubis, how far appli- cable. This opc- TKtion, whon first proposed, mid by whom. iiy whom first tried. occasion are the three following : He may reduce the head of the child by the crotchet or perforator. He may, in a small degree, enlarge the diameter of the pelvis by dividing the symphysis pubis. Or, he may make a section through the abdomen into the uterus. The first of these methods is designed to save the mother by a voluntary sacrifice of the child. The two last give a chance to the child, but at an imminent hazard of the mother. Where the difficulty proceeds from a morbid enlargement of the child's head, the question as to which of these three methods of treatment should be adopted, ought not to admit of a moment's delay. The child is, perhaps, dead already, or, if not, it is not likely that it would long survive the deformity it labours under, or live so as to render life a blessing : and the life of a sound woman must not be risked, and still less sacrificed, for the chance of saving an unsound child. The head, therefore, ought to be diminished, and consequently the perforator to be had recourse to. But there are instances of a deformity ofthe'pelvis so considerable as that the perforator cannot be employed to any advantage ; for how much soever the cranium may have been broken down, there may not be breadth enough to extract the child in any way. • And this will always bc the case where the range of the pelvis is under an inch and a half from the pubis to the sacrum, or on either side. Dr. Osborn asserts that he once succeeded in removing a child by means of the crochet, in a case where the widest side of the pelvis was only an inch and three (juarters broad, and not more than two inches long ;* which is a capacity so narrow as to throw some doubt upon the accuracy of the measurement in the minds of many practition- ers,! and certainly so narrow as to form an unparalleled case in the annals of the obstetric art. In situations, therefore, of this kind, some other plan must be pursued even to save the life of the mother ; and the only plans that can even be thought of are that of dividing the symphysis of the pubes, and that of the Cesarean section. Towards the latter months of pregnancy there seems to be a disposition in the bones of the pelvis to separate at their symphysis, insomuch that some pregnant women are sensible of a motion at the junction of the boues, especially at that of the ossa pubis.J This has been known ,4.0 anatomists for some centuries, and about seventy years ago, for the first time, gave rise to a question whether advantage might not be taken of this tendency in cases of pelvic contractions, to enlarge the space by dividing the ossa pubis at their symphysis, and thus obtain the same end as is answered by the Ce- sarean section, with a considerable diminution of risk. The operation seems first of all to have been proposed by M. Louis of tlie French Academy of Surgery to Professor Camper of Gro- ningen, who tried it first on a dead female body, and found it would afford space, and next on a living pig, which, for some days after- wards, was incapable either of walking or standing, but in a few weeks perfectly recovered. He was then desirous of trying it upon * Osboin's Essays, p. 203. " Dt-rnimx, Pm*t. «! "VTrrtwifP-i 1 Burn's Prtoc. of Midwifery, p, 351. 46. 44R. iiL. v.j SEXUAL FUNCT1 UN. [ord. in. 149 a yonng woman condemned to death at Groningen, but did not Gen. II. succeed in his request. Not long afterwards, however, it was per- Karodynia formed with complete success by M. Sigault of Paiis, upon the amurphica. wife of a soldier who had hitherto borne four children, each of b^Tbolm" which, from the mother's misformation, was obliged to be extractcii Mu s"!|ui[ piecemeal. The section of the cartilage connecting the ossa History of pubis enabled the bones to be separated, according to his account, case?"1 by a chasm of two inches and a half; and yielded a free passage to the child in four minutes and a half. The wife, with her husband and child, a few weeks afterwards, presented themselves to the members of the faculty assembled in their hall. The patient walked steadily and was found to be perfectly recovered.* Mr. Le lioy. who was requested to attend on the occasion, tells us that the same operation was afterwards performed by two other practitioners on two other women, and in both cases with an equally happy termina- tion. He also observes that although, in an unimpregnated state, Extent to the bones of the pelvis cannot be made to separate upon a division J^nes wu° of the symphysis to a space of more than an inch, which would be separate in insufficient for the purpose proposed, the additional softness and compared flaccidity which take place during pregnancy, as well in the bones ptJ^e,rh®" and cartilages as in the muscles, is so considerable, that a separation other times. of two inches and a half may be easily effected in labour, and was effected in the above cases, while the same bistoury that divided the soft parts, easily also divided the cartilage.t In various other parts Operation of the Continent, and especially at Mons and in Holland it has been formedYn repeated with complete emancipation both to the child and mother. various . t\ t tt ■»«• 1 i ■ t»- i /-•• i other parts. Dr. J. H. Myers, who witnessed it at raris, speaks ot it in the Account of highest terms of commendation. He says that the length of the JfoV'gTveVi incision does not exceed three inches, and that the whole operation °y Myers. is over in less than five minutes : while in the Cesarean operation the wound is necessarily more than nine inches long, the uterus is divided, and the surrounding viscera are uncovered. u I have seen," says Dr. Myers, " the operation twice performed in this capital with every possible success. The last patient, while I am writing, is in the room, coming to show herself in justice to her operator. It is only eighteen days since the operation was performed, and she is in perfect health, and by no means injured by it.'*| The operation, however, has been decried, and, in some in- Operation stances, has certainly failed ; but there appears to be some doubt fr°cm"odccn. whether, in several of these cases at least, if not in all, it was con- sionai faii- ducted with a sufficient degree of dexterity and skill : for when we sometimes are told by one operator that, after the division of the symphysis he per^r.m?,d. could not effect an opening of much more than a finger's breadth, and by another that the utmost extent of the hiatus was not more than an inch and a half, and compare these remarks with the fol- lowing assertion of Dr. Myers upon this very point, it is difficult to come to any other conclusion. " The moment," says he, " the ■ Med. Coram. Edin. Vol. v. p. 214. t Rccherches Historiques ct Pratiques stir la Section de la SvmphystJ dtt Pulrcs. &c. Paris. Svo. 1778. * Fvlin. Meil. f'pmrtr^it. Vrrl. tii. p. 453 15o CL. V.J UIAET1CA. [oUtf. Gen. II. Spec. V. Parodynia amorphics. Impractica- ble labour. Performed by Lamtion twice on the same patient. Undue prejudice aguinstthe operation 'n our own country. Whence its orisin. Character of the ope- ration as given by Denman : ami expe- riments to prove its rnngo and safety. l-.xamiri.i- tion of the above ex- periments. In what re- spects in- conclusive. division id made, there is an enlargement of the pelvis, I venture to say, to any extent desired : the last I saw was three inches, ac- curately measured by an instrument called pelvimctre, contrived by AI. Trainel." To which we may add that M. de Lambon performed the operation twice on the same patient; in the first instance with- out injury to the mother, and in the second with success to both mother and child.* After these decisive facts in its favour, to which the reader may add others from the volume of Nosology, I cannot but conceive that the prejudice against it, in our own country, has been carried too far. One trial alone has been made among ourselves, and that with an unsuccessful issue. But the chief opposition to it seems to have proceeded from the discountenance of Dr. Denman, added to certain experiments made in relation to it by Dr. William Hunter. which do not seem to have been conducted under circumstances that can fairly call in question the truth of the preceding state- ments. " Immediately," says Dr. Denman, " after the accounts of the operation were brought into this country, wishing, as a matter of duty, to understand the ground of the subject, I had a conference with the late Mr. John Hunter, in which we considered its first principles, its safety ; and after the most serious consideration it was agreed that, if the utility could be proved, there appeared from the structure of the parts, or from the injury they were likely to sustain by the mere section of the symphysis, no sufficient objection against performing it. Of its real utility it was, however, impossible to decide before many experiments had been made on the dead body, to ascertain the degree of enlargement of tlie capacity of the pelvis, well-formed or distorted, which would be thereby obtained. Such experiments were soon made : and their result published by (he late Dr. Hunter, and these proved on the whole that, in extreme or great degrees of distortion of the pelvis, the advantage to be gained was wholly insufficient to allow the head of a child to pass without lessening its bulk : and in small degrees of distortion that the operation was unnecessary, such cases admitting of relief by less desperate methods. They proved, moreover, that irreparable injury would be done by attempts to increase the common advan- tages gained by the section of the symphysis by straining or tearing asunder the ligaments which connect the ossa innominata to the sacrum, and to the soft parts contained in the pelvis, particularly to the bladder."! Now it did not require these experiments to prove that this ope- ration, or almost any other, would become mischievous if unskilfully performed, but surely it was something too much to endeavour to set aside the facts and results known to have taken place in very numerous instances in the living body, and to call in question the veracity of those who made them and those who witnessed them, by facts and results made merely on the dead body, without one single experiment on the body while alive and in the peculiar circumstance* * Leake's Practical Observations on the Acnte Diseases of Women. 8vo .*. v.J SEXUAL FUNCTION. |_onn. in. lot under which alone it is admitted that thefacts and results contended Gen. II; for could possibly take place. paiodynia' Upon the whole it is allowed in the passage just quoted, as the uw<'ri'i»ica. n t-v «v i • in »«• t i vt i Impiactiea- concurrent opinion of Dr. Denman himself, Mr. John Hunter, and hie labour. apparently Dr. William Hunter, and this too after " tlie most serious ^.'JuV'."' consideration,"—that "there appears from the structure of the parts or from the injury they are likely to sustain, by the mere section of the symphysis, no sufficient objection against performing the opera- tion." That it will answer in every degree of a contracted pelvis was never asserted by its most sanguine advocates, but only in cases where the constriction was somewhat too considerable to allow of the extraction of the child by the forceps. And lastly, it is after all admitted by Dr. Denman himself, that where the life of a child is of more than ordinary importance from public or other considerations, and the mother who is in labour with it possesses a pelvis so deform- ed and contracted, that ;t cannot pass through the passage in its pre- sent state," there the section of the symphysis of the ossa pubis might be proposed and performed,—being less horrid to the woman than the Cesarean operation, and instead of adding to the danger, giving some chance of preserving the life of the child."* It is perfectly clear, however, that be the advantages of dividing Dms,™ of the symphysis what they may when the pelvis is under certain states piTysiV'una- of deformity, it is an operation that can never be of any avail where v^™5ihe the passage is so narrow that the child cannot be brought away piece- passage is meal even by the use of the perforator. And in such circumstauces narrow*1* the only alternative is to leave the patient to nature, in the slender i» which and desperate hope that the pains may gradually wear away as the patient parts become habituated to the irritation, and the child, as in many m^1 bc cases of extra-uterine fetation, be thrown out in detached fragments by an abscess; or to have recourse to what has been called the cesa- n^r^°,Uhf rean operation, and deliver by making a section into the uterus cesarean 11111 oporatiop. through the abdomen. ^ The love of offspring, or a sense of duty, has been so prevalent in Matcmai^ some women as to induce them to submit to this severe trial in cases ^ns'eoV1 where the pelvis has by no means been so straitened as we are now J"7nh,«. contemplating. And these motives not being confined to any par- vuiicd on ticular age, the operation is of considerable antiquity and is particu- "„""" £ larly noticed by the elder Pliny, who tells us that the elder Scipio Afri- tin* opera- canus, and the first of the Cesars were brought into the world in this taan- manner, and adds that the name of Cesar was hence derived, "-a ""^P"riea caso matris utero.'t In recent times, one of.the earliest cases in world which it was submitted to was that of the wife of a cattle-gelder at Ca„luls°nri,i'" Siegenhausen in Germany in the beginning of the sixteenth century. ;£*'«£' The child it seems was, from its size, supposed to be incapable of thus born. being expelled in the natural way, and the operation was performed fnx^l by the cattle-gelder himself. Barehin, in his appendix to Rousset, ny. who was a warm supporter of the practice, and wrote in favour of it in 1581, tells us that this woman did well and bore several chil- dren afterwards in the natural wav. There are a few other instances Revived by lay hands in recent Drnman, lit supr. 449. t Hist. Nat. Ub. vn. cap. ix. timc»- 152 cl. v.j GENETICA. [ord. m. Gen. II. Spec. V. l'cirodynia amorphica Im|iractica- blc labour. in Ireland. Result upon the whole very doubtful. Proportion- al fatality. Has been performed several times on the same per- son. Case of late occurrence. Has proved peculiarly fatal in our own coun- try. Exempli- fied. Want of success how ex- plained by Hamilton. The expla- nation hardly sa- tisfactory ; and tho want of success as- cribed to another cause. related of its having been executed by lay hands, and with equal success; particularly one performed in Ireland by an uninstructed midwife \\ hose instrument was a razor. The case is related by Mr. Duncan Stewart in the Edinburgh Medical Essays,* who saw the woman a few days after the operation. She was well in about a month. Among regular practitioners, however, it has been gene- rally opposed on account of its very doubtful result, from tlie time of Pare* and Guillemeau, who warmly resisted its employment. Dr. Hull not long since made a collection of all the cases in which the operation had been performed both at home and abroad, and calcu- lated them at 231, of which 139, being considerably more than half, had proved successful.t The German collections, indeed, give various examples of its having been repeated several times on the same person : and M. Trestan narrates the extraordinary history of one woman who had submitted to it not fewer than seven times. J One of the latest examples is, I believe, the case furnished by Dr. Locker of Zurich, and published in a late volume of the Transactions of the Medico-Chirurgical Society; in which the mother and child were both happily preserved.§ Under this view of the subject it is singular to observe the general fatality, at least to the mother, with which the Cesarean section has been followed in our own country. " There are, I think," says Mr. Burns, " histories of twenty cases where this operation has been per- formed in Britain : out of these only one woman has been saved, but ten children have been preserved."|| At Edinburgh, Mr. Hamilton remarks,1T that it had been per- formed five times at the date of his publication : and that in no in- stance had the patient the good fortune to survive it many days. Of the last case he was an eye-witness, and it was only resorted to after every other means had proved ineffectual : the child was saved but the mother survived only six and twenty hours. This ingenious writer enters with great pertinence into theauestion to what cause so gene- ral a failure is to be ascribed. And while he admits that nervous or uterine irritation from cutting, internal hemorrhage, or an extrava- sation into the cavity of the abdomen may each have an influence: he is disposed to think that its unsuccess is principally to be imputed to the effect which access of air is well known to have on viscera exposed and in a state of irritation. Dr. Monro repeatedly found that, in making even a large aperture by incision into the abdomen of ani- mals, if the wound be quickly closed the animal readily recovers : but that if the viscera be exposed for only a"few minutes to the air, severe pains and fatal convulsions ensue. And hence Mr. Hamilton most warmly exhorts that, in performing the Cesarean operation, the bowels be denuded as little as possible, and the wound be closed with the utmost expedition. This answer, however, is hardly satisfactory : and I am rather in- clined to think that the comparative want of success at home, is owing to the greater reluctance in performing the operation than t Translation of M. Bandeloque's Memoir, p. 233» * Vol. v. p. 360. I Journ. de Medicine, Tom. xxxvi. p. 69. !) Vol. ix. p. 11. || Princip. ut stipr. p. 348. ? Elements of the Prartic<» of Mi«hv;f»rv, fivo. ci,. v.] SEXUAL FUNCTION. Jord. hi. 153 seems to be manifested in France and Germany ; in consequence of Gen. H. which it is rarely determined upon till the woman is too far exhausted, parodynia" and has an insufficiency of vigour to enable the wounded parts to jmorphica. ... ,.*. *2 - , , , , Impractica- assume a healing condition. In most of the cases recorded, there bie labour. does not seem to have been any deficiency of skill; and particu- larly in that which occurred about five and thirty years since, and was attended by Mr. John Hunter and Dr. Ford,* and hence the unfa- vourable issue must be resolved into some other cause. It is happy for the world, and peculiarly so for those who are pos- Premature sessed of a contracted pelvis, and in many cases without knowing it till its great' they are in labour, that a far safer and less painful operation may be J^"^,,. had recourse to, where the deformity is known in due time, I mean that of a premature delivery. " A great number of instances have illustrated, occurred," says Dr. Denman, " of women so formed that it was not possible for them to bring forth a living child at the termination of nine months who have, in my own practice, been blessed with living children by the accidental coming on of labour, when they were only seven months advanced in their pregnancy, or several weeks before their due time. But the first account of any artificial 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 0risin of. i ■ ■ x i • i /• i- e Prac"ce the most eminent men at that time in London to consider ot the in London. moral rectitude of, and advantages which might be expected from, this practice ; which met with their general approbation. The first Success in case in which it was deemed necessary and proper, fell under the care case.'" of the late Dr. Macauley, and it terminated successfully. The patient was the wife of a linen-draper in the Strand. Dr. Kelly informed me that he himself had practised it; and, among other instances, mentioned that he had performed 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 m?^ married many years, was soon after her marriage delivered of a success on living child in the beginning of the eighth month of her pregnancy, j^"^!. She had afterwards four children at the full time, all of which were, after very difficult labours, born dead. She applied in her next preg- nancy to Dr. Savage, whom I met in consultation. By some accounts 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 utdro-ges- tation ; and it has lived to the state of manhood. In a subsequent pregnancy the same method was pursued, but whether the child was of larger size, or the pelvis was become smaller, whether there was * Desman, ut supr. p. 463. Vat, V.-—20 134 OEM. II. SrEc. V. Farodynia amorphica. Impractica- ble labour. } GENETICA. [onn. ua< Interval between rupturing the mem- branes and the acces- sion of the labour- pains varies ia different individual?. CL. V _ any mistake in the reckoning, or whether the child fell into any un- toward 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 recovered without any unusual inconvenience or trouble."* It is only necessary to add that the time in which labour-pains will come on after thus rupturing the membranes and discharging the waters, is uncertain, and appears to depend much on the irritability 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. SPECIES VL PARODYNIA PLURALISM MULTIPAROUS LABOUR. LABOUR COMPLICATED BY A PLURALITY OF CHILDREN.' Gen. II. Spec. VI. Fertility dependent on various circum- stances. Fifty-one children Sroduccd y ono woman. Constitu- tional ferti- lity heredi- tary. Multipli- cate ferti- lity. Throe at a hit lb. Sometimes four. Five re- ported, but upon doubtful authority. Twins mostly pro duced at a common birth: Cut The fertility of women seems to depend upon various circum- stances, 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- menger gives us the history of a Woman who produced fifty-one chil- dren :t and sometimes the fertility seems to pass from generation to generation, in both sexes, though it must be always liable to some variation from the constitution of the family that is married 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 occasionally but very rarely been brought forth together, and there are a few wonderful stories of five, but which rest on no well-authenticated 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 expulsion, and * Enist, App. ad Strauss de foeta. Mussipont. p. 29g. t Ibid, p. 228. cl. v.j SEXUAL FUNCTION. [ord. hi. 155 consequently, therefore, in their bulk or degree of maturity, giving g*EN- **; us the two following varieties : Parodjnia' pluralis. 1 1 1 j Multipa- rt Congruens. Of equal or nearly equal growth, and rouslabour. Congruous twinning. produced at a common birth. aHyTt°dif- |3 Incongruens. Of unequal growth, and produced at ferent pe- Incongruous twinning. different births. In congruous twinning or ordinary twin cases, in which there is « p-pj""; • t i • i i> i_ .. lis congrua. no great disparity of size between the two, on the birth of the one, it congruous can be pretty easily ascertained that another is still in the womb by twinmDs- applying the hand to the abdomen; for the limbs, and, if the child be alive, its movements, may generally be felt very distinctly, except, indeed, where 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 ^°nPr°cise determine whether she be pregnant of twins or not. Inequalities in which the prominence of the abdomen, peculiarities of internal sensation ^"twma or motion, slowness in the progress of a labour, have been advanced can be ™- as signs ; but they belong as frequently to the uniparient as to the cei aine< multiparient, and hence are unentitled to attention. The claim to priority of birth in a twin case is dependent, not on {^'^ of superiority of strength, or any other endowment, but on a closer twins de- proximity to the mouth of the uterus alone, and, consequently, on a ^nv*['t on greater convenience of position. Though when, on the birth of "^noffor twins, one is found small and emaciated, and the other plump and birth. 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 clnl- Generri dren, govern equally in morbid labour of twins. The second child m0erbidia- is usually delivered with comparatively few pains and little incon- J,0"^^" venience, as the parts have been sufficiently dilated by the passage of govern in the first; and, although there is commonly some interval between ££„££,*' the termination of the one and the commencement of the other sv°™o"lt8t- struggle, it is not often that this interval exceeds half an hour or an tween thi hour. It has, indeed, in a few instances extended to whole days ; in «^£0° °f one instance to ten,* and in another to seventeen days.f But these jjurtber. are very uncommon cases : and as mischief may possibly happen to te*de^"t0 a the womb, and to the system at large from a long protraction of %'£££ uterine irritation, it is now the practice to deliver the second child by to seven- art, after having waited four or five hours in vain for a return of ex- g^ pulsory exertions. .. ^ftffiE*. In incongruous twinning we meet, in diiierent cases, witn every pr..piuraUs possible diversity in perfection of form, and term of expulsion between j»™»|£* the co-offapring. Nor is this to be wondered at in either respect, oustwin- We have already seen that a single fetus may die during any period ^io]o&J of parturition from a variety of causes ; and hence we may readily ™£°*^- * IIist.de 1'Acad, des Sciences, 1751, p. 107. + Pe Bo«et in Verhendelingen van Harlem, xu, App. Wo. fa. one may Jlirive ioii cL.v.j GENETICA ' [om 111 Cen. II. conjecture that one of the twins may die at any period, while the Spec. VI. other stUl thrives and remains unaffected. This twin may remain lis inPcoUn-a" in the womb, and both be expelled together at the full time. But fncoangru- it may happen, also, from the peculiar irritation of the uterus ge- ous »win- nerajiy^ or the peculiar position of the dead fetus near the cervix, while the that this organ may be so far stimulated by the death, and corrupt deadend state of the fetal corse and its membranes, as to expel it from the first be tne body, while the living child receives no injury, and continues vSne the to thrive, and is maturely delivered at its proper time. mairi^itT In tne latter case> where the dead fetus has been discharged in the fun time, second or third month of pregnancy, the mother, not knowing herself mother, on to have been pregnant with twins, has been erroneously conceived, ttoMcondf on tue arrival of the second birth, to have produced a perfect child may ima-' within the short term of six or seven months. !asenot9 In the former case, or that in which the dead fetus remains than six"3 ^lmet m the womb through the remaining term of pregnancy and or seven both are discharged at a common birth, an opinion equally erroneous megtant. was formerly entertained in order to account for the apparent differ- Those facts ence of the two in growth and size: for it was supposed that the accounfed dead and puny, and apparently premature fetus, was conceived Soctrine'of some months subsequently to the perfect and vigorous child, and ■uperfeta- hence had not time to reach it in size and perfection ; and to this supposed subsequent conception was given the name of super- fetation. guperfeta- We have reason to believe that such a process does occasionally sioaaHya take place in some quadrupeds whose wombs are so formed as to uaquadru' au ""»««- In Henchel we have an account of a minute* and a mature fetus fnc»ngru- born at the same time : and in the Transactions of the Medico- °ms_lwin~ Chirurgical Society, a similar account by Mr. Chapman, with the Further exception of the time, which varied considerably: the dead and llluBtratc • minute fetus, apparently not mere than three or four months old, having in this case been born in October 1816, and the twin, a full- grown child, not till December, just two months afterwards.t In this last instance, however, there can be no doubt that the j^d™™" aborted fetus had remained quiet in the uterus for some months after plained. 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 Undisturb- the death of the fetus by any means uncommon, whether the off- nuance of spring be single or double. We have already given examples of an JJ,^',^ interval of ten, and even seventeen days, in the case of twins born after death, equally of full size. But where the growth has been discrepant, rn00n"ncom" and the dead fetus has remained behind unsuspected, it has some- times been several months before expulsion has taken place. Ruyset Haa con- gives a case in which it was delayed a twelvemonth after the appa- tweive- rent term of its death, and even then discharged without corruption :f "j11* j,bte and some of the foreign collections have instances that more than this time. double this time.§ The present author was once engaged in consultation upon the illustrative 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 attacked with a flooding and rigors, had had various subsequent uterine he- morrhages, and had never been able to quit a recumbent position without producing some return of the bleeding. SPECIES VII. PARODYNIA SECUNDARIA. SEQUENTIAL LABOUR. DISEASED ACTION, OK DISTURBANCE SUCCEEDING DELIVERY". In ordinary child-birth the pains of labour may be said to cease j^E£"yj; with the expulsion of the fetus : since though sequential, or after- In ordinary' pains as they are ordinarily called, are not uncommon for a day or ^'^^ after the * PJeue Medicinisctae und Chirurgische Anmerkungen, B. 11. !^ft?!Sf«(u. t Vol. ix. Art. p. 195. % Theraw. Omnium Max. oimeteuv i Neue Samml. WanrnehmuDsen. Band. iv. p. 24!, 168 Gen. II. Spec VII, Parodynia secundaria. Sequential labour. but from particular circum- stances great diffi- culty and distress. CL. V.J GENETICA. [ORD. IU. a "P. se- cundaria rolentiva. Retention of the se- c undines. Usually expellod by natural efforts: but may generally Be assisted by remov- ing the funis. Funis Eoinctimes gives way and leaves the placen- ta behind. And some- times no pains to separate and expel the placen- ta. Experiment as to the effect of leaving the placenta to nature. In this in- stance no mischief: and was henco a* practice with many at home, as it had long been abroad. But great evil has often hap- pened, and 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 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 antecedently, so that the labour itself may be fairly said to be protracted into-this secondary stage, which offers the following varieties of morbid affection c a Retentiva. |3 Dolorosa. y Hemorrhagica. ^ Lochialis. Retention of the secundines. Violent after-pains. Violent hemorrhage or flooding. Inadequate 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 remedial power of nature is just as competent of itself to do this as to expel the child ; but, as unquestionable benefit is found from assisting 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, without 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 drawn 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 pla- centa is 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 exhaus- tion, a sufficiency of natural exertion does not in numerous instances return for three or four days afterwards, and sometimes even longer ; while the placenta, by remaining in the uterus, keeps up a febrile cl. v,} SEXUAL FUNCTION. |ok». m. 158 irritation and, what is infinitely worse, by being in many instances Gen. II. partly though not wholly detached, and rendered a dead as well as «pB«ecifr!- a foreign substance, the detached part putrefies, and produces a dinana re- fetor through the whole atmosphere of the chamber sufficient of Retention itself to render the patient sick, and faint, and feverish, if it do not °^^ occasion a genuine typhus. of various I was lately requested to attend in consultation upon a case of strikW this kind. The patient had had a very difficult labour, and after two J^^tion. or three days of severe suffering was delivered by the use of the cro- chet. She was afterwards for a long time in a state of syncope, and the placenta was suffered to remain without any attempt to remove 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 was 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 pulse, slight delirium, and occasional shiverings. It was in this state I was requested to see Patient irf her. The room which was small, wasinsupportable from its stench, |™ftdau" 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 answered that gan- grene had already begun, the patient would certainly 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 I 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 prac- tice, and give the patient this only chance of recovery. This decla- The pia- ration inspirited the rest: the operation was determined upon, the ^ovedTand placenta, as I suspected, was found nearly separated throughout, «*»» patient and half advanced into the vagina, and was removed without diffi-re' culty. By the use of cinchona and the mineral acids, with a nutri- tive regimen, the patient gradually recovered, and is now in a state of perfect health. The modern practice, therefore, of not trusting the placenta to Hence the the mere powers of nature, when those powers are exhausted or (2™^^ inoperative, is founded upon a principle of the soundest observation. »a not to be Four or five hours is the utmost time now usually allowed, and if it rjowera 0ef be retained beyond this period, the operator interferes, brings it J^"^^ away by the funis, if the uterus will hereby become sufficiently sti- are ex- mulated, and if not, or the funis be broken, by cautiously introducing •r'irueetobe his hand into the uterus, and peeling the placenta gradually from its g"^tve4 walls by the action of his fingers. iemovai. If the uterus, instead of contracting at all at its fundus, should Hout-giau contract irregularly and transversely so as to form what has been conuactioa called an hour-glass contraction, the removal of the placenta should r0B. lake place before this time 160 cl. v.] GENETICA. [ORD. Ill Gen. II. In some irritable habits it is sometimes found on the contrary that iBp'secun-' after-pains, instead of ceasing gradually, continue almost without nariadoio- ceasing, and with nearly as great violence as the pains of labour violent* itself; and this for many hours after the extraction of the placenta. H^owtobe' If sucn after-pains follow close upon the labour, they proceed distinguish- from a morbid irritation and spasmodic tendency of the uterus alone; Treatment and the best remedy is an anodyne liniment applied to the abdomen, with an active dose of laudanum, which last must be repeated 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 introduced for such purpose, and the organ be rendered easy : if not, an opiate will here be as necessary as in the preceding case. yp.secnn- Haemorrhage or flooding after delivery is another evil which the moirrnagia. practitioner in the obstetric art is not unfrequently called upon to Treatment. com^at' 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. diachafge ^ne uterus is, at this time, so stored with blood of its own, that a of blood at prodigious rush will often flow from it without producing syncope SuV^eak"- or an.v serious evil upon the general system : for it is only till it has e"ainedex" *ost 'ts own ProPer suPPty> ar,d begins to draw upon the corporeal Yet great vessels for a recruit, that any alarming impression is perceived. Yet gerdousnex- ^rom t^ae ^rst moment the attendant should be on his guard, and haustion should have recourse to the means already laid down under flooding Patient' " occurring in the latter months of pregnancy.* From the very open dieTinT8 state in the present case of the mouths of all the uterine vessels that few mi- have anastomosed with the vagina, the floodinsf is here, however, rimes. • /■ n . . . 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, exhaust a.nd TOldness "f the eyes that is most heart-rending. And, in such a of the h situation, as the living powers are failing apace, and must be sup- eo^ia?*w«ef ported at all adventures, while cold and astringent applications are "imaiart 3ti11 aPP,ied to the affected region, we must have recourse to the kind neces- warmest, the most active, and most diffusible cordials, as Madeira sary- 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 degrees, or exchange them for food of a rich and nutritive, but less stimulant description. dari8su,c-un" When the discharge of blood from the uterus ceases, it is suc- Squate Ceeded by a flmd °f a ti^1™1 appearance which is commonly called lochia! discharge. * VoL ,T# p> n6- Gen ,% Spcc „ Paraeyesis uterina Lcemorrhagica and com. pare with vol.,,,. ci. m. Ord. it. Gen. n. Spec, n, Hwmorrhagia atonica vtw ta. v.] SEXUAL FUNCTION. [onn. m. 161 lochia, (*«£<«,) a term employed by Dioscorides in the sense of sGen* */• secundae, or the materials evacuated by a lying-in woman after the 5 pf geeun-' birth of the child. The nature of this discharge does not seem to dj»?ia. lo~ have been very fully explained by pathologists. The numerous and inadequate expanded blood-vessels of the uterus contract gradually, and par- j.^,™.'1"' ticularly in their mouths or outlets ; by which means the fluid they Origin of contain, and which is not entirely evacuated by the vagina, is thrown Natureof back on the system with so much moderation as to produce no th°dis- ■1 1 ■ • 1 • 1 ■ <. .. «i chaige ex- senous evil, and its stimulus is chiefly directed to the breasts. As plained. the mouths of these vessels progressively collapse, the finer part of sSt^anfi the blood only, or at least with not more than a small proportion of change «f the red particles, issues from them, and in smaller abundance, and counted hence the discharge appears less in quantity and of a more diluted for" 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 venous blood, assumes a purple or Modena hue: and as this hue becomes 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 ofNodis- the idiosyncrasy', for the quantity differs considerably in different while" this Women, there is little fever or irritation, and we have no ill conse- JJ,B0udeesra"e quences to apprehend : but the mouths of these vessels may be irri- quantity: tated by various causes, as catching cold, violent emotions of the cretion M mind, the use of too stimulant a diet, or the want of a sympathetic ma> be, ••11 ii 1 1 i-m • . rendered action in the breasts; and the result, under different circumstances, morbid by is of a directly opposite kind. If there be no spasm hereby induced excesB: on the mouths of the closing vessels, they will throw forth a morbid superabundance of serous fluid, without running perhaps into a hemorrhage, 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 peculiarly dispirited in her mind. If, on the contrary, which is more frequently the case, the mouths or suppres of the uterine vessels become suddenly and spasmodically closed in slon" 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 patient will be in danger of a puerperal typhus. These are the evils which result from a disturbance of the balance of the lochial discharge. In attempting to remedy them the exciting Remedial cause should, in the first place, be removed as far as this is capable means. 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 heat, and other febrile symptoms are to be subdued by antispasmodics and relaxants, particularly camphor, with small doses of ipecacuan or antimony. The neutral salts have also in this case proved ser- viceable, which have the farther advantage of opening and cooling the bowels. It will likewise be found highly useful to foment the abdomen with flannels wrung out in hot water, or. which is far Vrir,. V.—91 162 cl. v.j i,i:\ETICA Lord. m. Gen.H. better, to bind a ilannel swathe wrung out in hot water, in the same Spec.VII. manne, round the whole of the abdomen and the back, and to en- dariaTn" circle it with a band of folded linen to prevent it from wetting the i„hadenuate sheets, and to let it remain on like a cataplasm, till it becomes dry lohChiffidU ^y evaporation. Sion- It should not be forgotten, however, that in some women who ffaMi.- have healthy labours, there is no lochial discharge whatever, the charge in blood-vessels of the uterus contracting suddenly and closely as soon labouw. as the red blood ceases to flow. 1 have already pointed out one example of this kind that occurred to Professor Frank, even after a third natural delivery ; the patient, moreover, having been from a girl as destitute of menstruation as afterwards of lochia: yet her health was in no respect interfered with.* Great im- In all the diseases here referred to, cleanliness and purity of air cTeMnnesf are of tne utmost importance ; without these, no plan whatever can succeed: and with them, no other plan is often wanted. They are, moreover, of as much moment to the infant as to the mother. It is a striking fact that in the space of four years, ending in 1784, there died in the Lying-in Hospital of Dublin, at that time a badly ventilated house, 2944 children out of 7650 : though after the ventilation was improved, the deaths within a like period, and from a like number, amounted to not more than 279. and pure air. Strikingly exempli- fied. GENUS III ECCYESIS. EXTRA-UTERINE FETATION. IMPERFECT FETATION IN SOME ORGAN EXTERIOR TO THE UTERUS. Gen. III. Physiolo- gical ex- planation. 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 tho 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 percul- sion. It sometimes happens, however, that the Fallopian tubes, or the openings from the uterus leading into them, are so impacted 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 sometimes occurred that the ovulum or vesicle that has been detached in the ovarium has * T)« Cur. Horn, Morb. Epit. Tom. vi. Lib. vi. Para in. 8vo. Viennte, 1824. cl. v.J SEXUAL FUNCTION, [ord. hi. 163 been incapable of making its way out of the ovarium itself, and has Gen. III. become impregnated in its original seat without a possibility of Extfa-81"' stirring farther. £™0en. 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.-------ABOOMINALIS. ABDOMINAL EXFETATION. It is a very remarkable fact that the uterus still sympathizes, in Uterus every one of these species with the imprisoned and impregnated zeTwith"" ovum, in whatever part of the body it may happen to be lodged, "jegrowtii produces ordinarily the same efflorescent membrane or decidua, ovum which we have already observed it secretes in the commencement of ^"jv" utero-gestation for the reception of the ovum upon its arrival in the deciduals uterus, enlarges its capacity and thickens its walls as though the uterusea- fetus were really present in its interior ; exhibits the same symp- J^tea the toms and excites the same caprices of the stomach as those by capricious which utero-gestation is usually distinguished ; and at the expiration eJfgenuine of the regular period of nine months, and sometimes, as in ordinary pregnancy, pregnancy, even before this, is attacked with spasmodic or expulsory close of pains, which often continue for some hours, and seldom altogether {^"cked* subside till the organized and extra-uterine substance loses its living with ex- power, and becomes of the nature of a foreign material to the pains7 organs by which it is surrounded. After which menstruation again which sub- returns regularly, as it has hitherto been suspended. the ex-fetus The extra-uterine ovum, in the mean while, endowed in conse- {"v",1" quence of its impregnation with a principle of life, continues to power. grow, whatever be the place of its aberration, in some instances the°ex- ° becomes surrounded with an imperfect kind of placenta, developes ovum' the general structure of its kind, and exhibits an organized compages 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- state of the quently the general frame, frequently becomes quiet; and the bulky after death. substance, enveloped in a covering of coagulable lymph, remains unhurt6-* for years, or perhaps through the whole of life, with no other incon- ing through venience than that of a heavy weight and tumour in the part in onife!"*'0 which the dead fetus is lodged. But, in many instances, like any But some other intrusive or foreign material, it produces great irritation, duwhe'of which is succeeded by the ordinary process of ulcerative inflamma- great mis- tion, and an opening is hereby made into the intestines, or the va- rWuVwayp. gina, 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 lo sustain the progressive expulsion, and at length restored to the eniovment of former health. f •I.'YI.'TK ' V I OKU. III. 164 CL. N.J (.ibM-lllyA SPECIES I ECCYESIS OVARIA. OVARIAN EXFETATION. IMPERFECT FETATION OCCURRING IN THE RIGHT OR LEFT OVARIUJ Gen. III. The physiology and general pathology have been already given Spec. I. somuch at large in the paragraphs immediately preceding, that it is comrnon0'68 only necessary to observe further that this form of extra-uterine l«t°K.a fetation is very common, as well as very distressing. Vater relates very uib~ j * # •* 1 * * £* tressing. a singular case of this kind producing a general intumescence ot illustrated. the ab(jomen on the rignt gjj^ tne 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 author's Volume of Nosology. Rudimentai It is in this organ more especially that rudimental attempts at feuforga-1 fetal organization, the mere sports of nature, are frequently found nization produced without impregnation, or any contact with the male sex, sometimes r , . . r o * j found in and sometimes in very young subjects. withoutan ^ne °f t^ie most singular cases of this kind is that communicated impregna- by Dr. Baillie to the Royal Society in the year 1788-t The Irfv'er'y'1 young subject of the case was not more than twelve or thirteen young sub- vearg old, with an infantine uterus and perfect hymen: and the singular fetation consisted of a suetty substance, hair, and the rudiments of « fflftu" four teeth. Example m The same kind of formative ludibria are found, also, in mature virgin. life in women of the most correct lives, 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 suf- fering, 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 enclosed 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.J How ex- Such rudiments of organized form have been resolved by the Se'foHow7- disciples of Buffon into the peculiar activity of his molecules ian°fBuf organiques, concerning which we have already spoken in the Physiological Proem to the present class, thronging with a more * Dissert, de Graviditate apparente ex tamore ovarii dextri enormi, &c. * Phil. Trans. 1789. + Vol. ix. t>. 427. cl. v.j SEXUAL FUNCTION. [ord. hi. 165 than ordinary proportion in the region or organ in which the Gen. 'J1, preternatural productions have been found to exist: and by still Eccyesls' later physiologists into a salacious temperament in the individuals ^vyftria- who have been the subjects of them, and who are still further said, exfctation. as we have also remarked in the same Proem, to have a power p^X- when this orgastic erethism is at its utmost heat, as about the period g'sts. of menstruation, of irritating and even inflaming the ovaria, and occasionally even of detaching one or more ovula and putting them into a like state of irregular action. And where cases occur in infants they are ascribed to the same cause operating on a constitu- tion diseased by a morbid precocity.* The first of these explanations it is hardly worth while to combat Neither of in the present day, and particularly in the present place, after having pilnttfona already illustrated in the Proem above referred to, the feebleness of auequ«te r. . . !••/**• °f 8atl3IaC" its first principles. And with respect to the second it is sufficient to tory. observe, that the very same attempts at fetation are sometimes made and carried quite as far towards completion, in organs that cannot be suspected of any salacious sensation, and even in males as well as in females. Thus, Dr. Huxham gives a case in which the rudi- ments of an embryo were found in a tumour seated near the anus of a child ;t and Mr. Young a still more extraordinary one, yet a case well known, I suppose, to nearly all the medical practitioners of this metropolis from personal inspection, of a large protuberant cyst, containing a nucleus of fetal rudiments found in the abdomen of a male infant about fifteen months old. The child died after a tedious and painful illness. The body was opened, and the cyst examined : " The substance it contained," says Mr. Young, " had unequivocally the shape and characters of a human fetus:" for a particular description of which the reader must turn to the account itself.^ Upon this subject we can only say that all such abortive attempts illustration are monstrosities ; and that monstrosities are not confined to any ra°™r?ncf- particular age as that of fetal life, or to any particular organ. They pnes8°0f1().., run occasionally through every part of the frame, and every part of the life, and appear in the form of cysts, and excrescences, and polypi, and ossifications, and a thousand other morbid deviations from the ordinary march of nature, though they are most frequently found in the first months of impregnation, unquestionably because the excited organs are, at that period, more capable than at any other, of being moulded, by accidental circumstances, into anoma- lous shapes, and of preserving life under almost every kind of mis- construction and deformity. In extra-uterine fetation of whatever kind, or wherever situated, Medicine of the art of medicine can do but little. If the tumour be free from avail. pain, and the general system not essentially disturbed by it, nothing ^"be'used should be attempted whatever. And if, in a case of irritation and if the m- ulcerative inflammation, nature herself seems to point out one ™nTet. ° particular part for the opening of the abscess rather than another, J^""'"?* course pr<. * Vol. iv. Prceotia femjnina, Ord. i. Gen. u. Spec. 11. of the present class. V0SC1',,v \ Phil. Trans. Vol. xLv. 1748. p. 325. Medicn-Chir. Trans. Vol. i. p. 241. lbtj cl. v.J GENETICA. [okd.iii. Gen. Ill, Spec. I. Eceyesis ovaria. Ovarian oxfetation. the reme- dial power of nature to be watched, and advan tage taken of it. The cyst has lain dormant for many years: and then become a source of irritation from some accidental cause: has produced an abscess. In this case opens in different directions: as near the navel, in the vagina or larger intestines. Exempli-] tied. Has gome- times been successfully removed by art without waiting for any natural indication. Illustrated. Often ac- quires a considera- ble deve- lopement. it will almost always be far better merely to watch her foot-steps, and assist her intention, than to attempt a cure or removal of the cyst in any other way : for we had long ago an opportunity of observing, when treating of inflammation generally, that " it is a wise and benevolent law of Providence, and affords an incontroverti- ble proof of an instinctive remedial power, that inflammation, wherever seated, is always more violent on the side of the inflamed point nearest the surface, and shows a constant tendency to work its way externally rather than internally ;"* er, in other words, in that direction in which the most salutary end can be obtained with the least essential mischief And, hence though it may often be found adviseable to enlarge an opening made externally by the effort of nature alone, it will generally be injurious to deviate from the spot thus instinctively marked out, and make an opening elsewhere. The cyst has sometimes lain dormant, or without producing much disturbance, for many years, and then, from some accidental cause, has become irritated, inflamed, and produced a large abscess : the ovarium, in the progress of the inflammation, forming an adhesion to the integuments of the abdomen, and thus at length breaking externally ; mostly in the course of the linea alba, often near the navel, but sometimes towards the groin. In a few instances, how- ever, the inflammatory action has travelled in some other direction, and sought some other outlet: so that the ovarium has formed an adhesion with the vagina, or the larger intestines, and ultimately opened into them, and the bones and other indissoluble parts of the fetus have been thrown forth in fragments from the vagina or the anus. Zacutus Lusitanus gives a case in which the bones of an impregnated ovarium were discharged piece-meal by the anus after the impregnation had continued for twelve years :| and Bartholin another of much longer duration, in which an exit was formed in the hypochondrium after the fetus had been imprisoned for not less than eighteen years. In a few instances, however, the extra-uterine substance has been removed by art without waiting for the formation of an abscess. A successful operation of this kind is related in the Histoire de l'Academie Royale, after a gestation of twenty-seven months, the child being extracted by an incision into the abdomen. J M. Trisen gives a similar example, attended with a like favourable issue :§ and in the Edinburgh Medical Commentaries we have an account of the vagina being laid open for the same purpose. || The fetus has occasionally been found to acquire a very con- siderable developement and advance towards perfection. Bianchi gives the history of one that on dissection, after the death of the mother, who carried it fourteen years after its apparent death, weighed eight pounds ;^I and Mr. Painter has lately given the case of a lady who seems to have died in labour of a fetus of the same * Vol. n. p. 189. t De Praxi admiranda. Lib. t Hist, de l'Acad. des Sciences, 1714. p. 29. 1716. p. 32. § Observ. Chirurg Leid. 1743. 4to. r: Smith, Vol. v. p. 337. " Lienkand, Hist. Anat. Med. i. Obe. 1533, u. Obs. 157. ,;L. v.] SEXUAL FUNCTION. [ord. in. 167 kind, that on being taken from the body immediately after death, Gen. hi. was found dead indeed, but complete in its parts, and nearly of the Eccyesis size which is usual at the fifth month of uterine gestation. The g^ Fallopian tubes, apparently too much obstructed at the time of wfetation. impregnation for a descent of the ovum, were now altogether impervious.* The uterus itself was not much enlarged, but there was not the ordinary appearance of a deciduous tunic. SPECIES II. ECCYESIS TUBALIS. TUBAL EXFETATION. IMPERFECT FETATION OCCURRING IN TIIE FALLOPIAN TUBE. DiEMnRBROECK has observed that this is the most common cause gen. Ill, under which extra-uterine gestation shows itself,t and it is at the same ^"J-"• time the most dangerous. There is in truth less room for distention common here than in any of the other cavities in which the exiled ovnm may efXauoD, happen to lodge : and hence the overstretched tube has occasionally anodgtthdean. bursted, and the patient has soon fallen a sacrifice to the irritation ger0Us. and fever produced by so large a rent: while, if this have not taken Explained. place from the mischief done to the tube, it has followed nearly as soon from the morbid excitement and inflammation produced in the abdomen in consequence of the sudden entrance of so large a foreign body into its cavity. Dr. Middleton, however, has described a sin- Singular • n • 1 /» n • a • example. gular case of a woman who carried a fetus for sixteen years in one of the Fallopian tubes with so little disturbance to the general health of the system, that at this period she became pregnant in the regular way, and appears to have passed through her pregnancy with a favourable issue.! The general pathology and mode of treatment General ..... +. n■ . i- • treatment. run parallel with those of the preceding species. SPECIES III. ECCYESIS ABDOMINALIS. ABDOMINAL EXFETATION. IMPERFECT FETATION OCCURRING IN THE CAVITY OF THE ABDOMEN. An extra-uterine fetus may be deposited in the cavity of the abdo- Gen. III. men by bursting through the walls of the ovarium or Fallopian tube t^,;,"1' how arrives * Lond. Med. Repos. June 1823. t Opera omnia Anatomica, p. 135. inthecavi- «• Phil. Trait*. Vol. xliii. 1744—5. \fthe lodornen 168 cl. v.] GENETICA. Jord. m. Gen. III. after it has been produced there, or by an accidental drop of the im- IcTe'si!11' pregnated ovum from the extremity or fringe of the tube in its way Bbdo'rm-8 to the uterus. In the two former instances there is danger of great Abdominal and fatal inflammation, not less from the rent produced in the organ whefnta'ion Just quitted by the fetus, than from the irritation which so large a drop'pedby foreign body cannot fail to produce on the organs on which it presses. Safdan- In the last instance, on the contrary, the substance on its first ger ot in- entrance, is so minute, and its growth so gradual, that the contiguous frommtho°n organs suffer little or no irritation except from some accidental ex- xvheu pro citement, till at length, indeed, the magnitude of the fetus may alone duced here be a sufficient cause of morbid action, and lay a foundation for the from an ex-ovum most serious consequences. irritat°onn° In the introductory remarks to the present genus,* we observed, Even in ' that, in almost all cases of extra-uterine fetation, the moment the theut«eruses ovum becomes impregnated the womb regularly sympathizes in the eympathi- action, produces a tunica decidua, enlarges, ceases to menstruate, mns mimic? the entire process of utero-gestation, and, at the expiration vhohfu^n OI* nine months, is attacked with regular labour-pains. After these of prognant have continued for some hours they gradually cease : and, what is i^mpoms. g^jj more remarkable, the ex-fetus, which, till this moment, is endowed with life, and continues to grow, how imperfect soever its form, dies as though strangled in its imprisonment; and by becoming a dead substance, becomes, at the same time, a substance obnoxious to the living organs around it, which have hitherto suffered little inconvenience from its proximity ; oft>n excites irritation and an abscess, and from such abscess, as we have already observed, is thrown forth piece-meal. Singular The following history which is highly curious in itself, forms a iustra'tion striking illustration of the whole of these remarks. It is published of0DuUbiin. by Dr- Bel1 of Dublin, from a full knowledge of the entire facts. A young woman aged twenty-one, after being married fifteen months had the usual signs of pregnancy, and at the expiration of her reckoning was attacked with regular labour-pains which were very violent for some days, when they gradually left her. But the abdomen still continued to enlarge, while the strength of the patient as gradually failed, and she was reduced to the utmost state of ema- ciation. Eight or nine months from the cessation of her labour- pains she discharged a considerable quantity of fluid from a small aperture at the navel, along with which were perceived some fleshy fibres and pieces of bone. It was proposed to follow up this indica- tion of nature, and make an opening into the abdomen at this very point, large enough to remove the fetus supposed to be lodged there. This was accomplished by an incision running two inches above and the same length below the navel, when the bones of two full grown fetuses were extracted, for little besides bones at that time remained. No hemorrhage ensued, and the patient recovered her health so speedily as to be able to menstruate in about three months. After three months more she was prevailed upon again to cohabit with * Supra, p. 163. oi,. v.J SEXUAL FUNCTION. [okd.iii. 16'9 her husband, became pregnant, had a natural labour, and bore seve- Gen- m, ral children in succession.* Eccyesis In this case it is clear that the sensations of the uterus during the *)$°mi" developement of the twin ex-fetuses, were those of mere sympathy ; Abdominal as it is also that they ceased to grow, and became dead and irri- cafera"" fating substances after the common term of utero-gestation, or on plained. the cessation of the labour-pains. This is the usual course, but in some eases the irritation the dead inUamwa- substance excites, is less violent, and, instead of an ulcerative, an duced not adhesive inflammation is produced, and coagulable lymph is thrown "'j*^.'£„, forth, which, by the law of nature, is gradually transformed into a only suffi- soft and membranous material that becomes a sheath or nidus for J^m a se- the dead fetus, and prevents it from exciting any further irritation. ,caree\°"fand And in this manner an abdominal ex-fetus has sometimes been borne coagulable for a considerable number of years, or even to the end of life, with* ^Jjjjljj be. out any serious mischief. In the volume of Nosology I have refer- comes a red to various proofs of its having, in this way lain quiet for twenty- {hVfetus, two, twenty-six, and even forty-six years. tecdtsPthe Even in the uterus itself the whole of this process has in a few adjoining rare instances happened where a morbid cartilaginous membrane Potion"1 has taken the place of the ordinary tissue, or there have been any The same • sornctiniGS other means of obstructing the descent of the fetus, of which the in the ute following cited by M. Fouraier, is a striking example. A woman rus ,teclf' of Soigny, thirty years of age, after four years of marriage, and one miscarriage, became pregnant, quickened, and had a flow of milk in the breasts. At nine months regular symptoms of labour came on, but shortly ceased. In the course of a month she became greatly debilitated, and continued so for a year and a half, during which time her life was often despaired of; afterwards she recovered strength. but the milk continued in her breasts for thirty years, yet she had never any return of the catamenia. At the age of sixty-one she died of peripneumony, and the body was opened. A tumour, eight pounds in weight, was found attached to the fundus of the uterus, enclosing a male child perfectly formed, and of full size for nine months. It did not exhibit any signs of putrefaction, nor exhale any disagreeable smell. It was enveloped in a chorion and amnios, which membranes were ossified, as was also the placenta. The dissection was performed in the presence of two physicians and another surgeon.f Putrefaction, under these circumstances, does not take place, for J^""■*!"' the imbedded substance is shut out from the chief auxiliary to putre- does not faction, which is air : but a change of some other kind is generally on'tV1'1" found to prevail, though with some diversity, according to the acci- change of dental circumstances that accompany it. And hence the fetus, on kind is opening the cyst, after the death of the mother, or on its own extrac- variedly111 tion antecedently, has been found sometimes converted into adipo- circum- cire, or a suetty or cetaceous material,! making a near approach to aconver-* sion into adipoclie o * History of a case in which two Fetuses that had been carried near twenty-one- suet, months, were successfully extracted from the abdomen by incision, &o. t Diet, des Sciences Medicales, Art. Cas. Rares. t Wagner, Nov. Act. Liter. Maris. Balth. 1699. Vol, V.—22 170 cl. v.J GENETICA. [ord. ai. Gen. III. Spec. III. Eccyesis abdomina- lii. Abdominal exfetation. OsteopsB- dion what Lithopui- dion what. Bulk and weight of the fetus greatly al- tered by such change'si it; sometimes into a leathery or cartilaginous structure ;* and some- times into an osseous or almost stony mas-, which has been distin- guished by the name of osTEor^nioN or lithopajdion.T Under these circumstances, also, the bulk and weight of the fetus have considerably varied ; for, the fluids having evaporated, it has often been found light and shrivelled, yet, when loaded with osseous matter, it has been peculiarly heavy. In a structure of somewhat more than ordinary completion, Krohn found the weight amount to four pounds and a half. J For medical treatment there is little scope, and this little has been already touched upon under the first species. GENUS IV. PSEUDOCYESIS. SPURIOUS PREGNANCY. riYMFTOMS Ol' PREGNANCY WITHOUT IMPREGNATION ; CHIEFLV OCCURRING ON THE CESSATION OF THE CATAMENIA. Gen. IV.- Compari- son of the preceding with the present species. Train of feelings and action ex cited in the uterus from the force of habit in both spe- cies. But in the present species in conse- quence of uterine irri- tability alone without any fetal formation whether uterine or extra-ute- rine. In the preceding genus we beheld the uterus excited to action. and mimicking the progress of pregnancy, though without any pre- tensions to it, in consequence of its association with some extra- uterine impregnation. In the present genus there is no proper im- pregnation any where, but a mere irritation derived from the lodg- ment of some morbid and unorganized substance, which excites a train of feelings, and not unfrequently a change of action, easily recalled from the force of habit. It is on this last account that virgins are rarely, if ever, liable to this affection. Such at least is the general opinion, which appears to be well founded ; " And no case," says Mr. Bums, " that I have met with contradicts the sup- position." This train of feeling and change of action seems also, at times, excited by a peculiar kind of irritability of the uterus itself, even where there is no substance whatever in its own or any other cavity that can become a stimulus : and we are hence put into possession of the two following distinct species : 1. PSEUDOCYESIS MOLARIS. 2.------------INANIS. MOLE. FALSE CONCEPTION. * Phil. Trans. Various examples, passim. t Abhandl. der. Josephin. Acad. Band. I.—Eyson, Diss, de Fcetu lapidescentt. Groning. 1661. 1 Foetus extra uterum historia. Lond. 1791. Gutt. Ana. 1791. . v.j (iENETICA. [oku. in. Gem. IV. Spec. 1. Pseudocye- sismolaris. Mole. lodged in the sulci: and swul Ion the mass to an enormous size. Where fragments of an ute- rine fetus aro found not properly called a mole: such being rather mis- carriages, or remnants of miscar- riages lying for a long time unex- pelled, as already ex- plained. Stimulating pregnancy from molar concretions often mis- taken for utero ges- tation. Distinctive characters. The state ot the ute- rus to be examined by which the concre- tion may often be removed. Moles wholly or in fractions discharged at different periods: but often rotiined for many years. nidus in some one of the sulci of the womb, and, by swelling into a considerable vesicular tumour or various clusters of such tumours, have very considerably added to the enlargement.* The distinguishing character in this case is the perpetual oozing of a colourless watery fluid from the vagina. The hydatid is usually dispelled by a process resembling labour, which is followed by a profuse and alarming hemorrhage, that however seldom proves fatal under proper management.! 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 by an adscititious involufium, or some part of its placenta or membranes, but so changed by some subsequent chemical or animal operation, as to have little resemblance to their original structure. These, however. are rather miscarriages, or remnants of miscarriages, than moles. They manifestly bespeak an impregnation and organic growth in the proper organ, but, owing to torpitude or some other diseased con- dition of the womb, were not expelled at the period of the death of the fetus. We have already observed, in treating of miscarriage, paracyesis abortus, and more particularly still under paracyesis pluralis, that such retention, and almost to an unlimited period, is by no means uncommon, and have illustrated the remark by nume- rous examples. Stimulating 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 considerably 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 retention of the menses. If we suspect the disease, the state of the uterus should be ex- amined, 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 ; J and in one described by Zuingen for not less than seventeen.§ S^C^^^^Xk^ Ann' "»• 60-' ^bi.-Morgagni, De t Clarke, Observations on the Diseases of Females, &c. 8vo. 18»1 - Ln. Med. 1696, p. 29,. § Theatrnm Vitse Unmans, pp. 331. S57. %- SEXUAL FUNCTION. [ord.iii. 173 SPECIES II. PSEUDOCYESIS INANIS. FALSE CONCEPTION. THE UTERUS VOin OF INTERNAL SUBSTANCE ; AND IRRITATED BY SOME UNKNOWN MORBID ACTION. There are two periods during the active power of the womb in GfiN- Iy- which it is peculiarly irritable ; and these are at the commencement, Sj U' and at the final termination of the catamenial flux. And hence it mostirita- sometimes happens at the last period, from some unknown excite- earnest rnent, though generally, perhaps, the increased erethism, which, in fatestnpow- consequence of such irritation, accompanies the conjugal embrace, erof ac- that it becomes sensible of feelings and communicates them to the hence*o- stomach, not unlike what it has formerly sustained in an early stage wards 'he of impregnation ; and, a catenation of actions having thus com- menstrua- menced, every link in the chain that accompanied the whole range Smei"™8' of former pregnancies, is passed through and as accurately imitated assumes „„ -e ,l i\ c j .• c ?u the feelings as it there were a real foundation tor them. ofpregnan- This illusory feeling, however, sometimes dies away gradually at %££™ the end of three months, but more usually runs on to the end of the sustained, ninth, when there is occasionally a feeble attempt at labour-pains, throughSth3 but they come to nothing : and the farce is gradually, and, in a few e"tire f"»n instances suddenly, concluded by a rapid diminution of the abdo- toms.mp minal swelling, and a return of the uterus to its proper size. sory fe'e'iin" The most extraordinary case of this kind that has ever occurred dies away3 to me, is given under the unmeaning name of nervous pregnancy, fornelfmes by M. Rusel of Var, in the department of the Charante, in the first J1t0t^h3e number of the Gazette de Sante for 1824 ; which is peculiarly but some- characterized by the perpetuity of its annual recurrence for twenty «n nine01 years, or rather through the whole of the patient's life. Mary when there Gibaud had uniformly enjoyed good health previous to her marriage, attempt rft This took place when she was about thirty ; shortly after which, Jf^"1" menstruation ceased ; nausea or sickness was complained of in the False con- morning ; the abdomen enlarged ; quickening and subsequent Imguin'r motions of the fetus were supposed to be felt: and at length what were esempiifi- conceived to be labour-pains supervened. These continued while a female midwife was present, for thirty-six hours ; but without any enlargement of the os uteri. A surgeon of reputation was applied to, at the moment of whose arrival a considerable uterine hemorrhage took place, accompanied with syncope. The surgeon proceeded instantly, to deliver, but to the astonishment of all present, he found the womb entirely unimpregnated. The hemorrhage took off the pains for two or three hours, at which time they returned again. The sursreon now bled her copiously, and every symptom vanished. 1/4 CL. v.] GENETICA. [ord. ill- Gen. IV. ^t the end of a month, the menstrual excitement not producing any Pseudocye- discharge, the same train of feelings were produced in their stead, Ms inanis. ran tne same round, and terminated in the same way ; the same ception. precise order being repeated for twenty times in succession. The patient was from time to time visited by different professors of eminence ; and on one occasion was taken to the hospital of Angouleme, where she was tapped, as being supposed to be ascetic; but no fluid was evacuated. Her breasts through every period were gorged with milk, and she at length died in her fifty-first year, of an inflammation of the ear, that spread to the brain.* How dis- The ordinary distinctive signs which indicate real from spurious tinguished^ pregnancy under the last species, and which we have already noticed, ine preg- are equally applicable to the present, and the practitioner should nancy- avail himself of them. * See Cl. in. Ord. n. Gen. vn. Spec. n. Empresma otitis interna. CLASS VI. CLASS VI. ECCRITICA. DISEASES OF THE EXCERNENT FUNCTION. ORDER I. MESOTICA. AFFECTING THE PARENCHYMA. II. CATOTICA. AFFECTING INTERNAL SURFACE?. III. ACROTICA. AFFECTING THE EXTERNAL SURFACE. CLASS VI Physiological proem. Tim structure of the solid parts of the body consists of three Class VI. distinct substances—a filamentous, a parenchymatous, and a cellu- composed'8 lar or web-like, as it was denominated by Haller, the tissu muqueux of three of Bordeu,* and the tela mucosa of Blumenbachj. The filamentous FUamen"' is chiefly to be traced in the bony, muscular, and membranous parts : tou".pa'en »l 1 <• i i ■ t-i - i chymutous, trie parenchyma, a term first employed by Lrasisfratus, and, as we cellular, shall show hereafter, in a very different sense from that in which it is t^Tues.0"8 used at present, in what are commonly called visceral organs: and the cellular in both. This last, while it serves the purpose of giving Use of the support to the vessels and nerves of the fibrous parts, of separating Illst* them from each other where necessary, and where necessary of con- necting them, is the repository or receptacle of the gelatinous or albuminous 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 placenta, from all the rest. It is usually supposed to be a condensation of this that forms the proper membranes which line the exterior of the viscera, as well as the interior of those that are hollow, and which, as we have already observed,! are divided into serous, mucous, and fibrous by Bichat and his followers. All these parts are perpetually wearing out by their own action— A" tf"*o the most firm and solid as well as the most spongy and attenuate, out hy"their They are supplied with new materials from the general current of °"dnaur^e the blood, and have their waste and recrement carried off by a cor- supplied i from the respondent process. blood. It is obvious that, for this purpose, there must be two distinct sets "'J^,.1"* or systems of vessels : one by which the due recruit is provided, of vessels: and the other by which the refuse or rejected part is removed.§ ta0srisecBcrBeod These vessels are, in common language, denominated secretories absorbents. and absorbents. They bear the same relation to each other as the Related to each other ,_,.-, as arteries * Kccbercbes sur le Tissu Muqueux ou Organc Cellulaire. Pans, 1767. to-veins: t Physiol. $.21. t Vol n Physiol. Proem. \ Bostock, Elementary Syfctefn rf Physiology, p. -70. 8vo. 1821, \tol. V.---73 178 cl. m.J PHYSIOLOGICAL PROEM Class VI and fulfil the eccri- tical or excernent function. Refuse matter not all wasted- Eliminated matter of two sorts: one capable of being restored to use : the other alto- gether in- capable of revival. Absorbent system takes the charge of the first: the second is thrown out from the system. arteries and veins : the action which commences with thti former is carried forward into the latter : and we may further observe that while the secretories originate from the arteries, the absorbents ter- minate in the veins. The general function sustained by these two sets or systems of vessels is, in the present work, denominated eccri- tical 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 undue 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 misohievous. It is the province of the absorbent 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 innu- merable 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 action of the ab- sorbents, is at once thrown out of the general system by the mouths of the secerncnts themselves, as in the case of insensible perspira- tion ; or, where such a perpetual efflux would be inconvenient, is deposited in separate reservoirs, and suffered to accumulate, till the individual has a commodious opportunity of evacuating 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 vessels, 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 im- portance, and may, perhaps, be best considered under the three fol- lowing 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 THES£ TWO SYSTEMS ON EACH OTHER. i. Secer- l# ft was at one time the common doctrine among physiologists, tem. as well chemical as mechanical, that all the vast variety of animal maufrseted productions which are traced in the different secretory organs, formerly whether wax, or tears, or milk, or bile, or saliva, were formerly con- uePcor.tain° tained in the circulating mass ; and that the only office of these oircuia'thig organs was to separate them respectively from the other materials -i.ass. that enter into the very complex crasis of the blood; whence, indeed, the name of secerne^ts or secretories. which mean 'Lvi.j PHYSIOLOGICAL PROEM. 179 nothing more than separating powers. This action was by the che- Class VI. mists supposed to depend on peculiar attractions, or the play ofnentsys- affinities, which was the explanation advanced by some ; or on pecu- "„"} Jepa_ liar ferments, conveyed by the blood to the secernent organ, or pre- rated by existing in it, which was the opinion of others. The mechanical hMtiong*1' physiologists, on the contrary, ascribed the separation to the pecu- °J^remenU: liar figure or diameter of the secretory vessels, which by their make, cuiiar figure were only fitted to receive particles of a given form, as prisms where gPrechtiVee the vessels were triangular, and cubes where they were square, vessels. Such was the explanation of Des Cartes : while Boerhaave, not essentially wandering from the same view, supposed the more atte- nuate 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 Th,**°^y" and many other hypotheses founded upon the same common prin- disproved ciple, by proving that most of the secerned materials are not form- cLm^iry" ally existent in the blood, and, consequently, that it is not, strictly an°" t'ie speaking, by an act of separation, but of new arrangement or recom- fluids position that they are produced out of its elements. And hence, p^uncedbe physiologists have been led to a critical inquiry into the fabric of by recom- the secerning organ, but hitherto without much satisfaction. In its Fabricnof simplest state it seems, as far as it can be traced, to consist of nothing fhc >CCBra- • • i i • -n -n • ,i ing organs: more than single vessels possessing a capillary orifice, as in the simple ca- Schneiderian membrane. In a somewhat more compound form we vegselB3w:iU| find this orifice opening into a follicle, or minute cavity of an elliptic the appen- Bhape ; and, in a still more complicated make, we meet with aglan- nfificie; a dular apparatus more or less glomerate, consisting of a congeries, &nd e'»««i*. of secernent vessels, with or without follicles, and occasionally accompanied with a basin or reservoir for a safe deposite 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 ^dBo af device produced by this complication of machinery beyond that of ford noth- affording the means of accumulation : for large as is the organ of '£1™™ the liver, it is in the penicilli, or the pori biliarii alone that the bile means of is formed and completely elaborated : the liver is a vast bundle or ^i"^^™ combination of these, and hence affords an opportunity for a free Jjj""^ ™ 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 mamma? and in the offer us the same results, for the milk here secreted is as perfect reasts' milk in every separate lactiferous tube, as when it flows in an accu- mulated form from the nipple. And hence, follicles themselves may be nothing more than minute reservoirs for the convenient accumu- lation of such fluids as are deposited in them till they are required for use. Mucus and serum are inspissated by retention, but they rarely undergo any other change. We are obliged, therefore, to conclude-, with Sir Everard Home, that " the organs of secretion 180 cl. vi.] PHYSIOLOGICAL PROEM. Class VI. I. Secer- nent sys- tem. Secretion how far produced by a nerv- ous power. Electrical organ of gynnotus elcctricus, applied to this inquiry, Secretions affected by mental- emotions. Objections to this con- jecture. The sim- plest unci most co- pious secre- tion, the halitus of internal surfaces. The mouths of the vessels producing this, never yet disco- vered. 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 referred to, has " observed that in fishes which are capable of secreting the electrical fluid the nerves con- nected 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 confirmation 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, as the secretory organs, by mental emotion. The whole surface 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 kidneys, 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 already 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 chiefly influenced by the sensorial system ; yet Haller has long ago observed that the larger branches of the nerves seldom enter into them, and seem purposely to avoid them :§ the secernent glands have little sensibility ; and the secretions of plants, which have no nervous sys- tem, are as abundant, and diversified, and as wonderful in every respect, as those of animals. The means, therefore, by which the very extensive and important economy of secretion is effected, seems hitherto, in a very con- siderable 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 copious of the fluids, which are in this manner separated from the blood, is that discharged by very minute secernent vessels, supposed to bc terminal or exhalant arteries, which open into all the cavities of the body, and pour forth a fine, breathing vapour, or halitus, as it is called, which keeps their surfaces moist, and makes motion easy— an effluvium which must have been noticed by every one who has ever attended the cutting up of a bullock in a slaughter-house. We have formerly had occasion to observe that arteries terminate in two ways—in minute veins—and in exhalant vessels. The former ter- mination can often be followed up by injections, and occasionally traced by the microscope; but no microscopic experiment has hitherto enabled the anatomist to discover the orifices of the exhalant * Phil. Trans. 1809, p. 387. * Vol. iv. p. 244. t Id. p. S86. § Physiolog. Tom. ix. passim. PHYSIOLOGICAL PROEM. (cl- vi. 181 branches of arteries. Their existence, however, is proved, as ClassVi. Mr. Cruikshank has observed, by their sometimes, and especially nenfsys when enlarged in diameter or acted upon by a more than ordinary xheireriat- visa tergo, pouring forth blood instead of vapour, of which we have encoand a striking instance in bloody sweat; as also in the menstrual flux, Wiethe0" which though not blood itself, proceeds, as Dr. Hunter has suffi- *r,®ri^,b ciently shown, from the mouths of the exhalant arteries of the ute- proved. rus, periodically altered in their diameter and secernent power. II. The fluid thus thrown forth to lubricate internal surfaces, n- A^1°I^ 11 ., . . . ..-. ent system. would necessarily accumulate and become inconvenient, if 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 dis- tributed over the entire range of the body, as well within as with- out, to answer this express purpose : and they are hence called ab- sorbents ; and, from the limpidity of their contained fluid, lym- phatics. Their course has been progressively followed up and developed Trl,t1)J;oan,e from the time of Asellius,* who, in the year 1622, " reaped the first sufficiently laurels in this field by his discovery of those vessels on the mesen- "J^on- tery which, from their carrying a milk-white fluid, he denominated strated. lacteals,"! and whose researches were confirmed and extended by what. the valuable labours of Pecquet, Rudbec, Jollyfe, Bartholine, Glis- son, Nuck, and Ruysch, till by the concurrent and finishing demon- strations 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 elaborate economy was completely explained and illustrated towards the close of the preceding century, and the opposition of Baron Haller was aban- doned. The vessels of the absorbent system anastomose more frequently ^nbas8°tr01mIrft than either the veins or the arteries; for it is a general law of nature more fre- that the smaller the vessels of every kind, the more freely they com- $™t]*nj, municate and unite with each other. We can no more trace their other ves- orifices, excepting, indeed, those of the lacteals, than we can the why a" orifices of the exhalants; but we can trace their united branches AJ'Jle"nj: i /• n *i u nate in tne. from an early function, and can follow them up singly, or in the con- thoracic federated form of conglobate glands, till, with the exception of a few ^kce that enter the right subclavian vein, they all terminate in the common 'heir con- trunk of the thoracic duct; which, as we have formerly observed, c^nveyTa receives also the tributary stream of the anastomosing lacteals, or j^*6 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. And as these all perform a common office, are of ■°j!oraiM£a* a like structure, pass through similar glands, and terminate in a common common channel, there is strong reason to suppose them to consti- *yslem- tute a common system ; and hence, as we are capable of tracing up the mouths of the lacteals, we are led to conclude analogically, * R)>istola ad Haller. * Hewson. Of the Lymphatic System, p.% 182 cl. vi.] PHYSIOLOGICAL PROEM. Class VI. II. Absorb- ent system. Hereby a prodigious saving of animalized fluids. Many of the secre- tions thus thrown into the circula- tion con- tribute to 0 invigorate the frame. Illustrated. Absorbents accompany every part of the frame, and enter into the coats of the mi- nutest ves- sels. Foksess very nume- rous valves. Valves vary in number and dis- tance both in the trunks and minutest branches. Glands of the absoib- ent system •rhat. that the lymphatics have mouths of like kind, and for like pur- poses, although from their minuteness they have hitherto eluded all detection. 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.| 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 more richly endowed, as we have just remarked, by very numerous valves, than any other sets of vessels whatever. " A lymphatic valve is a semicircular membrane, or rather of a parabolic shape, attached to the inside of the lymphatic vessels by its circular edge, having its straight edge, corresponding to the diameter, loose or floating in the cavity : in consequence of this contrivance fluids. passing 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 varies 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 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 * Vol. v. p. 12. Phys. Proem, supra. t Vol. i. p. 47. of the present work, as also Phil. Trans. 1813, p. 157 t Cruikshank, Anat. of Absorb. Vessels, p. 66. 2d. Edtt. ? Loc, citat. PHYSIOLOGICAL FROEM. [cl. vi. i&3 oval, oiie end being turned to the thoracic duct and the other from f.h/£* v'' it: but we are in the same kind of uncertainty concerning their use, en't system. and, in some measure, concerning their organization, as in respect to those of the secernent svstem. The vessel that conveys a fluid Vas iT,**~. . ii-ni • /• 11 i • i reD3 w"at. to one ot these glands is called a vas inferens, and that which con- Vas effe- veys it away a vas efferens. The vasa inferentia, or those that enter ,en8 what' 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 dia- meter, and sometimes consist of a single vessel alone. It is con- Glands ceived by many physiologists that the conglobate mass which forms Tonloiu- the gland consists of nothing more than convolutions of the vasa,ioi,B ?f- • .» • i-ii i 111 vaBa in'e" inferentia : whilst others as strenuously contend that they are a con- rcntia or a geries of cells or acini totally distinct from the absorbent vessels 0f"dgistinct that enter into them. Whatever their structure may be, they seem ceils. to the present author to be powerfully auxiliary to the Valves, by auxiliary abating the back force they are unquestionably called at times to ^°al,h*g. encounter from some morbid action, and there is reason to believe abating the that in this way, like the conglomerate glands of the secernents, „f the fluids, they become basins or receptacles. B^d answer As in the case of the secernents, we are also unacquainted with of recepta- the means by which the absorbents act. This, in both instances, is pre»Pui«ve said to be a vis d tergo,—a term which gives us little information power un- in either instance, and is peculiarly difficult of comprehension in the latter. In their most composite state they possess a very low degree Their sen- of sensibility, and are but little supplied with branches from the g'maiifond larger trunks of nerves. rnrejy SUP" Abstruse, however, as the process of absorption is to us at pre- branches sent, we have sufficient proofs of the fact Of six pints of warm fa°™r,ho water injected into the abdomen of a living dog not more than four nerves. ounces remained at the expiration of six hours. The water ac- ,™absorb- cumulated in dropsy of the brain, and deposited in the ventricles, we ent P°wer> 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 whether absorbent vessels that open on the surface of the body : yet a multi- ■ofbenig en tude of facts seem sufficiently to establish the positive side of this 0hfethuerfttCa question, though it is not fluids of every kind that can be carried b^dy: from the skin into the circulating system, and hence their power is ^"J,0 by no means universal. Sailors who, when in great thirst, put on "J1.^.^ shirts wetted with salt water, find considerable relief to this distress- fluid* of'aTi ing sensation. Dr. Simpson, of St. Andrews, relates the case of pjl^ftof a rapid decrease of the water in which the legsof a phrenitic their exist- patient were bathed : and De Haen finding that his dropsical patients po^*n filled equally fast whether they were permitted to drink liquids or not. did not hesitate to assert that they must absorb from the 184 cl. vi.] PHYSIOLOGICAL PROEM. Cl*s3VI. atmosphere. Spirits and many volatile irritants seem to be absorbed en't system, 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 esophagus, received nothing, either solid or liquid, into the stomach for two months: he was exceedingly thirsty, and complained 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."* The aliment of nutritive clysters seems, in like man- ner, 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. Xnrcotic Narcotic fluids rarely enter to any considerable extent and never ringiy or so as to do mischief, respecting which, therefore, the power of the sorbed't:b" cutaneous absorbents is very limited : and there are few poisonous as also few liquids, with the exception of the venereal, that may not be applied liquid"0"" with safety to a sound skin. Absorption This double"process of secretion and absorption was supposed by the an- by the ancients to be performed, not by two distinct sets of vessels pTrforin°dbe expressly formed for the purpose, but by the peculiar construction bythear- of the arteries, or of the veins, or of both. These are sometimes ve'inl.'orby represented as being porous, and hence, as letting loose contained were eon-h mi^s by transudation, and imbibing extraneous fluids by capillary ceived to attraction. There is, in fact, something extremely plausible in this or to'trans- view of the subject, which, in respect to dead animal matter, is "de. allowed to be true, even in our own day. For it is well known that tion wcii a bladder filled with blood and suspended in the air, from a cause ihVpresent we sna^ presently advert to, is readily permeated with oxygene gas, day to take so as to transform the deep Modenahue of the surface of the blood deada'ni- that touches the bladder into a bright scarlet: and thin fluids injected Kiustrated' m*° *ne °l°0(l-vessels of a dead body transude very generally ; insomuch that glue dissolved in water and thrown into the coronary veins, will permeate into the cavity of the pericardium, and by Additional jellying even assume its figure. And hence it is that bile is often lions' found, after death, to pass through the tunics of the gall-bladder and tinge the transverse aorta of the colon, the duodenum or the pylorus with a brown, yellow, or green hue, according to its colour at the time. Doctrine of The doctrine of porosity or transudation, was hencevery generally mainufned supported till the time of Mr. Hewson, by physiologists of the first or/iewsT/ rePutati°n- Boyle, hence, speaks, as Mr. Cruikshank has justly " observed, of the porositas animalium, and wonders that this property 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 body. The experiments of Hewson, J. Hunter, and Cruikshank, have, however, sufficiently shown that, while vessels, in losing life, lose the property of confining their * Anat. r.f the Absptb. Vessels, p. 10F, PHYSIOLOGICAL PROEM. [cl. vi. 186 fluids, they possess this property most accurately, so long as the Class vi. principle of life continues to actuate them. entlSm. There is, moreover, another method by which the ancients some- ^j6™* times accounted for the inhalation and exhalation of fluids, making conceived a much nearer approach to the modern doctrine, and that is by the anciems'to mouths of vessels ; still, however, regarding these vessels as arteries a{=1 by or veins, and particularly the latter. " The soft parts of the body," months"8 observes Hippocrates, " attract matter to themselves both from within and from without ; a proof that the whole body exhales and inhales." Upon which passage Galen has the following comment: aTiw. "For as the veins, by mouths placed in the skin, throw out what- by'ffippo- ever is redundant of vapour or smoke, so they receive by the same'^J and 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- T.!,ii> doc- rence of lymphatics, has been revived within the last eight or ten ed"by m™" years by M. Magendie, and M. Flandrin, of Paris, who have made |*andrinnd an appeal to experiments which appear highly plausible, and are with some entitled to a critical examination. alterations. The doctrines hereby attempted to be established are, indeed, HJP°the9i! varied in some degree from those of the Greek schools; and are epitomized? more complex. In few words, they may be thus expressed : that the only general absorbents are the veins ;—that the lacteals merely absorb the food;—that the lymphatics have no absorbent power whatever ;—and that the villi in the different portions of the intestinal 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? porta? 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 Cuticle iaa absorption in a sound state, either by veins or lymphatics ; but that, absorption if abraded or strongly urged by the pressure of minute substances in a sound that enter into its perspirable pores, the mouths of its minute veins are thus rendered absorbent. He supposes the function of the lymphatics to consist in convey- Magendie s ing the finerf lymph of the blood directly to the heart, as the veins ofTheVseof convey the grosser and purple part: and that they rise, as the veins, bmphatics. from terminal arteries. Proper lymph, in the system of M. Magendie, is tharopaline, Proper rose-coloured, sometimes madder-red, fluid which is obtained by Su 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 rea-ons weed for regarding veins as absorbents Vol, V.—!?4 160 cl.vi.] PHYSIOLOGICAL PROEM. . Class VI. iSi that membranes which absorb actively have, in his opinion, m"' en't system, demonstrable lymphatics, as the arachnoid. But according to Bichat, such membranes have no more demonstrable veins than lymphatics ; veins are seen to creep on them, but never to enter. Reviewer The two principal experiments, on which M. Magendie seems to chtff expe- rely in proof that the veins, and not the lymphatics, are absorbents, riments. are tne following:—First, M. Delille and himself separated the thigh from the body of a dog that had been previously rendered insensible 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 then- 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 com- pressing the crural vein between the fingers at the moment the action of the poison began to be developed, this action speedily ceased: it reappeared when the vein was left free, and once more ceased if the vein were again compressed. Remaiks These experiments are very striking, and, on a cursory view may above ex- be supposed to carry conviction with them : but the confidence of periments: those who have studiously followed the concurrent experiments, and the clear and cautious deductions of our distinguished countrymen, Hewson, both the Hunters, and Cruikshank, supported as they have been by those of Mascagni, and various other able physiologists on Roifseigen's the continent, will not so easily be shaken. Reifseigen has limited onPtehe'aent3 n^s researches to the lungs, but seems to have established the doc- lungs, trine of a distinct system of absorbents in this organ, by showing that the veins of the lungs do not absorb, and pointing out the occa- sional cause of error upon this subject.* and recon- We have already observed that lymphatic absorbents, in the withth" opinion of Mr. Cruikshank, probably in that of all these writer.-;, and^ta" enter as m'ty mto tne tunics of veins and arteries, and even into hiished those of the vasa vasorum, as into any other part of the animal doctrine. frame : and hence there can be no difficulty in conceiving that the poison employed in these experiments might accompany the veins by means* of their lymphatics. We also observed that while the lymphatics anastomose, or run into each other more frequently than any other set of vessels, their valves, which alone prevent a retro- grade course, and direct the contained fluid towards the thoracic duct, are occasionally placed at a considerable distance from each other, in some instances not less than six inches, and that this- * Uberdcn Ban der ungen, &c. Berlin 183?. PHYSIOLOGICAL PROEM. [cl. vi. 187 length of interval occurs in the minute twigs as well as in the Class VI. trunks. And hence, admitting that, in the veins that were cut or onttysTcm" isolated in M. Magendie's experiments, such a vacuity of valves incidentally 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 anasto- mosis 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 veins ; 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 Reconeiii- enter into the tunics of the lacteals, which M. Magendie admits to tah'e°comtth be" a system of absorbents altogether distinct from the veins, are mnndoc- equally destitute of valves in certain parts or directions, and commu- tinued.0" nicate by anastomosis some portion of the chyle and any substance * contained in it to the interior of the adjoining veins, and conse- quently 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 : and there are certain experiments of M. Foh- mann,* who has paid great attention to the subject, that seem to prove that such anastomosis is not unfrequent. In the singular expe- riments made with prussiate of potash by Dr. Walla3ton 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 prussiate, though it was so obvious in the fluid of the urinary bladder. The difficulty of accounting for this is considerable, but may perhaps be explained by the very diffused state of the prussiate in the entire mass of the blood, and its greater concentration when secreted 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 Effects pro- M. Magendie's experiments without abandoning the well-established animais'ln doctrine of absorption by the lymphatic system. It is a remark 1^*^- which ought never to be lost sight of, that experiments made upon iityorpain, animals in a state either of great pain or of great debility can give 0"ePto caVes us, by their result, no full proof of the line of conduct pursued by }^e^L nature in a state of health. In the dead animal body the valves or health, the lymphatic vessels very generally lose all elasticity and power of ^r|ng*'. resistance, and transmit fluids in every direction ; whence, in all dom from probability, that porosity or transudation, which we have already paui * Anatomische Untersuchungrcn iiber den Anastomosis der Lvmphatiken nit der Venen. Heidelberjr. 1821. lSti CL. VI.j PHYSIOLOGICAL PROEM. Class VI, II. Absorb ont system. Exemplifi- ed. Additional illustra- tions from Cruik- shank : and Mokel: observed as manifest, occasionally, in the stomach and intestines- and in various other organs, on tlie use of anatomical injection?. And hence there can be little doubt, that as an organ makes an approach to the same state of insensibility and inirritability, by the severe if not fatal wounds inflicted on it in the course of such ex- periments as are here alluded to, the valves of its lymphatic vessels make an approach also to the same state of flaccidity, and allow the fluids, whose course they should resist, to pass in ariy direction. The experiments, of alike kind, which have since M. Magendie's communications, been pursued in France by M. Fodere,* and in America by Dr. Lawrence and Dr. Contes,t are open to the same objection. They have been made under circumstances of ebbing vitality, or excruciating pain, and a few of them on pieces of animal membrane removed from the parent body. It is admitted candidly, however, by the last two physiologists, that the quill experiment of M. Magendie in most instances, though not in all, failed in their hands. Even this, however, is in every successful result referred by M. Fohmann to the anastomosing connexion which he has taken much pains to establish as existing between various veins and lympha- tics, and which we have just adverted to. 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 the vein, which he thought succeeded better than from the artery. In three different kidneys he injected from the uterus the tubuli uriniferi for a considerable length along the mamillaB ; 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 experi- ments, the colouring matter of the injection was vermillion. In numerous instances he filled the lymphatics of the lungs and liver with quicksilver ; 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.J Dr. Mekel§ had already shown the same facts by a similar train of experiments, instituted only a year or two before, and the conclu- sion he drew from them is in perfect coincidence with the explana- tion now offered. Dr. Mekel's experiments consisted in injecting mercury with great care, but considerable force, into various lympha- tics, and minute secreting cavities; and he found that a direct communication took place between such cavities and lymphatics, and the veins in immediate connexion with them : and hence, he contended, that the lymphatics and the veins are both of them * Journ. de Physiologie, Janv. 1823. t Experiments to determine the absorbing power of the Veins and Lymphatics, Philadelphia Journ. No. 10. I Edinb. Med. Com. i. p. 430, § Nova Experimenta et Observationes de fibribus venarum et vasorum lymphati- cyrura in ductus, risceraque corporis hamaiii, ejusdemque structure ntilitate. 8vo. PHYSIOLOGICAL PROEM. ,tL, vi. 189 absorbents under particular circumstances ; the lymphatics acting Class vr- ordinarily, and forming the usual channel for carrying off secreted "'t s^stem'T fluids ; and the veins acting extraordinarily, and supplying the place of the lymphatics where these are in a state of morbid torpitude or debility, or the cavity is overloaded. He traced this communication particularly in the breasts, in the liver, and in the bladder : and he thus accounts for the ready passage which bile finds into the blood, when the ductus choledochus is obstructed, as in jaundice ; and the urinous fluid which is often thrown forth from the axilla? and other organs upon a suppression of the natural secretion. It follows, therefore, that the experiments of M. Magendie, General allowing them to be precisely narrated, are capable of explanation resnU* without abruptly overthrowing the established doctrines of preceding physiologists in the same line of pursuit: and we have still ample reason for believing that the. economy of secretion and absorption 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. This doctrine is proof against impeachment, whether M. Magen- To'the die's experiments be believed or doubted ; for still, to adopt the Ian- H\™iayrT?c! guage of Mr. Herbert Mayo upon this subject, " the broad analogical argument advanced by the Hunters to establish the position that the lymphatics and lacteals form exclusively the absorbent system, re- mains unshaken. It must not be lost sight of that the entrance of any substance, raw and unassimilated, into the veins and arteries, is a very different occurrence from the conversion of the elements of the human body into lymph, and their subsequent re-admixture with the blood ; and, again, that the refusal of the lacteals to take up milk or starch, does not prove that these vessels habitually absorb un- changed, and in addition to the chyle, such simple fluids as may be carried without detriment into the circulation.* III. In different periods of life, many of the secretions vary ™ecGeeneral considerably in their sensible properties, or relative quantity. Thus i_ • and al)sorb- It is from this mysterious power of reproduction appertaining to ^lonth every part of the system, that we are so often able to renew the sub- ifence°iosT stance and function of parts that have been wasted by fevers or ^l1310 atrophy, or abruptly destroyed or lopped off by accident. quence of In the progress of this general economy, every organ and part of McldentB the body secretes for itself the nutriment it requires, from the com- Eve^o"3" mon pabulum of the blood which is conveyed to it, or from secre- gan secretes tions which have already been obtained from the blood, and deposited £0rmtstehe in surrounding cavities, as fat, gelatin, and lymph. And it is proba- common bie that the several organs of secretion, like the eye, the ear, and fhebiood? the other distinct organs of sense are peculiarly affected by peculiar M,nnyaffe~ct- stimulants and excited to some diversity of sensation. ed by pecu- In Germany, this idea has been pursued as far as in some la"^'^^ hypotheses, and particularly that of M. Hubner,t to lay a foundation perhaps for the doctrine of a sixth sense, to which, as we observed on a different former occasion,^ has been given the name of selbstgefiihl or oem^inge- gemeingefiihl, "self-feeling," or "general-feeling." The sensa- f«hi of the tions, however, we are at present alluding to, are not so much writes" general or those of the whole self, as particular or limited to the what- 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 tl ese 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 Proofs o:" we find the bladder stimulated by cantharides, and the intestinal oTgani" canal by purgatives ; and we may hence conjecture that every other ^j8^"! part of the system, where any kind of secretion is going forwards, tions. is endowed with a like peculiarity of irritability and sensibility, though not sufficiently keen to attract our attention. It is hence we meet with, that surprising variety of secretions which Variety of are furnished not only by different, but even by the same animal in furntshed3 different parts of the body. Hence sugar is secreled by the stomach, by the same . i ii-i iii ii- i i ar.imalin and sometimes by the kidneys ; sulphur by tne brain : wax by -the different ears ; lime by the salivary glands, the secretories of the bones, and, as^ugar, in a state of disease, by the lungs, the kidneys, the arteries, and the sulphur, exhalants of the skin ; milk by the breasts ; semen by the testes ; mTik' the menstrual fluid by the uterus: urine by the kidneys ; bile by the ™°e> liver ; muriate of soda by the secernents of almost every organ ; muriate of and sweat from every part of the surface. Hence some animals, as the bee, secrete honey ; others, as the honey. * Gibson, Manchester Memoirs, Vol. I. 633= f Comment, de. Ctenesthesi, 4794. t Vol. v. Physiol Proem. 192 cl. vi.j PHYSIOLOGICAL PROEM. Class VI III. Gene. ral effects Sroduced y the ac- tion of the secernents and absor- bents on each other wax, Bilk, phospho- rescent light, air, ink, electricity. Secretions among plants equally diversified. Singular exemplifi- cation in the milk- tree. ISo part of an organ- ized sub- s':'.nce in 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 Rcamur denominates tlie 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 very strong phosphorescent 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 circum- stances, but fishes of various kinds more largely, as those furnished with air-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 obtains a sufficient conceal- ment 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 tetradon 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 mat- ter diffused through the whole of its flesh. From the same cause 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 assafce- tida ; in the sap of its stem an astringent acid ; its glands give forth gum arabic ; and its flower an odour of a very grateful fragrance : while the milk-tree or cow-tree, the arbol de lache, or palo de vaca of South America, overflows with nutritious milk from every part. This is one of the many singular plants noticed by M. Hum- boldt in his voyage to the equinoctial regions. It is a native of Venezuela, and belongs to the natural family of the sapotae ; and its juice, in strict correspondence with its name, is said to possess almost all the properties of cow's milk. M. Humbolut visited the district where it was reported to grow, and found the account true ; but tells us that it is rather more viscous than cow's milk, and has a slight balsamic taste. He drank it plentifully in the evening and early in the morning without any unpleasant effects ; and was told that, when in season, the working people use it with their cassava bread, and always fatten upon it.* This subject is highly interesting and might be extended to volumes, but we are already digressing too far. There is no par' Annales de Cuiruie et de Physique, Juin 1823, Tom. xxm. 19 PHYSIOLOGICAL PROEM. [cl. vi. 193 of the body in which the process of secretion is not going forward: Class VI. we trace it, and consequently the fabric which gives rise to it, in the "! effects" parenchyma or intermediate substance of organs, in their internal Prodjjced surfaces and outlets, and on the external surface of the entire frame: tion of the thus forming three divisions of prominent distinction, both in respect aencderanbeao£ to locality and to the diseases which relate to them. It is on these bents on divisions, that the orders of the present class are founded. which se-r' cretion does not take plaec. Vol. V.—25 CLASS VI. ECCRITICA. ORDER I. MESOTICA. DISEASES AFFECTING THE PARENCHYMA, pbavity in the quantity or quality of the intermediate oh connecting substance of organs ; WITHOUT inflammation, - FEVER, OR OTHER DERANGEMENT OF THE GENERAL HEALTH. Class VI. The classic term eccritica is a derivative from tK*eiw," secerno," OrUnof1' " exhaurio," "to secern or strain off," " to drain or exhaust," and ordinal is preferred by the author to any other derivative which *£R». '■ Gen. I. portion of animal food ; till, at length, finding the plan work won- PcfiysVrcik ders as wel1 in his renewetl vigour of mind as of body, he limited adiposa. himself to a diet of simple pudding made of sea-biscuit, flour, and 0bes,,y' skimmed milk, of which he allowed himself a pound and a half about four or five o'clock in the morning for his breakfast, and the same quantity at noon for his dinner. Besides this he took nothing either of solids or fluids, for he had at length brought himself to ab- stain, even from water ; and found himself easier without it. He went to bed about eight or nine o'clock, rarely slept for more than five or six hours, and hence rose usually at one or two in the morn- ing, and employed himself in laborious exercise of some kind or other, till the time of his breakfast. And by this regimen he re- duced himself to the condition of a middle-sized man of firm flesh. Lambert of well coloured complexion, and sound health.* A like plan, or Leicester. ratner something approaching it, the present author once recom- mended to Mr. Lambert of Leicester on being consulted concerning the state of his health. But either he had not courage enough to enter upon it, or did not choose 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. But the When the reduced treatment thus recommended has been unne- meTper?1 cessarily and injudiciously entered upon and followed up with per- ni^°us m_ tinacity, as in cases where young females are desirous of becoming ployed in- celebrated for an elegant slenderness of form, it has often been pro- judiciously. ductive of a serious, and occasionally of a fatal result. Professor Frank gives a striking example of this in a young lady, who, for the above purpose, had for-nearly a twelvemonth greatly diminished her daily food, used severe horse-exercise, and drank every day a large quantity of vinegar. She at this time was labouring under dyspepsy, hysteria, and a dry cough, with a pungent pain in her side, hectic sweats, and occasionally purulent expectoration : she was pro- nounced in the last stage of consumption, and her life was entirely despaired of. Frank, however, succeeded in averting this event by the gradual renewal of a more nutritious diet, and the use of tonics.t in local The local disease is for the most part far less manageable ; but it obesity. nag so,netimes yielded to a steady perseverance in the above plan, in connexion 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. * Med. Trans. Vol. n. Art. xvh. t De Cur. Horn. Morb. Epit. Tom. vi. Lib. vi. 8yo. Vienna 1820 EXCERNENT FUNCTION. [ord. i. 201 UENUS li. EMPHYMA. TUMOUK. V LOME RATIO X IN TIIE SUBSTANCE OF ORGANS FROM THE PRODUCTION OF NEW AND ADSCITITIOUS MATTER : SENSATION DULL, GROWTH SLUGGISH. Phxma, in the present system, is limited to cutaneous tumours, Gen. II. or tubers, accompanied with inflammation, as already explained in fePr^"l. Class in. Order 11.* Emphyma imports, in contradistinction to plained. phyma, a tumour originating below the integuments, and unaccom- panied with inflammation, at least in its commencement: while ecphyma in Order in. of the present Class, imports, in contradis- tinction to both, mere superficial extuberances, confined to the in- teguments alone. The term glomeration, or " heaping into a ball," in the generic definition, is preferred to the more common terms protuberance or extuberance, because some tumours or emphymata lie so deeply seated below the integuments as to produce no promi- nence whatever, and are only discoverable by the touch. The species of this order, and much of their general character and arrangement, are taken with a few variations from Mr. Aberne- thy's valuable Tract on Tumours. The subject, indeed, though of a mixed description, is commonly Subject regarded as appertaining rather to the province of surgery than of *£{£*}:t0ns medicine, from the tendency which most tumours seated on or near the depart- the surface have to open externally, or to call for some manual ope- surgery ration. In a general system of the healing art, however, it is neces- ^g^";^. sary to notice them, though it is not the author's intention to dwell yetneces- upon them at length ; but rather to refer the reader, from the few nortfced ,S hints he is about to pursue, to Dr. Baron's and Mr. Abernethy's a |teen^raI works,! as the best comments upon them which he can consult: practice. widely differing indeed in their views of the origin of such extra- neous growths, but each drawn up with great candour, and appeal- ing to a host of indisputable facts, as we have already had occasion to observe when treating of hepatic parabysma,| and tubercular phthisis,§ to which pages the reader is referred for an account of the general origin and progress of morbid growths, and other physiolo- gical illustrations appertaining to them. * Vol. n. p. -17. t Observations on Tumours. I Class i. Ord. u. Gen. iv. Spec. i. § Class in. Ord. iv. Gen. in. Spec. v. Vol. V.— 2i- 202 cl.vi.J KCCIMTICA [ord. I. Gen. II. The species embraced bv the genus emphyma are the following : Emphyma. Tumour. 1. EMPHYMA SARCOMA. SARCOMATOUS TUMOUR. 2.---------ENCYST IS. ENCYSTED TUMOUR. W'N. 3.---------EXSOSTOSI3. BONY TUMOUR. SPECIES I. EMPHYMA SARCOMA. SARCOMATOUS TUMOUR. TUMOUR IMMOVEABLE ; FLESHY AND FIRM TO THE TOUCH, Gen. li. The varieties of this species, modified in respect to structure and Spec. I. situation, are very numerous. The following, distinguished by the former quality, are chiefly worthy of notice: x Carnosum. Fleshy tumour. (3 Adiposum. Adipose tumour. - V Pancreaticuin. Pancreatic tumour. I Cellulo.sum. Cystose tumour. Derbyshire-neck. ; Scirrhosum. Scirrhous tumour. Vascular throughout: texture sim- ple : when bulky mapped on the surface with arborescent veins. Found over the body and limbs generally. Suetty throughout : enclosed in a thin capsule of condensed cel- lular substance : connected by minute vessels. Found chiefly in the fore and back part of the trunk. Tumour in irregular masses : con- nected by a loose fibrous sub- stance, like the irregular masses of the pancreas. Found oc- casionally in the cellular sub- stance, but more usually in con- voluted glands : chiefly in the female breast. Tumour cellulose or cystose: cells ova], currant-sized or grape- sized, containing a serous fluid ; sometimes caseous. Found ge- nerally, but mostly in the thy- roid gland, testis, and ovarium. Hard, rigid, vascular, infarction of .glandular follicles : indolent, in- sentient, glabrous ; sometimes shrinking and becoming more indurated. Found in irhndular EXCERNENT FUNCTION. [ORD. I. 203 £ Mammarium. Mammarv tumour. Tuberculosum. Tuberculous tumour. Medullare. Medullary tumour. structures, chiefly those of the Gen. II. Spec I secernent system. Em^ym* Tumour of the colour, and assum- Sarcoma. . Sarcoma- ing the texture of the mammary tous tu- gland : dense and whitish : mour' sometimes softer and brownish : often producing, on extirpation, a malignant ulcer with indu- rated edges. Found in various parts of the body and limbs. Formed of firm, round, and clus- tering tubercles; pea-sized or bean-sized ; yellowish or brown- ish-red ; when large, disposed to ulcerate, and produce a pain- ful, 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; some- times reddish-brown; when large, apt to ulcerate, and pro- duce a sloughing, bleeding, and highly dangerous, sore. Found in different parts : chiefly in the testes : at times propagating it- self 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 produced by some increased action or irritation in the part in which they occur, the cause of which it is rarely in our power to ascertain. In general, they commence slowly and imperceptibly, and are seldom accom- panied with much pain whatever be the extent of their growth. They are all more or less organized through the w^iole of their structure, by which they are particularly distinguished 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 of site, habit, idiosyncrasy, or local misaffection. In their formation, however, there seems to be a greater tendency to inflammation, and especially adhesive inflamma- tion in the fleshy tumour, or proper sarcoma, than in any of the rest; and, from the more perfect elaboration of its fabric, there is no other form that maintains itself so firmly, or is removed, excepting by excision, with so much difficulty. The origin of the adipose may, in some degree, be understood from the remark we have offered under the last jrenus. and particularly under its second vnrietv. General remaiks. Some causes of- ten com- mon to all: the differ- ence in ef- fect pro- duced by habit, idio- syncrasy, or local influence. Peculiar character of sarcoma. 201 cl. vi.J ECCWT1CA. [oiu>. I. Gen. II. The scirrhous tumour, when irritated, has a general tendency to j^nifhyma run into a cancerous ulcer: for whiHi it is not always easy to Sure,ma. account, excepting where there happens to be an hereditary taint in tolls tu-11 the blood : for neither the tumour nor its ordinary result, as we poc'uiiar observed when treating of carcinus, is by any means confined to a character glandular or to any particular structure, though the secernent glands constitute its most common seat. In Mr: Abernethy's Trea- tise, the place of the scirrhous tumour, however, is occupied by ano- ther to which he gives the name of carcinoma, which, in the present system, is regarded as a modification of the scirrhous, degenerated, and ulcerated mostly by a cancerous diathesis ; and in such case appertaining 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 ritiosum. The scirrhous tumour is, in fact, the most important of the whole tribe, not only as leading, under peculiar circumstances, and in par- ticular habits, to the most fatal result, but as being more common to every Organ than any other variety whatever : and, in a few instances, common to almost every organ collectively or at the same time.* • cvher The other varieties are looser and more spongy, and contain far o,lit and less of living power.: in consequence of which they are more easily •'y,'and°n" deposed to ulcerate, and, when in this condition, often spread and contain become sordid and malignant from debility alone. power"18 ^v c have said that the tumours of this species will sometimes M°^t°egthe grow to a vast and preposterous bulk. This is particularly the case occasion- with the first variety or fleshy sarcoma, and more especially when it toaif'euor- sea^s itself in the scrotum forming the sarcocele, or hernia car- moussize. nosa of authors. Negroes are particularly subject to this affection, Exemplified ,. . ., ° ■ i i /-p , ± . .- • i i in sarcoma, and in one instance the tumour weighed fifty pounds.! i^wcdiaur indeed orhe-ni*3' arfirms that they have occasionally weighed a hundred pounds.J camosa, The skin is here thick, rugose, of a dirty yellow, often covered with ex-ulcerations that ooze a fetid ichor. It is said that among negroes 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 Pfcffinger and Friedius. He has moreover generalized his assertion by contending that the left ovary of women as well as the left testicle of men is more subject to diseases of all kinds than the right.§ Female Baron Larrey describes a sarcoma of the labia among tropical wiiat.cee' women of the same nature as the scrotal sarcoma among mcn.il Exemplified The adipose tumour is also frequently of a very large magnitude. in adipose ,. ,. ' . . . c 1 "! • , tumour: Mr. Abernethy gives an instance ot one on the thigh that weighed fifteen pounds after extirpation,IT and M. Lesko of another of the * rjensgen, Museum der llcilkimde, Rami. n. p. HI. t ScluVt'te, Phil. Trans.. Vol. i.xxitl. 1783. I Nov. N«.-ol. Metli. Sy-t. n. 529. I Nov. Act. Physico-.Yltf]. Acad. Nat. Cur. Tom. it. Norim. fl Relat. Hist. et. Chirurg. de ^Expedition de l'Armee en Eeypte, &c. 8vo, Paris, 1S03. '■ On Tuiiiours?. j). 31. 8vo. 1^11. cl. vi.j EXCERNENT FUNCTION. Lord. i. 205 weight of nineteen pounds dissected from the face.* In the Journal Gen. ii. de Medicine, is an account of a third, that weighed not less than i^'J^ forty-two pOUnds.j Sarcoma. The bulk of the scirrhous tumour, however, and especially when i.l'Ja'tu-" seated on the breast, has often equalled and sometimes exceeded U10U[- the largest of these. M. Leske, indeed, gives a case, in which a scirrhous tumour of this kind was amputated from the breast, of the enOr- tumour" mous weight of sixty-four pounds, that had been increasing for years, and was at last so oppressive as to endanger the patient's life.J The most unsightly, however, of the whole, is the sarcoma Broncho- ccllulosum, when it fixes in the thyroid gland ; in which situation it u'^GoUre is often called Botium, Bronchocele, or Goitre; and, in our own »' ""^y- i , ,. ■ i /» ■ i shire-neck. vernacular language, derhysiiire-neck. from an idea, of consider- Frequently able antiquity, that the inhabitants of that county are more subject f^"^a to it than those of. other districts, an idea that does not seem to be shire; without foundation ; for in a visit which the author lately made to ^tuJe e"ary Matlock he found a much larger number of the poor affected with plained. this disease than he had ever seen before, while the rich escaped ; and he found also that by far the greater part of those who were la- bouring under it, were not only exposed to all the ordinary evils of poverty, but derived their chief diet from that indigestible and innutri- tive substance, the Derbyshire oaten cake, which is probably the chief cause of all the glandular and parabysmic enlargements which are so common to that quarter. We shall see when treating of creti- nism that a like innutritive diet is one of the most obvious causes of the same appearance as a concomitant in those countries in which cretinism is most frequent. The cells in this protuberance are 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 those may be frequently repressed or resolved if disco- General vcred and attended to in their origin. The fleshy, which always ™a"ti • ■eminences with some degree of inflammatory action, should be -Mdy t,e. vigorously attacked with leeches, repeated as often as may be neces- frequently sary, and afterwards with astringents or alterants, as the dilute solu |("i'iinlr tion of the acetate of lead, for the former purpose, and the mercurial oinplaster 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 with the knife without loss of time, or allowing it to acquire any considerable bulk. Baron Larry affirms that he has often removed by the knife the largest scrotal sarcomas or sarcoceles, and this with very little pain, while the wound has readily healed afterwards.§ The scirrhous tumour is usually indicative of weak, instead of Treatment J ot -cirrhous * Auserlcsene Abhandlungen, &c. Leipzig, 1774, 8v. t Tom. xx. p. 551. I Op. citat. _ . S Relat. Hist.et Chirunr. de. l'Expedition de rArmee en Esvpte et en bvrie. Rvo. Paris. |W. 20G cl. vi.J ECCRITICA. [ORO. I. Gen.H. Spec. I. Emphyma Sarcoma. Sarcoma- tous tu- mour. Little ten- dency to inflamma- tion in any of the va- rieties : and hence stimulant applica- tions with pressure are often serviceable Treatment of broncho- cele, or Dorbyshire- neck. Its pro- gress : and general character entonic, action in the organ in which it' makes its appearance ; in consequence of which the lymphatics absorb only the more attenuate part of the secerned fluids, and leave the grosser which thicken and harden in the parenchyma. There is little irritation at first, but as the distention and obduration increase, the part becomes stimulated, and, as we have already observed, in a scrofulous can- 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 stimu- lants 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 effectual 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 excep- tion 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. Extirpation 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 always be found adviseable. This is particularly true in that variety of the cystous sarcoma which is denominated b^onciiocele, goitre, or derbvshire-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 sufficiently defined from the first for any effective use of chirurgical means.t 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 irre- gular, 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 vari- cose ; the respiration is sometimes rendered difficult, and from the * See Vol. in. Cl. in. Ord. iv. Gen. xm. Spec. u. Ulcus vitiosum. : F. Fa. Foderv. Traite tin Goitre et du Cretinisme. Paris. 8vo. Isor m De Haen. Stimulants and tonics, especially alkaline stimulants. These em- ployed both externally and inter- nally. Prepara- tions from Iodine. Coindet's successful employ- ment of them. solid, and gives no discharge ; and in a few instances the morbid growth has evinced a complication of almost every diversity of structure, and especially in those who are constitutionally predis- posed to a production of tubers or tubercles. De Ilacn has given us a striking example of this in a patient who after having suffered much from visceral tumours, at length died in a state of dropsy.- " In cadavere," says he, " horrendam mole thyroidceam glandulam nactus. publice dissecui. Mecum auditores mirabantur nullum fere genus tumorum dari, quin in hac sola tbyroidcea inveniretur. Hie enim steatoma, ibi atheroma, alio in loco purulentus tumor, in alio hydatrius, in alio erat coagulatus sanguis, fluidus fere in alio, imo hinc glutine locutus plenus erat, alibi calce cum sebo mista, &c. Hasc autem omnia in una, eademque thyroidcea glandula."* 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 debilitated by growth, and especially where this effect is produced by innutri- tive food, and partly by a larger flow of catamenia than the general tone of the system can sustain without yielding. On this account 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 nor seem hitherto to have been sufficiently explained, in this kind of tumour, as in those of scrofula, the most successful stimulants are the alkalies : and of these the ammoniacal were formerly 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 predilection, and hence in a later day, the subcarbonate, or the carbonate of soda, were pretty generally allowed to supply the place of all the other preparations of this kind, as the most convenient form in which the alkali could be given. It was also recommended to be applied externally, in the guise of sea-water, or the bibulous sea- plants, as already described in the treatment of scrofula :| both diseases having many points of resemblance, and especially as being chiefly seated in the glandular parts of the animal frame, and accompanied with great indolence in the lymphatic system. In the present day, however, every other kind of preparation, as well for the one as the other complaint, has fallen prostrate before the newly-discovered alkali, now well known by the name of iodine, so denominated by M. Courtois from its violet hue. For the pur- pose before us it has been used both internally and externally. M. Coindet employed it in the form of an ointment, which he made by mixing pure iodine or the hydriodate of potash with lard, under an idea that the ill effect it produces when given injudicious!}', mav f Rat Medcndi. Persvii. p. 285. * Vol. m. Cl. in. Ord, iv. .Spec. I, Sfrniiin znlgnn cl vi.] EXCERNENT FUNCTION. [ord. i. 209 be hereby avoided ; and Coster affirms that by the use of Coindet's Gem. ii. ointment, of nearly a hundred individuals affected, more than two- Emphyma thirds were completely cured under his hands* M. Breraf thinks |*™°™*l it quite as void of mischief, and in most cases more efficacious em- tous tu- ployed internally ; and uses it in the form of pills, or tincture made T^eaVment. with pure iodine ; or a, solution of the hydriodate of potash in dis- Brera's tilled water. The dose, in either case, is from a quarter to half a met ° ' grain three times a day, for an adult. Where it agrees with the system the appetite is increased, and Effects. the pulse acquires more elasticity and beats stronger ; but it has a ^ree",1' tendency at the same time to stimulate the salivary glands in the manner of mercury. Where it does not agree it produces a sense When it of heat and irritation in the fauces, pain in the orbits and balls of ,aagree! the eye, and obscure vision ; with tremours or convulsions of the extremities. Dr. Brera, as already observed, has employed it, on account of its absorbent powers in various cases of parabysma, or visceral turgescence, and especially in tubercular formations ; and, as is well known, with considerable success : a success which the present author has extensively confirmed by his own practice in all the forms of this remedy. Yet from the great and general excite- Jj™ ^f*" rnent it produces, more judgment is-called for in prescribing iodine, sary. whether externally or internally, than is often manifested : and in no Its use> case whatever is a bold or daring practice more to be reprobated than in the present. The danger indeed is the greater, because the irritation or inflammatory effects are often not visible for a fortnight or three weeks ; though, when they have once commenced, they are in many persons very intractable, notwithstanding an utter disuse of the medicine. " I saw two cases, with Dr. Peschier of Geneva," says Dr. Gairdner, " in which the patients had suffered more than twelve months, and yet their sufferings had undergone little mitiga- tion."J There are some idiosyncrasies, however, that are little affected by its use. Bronchocele has sometimes been cured spontaneously, an in- sometimes stance of which occurred not long ago to the present author, in a tane^y!" young lady who had for six or seven years been successively under Exempu- 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 of frictions, and blisters, and setons, and mercury in every form, and the alkalies, and hemlock and hyoscyamus, 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 places and a thin fluid issued from the foramina. This natural discharge was encouraged, and the sac by degrees exhausting itself, the tumour as gradually diminished, and at length completely disap- peared. * Archives Generates de Medicine, &c. in re. t Saggio Clinico sull' lodio e sulle difierenti sui combinazioni c preparazioni. &c. Padua. 1822. % Essay on the Effects of Iodine on the Human Constitution, &c. 8vo. London, 1824. Vol, V.—27 2ie cl. vi.J ECCRITICA. luKD* U SPECIES 11. EMPHYMA ENC^STIS. ENCYSTED TUMOUR* WEN, TUMOUR MOVEABLE ; PULPY ; OFTEN ELASTIC TO THE TOUCUV Gen. ii. A very small change in the power or mode of action of a secer- p&mhJr- went vessel will often produce a very considerable change in the erire-°Sl" nature of the fluid .which it secretes. Of this we have a clear marks* proof in the thin and acrid lymph poured forth from the mucous membrane of the nostrils in a catarrh, compared with 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 mild, when in .a morbid condition throw out a tenacious phlegm, a watery, or wfiey-like sanies, or a muculent pus. And we may hence easily account for the .great diversity of .materials found in the spe- cies of tumour before us, which is peculiarly distinguished by being surrounded with a proper 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 of notice: .'.-... . .: x Steatoma. Encysted extuberance*containing a :fatty or Steatome. suetty substance, apparently secjreted from Adipose Wen. 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 pumpkin. .... , 3 Atheroma. Encysted extuberance containing, a mealy or Atherome. curd-like substance, sometimes intermixed Mealy Wen. with harder corpuscles .- apparently secrer ted as the last. Found qf different sizes over most parts of the body,. , . y Melliceris. Encysted extuberance containing • a honey- Honeyed Wen. like fluid. Found of different sizes over most parts of the-body, } Ganglion. Encysted extuberance containing a colour- Ganglion. less fluid ; the extuberation fixed upon a tendon. < Testudo. Encysted extuberance containing a fluid Horny Wen. readily hardening into horn or nail : and especially when protruded externally upon an ulceration of the surrounding integu- ments. ..-,..-.. o -a '•*.. \i.j EXCERNENT FUNCTION. [ord. i. 311 Most of these are supposed by Sir Astley Cooper to be nothing Gen.- «• more at first than obstructed and enlarged cutaneous follicles : the iXma' sebaceous matter accumulating in the hollow of the follicle, which l™**}'^ is lined with cuticle, and expanding it often to a considerable extent tumours. by pressure, in consequence of the mouth of the follicle being ™°"cre} plugged up or entirely closed. Where1 it is plugged up the obstructed origin of mouth is generally visible by a black dot, Which is carbonized seba- Sw ceous matter. This being picked off or otherwise removed, a probe may often foe 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 tumours seated on the surface. But But varie- they will necessarily vary m their structure and contents from a ",°u°„re multiplicity of adventitious circumstances, and perhaps also from and con- idiosyncrasy.- ---- ' .....■ " ' " ■ 3*g« The steatome grows f o a larger feize than any of the rest. Rhodius "<»»■ °r gives a case in which it weighed sixly pounds:f and it has been cumstanccs. dissected of the weight of tWehty-six pounds from this scapula.^ Steat°me- In its substance it often makes a near approach to adipocire : and onen up- as it is well known that every organ is convertible into this material J5i"oclrc. by certain laws of chemistry after death, we can the more easily conceive "the formation of such a material even during life where the action of the living power is locally weak or morbid in some other respect. The ganglion is introduced into the present list from the parity . 12«. 212 cl. vi.] ECCRITICA. I°K1>- '■ Gen.ii. nabit 0l. constitution, and the remark may be applied to several of ErnSyrna the other varieties. They have hence been found scattered over the Encysted whole body ;* and in one instance appear to have been connate tumour0 and hereditary.! In these cases they will sometimes yield to a habit or general treatment or a change of regimen. Richter gives examples SoT-'wd of the cure °f a steatome, one of the most difficult to be operated yield to a upon by internal means, by emetics ;| and Kaltschmid, by a diet of treatment, great abstinence ;§ by which plan we have already observed that or change adipose corpulency is commonly capable of being removed, and Have^bocn hence not unreasonably advised where there is a tendency to the by'emeti'cl. formation of adipose tumours. ^ectneity Electricity, and particularly that of the voltaic trough, seems to urafurn have been serviceable in dispelling many tumours belonging to this and the last species ; and having omitted it in its proper place, we may here observe that Dr. Eason of Dublin has given an instance, in which a hard scirrhous tumour was removed from the breast of a woman who was struck to the floor, and for some time deprived of the use of her limbs by a stroke of lightning. It was observed to be much softer almost immediately after the accident, and in a short time totally disappeared, though it had for a long time resisted the power of every application that could be thought of.H For the rest the writers on practical surgery must be consulted, and especially Mr. Sharpe's excellent Treatise, and Mr. Abernethy's work already referred to. SPECIES III. EMPHYMA EXOSTOSIS. BONY TUMOUR; TUM OUR INELASTIC, OFTEN IMMOVEABLE ; HARD AND BONY TO TIIE TOUCH, Gen. ii. These consist of calculous or bony matter ; and are sometimes Spec. HI. seated immoveably on a bone, sometimes immoveably on the perios- teum, sometimes pendulously in a joint, sometimes either moveably or immoveably in some fleshy part of the body, thus constituting the four following varieties : x Ostea. Immoveable; protuberant; seated Osteous Tumour. on the substance of a bone. 0 Periostea. Immoveable: protuberant; from a Node. bony enlargement of the perios- teum. * O'Donnel, Load. Med. Journ. vi. p. 33. | Vogel, Bnefen an Haller. i. Hundest. t Chir. Bibl. Band. V. § Pr. de steatomate fame curato. Comp. GirarS, lupiologie: on Trait€ des Tu- meurs connues sur le nomdes Loupes. Paris 1775 l 6 *«»«= uco xu || Edin. Med. Comm, iv. p. 84. cl,vi.J EXCERNENT FUNCTION [old. i. 213 y Pendula. Bony tumour hanging pendulous Gen. II. Pendulous Exostosis. into a joint. Einphyina.', ^ Exotica. Bony tumour moveable or immovea- Exostosis. Exotic Exostosis. bie, seated in some fleshy part of mouf. the body. Lime is one of the substances most easily secreted in the body of Pathoiogi- all animals. How far it may be formed in the body we shall have ^arks. occasion to notice under the genus ostiiexia, forming the fifth of the present order. We behold it at an early period of fetal life, and, in old age when every other secretion has diminished or failed altogether, wd are perpetually meeting with examples of a morbid augmentation of this in the coats of the blood-vessels, the bladder, the brain, and various other organs, afflicting the closing years of life with a variety of troublesome, and not unfrequently highly pain- ful disorders. The first variety is found in most of the bones of the body, oE.Exo*- but chiefly perhaps in the bones of the cranium : where they are ostaous sometimes excrescent, and composed of bony spicula resembling tumour- crystallizations : sometimes exquisitely hard and glabrous, analogous to ivory ;* no doubt from their being composed of phosphate in a greater measure than carbonate of lime. According to their structure, Sir Astley Cooper has subdivided these tumours into cartilaginous and fungous ; and, according to their seat, into periosteal, when they commence between the exter- nal surface of the bone, and the internal surface of the periosteum ; and medullary, when they commence in the medullary membrane . and cancellated fabric of the bone.t * This periosteal subdivision includes the second variety of the 0 ?• Ex°s- present species : which is chiefly found as a symptom in lues, and oateaf8" is commonly described under the name of node. In some instances N ode it has occurred as a sequel of acute rheumatism. And in both cases its treatment must depend upon the nature of the disease to which it appertains, and must form a part of the general plan, as we have already observed when discussing these maladies. The third and fourth variety are chiefly derived from Mr. v E- Exos- Abernethy's classification. The difference of their form and mode d™".1*11 of union with the adjoining parts, depends chiefly upon the differ- \^^ ence of their seat.- " A woman," says Mr. Abernethy, " was illustrated. admitted in St. Bartholomew's Hospital with a hard tumour in the ham. It was about four inches in length and three in breadth. She had also a tumour in the front of the thigh a little above the patella, of lesser size and hardness. The tumour on the ham by its pressure on the nerves and vessels had greatly benumbed the sensibility and obstructed the circulation of the leg so that it was very edematous. As it appeared impossible to remove this tumour, and as its origin and connexions were unknown, amputation was resolved on. On examining the amputated limb, the tumour in the ham could only * Baillie, Morb. Anat. Fascic. x. PI. i. Figg. 1, 2. t Surgical Essays, Treatise on Exostosis. 214 cl. vi.] ECCRITICA. L^n. l Gen. ii. be divided by a saw : several slices were taken out of it by this v eEe'x"-* means and appeared to consist of coagulable and vascular sub- tosis per?8 stance, in the interstices of which a great deal of bony matter was pendniou deposited. The remainder of the tumour was macerated and dried, exostosis. antj jt appeared to be formed of an irregular and compact deposition of the earth of bone. The tumour on the front of the thigh was of the same nature with that in the ham : but containing so little lime otica: that it could be cut with a knife. The thigh bone was not at all o^ie6*" diseased."* " Aiuhese Of the general nature of the exotic variety we shall have to treat surgical' under osthexia infarciexs, of which perhaps it is only a modifica- rather than tion. treatment; These in all instances are cases for surgical: rather than medical taonber"ured treatment, and are seldom to be cured except by extirpation, and, but by ex- when this cannot be done, and the tumour is seated on a limb, by tirpation. amputation. GENUS III. PAROSTIA. MIS-OSSIFICATION. BOXES UNTEMPERED IN THEIR SUBSTANCE, AND INCAPABLE Ol AFFORniNO THEIR PROPER SUPPORT. Gen. III. Parostia is a compound from nx^x, u perperam," and <,tt%<,\, thegeneric " os. ossis." The genus is new, but sufficiently called for. It term. includes two species connected by the common character of an inaccordant secretion of some one of the constituent principles of the bony material, in consequence of which the substance is ren- dered too brittle, and apt to break on slight concussions, or other movements, or too soft, and equally apt to bend. These species are as follow : ...,....-- 1, parostia fragilis. fragility of the bones, 2. ------— flexilis. flexibility of the bones. * Surgical Observations, Classifipation of Tntnqjy-Sj P-102, ";i.. vi.j EXCERNENT FCNCTION. {oru. I. 215 SPECIES I. PAROSTIA FRAGILIS. FRAGILITY OF THE BONES. SUBSTANCE OF THE BONES BRITTLE AND APT TO BREAK ON SLIGHT EXERTIONS, WITH LITTLE OR NO PAIN. Bone, shell, cartilage, and membrane, in their nascent state are Gen. Ill, all the same substance, and originate from the coagulable lymph of Phy*fo\0s£. the blood, which gives forth gelatine and produces, by secretion, caire- thougb as already observed it does not contain, albumen. Mem- brane is gelatine with a small proportion of albumen to give it a certain degree of. firmness: cartilage is membrane with a larger proportion of albumen to give it a still greater degree of firmness ; and shell and bone are cartilage, hardened and rendered, solid by the insertion of lime into their interior : in the case of shell, the lime being intermixed with a small proportion of phosphoric, and a much larger proportion of carbonic acid ; and in the case of bone, with a small proportion of carbonic, and a much larger of phosphoric acid. It is hence obvious that if the earthy and the animal parts do not bear a proper, relation to each other, the bone must be improperly tem- pered, and unadapted to its office: that if the earthy or calcareous pai^t be, deficient, its substance must; be soft and yielding ; and that ifthe.animal part, be deficient, or..the calcareous part' in exeess,it must Jose its cohesive power, become brittle, and apt to break. It is the second of these morbid states that forms the proximate Pathology: cause of the species before us, as the first forms the cause of the ensuing species. . „ PaRostl*. fragilis is the fragilitas ossium, or fragile vitreum of Fragiiitaa authors, and is most frequently found as an attendant upon advanced tra^te'v?-' age. It is, also, occasionally to be met with as a symptom in lues, £™™» struma^;porphyra, cancer,* and general intemperance; and has occurs been known as a sequel of small-pox. In most of these diseases advMciog the blood becomes attenuate, and the coagulable lymph loses much years, and of its viscidity. In old «ge the diameter of the blood vessels w y' becomes contracted, all the secretions are separated less freely, and particularly that of animal oil; and the grossest of them, and hence, particularly the earthy corpuscles, are less freely absorbed, and con- sequently accumulate. We are, therefore, at no loss to account for the increased hardness and fragility of the bones under these circumstances ; nor for their tendency to break upon slight and sudden movements. The author was once present at a church in which a lady nearly seventy years old, in good general health, broke both the thigh bones in merely kneeling down ; and on being taken hold of to be carried away, had an os humeri also broken without NVniveau Journ. de Medicine, Tom. i. p. 138. 216 cl.vi.J ECCRITICA. I_ord. i. gen. III. any violence, and with little pain. It was in the winter season, and Parortia1' the cold mi£ht nave added t0 tne constitutional "gidity. From the fra?m9.a general inirritability of the system no fever of importance ensued, n.reionLof and, under the influence of a warm bed, and a diluent but some- E*emi>ii- wnat cordial regimen, the bones united in a few weeks. Mr. Gooch relates a similar case of fracture occasioned by a violent fit of coughing.* Common The common cause seems to consist in a general inirritability of cause. tne system, and a torpitude of the absorbent powers, which, by car- rying off only the finer and more attenuate particles, and suffering the grosser, and particularly the earthy, to accumulate, overcharge the bones with this material. Remedial Hence the best remedy is to be found in a plan of warm tonics process. that mav supp]y tne system with something of the stimulus it stands in need of, and in a free use of acids whether mineral or vegetable, that, by their tendency to dissolve calcareous earth, may at least diminish its introduction into the chyliferous vessels in the process of digestion, if they do not reach the assimilating vessels of the bones and lessen the separation or elaboration at the extremity of the nutritive chain. Of the mineral acids the sulphuric will generally be found pre- ferable ; it seldom gripes or nauseates, and almost always promotes the action of the stomach when weak or indolent. It is hence, also, an excellent tonic, and may be persevered in longer than any of the rest. The muriatic agrees in most cases with the stomach, but not with the bowels, which always become more relaxed during its use than where the other acids are employed. It is on this account, however, peculiarly adapted to cases of habitual consti- pation. The nitric acid, in a few idiosyncrasies, has proved a very powerful tonic, as well as solvent of animal earth; but in many cases it disagrees with the stomach, and produces flatulency, eruc- tation, and other symptoms of indigestion. Where these cannot be employed, we must have recourse to the vegetable acids, and espe- cially the citric, or tartaric, the last either in its pure form or in that of creme of tartar. Lemons and oranges may also be taken copi- ously, and the carbonic acid, combined with water by means of Nooth's apparatus. * Observations, &c. Appendix. cl. vi.j EXCERNENT FUNCTION. [ord. i. 217 SPECIES II. PAROSTIA FLEXIL1S. FLEXIBILITY OF THE BONES. SUBSTANCE OF THE BONES SOFT AND APT TO BEND AND BECOME CROOKED ON SLIGHT EXERTIONS WITH LITTLE OR NO PAIN. This is the mollities. ossium of authors, formerly denominated 9EN* "J* spina ventosa, from its being first noticed on the spine, and accom- MoiiiUa panied with protuberances which were supposed to proceed from g6*^,™1' inflation. vantosa. Its physiology has been given under the preceding species, with which it is connected in the relation of contrast. As fragility of the bones proceeds from an excess of osseous earth, flexibility proceeds from a deficiency of one or more of the elements which constitute it. This deficiency may proceed from two causes, each producing some peculiarity of symptoms, which we shall presently illustrate by examples. For first, there may be:too small a secretion or ela- Proceeds boration of calcareous phosphate t6 allow a sufficient compactness ficiency of to the bones : and secondly, there may be an adequate separation *| °,e^f of the calcareous earth but a deficiency of the phosphoric acid calcareous which, we have already observed, is necessary to give it fixation ; in ^Siatm consequence of which it is often carried back in a loose state into the earth the circulation, and discharged as a recrement by the kidneys or phosphoric" some other emunctory. acid* The disease is sometimes idiopathic, and occurs sometimes as a symptom of porphyra, diabetes, and some forms of colic. In direct Found in opposition to the preceding species, moreover, it is commonly found rather'than in the earlier rather than in the later periods of life, and has been in *« late.r observed in infancy. It has occasionally been detected in quadru- Fife!° S peds, and of the stoutest kinds, as the ox and the lion. It is some- Haced^n" times general, and sometimes confined to particular bones. the stoutest The cause is commonly obscure : it appears frequently to consist caLeTb^' in a morbid state of the digestive organs, but is seated, perhaps, as scure. often at the other extremity of the great chain of the nutritive UJ^hcfdi-* powers, in the assimilating or secernent vessels, where it must neces- s|nliTebor" sarily elude all detection. In the museum of Professor Proskaska as often in the assimi- pow- of Vienna, is a preparation of an adult who died of this disease, in ,"\eing which all the vertebrae are glued into one mass, the sacrum being era- scarcely distinguishable, and the ribs bent inward, and marked by tebra^hlve the impression of the arms, which the patient was in the habit of £f*"/{"",, pressing forcibly against his sides. The whole skeleton is extremely ther. light. This last fact is always the case from the absence of so large a portion of animal earth. An analysis, by Dr. Bostock, of Great loss the vertebrae of an adult female who died of the species before us, "nthon!^ Vol. V.— 2tf 21b ci>. vi.J ECCRITICA. [ord. I. Gen. III. indicated that the earthy matter was only one-eighth part of the rarTstfk11' weight of the bone, instead of amounting to more than half, whicn flexHis. i)r. Bostock estimates to be its proper proportion in a state ot Flexibility ... * * or the health.* p . nTaTframe A singular case of this disease is given by Dr. Hosty, ol rans, Z caicuia- in the Philosophical Transactions..! The patient, a married woman, •*ok!yDos" between thirty and forty years of age, was attacked by it gradually, cxT'hfi aftcr several lyings-in and two falls on the side, which gave her great clrioT " pain over all her body but fractured no bone. The first decided symptom was an incurvation of one of the fingers, accompanied with a very considerable discharge of bony or calcareous earth by the urine, which was loaded with it, and gave a copious deposite. The incurvation by degrees extended to all the limbs, so that the feet were at length bent upwards nearly to the head, but without Coicweooa muscular contraction or fracture. The calcareous matter at length char^ny ceased to flow towards the bladder, and seems to have been trans- the bladder ferrej to the salivary glands, from which was discharged a flux ot ry Bland*" dark discoloured spittle. All the functions of the body were in a state of great disorder ; she had at times a very considerable degree of fever, which was at one period accompanied with head-ache, de- lirium, and subsultus tendinum. She died in about a twelvemonth from the commencement of the disease, and all the bones on being examined were found soft and supple, though many of them, as the ribs, were still in some degree friable ; the scalpel, with very little force, ran through the hardest of them. Nothing extraordinary was found in the thoracic or abdominal viscera, but the right hemisphere of the brain appeared to bc one-third larger than the left. cam ex- In this case the disease evidently commenced in the bones them- piained. selves, and seems to have proceeded from a want of phosphoric acid to give compactness to the calcareous earth ; for that there was a sufficiency of this earth, is clear from its being found loose in the fluids and thrown out as a recrement by the urine and saliva till the whole was removed, and nothing of the bones remained but their Discharge cartilaginous or membranous fabric. In a similar case, related in a ousCmattor work of considerable value by Mr. Thompson, this tendency to the b?lhe . discharge of the absorbed and loose earth of the softened bones at of1 the body the emunctories of the body was still more considerable. The urine, f£n larger. we are to^d' wr tne m#rft tvvo >'ear9 of the patient's illness, deposited ■Exempli- generally a whitish sediment, which upon evaporation became like mortar, and on one or two occasions he voided a few jagged cal- culi. After this period the calcareous discharge ceased, the bones having no more earth in their composition, as was sufficiently ascer- tained on the patient's death, which, however, did not occur till nine years from the commencement of the malady.J singular It is probably to this species we are to refer the singular case, cation'ftom translated by Reiske from the Arabic of Ghutzi,of an individual, con- Bciske. temporary with Mahomet, who had no proper bones but those of the * Transactions of the Medico-Chirurg. Soc. Vol. tv. p. 42. T Vol. xlviii. year 1763. I. Medical Observations and Inquiries by a Society of PnvsicianS in London. Vol cL.vi.] EXCERNENT FUNCTION. [ord. i. 219 cranium, neck, and hands; every other part of the body being pliable Gen. iir. as a piece of cloth to the touch of other persons, though the indivi- Pafoafio.11' dual could not of his own accord bend a single limb. He was a Sfj1'1.'?:,. man, we are told, of the highest dignity, and had acquired celebrity of "the''y for his wisdom. He was usually carried from place to place in a bone8, wicker basket of palm twigs.* In some cases there seems to be but little deficiency of phos- Sometimes phoric acid, while there is an evident want of earthy matter : for we }{£if"cfi- meet with no calcareous discharge by any of the emunctories, while cientiy se^ the union which takes place between whatever portion of the earth in sucli is conveyed to the bones and the phosphoric acid which is secreted J^a™ at the same time, renders them in some degree friable, though weak, charge. and hence as liable to fracture on slight exertions, as in the pre- ceding species. A case of this kind was, not long ago, under tlie joint care of the nius'xiteji author and Mr. Howship. The patient was a lady, heretofore in good health, of about eight and twenty : both the thigh-bones had been broken without any violence about a twelvemonth antecedently, and all the other bones showed a strong tendency to softness 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 regi- men and diet, she was put into a way of recovering. Her general health improved, the extremities of both bones appeared to be united and buried in an irregular mass of callus that clustered around them, and in a few months it was recommended to her to be removed by an easy conveyance to the sea coast. A somewhat similar case, but of greater severity, communicated Additional by Sir John Pringle to the Royal Society, is contained in its forty-' uslr*t""s eighth volume.f The patient was an unmarried female servant of good character. A parostic diathesis seems from some cause or other to have existed, and 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 gene- ral health suffered, her habit became cachectic, and there being an increasing inability to a supply of compact calcareous 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, was throughout 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 of the two preceding cases mercury was employed, and Medical 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 plan. The deficiency of one or all of the con- useful. Deficiency of the con- • Opnscula Mediea ex Monumentis Arabum, 8vo. Halt* 1776. stittwu of ■f Phil, Trans, year 1765. 2JU CL. VI.J KCClilTICA. [ORD. 1. Gem. III. Spec. II. Parostia. flexilis. Flexibility of the bones. the eaith of bones de- pendent upon local or general debility. Hence per- fect quiet necessary : a recum- bent posi- tion : nu- tritive and generous diet: and tonic medicines. stituents of perfect and healthy earth of bones, is evidently 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. And hence, the only line of treatment we can engage in with any hope of success is that of perfect quiet, and a recumbent posture on a hard matrass, or slightly inclined plane, 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 was put into a train of recovery, the medicines chiefly em- ployed were various preparations of cinchona and iron, chiefly the pilulae ferri compositze, with an allowance of ale instead of wine with her dinner. Since the first edition of this work, I have learnt that this patient, when in the full hope of resuming her former health, was suddenly carried off by an attack of pleurisy. GENUS IV. CYRTOSIS. CONTORTION OF THE BONES. HEAD BULKY, ESPECIALLY ANTERIORLY ; STATUTE SHORT, AND INCURVATED ; FLESH FLABBY, PALE AND WRINKLED. • Gen. IV. The term cyrtosis is derived from the Greek *&fTe«, " curvus, gener?c0f incurvus, gibbosus," and, among the ancients, particularly imported term. recurvation of the spine, or posterior crookedness, as lordosis Lordosis (ao^JWi?), imported procurvation of the head and shoulders or ante- Cyrtonosos. rior crookedness. It has, in recent times, more generally been written cyrtonosos, literally " morbus incurvus :" but the term veeruj, or morbus, is pleonastic in a system of nosology, and hence, cyr- tosis is preferable. The genus is intended to include two specific diseases which have a close connexion in many of their most prominent symptoms, and especially in the sponginess and incurvation of the bones, and in the withered appearance of the flesh, insomuch that the second is, by some, regarded as only a modification of the first; but which, however, are peculiarly distinguished from each other by the differ- ent state of the mental powers.—These are : 1. CYRTOSIS RHACHIA. 2i „ ,, ,., i CRETINISMITS. RICKETS. CRETINISM ix.vi.J EXCERNENT FUNCTION. [ord. r. 221 SPECIES I. CYRTOSIS RHACHIA. RICKETS. CHIEFLY AFFECTING THE LIMBS AND BODY : SPINE CROOKED ; RIBS DEPRESSED ; ARTICULAR EPIPHYSES ENLARGED AND SPONGY ; BELLY TUMID ; MENTAL FACULTIES CLEAR, OFTEN PREMATURE. There is some doubt about the origin of both the vernacular Gen. IV. names. Cretinism on its first discovery was, by many writers, sup- or^'of' posed to be produced by an habitual use of water impregnated with »he vema- chalk or creta, in the low Swiss valleys where it was earliest traced : names of and it is commonly supposed that the specific name is derived from ci°et8hspe" this opinion. cretinism. The English word rickets is usually written in technical language, *}jckh?tt9 or rhachitis ; a name first given to it by Glisson, and said to be derived ' from£*«£/« (rhachis), the spine, in consequence of the distortion and curvature of this organ, occasioned by its being no longer able to bear the weight of the head and upper extremities. As this malady, however, was first observed in England, and particularly in the western counties, and was provincially denominated rickets, before it attracted the attention of medical writers ; it is more probable that rickets is derived from the Saxon {ricg or rick) " a heap or hump," and particularly as applied to the back, which also it denotes in a second sense ; so that ricked or ricket is literally, in its full import, " hump-backed," It is from this root we derive hay-rick, u a heap of hay," and not, as Dr. Johnson has given it, from " reek," to smoke. Rhachitis might, however, be a word sufficiently good Rhachitis c xu -a. a. c -a. a. -a- ■ -.I. whv not for the present purpose, were it not lor its termination ; itis, in the employed medical technology of modern times, implying visceral inflamma- effi^?m." tion, and being limited, by a sort of common consent, to the nume- rous species of disease arranged in the present method under the genus empresma, which we have considered alrer.dy •,* and on this account it is that, in the species before us, rhachitis is exchanged for rhachia. If this disease were known to the Greeks, we should expect to Rhachia find it, not indeed under the specific term rhachia. but the generic known to term cyrtosis; for while neither rhachia or rhachitis is to be traced the Gieeks- among the Greek writers in the sense of diseased action, the latter is common to them in the signification already ascribed to it. There is much reason for believing, however, that both rickets "°Bh sr||£a_ and cretinism are comparatively of modern date : and it is a singular biy of mo- circumstance that both these species should have been first noticed. + Vol, ii. Cl, ui, Ord, n: Gen. vn. {>. 249, CL. VI. j ECCRITICA. [ORD. I. Oyrtofit Rhachia Rickets. bat have been of to trace these to a remote pe riod. Goitre or bronchocolc Gem. IV. anti apparently have made their first appearance, coetaneously. S"ri.L The earliest account we have of rickets is that published by Glisson as it occurred in England in the middle of l!,< seventeenth century; the first account of cretinism is that of I'latt :, who met with it about the same time in Carintiua and the Valais. • in disease is also late traced common in Navarre, and in many of the vallevs of the Pyrennees, leryle°"s particularly that of Luchen ; and it has been observed by Sir George mote from Staunton as far off as Chinese Tartarv, in a part of the country each other. much resembi;ng Switzerland and Savoy in its Alpine appearance. Failure of There are some writers, however, who have endeavoured to trace tne medical . ' ^ i tj rpi iiateuio- both species of this genus up to the Greeks and. Koinans. l nus fiawTn-0 Zeviani contends that rickets, if not cretinism, is to be discovered ^™™ed in the Roman names of Vari, and Volgi, as also in several passages ridiculing deformity, in Thersites, the supposed iEsop of Greece, as well as in other authors ;* but all such remarks are too general; he cannot produce a single passage from the medical writers of anti- quity clearly characterizing the peculiar deformities before us. De Haen has attempted to trace the same disease in the works of Hip- pocrates, but has failed ; and hence it is generally admitted in the present day, and has been so from the time of Glisson himself, sup- ported by the concurrent opinions of Bate, Regemorter, Van Swieten, and Trinka, that both rickets and cretinism are of the recent date we have just assigned to them. The enlargement of the thyroid gland, called goitre or bronchocele, on "o is the most striking feature in the unsightly aspect of a cretin ; but cretins, but this, as Err. Reeve has observed, is not a constant attendant, nor is not a ne- . . , . , . . cessary there any necessary connexion between goitre and cretinism, not- Ihe'dfsease. withstanding the assertions and ingenious reasoning of Fodere. Cretinism is frequently observed without any affection of the thy- roid gland, and this gland, on the contrary, is often very much enlarged without the slightest degree of that affection of the intel- lectual faculties by which cretinism is particularly marked, t Cretinism, in many of its symptoms, though not in all, may be regarded as a most severe and complicated modification of rickets ; and the pathology of both is closely connected with that of atrophy, as we endeavoured to explain it in its proper place. J In order that the various parts of the body should thrive and enlarge in the infancy of life, it is necessary not only that there Be a due supply of nutritious food, but that the entire chain of the nutritive organs, from the digestive to the assimilating powers, should be in a state of sound health, and capable of fululling their respec- tive functions. In several of the varieties of atrophy this is not the case. In one or two of them we have reason to believe that the digestive process is imperfect, and that the disease is chiefly seated in the chylific viscera. In others that proper nutriment, though duly introduced into the blood, is not duly elaborated from it, and converted into the structure of the different parts whose waste it is to supply ; and consequently that the disease is chiefly seated in the * Delia curadi Bambini, attacati delta Rhachitide. Cap. n. p. 15. t Storr, Alpenreise Vorbereitung, p. 55. I Vol. hi. Cl. hi, Ord. iv. Gen. m. Spec. i. Marasmus atrophica. Cretinism in many symptoms a compli- cated mo- dification of rickets: and both allied to atrophy. Physiologi- cal re- marks. cl. vi.] EXCERNENT FUNCTION. [ord. i. 22S assimilating powers. And in treating of atrophy, we observed that Gen. iv, the one extremity of the nutritive chain so closely harmonizes with c%osi.L the other, that, let the disease commence at which end soever it RhaeMa. may, the opposite is affected by sympathy. We also observed that Rlckot*" the different divisions of secernents are not all equally under the influence of a morbid torpitude ; since occasionally those that secrete the animal oil cease to act long before any of the rest; whence emaciation occurs, and in many instances continues, for some time as a solitary symptom : and the individual falls away in plumpness without being sensible of any other failing. In rickets the nutritive organs are disturbed generally through the in rickets whole length of the chain, but the chief failure is in a due supply Sre"Sm of bony earth, or the phosphoric acid that should combine with it. disturbed The evident intention of this kind of supply is to enable the bones D ^chiefly to expand and acquire maturity while growing, and to uphold their ^°9*lh,atB strength and firmness afterwards. And so long as they obtain a ealth.y sufficient supply, and the waste earth of the bones is proportionably carried off by the absorbents, so long this part of the animal economy continues perfect; but with the exception of the fat or animal oil, there is perhaps no secretion that is so liable to have its proper balance disturbed, whether by excess or deficiency, by a morbid condition of the digestive or of the assimilating powers, as that of bony or cal- careous earth. A deficient formation then, or elaboration of bony earth, consti- Proximate tutes the proximate cause of both rickets and cretinism. The ?iXu0ancV remote or exciting cause it is not always in our power to ascertain ; cretinism. D , ••' . r , . ' Remote an<3 yet in numerous, perhaps in most instances, we are capable of exciting tracing them to a want of pure air and a warm and dry atmosphere, cause»- nutritious food, regular exercise, cleanliness, and the concomitant evils attendant upon a state of poverty ; and hence it is chiefly in the hovels of the poor, the destitute, and the profligate, that both diseases are met with ; while the severity of the symptoms is very generally in proportion to the extent or multiplication of these con- current causes. But there are other diseases that result from the evils we are now These contemplating as well as rickets or cretinism, such as atrophy, au"t8fvsep0™' scrophula, scurvy, and typhous fevers : and hence, there must be other di»- some predisponent cause operating in the present instance, and wdii'"nd calling rickets into action rather than any one of the rest. Such cause ben£e sonie we do not seem always able to trace, but there is reason to believe nent cause that it is sometimes dependent upon an hereditary taint of an idiopa- et"rafheTk" thic nature, sometimes upon a scrofulous or venereal depravation in tha" an7 the constitution of the father or the mother. Such, also, is the ease'into opinion of Dr. Cullen. " This disease," says he, " may be justly l^)"11- considered as proceeding from parents : for it often appears in a times an great number of the same family ; and my observation leads me to taint!lta'y 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. 224 cl. vi.J IXCR1TICA. [ORD. I, Gen. IV. ii that in many cases I have not been able to discern the condition of oyrto* '" the parents to which I could refer it."* Rhachia. Rickets seldom appears earlier than the ninth month ot mianc), App^; and not often later than the second year, being preceded, according SlrnneVandto Dr- Strack, by a paleness and swelling of the countenance, and rtiidhooT a vellow, sulphur-hue in that part of the cheeks which should ?£n«.,,"Ive naturally be red.t In some instances it seems to have originated Sometimes iater . jn every stage, indeed, of a child's growth, till the bones later. " have acquired their full size and firmness :J 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 Jlexilis. commence- Rhachia, in its ordinary course, commences imperceptibly and pr'grew advances slowly ; the body becomes gradually emaciated, the flesh the disease flac^ and the cheeks wan or sallow, with a slight degree vi 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 carry ; the ribs and sternum partake of the distortion, the former lose their convexity, and the latter projects into a ridge. Deficiency The same deficiency of bony earth runs through the entire ma«e?yruns skeleton, and affects not only those parts that are composed chiefly through the of lime and phosphoric acid, as the flat bones and the middle of the skeleton, 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 elaborated but without its correspondent acids, and consequently, without Bony earth compactness, and to no purpose : for we can occasionally trace it looseln loose in the urine, in which it forms a calcareous deposite, as though the urinei carried off from the blood as a recrement. ah the as All the assimilating powers participate in the debility in a greater poweiapar- or 'ess degree : the process of dentition is slow and imperfect, and take of the while the cellular membrane is without animal oil, the muscular hut'th^sen- fibres are tabid, without energy, and almost inirritable. It does not soriai pow- seern however, that the secretion of sensorial power is so much cr least of . ' . . , ' , . . ' ail: intertered with as tiie other secretions of the system. Some part, indeed, of what should be sent over the frame at large, appears to be concentrated in the sensorium : so that its equipoise is disturbed, and heneo but the general average is not perhaps much diminished. And we the mind rii, /» i ■ i • ■ n . advances - are lience able to account lor the curious and interesting fact that i^dy"^ wmle the body is generally failing, the mind in many instances ad- The truth vances in its faculties, insomuch that a very slight recapitulation of niarkeasuy the names ofthose who have been pre-eminently gifted with mental confirmed talents in every age and nation, and have immortalized themselves ence to' as poets, philosophers, and even leaders in the field, will put before history. r * Pract. of Pbys. Vol. iv. Book. n. Ch. iv. § mdccxxh. 7 Act. Philesophico-Medico Soc. Acad. Princ. Hassiae, &c. 4to. Giessa; Catborum. t Thomasin, Journ. de Med. Tom. xliii. p. 222. cl. vi.] EXCERNENT FUNCTION. |obd. i. 225 the eye of persons who have not much attended to this subject, a Gen. iv. far greater proportion of the hump-backed, and the ricketty, than *J%^ h they may hitherto have had any conception of. We had occa- Rhachia. sion to make a like remark when treating of scrophula, and the Rieket* 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 of Little or no fever, but, as the disease advances, irritability, as in scrophula, sue- commence? ceeds to inirritability, and a hectic is produced. Or it may happen mentor tho that the sensorium at last participates in a greater degree with the gSred as disease of the rest of the frame, and the mind itself becomes hefTce?"©* onfeebled, and torpid, or fatuous. mind at In the treatment of rickets, the eye should be directed to the two fooled.* following intentions : that of strengthening the system generally : Medical and that of facilitating a supply of phosphate of lime to the organs embraces that form the chief seat of disease. !£°inten ■ tions. For the former purpose, a pure, dry, and temperate atmosphere, *«■» mten- a wholesome and somewhat generous diet, regular exercise, of such 8trengihcn°- kind as can be indulged in with the least inconvenience, cleanliness, iDetlie system and cold-bathing are of essential importance, ^tnd have often worked generally. a cure alone. And it is possibly owing to a more general convic- tion of the advantage of such a regimen in the present enlightened 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 Metallic can employ those remedies only which are neither very bulky nor 8a ts' 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 Buchner. Dr. Cullen, however, is persuaded that the ens veneris of Boyle was a preparation not of copper, but of iron, in fact theflores martiales of the old dispensa- tories, and there is no doubt that this conjecture is right. From the general irritability of the system, iron, indeed, seems to be more adviseable 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 Emetics 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 anv Anericnt.'. Vol. V._?n 226 cl. vi.] Kcunmc.A lvliV-u Gs^. iv. other symptoms of an affection of the mesenteric gland", mercury pya";L in sma11 doaes ma.y ,,e advantageously had recourse to, and com- Rbachia. bined with the tonic plan. Kfnont. The means of carrying into execution the second intention, or ic'.li'i'oo "'" that of-producing a direct supply of osseous matter, is accompanied that oDf pio- with more difficulty, nor is it certain that we are in possession of any dlrec^V remedy whatever by which this can be accomplished, though it has E^'u/mTt- °ften ueeu attempted. h?!" ' Bone may be regarded aa a cancellated fabric of gluten whose "br/Jy be eelb are filled up with the earth of lime and a combination of car- accom- bonic and especially phosphoric acid. In all cases of rhachia H,shcd' 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 when Acids, however, of every kind, when in excess, have a tendency dNssoiTe ho- to dissolve calcareous earth instead of concreting it into a solid ny eaith, masg . au(j j,cnce Qne ^ me mogt effectual means of preventing that tendency to the separation or production of a morbid supera- bundance of calcareous earth in osthexia and lithia, is a free uso of acids as a solvent. *n. I. Gen. IV. yielding, so that he may be carried upon it in the open air for exer- c*™\*1' cise. Moderate warmth is of great service, but a downy bed that luVachia- gives way to the pressure of the body and sinks into unequal hollows Treatment, cannot fail to increase the incurvation.* Second in- tention. SPECIES II. CYRTOSIS CRETINISMUS, CRETINISM. . IIIEFLY AFFECTING THE HEAD AND NECK ; COUNTENANCE VACANT AND STUPID ; MENTAL FACULTIES FEEBLE OR IDIOTIC : SENSIBI- LITY OBTUSE : MOSTLY WITH ENLARGEMENT OF THE THYROID 6 LAND. Gem. IV. Cretinism makes a very close approach to rickets in its general if" a'-U' symPtoms- ^ differs principally in the tendency to the peculiar en- tinguished largement of the thyroid gland, which, in France, is denominated from rickets. goitre, and with us, Derbyshire-neck, and in the mental imbecility which accompanies it from the first. Occasional In treating of rhachitis we observed that, while all the functions Cnt°acilty °f of the general frame are here in a state of great debility, with powers in the exception of the mental, these last exhibited, in many instances, a precocity and a vigour rarely found in firm health. And we endeavoured to account for it by supposing that the flow of sensorial fluid instead of being in deficiency, like all the other secretions, is only disturbed in its balance ; and that much of the proportion 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 In cretinism the organ of the brain seems to follow the fate of the ofth*r|brain rest of the body, and, in many cases, even to take the lead, so that fateTftno* tne chief imbecility is to be found in this region. For the peculiar other or- symptom of goitre it is not so easy to account. We know so little of hence men- tfic purpose, and even of the fabric of this gland, as to be incapable tai weak- 0f assigning its use in the animal economy, and hence, it is not much Appearance to be wondered, at that its peculiar tendency to associate, in the pre- notge°asiiy sent disease, with the morbid condition of the bones and of the intel- accounted lect, should not hitherto have been ascertained. It does not always, not always however, accompany the other symptoms, though it is, for the most an accom- part an associate. pamment. * __1 . . . . chorogra- We nave already observed that cretinism was first distinctly tinfsm: cro" noticed and described by Plater about the middle of the seventeenth * On the Nature and Treatment of the Distortions to which the Spine and Bones of the Chert are subject, &c. By John Shaw, 8vo. 1823, CL. VI.J EXCERNENT FUNCTION. [ord. i. 229 century, as occurring among the poor in Carinthia and the Valais ; Gen. iv. and that it was afterwards found in a still severer degree in other -fj*^a' valleys of Switzerland and the Alps generally; as it has since been Cretinis- detected in very distant regions where the country exhibits a simi- cretinism. 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 Whether use of snow-water, and by others to the use of water impregnated beTcausT: with calcareous earth : both which opinions are entirely without ?r water foundation. The first is sufficiently disproved by observing that teTwftha persons born in places contiguous to the glaciers, and who drink no ga,jn,reou" other water than what flows from the melting of ice and snow, are These opi- not subject to the disorder, and that Sir John Pringle and Captain S^foun-11 Cook have found melted snow or ice-water afford to seamen a pecu- Nation. liarly wholesome beverage; while on the contrary the disorder is theCrst. observed in places where snow is unknown, as at Sumatra. The Disproof of second is contradicted by the fact that the common waters of Swit- to6860011'1, zerland, 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, swellings of the throat are not uncommon in both sexes, though cre- tinism is rare." As comfortable and genial warmth form one of the best auxiliaries Snow-wa- in attempting the cure of both cretinism and rickets, there can be chnaneV111 no doubt that the chill of snow-water, if taken as such, must con- raa? how siderably add to the general debility of the system when labouring aneaiuSi£e under either of these diseases, though there seems no reason for sup- ary- posing that it would originate either. It is not difficult to explain Why cai- why water impregnated with calcareous earth should have been wa'ter" regarded as a cause : for in cretinism, as in rhachia, the calcareous 'Jj""^^ c earth designed by nature for building up the bones, is often sepa- cause, ex- rated and floats loose in various fluids of the body for want of a suf- P,a,nod- ficiency of phosphoric acid to convert it into a phospate of lime, and give it solidity. And as it is, in consequence hereof, pretty freely discharged by the urine, it seems to have given rise 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 unques- Jj;^*^ tionably the real cause of the disease in referring us to a few other assigned by physical features of the Alpine districts in which it makes its Soussure appearance chiefly. The valleys, he tells us, are surrounded by very high mountains, sheltered from currents of fresh air, and ex- posed to the direct, and, what is worse, the reflected rays of the sun. 230 cl. vi.j ECCRITICA. [okd. i. Gak. IV. They are marshy, and the atmosphere is hence humid, close, and Cyrtosi's. -oppressive. And when to these chorographical causes we add the Cretinis- domestic ones, which are also well known to prevail very generally Cretinism, among the poor of these regions, such as meagre, innutritious food, concerning which we have already spoken under bronchocele, indo- lence, and uncleanliness, with a predisposition to the disease from an hereditary taint of many generations, we can sufficiently account for the prevalence of cretinism in such places, and for the most humi- liating characters it is ever ft.und to assume. Commence- The general symptoms of cretinism are those of rhachia ; but the progress of disease shows itself earlier, often at birth, and not unfrequently cretinism, before this period, apparently commencing with the procreation of the fetus, and affording the most evident proofs of ancestral contami- nation. 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 muscles are loose and flabby, the throat is covered with a monstrous prominence, the complexion wan, and the countenance vacant and front viow stupi('- The cranium bulges out to an enormous size, and particu- of the heud larly towards the occiput, for it is sometimes depressed on the crown, umnuuve. an(j at t|ie tempies. 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 oven to blows or wounds. " They are, generally," observes Miserable M. Pinel, u both deaf and dumb. The strongest and most pungent sensation, 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 tasto. and of Their organ? of sight and feeling are equally limited in their opera- moral *" tion- Of moral affections they seem wholly destitute ; discovering powers. no signs of gratitude for kindness shown to them, nor any attach" rnent to their nearest relations." u^auncnt ^i0 mecuca^ 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. CL. VI.J EXCERNENT FUNCTION. fORD^I. 2&1 GENUS V. OSTHEXIA. OSTHEXY. flOFT PARTS MORE OR LESS INDURATED BY A SUPERFLUOUS SECRE- TION AND DEPOSITE OF OSSIFIC MATTER. Osthexia is derived from oft-v^m, " osseous or bony," and f|/s, Gen. v, "habitus or habit,"—" ossific diathesis or idiosyncrasy." This ^'eneric morbid affection, though repeatedly alluded to and described by name. miscellaneous writers, has seldom been attended to in nosological arrangements. It does not occur in Dr. Cullen's Classification ; but he alludes to it in his " Catalogue of omitted diseases," as one of those which he thinks ought not to have been omitted. We have had various occasions for remarking that as the calca- Physioio- reous earth, which gives compactness and solidity to the skeleton marks™ of the animal frame, becomes waste, and is consequently absorbed and carried off, it is necessary that there should be an equal and regular supply of the same material. This is partly obtained from the lime which enters, in some proportion or other, into almost every kind of nutriment on which we feed : but it seems to be obtained also, and perhaps in a larger proportion, by some chemical elabora- tion out of the constituent principles of the blood itself: for a healthy animal of any kind appears to supply itself with the requisite quantity of bony earth whatever be the nature of its food, and though the soil on which it is grown contains no lime whatever, as is the case 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 caicaroon9 to the present genus, it is, on the contrary, produced or secreted in **rth in os" excess : and deposited, sometimes in single organs for which it is duced m not naturally intended, and sometimes throughout the system at deposltedfn large, occasionally in the parenchyma or general substance of or- Bins,e or- gans, and occasionally in the membranes or tunics by which they over'the are covered and protected, or in the vessels by which they are £hra'g furnished with their proper stores. We see much of this irregularity in old age, the cause of which Ossification we have already endeavoured to explain. The excernent vessels of J,n0°f^8 both sets, absorbents and secretories, partake of the common de- excess of bility and torpitude of this advanced period. There is hence, in Iiaeibutte all probability, a smaller quantity of lime, as of every other secerned fjj5JJd*$r" material, formed at this period than in the earlier and more vigorous the secer- stages : but, however small the quantity, it is carried off, on ac- abrorben'ts count of the grossness of its corpuscles, less freely by the debilitated 232 cl. vi.J ECCRITICA. [okd-x- Gen. V. Osthexia. Osthexy. When os- thexy oc- curs in ear- lier life and in vigorous health ex- cess of se- cretion un- question- able. 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 espe- cially 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, lays a foundation, as it appears in the parenchyma, or in the membranes or vessels of organs, for two very distinct trains of symptoms, and may be contemplated under the two following species : OSTHEXIA INFARCIENS. ---------IMPLEXA. PARENCHYMATOUS OSTHEXY- VASCULAR OSTHEXY. SPECIES I. OSTHEXIA INFARCIENS. PARENCHYMATOUS OSTHEXY. Gen. V. Spec. I. Found most com- monly in the kidneys and blad- der : but here de- tached and with pecu- liar symp- toms. Found in- teriorly, mostly in the pineal gland. Often found in other organs. OSSIFIC MATTER DEPOSITED IN NODULES OR AMORPHOUS MASSES, IN THE PARENCHYMA 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 domestic as foreign, give numerous examples, as do likewise Diemerbroeck, 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 * Baillie, Morb. Anat. Fasc. n. PI. 6. cl. vi.J EXCERNENT FUNCTION. [ord. iv 233 heart, in one instance weighing two ounces ;* in the thymus gland ;f Gen. V. in the thyroid J ; in the parotid ;§ the sublingual, and most other cSxia1' glands ;|| in the deltoid and most other muscles ; nor is there an infareiens. organ in which it has not been traced on different occasions. matowhy" Paullini records one instance of an ossified penis : in the Ephemera °»thexy- of Natural Curiosities, we meet with another :1T and M. Forlenze Found in has lately met with an extensive ossification in the globe of the eye. thfet|l0g°e The sclerotic was natural, but not only the crystalline lens, which is ° often found in this state, but the iris and the vitreous humour were completely ossified.** The general pathology we have already given: the symptoms General and effects vary to infinity. Most of the above cases seem to have HSSJJ1* occurred after the meridian of life ; and, in many instances, to s^en. have been connected with atonic gout, which, by adding to the de- bility of advancing age, adds to its tendency to form such deposite?. SPECIES II. OSTHEXIA IMPLEXIA. VASCULAR OSTHEXY: OSSIFIC MATTER DEPOSITED IN CONCENTRIC LAYERS IN THE TUNICS OF VESSELS OR MEMBRANES, RENDERING THEM RIGID AND UNIM- PRESSIBLE. All the vessels and membranes, as well as the more massy or Gen. W complicated organs of the body, are subject to deposites of phos- ^f^eVes- phate or carbonate of lime, from the causes already pointed out: seis and some of which are those of weak and others of entonic action : the Subject8?©* former operating upon the debilitated and the aged, the latter upon ear^y de" the young and vigorous, who labour under a peculiar diathesis or from causes predisposition to the formation of bony earth. The chief modifica- ^ed7 tions appertaining to this species may be contemplated under the following varieties : « Arterialis. Ossification of the aorta or other large Arterial osthexy. arteries. (3 Membranacea. Ossification of membranous or con- Membranous osthexy. necting part*. y Complicata. Ossification of different parts simulta- Complicated osthexy. neously. * Burnet, Thesaur. Med. Pract. in. 254. t Act. Med. Berol. Tom. i. Dec. m. 28. t Contuli, De Lapid. &c. § Plater, Observ. Lib. in. 707. || Haller, Pr. de indnratis corp. hum. partibus Goett. 1753.—Pranser. Diss, de iu« duratione corp. in specie ossium. Leips. 1705. 1f Dec. n. Ann. v. ** Diet, des Sciences Medicales, Art, Cas. Rar^ Vox.. Y._-30 *M cl. vi.j ECC1UT1CA. i>»- r Ges. v.. Where the deposite takes place in the aorta, it is rarely ofthMii1' confined to this artery alone, but spreads to some parts of the heart, impiexa. and, perhaps, of the pulmonary, or some other large artery as well. oi'hes" Dr. Baillie gives an instance in which a considerable portion of the "iwa'arte- "£nt vent"cle and right auricle of the heart, were affected at the riaiis. same time ;* and Morgagni another in which the ossification ex- es^ification. tended to the valves, and this too without having produced in the flwaorta Patient either palpitation or dyspnoea.t So wonderfully is the in- rareiy con- stinctive or remedial power of nature capable, in various instances, Exempli-' °f accommodating the general system to morbid changes. ced. We have other examples of the trunk of the aorta being wholly ossified,| and in one case so rigidly, both in its ascending and de- scending branches, as to compel the sufferer to maintain an erect position. § £ o. im- The most troublesome of the membranous ossifications are those mo" of the pleura, of which an example is given by Dr. Baillie in his branacea. Morbid Anatomy :|| though the trachea affords at times severe and branous even fatal examples of this affection,IF in consequence of the stric- ossincanoB. ture wnjcn js 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 the dis- Yet, in the structure of the arteries, ossification is found more morafre- frequently than in any other organ, with the exception of the pineal quently in gland : the cause of which seems to have been first glanced at by Iiig B.rtcri68 .' than in any Dr. Hunter, and was afterwards followed up with much patient in- cejt'the vestigation and accuracy of research by Mr. Cruikshank. The pineal former used to send round at his lectures a preparation of the pa- found thusy tella, in which he demonstrated that the ossification of that bone tet'aiel began in the arteries running through the centre of the cartilage which, in young subjects, supplies the place of a bony patella. Mr. Cruikshank on prosecuting the subject, discovered that all other bones ossify in the same manner, and made preparations in proof of this fact; distinctly showing that the ossification of bones is not only begun, but carried on and completed by the ossification of their arteries : and, consequently, that arteries have a natural tendency to become ossific above that of all other parts of the system whatever. / o. im- One of the most extensive appearances of this habit acting mor- pifcata.°m bidly on the tunics of vessels, is related by Dr. Heberden in the ed° osthexy. Medical Transactions,** in the case of a very old man who at last singular died suddenly, as well indeed he might, since almost the only viscus example. ^^ wag foum^ on examination, to be in a healthy state was the liver. The internal carotid andbasilary 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- ventricular opening were partially ossified, those of the aorta com- ' «Ioub' An»a£ Ff c-,-Z;FLtr * De Sed- et-Cans- Ep. XXIII. 11. j .Buchner, Miscel. Ii27, p. SOS. § Guattani, De Aneurism, &c. '■'. Fascic. u. PI. i. if Kirkrin*, Specileg. Anat. Ob?. 27. ' » o!. y, Art., x'ns CL.VT.J EXCERNENT FUNCTION. r«»i».i. 235 pleteiy so, and small depositions of bony matter were found in the Gen. v.. tendinous portions of the camea; columnar. The coronary artery was ? a hn- essified through its whole extent. The descending thoracic and ab- pip** com- dominal aorta, with all their primary branches, were converted into compn'cat- cylinders of bone, as were the external and internal iliacs. It is noted osthexy necessary to pursue the description into the morbid appearances of almost every other organ : and I shall only observe farther that though the substance of the brain was healthy, the ventricles con- tained 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 ad- vanced age, with the exception of an habitual deafness ; and at- tained upwards of fourscore years of age before he died. Where this diathesis prevails very decidedly, it sometimes converts The pa- not merely the vessels but the whole of the tendons and the muscles limesIw"6'" into rigid bones, and renders the entire frame as stiff and immovea- stiffened as bie as the trunk of a tree. There is a striking illustration of this power of remark in a case communicated to the Royal Society by Dr. Henry Exempii- of Enniskillen.* The patient was a clay labourer who had enjoyed fied. good health till the timexif his being attacked with this disease. 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 winch were con- verted into a like hardness, and were of double their natural 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 fingers 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 ankle 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 salivation had been tried to no purpose. Salivation has, indeed, often been tried, probably from its success Medico in removing venereal nodes, but it does not seem to have been of gai*v™fi"on much more avail in any instance than in the present. whorelnV We have pointed out two opposite causes, or rather states of body, cause is in which a tendency to ossification chiefly shows itself. One is that deblht-v. of general debility, and the other of an entonic action in the assimi- lating organs which are chiefly concerned in the fabrication or sepa- ration of lime : and in laying down any plan for relief, it seems necessary to attend to this distinction. Where debility becomes a ^*™luhs> * predisponent of morbid ossification, it is mostly a result or conco- diet, and mitant of old age, a scrophulous diathesis or atonic gout: and in all ^Jj** these cases warmth, a generous diet, and tonic course of medicines cines^re- will form the most reasonable curative plan that can be pursued ; qnisi and that which will tend most effectually to stimulate the absorb- ents- and prevent that retardation of bony earth in the lymphatics PiiiL Trstos. Vol. 1.1. vear 175«»< 236 cl. vi.J ECCRITICA. [orv. 1. Gen. v. an(j vasa vasorum, on which we have already shown the disease to ya'irn- depend in this modification of it. Pnc*aataCom" °n the contraryi where it occurs in the middle and vigour of life, compiicat- and we have reason to believe from the existence of too much action Medical^' in vessels which we cannot very accurately follow up, a reducent WhereThe plan wJ1 be far more likely to Prove successful. We should bleed disease oc- and move the bowels freely, and restrain the patient to a low diet m"ddieand with a copious allowance of diluent drinks. vigour of And in both cases with a view of dissolving, as far as we are able, duc'ent'pTan tne calcareous matter that may morbidly exist in the system already, necessary, Cr be on the point of entering into it, we should prescribe a free use ETal" r ofthe mineral or vegetable acids, as already recommended under &of VMo&riAfragilis, " drinks, a free use of acids in Doth; CLASS VI. ECCRITICA. ORDER II. CATOTICA. DISEASES AFFECTING INTERNAL SURFACES. PRAVITY OF THE FLUIDS, OR EMUNCTORIES THAT OPEN INTO THE INTERNAL SURFACES OF ORGANS. Catotica is derived from xxra, "infra," whence Kurure^t and ClassVI. xxToTxres, "inferior," and " infimus." The order includes four orMno/1' genera as follows, some of which will be found of extensive range : orEi0 term. I. HYDROPS. DROPSY. II. EMPHYSEMA. INFLATION. WIND-DROPSY. III. PARURIA. MISMICTURITION. Hr LITHIA, URINARY CALCULUS 338 cl. vi.] ECCRITICA. |om». n. GENUS I. HYDROPS. DROPSY. PALE, INDOLENT, AND INELASTIC DISTENTION OF TIIE BODV, OR ITS MEMBERS, FROM ACCl Jtl'LATlON OF A WATERY FLUID IN NATURAL CAVITIES. Gen. I. Hydrops is a Greek term (ifyo-*l>) importing an accumulation of the'leneric water '• and in nosology there is no genus of diseases that has been term. more awkwardly handled. The term hydrops does not occur in Sauvages, Linneus, or Sagar, and only once in Vogel in the com- Synonyms: pound hydrops scroti. Linne'us connects anasarca and ascites, its andexami- u • f . ' .,, , ., . , . nations of cmet species, wibi tympanites, polysarcia, or corpulency, and gra- rangements ^itas or pregnancy, into one ordinal division, which he names TUMinosi, and of which these constitute distinct genera. Sagar arranges all the same under the ordinal division cachexias. Vogel pursues the same plan with the omission of graviditas or pregnancy, which he does not choose to regard as a cachexy. Sauvages employs 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 intumescentia, under which, as in the arrangement of Linneus, it is united with corpulency, and pregnancy ; while hy- drops 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 intumescentia for the name of his order ; but divides it into the four sections of adiposae, flatuosae, aquosae 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 quarters. It would, however, have been a much greater improvement, and have added to the simplicity he aimed at, to have employed hydrops Hydrops as a generic, instead of hydropes as a tribual or family term. It pioyeTby is to Boerhaave we are indebted for the first use of hydrops as era- in°ftshareV-e PWea" in the present method ; and he has been followed by Dr. sent scope. Macbride and Dr. Young with a just appreciation 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 : 1. HYDROPS CELLULARIS. CELLULAR DROPSY. 2.--------CAPITIS. DROPSY OF THE HEAD. 3.--------?PIN.^. --------------SP/XE CL. vi.] EXCERNENT FUNCTION. [ord. h. 239 4. HYDROPS THORACIS. DROPSY OF THE CHEST, GeM-I. - Hydroflft. 5.-------ABDOMINIS.------------BELLY. Dropsy. 6. ------- OVARII.------------OVARY. 7. ------- TUBALIS.---------'■-- FALLOPIAN TUBE. 8. ------- UTERI.----------— WOMB. 9.-------SCROTI. ------------SCROTUM. Before we enter upon a distinct view of the history and treatment 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 ge- ah dropsies neral or local, produce a general or local disease. The common c°™e!jke predisponent cause is debility. The remote causes are very nume- Predispo- rous, and most of them apply to every form under which the disease "emote1180' makes its appearance; for the accumulation of watery fluid which °*^|j!0U9. constitutes the most prominent symptom of the malady, may be pro- duced by a profuse halitus from the terminal arteries occasioning too large a supply of that fine lubricating fluid which, as we have observed in the Physiological Proem to the present Class, flows from the surface of all internal organs and enables them to play with ease and without attrition upon each other ; it maybe produced by a torpid or inactive condition of the correspondent absorbents occasioning too small a removal of this fluid, when it has answered its purpose and is become waste matter ; or it may be produced by each of these diseased conditions of both sets of vessels, operating at the same time ; and it is to this double deviation from healthy action that Dr. Cullen applies the name of an hydropic diathesis. Want of action on the part of the absorbents is, in every instance, 1Fu[tbtei(£I* the result of debility. Profuse exhalation on the part of the secer- nents or terminal arteries, in most cases, proceeds from a like cause, for it takes place from a relaxed state of these vessels, which open their mouths too widely, and suffer the serum or other aqueous fluid to escape with too much freedom. Dropsy is, in most instances, therefore, a disease of debility : and, °r0gUsyya if we minutely attend to the histories of those who are suffering from disease or this disease, we shall generally find that they have for some time and'the" antecedently been labouring under debility either general or local: "^"dtbnity that they arc weakened by protracted fevers ; or languishing under often ob- the effects of an unkindly lying-in ; that they have unstrung their so°uTce« of frames by a long exposure to a cold and moist atmosphere ; or have debility ^ worn themselves out by hard labour; or, which is still worse, by hard eating and drinking ; or that they are suffering from habitual dyspepsy or some other malady of the stomach or chylopoetic organs, especially the liver, which destroys or deranges the digestive process, and hence lays a foundation for atrophy. And, for the same reason, innutritious or indigestible food is a frequent cause of some species of this disease :* as is also great loss of blood from any organ, and especially when such discharge becomes periodical. Where the digestive organs are in a very morbid state dropsy may blJ-",0f^'B produces ,..-., » the same ■ ' ibererzgeburgisches Journ. iv, St effeet n* 240 ci. vi.] ECCRITICA. Iord. u. ^Gen. I. take p]ace as a result of general debility ; but it more commonly Dropsy5"" occurs from that peculiar sympathy whicii prevails so strikingly oXiity. between the two ends of the extensive clia.u of the nutritive, or, in where tho other words, the digestive and assimilating power>. \vhich we had occasion to explain when treating of marasmus :* the iticrtness and organ ■ympa-y relaxation of the excernent vessels being, in tuis cast:, produced by thiz*swith the torpitude of the ch-lopoetic viscera ; mid th« usual forms of exhaian"!d dropsy being those of the cellular membrane >r ot the abdomen. Hence tor- Hence a single indulgence in large draughts of cold drinks, and theUchyh- especially of cold water, when the system is generally heated and ceraVaevis exhausted has occasionally proved sufficient to induce dropsy in one cause from of these forms ; of which we have a striking example in the army sympathy. qC cnaries y. during its expedition artinst Tunis, the greater part ;i3fe of it, as we are told by De Haen, having fallen into this disease in consequence of having freely quenched tlu:ir thirst with cold water in the midst of great fatigue and perspiration, j Torpitude A like sympathy not unfrequently takes place between several taneousCex- other organs and the mouths of tlie --xcernents: as the skin and the haiauts act uterus : the former as loaded with an extension of the same terminal manner., 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 collapse of its capillaries produced by the coldness of the beverage, that the excer- nent system became affected in the extensive dropsy just alluded to in the army of Charles V. And we frequently perceive a similar effect on a sudden suppression or repulsion of cutaneous eruptions, the mouths of the excernent vessels opening into internal cavities As also a partaking of the torpitude of the cutaneous capillaries. The sym- State of pathetic influence exercised over trie -same vessels by a morbid state the uterus. Qf tne uterus is not less manifest: for in chlorosis the abdomen becomes tumid, and tho lower limbs edematous ; and on the cessa- tion of the catamenia, cellular or abdominal dropsy are by no means uncommon. Pthe^[ ""P" Such are the general causes of cellular dropsy as well proximate casionai as predisponent. But there are a few other causes which it is neces- caucea: gary to enumerate as a. ting occasionally, though the effects produced by some of them can hardly be called dropsy in the proper and idiopa- thic sense of the term. Retrograde jn the first place, the absorbents are supposed by some pathologists, the absorb- as M. MezlerJ and Dr. Darwin, to be at times affected with a retro- 6nts' grade action, and hence to pour forth into various cavites of the body a considerable mass of fluid instead of imbibing and carrying it off. 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 of stimulus applied to them. The most common stimulus to which they by.a retard- are exposed is distention, and that by a retardation of the blood in the bioodln veins, and a consequent accumulation in the arteries. This retarda- te veins, tion or interruption of the flow of venous blood may arise from diseases Illustrated. J * Vol. ii. CL in. Ord. iv. Gen. in. opening remarks. t Rat. Med. Part. v. 38.90. I Von derWassersucht. vl. vi.J EXCERNENT FUNCTION. [ord. ii. 241 of the right ventricle of the heart or its valves ; from various affections ,p^ N* *» of the lungs or their surrounding muscles ; from an upright posture Drops^.3' continued without intermission for many days and nights, as is often the case in monthly nurses ; from a gravid uterus, whence the edematous ankles of pregnant women ; from scirrhous or other ob- structions in the liver or spleen ; from polypous concretions in the veins, aneurisms in the arteries, or steatomatous or other hard tumours in the vicinity of the^'larger arterial trunks. In some cases inflammation succeeds to distention, and thequan- Hence tity of fluid poured forth is still more considerable. It is from this dou- f,™ vTntri ble source of stimulus, distention and inflammatory action, that the cies of the ventricles of the brain becme filled in meningic cephalitis, and the men?nglc cavity of the pericardium occasionally in carditis, and hence Dr. Sto- pernio'■ Iter with a view of exemplifying and supporting the humoral patho- and adyna- logy, has divided dropsies into two kinds, dynamic and adynamic, mic d'op^ these evincing too much action, and those evincing too little.* Thirdly, the aqueous fluid of a cavity may be unduly augmented, Rupture of and consequently dropsy ensue, from a rupture of the thoracic duct, ^uuct%r or of a large branch of the lacteal vessels. These, however, are not lacteal ves- common causes ; the lymphatics of the kidneys may, perhaps, most ReUpture of frequently have occasioned the disease when ruptured by accident ^Jf™^ or idiopathic affection in the case of renal ischury ; during which the kid- the watery parts of the blood that should pass off by the kidneys neys; have been thrown back into the system, and lodged in some cavity. And it is probable that when dropsy follows upon long exposure to a cold damp atmosphere, it is produced, in some instances, in the same manner ; the fluid that should pass off by the exhalants 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 A^or!'^u moisture too freely from the atmosphere ;t the stomach is said, as from the in the case of dipsosis avens, to demand too large a quantity of ^'r°es: liquids to quench its insatiable thirst; J and the blood is said to be insatiable in a state of preternatural tenuity from saline acrimony ;§ and each M^0'id te- of these conditions it is affirmed has occasionally proved a source J^'* °0fd of dropsy. The first of these unquestionably occurs at times during dropsy, and' all of them may have operated as causes ; but preter- natural tenuity of blood, adequate to and producing such an effect, is very uncommon from any cause; and the remedial power of nature is at no loss for means to carry off a superabundance of fluidity introduced by any means into the system, provided the ex- cernent function itself be not diseased. From this diversity of causes we may reasonably expect that the }^eJli0 dropsical fluid discharged upon tapping l1 t Erastus, Di>p. iv. p. 206.—De Haen, Hat. Med. P. iv. p. 125. scq. LU,our I Kuclnier; Miscell. 1730. p. 888.—Mondschien. p. 12. & Galen', Dc Lvraph. Caus. Lib. m. cai>. $.—Van Swieten ad Kvt. l-'-J Vot., Y.-o:" 24\l cl. vi.j ECCRITICA. [<«">• "• Gen. I. water, incapable of coagulating when exposed fo heat, which only Dropsy!" renders it turbid ; while, at other times, it flows in a ropy state, and accords, upon exposure to heat, with the natural serum of the blood. A similar discrepancy is discoverable in its colour, or some other condition : for it has sometimes been found black and fetid,* bloody, sanious, milkv,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.II It has been occa- sionally so urinous or ammoniacal as to turn syrup of red poppies green :IT and, according to Dr. M'Lacklan, lias sometimes con- tained so much soda as by the addition of sulphuric acid to produce Glauber's salt** with little or no trouble. iect further From the nature of the fluid itself, therefore, we have a clear iilostrated. 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 pro- ceed 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 )iver, spleen, or morbid lungs.ft -SPECIES I. Hi DROPS CELLULARIS. CELLULAR DROPSY, COLl) AND DIFFUSIVE INTUMESCENCE OF THE SKIN, PITTING BK- NEATH THE PRESSURE OF THE FINGERS. Gen. I. This species includes three varieties, as it is general to the cel- s*ec. 1. j,,{ar membrane, limited to the limbs, or accompanied witli a com- * Galeazzi, in Com. Bonon. Tom. vi. t Willis, Pharmaceutice Rationalis.—Med. Com. of Edinb. Vol. v T Riicker, Comm. Lib. Nor. 1736. § Du Verney, M£moires de Paris, 1701. p. 193. ;j Guat De Aneurismatibus.—Steid. Chirurg. Beobacht. B. i M De flaen, Rat. Med. P. xi. p. 214. ** Med. Comm. Edinb. ix. n. '* Hetrjon Dwript. of Hie Lymph, Syst. Cl) xii » L, VI.] EXCERNENT FUNCTION. [ord. u. 343 bination of very peculiar symptoms, and especially severe, and in Gen. h most cases fatal, dyspnoea : Hydrops ' celluiaris. , , Cellular x Generalis. Extending through the cellular membrane Dropsy. General Dropsy. of the whole body. 6 Artuum. Limited to the cellular membrane of the Edema. limbs, chiefly of the feet and ankles ; and mostly appearing in the evening. y Dyspnoica. Edematous swelling of the feet, stiffness Pyspnetic Dropsy. and numbness of the joints ; the swel- ling rapidly ascending to the belly, with severe and mostly fatal dyspnoea. It is under the first of these varieties that cellular dropsy usually £«• «®£ appears as an idiopathic affection. Where the intumescence is raiis. confined to the limbs, it is usually a symptom or result of some 0?"*™* other affection, as chlorosis, suppressed catamenia or any other 0 h jeihi- habitual discharge ; a disordered state of the habit produced by a ^ Edema, cessation of the catamenial flux ; repelled eruptions ; or the weak* ness incident upon protracted fevers, or any other exhausting malady. The third variety is introduced upon the authority of Mr. W. £«■ g"; Hunter, ami taken from his Essay, published at Bengal in 1804. D°'8canetie The disease appeared with great frequency among the Lascars in p^pTy;"5 the Company's service in 1801. Its attack was sudden and its ^ by progress so rapid that it frequently destroyed the patient in two Hunter in days. From the description it does not seem to have been con- BeDsa • nected with a scorbutic diathesis : and Mr. Hunter ascribed it to the concurrent causes of breathing an impure atmosphere, sup- pressed perspiration, want of exercise, and a previous life of in- temperance. All or any of these may have been auxiliaries, but the exciting cause does not seem to have been detected. It is a frequent symptom in beribery. 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 the predisposing cause, ordinarily Qenera^ brought on by hard labour, intemperance, innutritious food, fevers nent cau?e. of various kinds, exhausting discharges, or some morbid enlarge- °acu;ae83lonal rnent of the visceral or thoracic organs that impedes the circulation of the blood, and produces congestion and distention. The disease is hence common to all ages though most frequently D'seas^ ^ found in advanced life ; the edema of the feet and ankles, with alleges, which symptoms it opens, appears at first only in the evening, and J„°sutfy t0 yields to the recumbent position of the night. By degrees it be- J^^ comes more permanent and ascends higher, till not only the thighs ment. 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 waxv. A general inactivity vurr*"-* 2U cl.vt.] ECCRITICA. [onn. n. Gen." I. Spec. I. Hydrops cellularis. Cellular dropsy. Treatment. Progress. Termina- tion. Medical treatment. General course to he pursued. The cause to be re- moved or palliated wherever possible. The mis- chievous effects to be removed: pervades all the organs, and consequently all their respective functions. The pulse is slow, often oppressed, and always inelas- tic : the bowels are costive, the urine for the most part small in quantity, and consequently of a deeper hue than usual: the respi- ration is troublesome and wheezy, and accompanied with a cough that brings up a little dilute mucus which affords no relief to the sense of weight and oppression. The appetite fails, the muscles become weak and flaccid, and the general frame emaciated. Ex- ertion of every kind is a fatigue, and the mind, partaking of the hebetude of the body, engages in study with reluctance, and is overpowered with drowsiness and stupor. An unquenchable thirst is a common symptom ; and whrre this is the case the general irritation that is connected with it sometimes excites a perpetual feverishness that adds greatly to the general de- bility. 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 respira- tion : 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 some- times continues for many years. In attempting a cure of cellular dropsy, and indeed of dropsy in general, for it will bc 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 arc 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 distention. In the two last cases it may be palliated by bleeding, a recumbent posi- tion, 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 scir- rhous induration or some other obstruction of one of the larger vis- cera 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 na- ture, so that it may be less operative hereafter. cl. vi.] EXCERNENT FUNCTION. [onn. n. 245 A removal of the accumulated fluid from the cellular membrane 9EN- '• generally has been attempted by inlcrnal and external means, as Hydro%L hydragogues of various kinds, and scarification or other cutaneous ceiiuiaris, drains Cellular Qralns- dropsy. The nvnRAooGUES or expedients of water, embrace medicines of ^'Interna!' all kinds that act. powerfully on any of the excretories, though the and exter- term has sometimes been limited to those that operate on the ex-internal"8 cretories of the intestines alone. And it becomes us therefore to {Jc*ns- contemplate them under the character of purgatives, emetics, dia- goVes, phoretics, and diuretics. ' which may 1 ,.,. . include 1 he purgatives that have been had recourse to are of two kinds, purgatives, those of general use, and those that have been supposed to act. with diap'Ce- some specific or peculiar virtue in the removal of the dropsical !,iCB'and n • » r diuretics. tlUia. Purgatives Among the first we may rank calomel, colocynth, gamboge, supposed"^ scammony, jalap, and several other species of convolvu'us, as the J? BPecjfic- ,..,., . , _ ' , . . ... General greater white bind-weed (convolvulus Sepium, Linn.) : the turbeth purgatives, plant (c. 'Jurjcf/vh^ Linn.) > p ;■ the brassica mariana, as it is called in the dispensatoiies (c. Soidar.eJla, Linn.). These may be employed as drastic purgat.-ves almost indiscriminately, and their comparative merit will depend upon llieir comparative cfiect, for one will often be found to ayree 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 g^1urg0lBt^cts0 effect in dropsies are almost innumerable. VVe n.ust content our- net specifi- selves with taking a glance at. the following, grana Tiglia, or bastard ca y' ricinus ; elaterium : elder, and dwarf elder; black hellebore ; senega ; and crystals of tartar. The uiiotoiv Tiglium, or bastard ricinus, affording the grana Croton Tiglia of the pharmacopoeias, is an acrid and powerful drastic in Bastard °r all its parts, roots, seeds, and expressed oil. The oil is of the same ricinus- character as the oi! of castor, but a severer and more acrimonious purge ; insomuch, indeed, that a single drop prepared from the dry seeds is often a sufficient dose ; while a largei quantity proves ca- thartic when rubbed on the navel. In India the seeds themselves have long been given as a hydragogue ; two being sufficient for a robuster constitution, one for a weaklier ; and four proving some- times fatal. By far the safest mode of giving it is in alkoholic solu- in an niko- tion, as practised by Dr. \immo,* since by such a diffusion, it has x\on. less chance of griping or producing inflammation. From the uncertainty and violence of the action of this plant, Elaterium , •• , ■ ■ /• 't -ii i ■ /• or juice of the elatekiu.m. or inspissated juice of the wild cucumber, is a iar wild cu- preferable medicine for the present purpose. Elaterium itself, how- cumber- ever, has been objected to as unduly stimulant; and both Hoffman and Lister, who as well as Sydenham strongly recommend it, observe * .Tonrn. of Science, xm. 62. 246 cl. vi.J ECCRITICA. [oito. ii. Gen. I. Spec. I. Hydrops cellulnris- Cellular dropsy. Treatment. Sambucus nigra and S. Ehulus. Elder and dwarf el- der. Melampo- diuni or Black hel- lebore. that its effect 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 lb. Cullen, who admits that he never tried it by itself, or otherwise than in the proportion of a grain or two in composition 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. Admit- ting 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, I have found it highly serviceable in a simple and uncombined state, produced, as it ultimately appeared, and especially in one instance, from a thickening of the walls of the heart, in a young lady of only thir- teen 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 the plants has been used ; but the liber or inner bark of the first, and the rob or inspissated juice of the berries of 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 : an 1 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 ii> no less degree by urine, and adds that, in his hands it has proved successful in a multitude of hydropic cases.j Dr. Brocklesby preferred the interior bark of the dwarf elder4 as Sydenham and Boerhaave did that of the black or common 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 seem in our own day to have sunk into an almost total disuse. Chesneau employed in- differently the seeds, and their expressed oil, the root and the inspis- sated juice of the root; though lie preferred the s. Ebulus to the s. nigra. \\ The melampodium or black hellebore, was at one time a favourite cathartic in dropsies, and has the testimony of high authorities for having very ge.-.etally 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 * Boulduc, Hist de l'Acad. Royal de Sciences de Paris. t Opp. p. 627. 768. t CEconom. and Med. Obserr. p. 273. 5 Mat. w- Med. Vol. i. p. 634. || Lib. III. Cap. iii. Obs. 8. c-l.vlJ EXCERNENT FUNCTION. [onn. n. 247 caution ; but we have reason to believe that the black hellebore of Gem. I. the present day is a different production, as it is milder in its effects ^ydfo'ps1* than the hellebore of Dioscorides, and different in some of its external ceiiuiaris. characters. Its root was the part selected, and the fibres of the d.^"'*.' roots, or their cortical part, rather than the internal. These were Tfetttn>e«* employed either in a watery infusion or extract. Mondschein* preferred on all occasions, the latter; Quarin used either indiffer- ently.! Bacher invented a pill which was once in very high repu- Bacher's tation, and sold under his own name all over Europe, for the cure p,1!s what 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 how- ever had their day, and are gone by, apparently with too little con- sideration upon the subject; for the experiments of Daignau and De Home, and especially the successful trials in the French Military Hospitals, as related by M. Richard,^ 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 hellebore has been limited to the list of emmenagogues, and even in this view is rarely employed at present. Whether this plant prove purgative, as has been asserted, when applied to the body externally in the form of fomentations or cataplasms like the croton, I have never tried. Ferrara, employed as hydragogues, the black and white helle- bore indiscriminately. The seneka or senega (polygala Senega, Linn.) was another Senega, medicine much in use about a century ago, and reputed to be of very great importance in dropsy, from its combinea action upon the kidneys and intestines, and, indeed, all the excretories. It reached Europe from America, where it had been immemorially 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 chiefly, if not entirely, trusted to, and this is given in powrder, decoction, or infusion. M. Bouvart found it highly ser- viceable as a hydragogue, but observes that, notwithstanding this 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 in the Materia Medica of the London College. There are unquestion- able instances of its e'^acy 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 nauseous 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 super-tat^ of dropsy, is the super-tartrate of potass, in vernacular language pr*t* "*, cieine of * Von. der Wassersucht, &c. j Anirnadversiones, &c. tartar. X Recueil des Observations de Medicine des Hopitaux Militaires. &c. Tom. it. Itc, Paris. 248 cl. vi.J ECCRITICA. LOIlD- li- Gen. I. Spec. I. Hydrops ceiiuiaris- Cellular dropsy. Treatment. Emetics; How far adviseable. the creme 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 pow- erfully diuretic. But it is as a purgative we are to contemplate 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. " 1 need hardly say," observes Dr. Cullen, " that upon this operation of exciting the absorbents, is chiefly founded the late frequent use of the crystals of tartar in the cure of dropsy."* Dr. Cullen, in this passage, apparently alludes to the practice of his friend Dr. Home, who was peculiarly 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 frequency 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 proportion of from three to eight drachms of each daily, largely diluted with some common drink.J 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 favour among earlier physicians. Their mode of action has a resemblance to that of the drastic purgatives ; for, by exciting the stomach to a greater degree of secretion, they excite the system generally; and, in fact, far more extensively and more powerfully than 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 obvious that 3uch exertion would be too considerable, and would only add to the general weakness ; and it is on this account chiefly that the practice has been of .'ate 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, espe- cially that of the scrotum when limited to the vaginal sheath, and that of the ovarium, when discovered 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 * Mat. Med. n. 513. 4to. Edit. f Medicinisches Wochenblatt, 1781. No. 40. t Cent. iv. Obs. 42. cl. vi.J EXCERNENT FUNCTION. [oep. u. U9 the foreign journals* abound with cases of the cure of ascites by a Gem. I spontaneous vomiting. if droC" L Diaphoretics have also been resorted to as very actively pro- ceiiuiaris. moting the evacuation of morbid fluids ; and many instances are drojly/ related by Bartholet,! Quarin,J and others, of the complete success D^hore^ of perspiration when spontaneously excited. Tissot tells us that it retics haTe was by this means Count Ostermann was cured, a very copious an^uc-" sweat having suddenly burst forth from his feet, which continued for ceeded- a long time without intermission. In the Medical Transactions there is a very interesting case of an InterMtins equal cure effected by the same means, in a letter from Mr. Mudge uted'by to Sir George Baker. The form of the disease was, indeed, an Baker ascites, but it will be more convenient to notice it here, while dis- cussing the treatment of dropsy generally than to reserve it for the place to which it more immediately belongs. The patient, a female of about forty years old, had laboured under the disease for twenty years : the abdomen was so extremely hard as well as enlarged, that it was doubtful whether the complaint were not a parabysma complicatum, or physcony of various abdominal organs, and tapping was not thought advisable. She was extremely emaciated : had a quick, small pulse, and insatiable thirst; voided little urine, breathed with difficulty, and could not lie down in her bed for fear of suffo- cation. For an accidental rheumatism in her limbs she had four doses of Dover's powders 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 continued to do through the whole night, and as fast as she discharged the water her belly softened and sunk. The third dose completed the evacuation ; and " thus," observes Mr. Mudge, " was this formidable ascites. which had subsisted near twenty years, by a fortunate accident car- ried off in eight and forty hours." The cure, too, was radical: for the constitution fully recovered itself, and the patient was restored to permanent health. We may observe from this case that the viscera are not necessarily Remark* on injured by being surrounded or even pressed upon by a very large d^case. 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 successful in establishing a harmony of action between the surface and the kid- neys, 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 fa"g|>'i{,o0Sbe relied upon * Sammlung Medicinischen Wahraeniungen. B. vm. p. 220.—N. Sammliing,&c. except B. vm. p. 114.—Scbulz. Schwed. Abhandlujjgeii, B. xu. p. 102. t Apud Bouet. Polvalth. P', 47, t Animadvcrsiones, &c, VOTj. X.—$^ 250 cl. vi.J ECCRITICA. [ord. n, Gen. I. points, sudorifics can be but little relied upon in the treatment of H^opa1' dropsy, and are rather of use as auxiliaries than as radical remedies. ceiiuiaris. They are also open to the same objections as emetics : they are rirop°yar apt, as Biichner has well observed, to do mischief by relaxing and whereTali- debilitating ;* and instances are not wanting in which they have ous eir- very seriously augmented the evil.! wrTcufin68 Diuretics are a far more valuable class of medicines, and there their fa- are few 0f them that operate by the kidneys alone ; the intestines, Generally the lungs, and oftentimes the whole surface of the body, internal as duly*, and weu> as external, usually participating in their action. augment Of diuretics, the most powerful, if not the most useful, is fox- Diuretics : glove. It was in high estimation with Dr. Withering, and Dr. Dar- vahiabiere ^*n regarQ,8 it almost as a specific in dropsies of every kind ; though class of he admits that it does not succeed so certainly in evacuating the Di^taiis9or fluid from the abdomen, as from the thorax and limbs. The prepa- i°VihTe' ration usually employed by the latter was a decoction of the fresh estimation green leaves, which, as the plant is biennial, may be procured at all thering^nd seasons of the year. Of these he boiled four ounces in two pints Darwin: of water till only one pint remained; and added two ounces of theVformDof yinous spirit after the decoction was strained off. Half an ounce of decoction. tnjg 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 jE» ^eof induced. In the hands of Sir George Baker, even when used in the Sir George form recommended by Dr. Darwin, its success was, occasionally, do^bt'ful ^eJy doubtful 5 While in some cases it was highly injurious without efficacy the slightest benefit whatever. J Even where it acts very powerfully time"°mis*- as a diuretic, and carries off five or six quarts of water a day, it chievous. often excites such incessant nausea, sinking, giddiness, and dimness injures 3 of sight, and such a retardation and intermission of the pulse, that more by its tjje increased evacuation bv no means compensates for the increased depressive - . . .. 1% „ ^^^^v. power than debility. And by a repetition it is often found to lose even its itodVnretic, diuretic effects. fosesus™ *n tne P0W^r made into pills it seems to operate with an equal diuretic uncertainty. It has sometimes produced a radical cure without any xepetftiori. superinduced mischief: but in other cases it has been almost or in the ibrm altogether inert. Sir George Baker gives an instance of this inert- °\v ' 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, con- taining 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 m-ect of substantia venenosa. Its roots have been tried as well as its leaves : * Diss, de diversa Hydropi Medendi Methodo. Hall. 1766. t Piso. de Morb. ex serosa Coll. Obs. i. Medical Tntrrsacttons, Vol. in. Art. xvn. cl. vr.j EXCERNENT FUNCTION. [ord. u. 2M and apparently with effects as variable but less active. It seems to Gen. I. have been first introduced into the London Pharmacopoeia in 1721 nydr0ps ' —folia, flores, semen ; was discarded in the ensuing edition of 1746, ^["^ and has since been restored in its folia alone : having encountered dropsy. a like alteration of favour and proscription in the Edinburgh Col- General"" lege. It is greatly to be wished that .some mode or management ^sul^iH could be contrived, by which its power of promoting absorption powers, 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 num- ber 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 Lessinju whole, the singular fact first noticed by Dr. Withering seems to be suf- jXVte ficiently established that in all its forms it is less injurious to weakly »«wu than and delicate habits than to those of firmer and tenser fibres.* fibres. The most useful of the diuretic class of medicines is the siliquose S^SSSc,. and alliaceous tribes ; particularly the latter, comprising leeks, ous plants. onions, garlic, and especially the squill. The last is always a valu- sini,u able and important article, and Sydenham asserts that he has cured dropsies by this alone. It has the great advantage of acting generally on the secernent system, and consequently of stimulating the excre- tories of the alvine canal as well as those of the kidneys. 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, though 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 vomit- ing, too soon for it to enter into the circulating system. The colchicum autumnale, or meadow-saffron,, ranks next, per- °n»J*'«™- haps in point of power as a diuretic, and is much entitled to atten- or meadow tion.' It is to the enterprising spirit of Dr. Stoerck that we are saffrofl" 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 stimulating ? 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, strangury, 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 senso- rial power, that a numbness or torpitude is produced in either organ, * Essay on Digital*, V- 18R. Mat. Med. Vol. n. Part. n. Hi. xxi :>& cl. vi.} ECCRITICA. LOEU- "• Gen. I. Spec. I. Hydrops .ceiiuiaris. Collular drjpsy. Treatment Gratiola officinalis, or hedge- hyssop. External means of evacuating" the fluid of cellular dropsy. 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.* 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 recom- mended by Sir Everard Home in cases of gout, 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 effica- cious than the oxymel of squills.! 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 diure- ticus, 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 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 (Leon- todon Taraxacum, Linn.) and tobacco. The former of these was at one time supposed to act so powerfully and specifically on the kidneys as to obtain the name of lectiminga; and is said 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 retains in the present day, so as to be scarcely worthy of attention: while with respect to tobacco, notwithstanding the strenuous recom- mendation 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 and in their extract, and, like many other simples, it appears 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 correct. The external means of evacuating the fluid of cellular dropsy are blisters, setons, or issues, punctures, and scarification. The last * Libellus de Radice Colchico atitnmnali. t Recueil. ii. Vindob. 1763. 8vo. ll. vi.J EXCERNENT FUNCTION. [ord. ii. 253 is as much less troublesome as it is usually most effectual. It is, Gen. I. however, commonly postponed to too late a period, under an idea Hfeyd?oCp8L that sloughing wounds may be produced by the operation, difficult ceiiuiaris: of cure, and tending to gangrene. In blistering this has often hap- dropty" pened, but in scarifying the fear is unfounded, while any degree of '^"atment. •a i ■!•■.. ■„ . J . *2 Blisters, vital energy remains : and it should never be forgotten that the longer sotons.nnd this simple operation is delayed, the more the danger, whatever t?0an"fica~ it may be, is increased. I have never experienced the slightest in- ^°t'*£ t. convenience from the practice ; and have rarely tried it without some Hal! bute° advantage ; seldom indeed without very great benefit. The wound JKadfc should be limited to a small crucial incision, resembling the letter T too !«*» on the outside of each knee, as the most dependent organ, a little Modeot below the joint. The cut thus shaped, and very slightly penetrating operating. into the cellular membrane will not easily close, and consequently the discharge will continue without interruption. In a young lady illustration of about twelve years of age, whom the author lately attended, SefiV'oVacV apparently labouring under an infection of the liver, but whose enor- rification. mous bulk of body as well as of limbs prevented all accuracy of examination, a common jack-towel applied to each leg after the incision was 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 scarcely 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 suc- cessful. The breathing was now affected, and there was great pal- pitation of the heart; so frequent and distressing indeed as to render her incapable of sleeping for a moment unless in an upright position. The patient 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 par- ticularly on the right side. During the progress of hydropic accumulation there is great whether. dryness of the tongue, and, as already observed, an almost intole- toma?P~ rable thirst. And the question has often been agitated, whether f^ouM^ under these circumstances, the patient's strong desire to drink indulged. 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 restored : 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 portion 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 peculiar irritability in the secernents of a par- ticular 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 On what 254 cl. vi.] ECCRITICA. LUK1 Gen. I Spec. I. Hydroi s ceiiuiaris. Cellular dropsy. Treatment such in- dulgence has been refused. But the re- fusal founded on false prin- ciples. Patient may be al- lowed to gratify his desire"; and why. The sur- fac" of the body under the irrita- tion of thirst ab- sorhsmorc moisture from the atmos- phere than would serve to quench the thirst in dropsy. Moisture absorbed from the air by the lymphatics of the skin in a state of health. Advanta- geous to know whe- ther the quantity discharged by the kid- neys ba- lances what is ta- ken by the mouth Disease lias been cured by chinking wster alone. has been very generally concluded that the greater the quantity of fluid taken into the system, the greater will be the dropsical accu- mulation : and consequently that a rigid abstinence from drinking is of imperative necessity. 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 arid, will imbibe a much larger quantity of fluid from the atmosphere than the patient is ask- ing for his stomach ; for it has been sufficiently proved, that, under the most resolute determination 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," says Mr. Cruikshank, " absorbs fluids that come in con- tact with it, I have not the least doubt. A patient of mine, with a stricture in the esophagus, received nothing either solid or liquid into the stomach for two months : he was exceedingly thirsty, and complained 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 bc to determine by measurement whether the quantity of.fluid discharged by the bladder holds a fair balance with that which is received 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 mo?- powerful diuretic, and has carried off the disease without any other assistance, of which a striking instance occurs in Panarolus ;! and hence Pouteau! occasionally advised it in the place of all othei aliment whatever : as does also Sir George * Anat. of Absorb. Vessels, p. 108. 4to. 1790. i Per'ec. u. Obs. 21. Oenvres Posthutncv i cl. vi.] EXCERNENT FUNCTION. [ord. ii. 253 Baker, in a valuable article upon this subject in the Medical Trans- Gen. r. actions,* in which he forcibly illustrates the advantage of a free use HydropsL of diluent drinks, by various cases transmitted to him, in which it ceiiuiaris. operated a radical cure, not only without the assistance of any other d'ropsy^ remedy, but, in one or two instances, after every medicine that Treatment. could be thought of had been tried to no purpose. But the fluid discharged from the kidneys may not be equal, nor ^"ce indeed bear any proportion to what is introduced by the mouth, and be'swal87 we may thus have a manifest proof that a considerable quantity of the e0v*„then latter is drained off into the morbid cavity. Still we must not en- lf>e kidneys tirely interdict the use of ordinary diluents, nor suffer the patient charge as' to be tormented with a continued and feverish thirst. If simple ^J."^1 as is diluent drinks will not pass to the kidneys of themselves, it will in this then be our duty to combine them with some of the saline or common acidulous diuretics we have already noticed, which have a peculiar d.et"?!'ib,k tendency to this organ ; and we shall generally find, that in this combined state of union they will accompany the diuretic ingredients, and ^."^311"° take the desired course. Of these, one of the most effectual, as 'ous diu- well as the most pleasant, is creme of tartar ; and hence this ought c>eme 0f to form a part of the ordinary beverage in all extensive dropsies,tartar* 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 better will they answer their end. A decoction of sorrel-leaves necotion makes also a pleasant diet drink for an hydropic patient; as does jeaves'6 likewise an aqueous infusion of sage leaves with lemon-juice : both sage-tea , \ r- n i i 1 i ii-i wl,n lemon sweetened to the taste. .Small stale table-beer, and weak cider, or juice. cider intermixed with water, may in like manner be allowed, with faw^'beer? little regard to measure. And it was by the one or other of these Cider. that most of the cures just referred to, as related by Sir George Baker, were effected. In one instance the cider 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 cider 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 whatever. Even Ardent ardent spirits, if largely diluted, and joined with a portion of vege- ^"^d table acid, have been found to stimulate the kidneys; and in the *n^a'bhd opinion of Dr. Cullen may make a part of the ordinary drink.! acfds. And it is chiefly owing to the tendency which the neutral salts s*>a-water, have to the kidneys, as their proper emunctory, and the sympathy which the secernents of these organs maintain with those of all others, that the cure of dropsy has sometimes been effected by large * Vol. M. Art. xvii. t Mat. Med. n. 549. 256 cl. vi.J ECCRITICA [ono. u. Gen. I. draughts of sea-water alone ; though sometimes this has also acted Hydfop's1" upon the bowels, and produced the same salutary result, by exciting ceiiuiaris. a very copious diarrhoea, of which a striking example is given by dropsy. Zacutus Lusitanus.* Tmilcpiari ^ should never, however, be forgotten, that dropsy is a disease of of medicine debility, and that the plan of evacuating will rarely of itself effect bine: a cure ; and never, perhaps, except in recent cases, and where oVevacuat- ntt'e inroad nas been made upon the constitution. In all other ing is only cases it should be regarded as a preparatory step alone; a mere and'preV-e palliative ; and an evil in itself; though an evil of a less kind to paratory. surmount an evil of a greater. And it is for want of due attention to this fact, 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 de- bility ; and if upon a very few trials the plan be not found to an- swer 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 than a palliative and present relief. Such an intention may often, indeed, be combined with that of evacuating the fluid; and hence Mondshein with great reason ad- vises us to employ bitters with diuretics,! as Martius does with purgatives.J Bitters, indeed, where the debility does not depend upon vis- ceral obstructions, form one of the most efficacious tonics we can employ. They are peculiarly adapted to the general loss of elas- ticity in the whole system and that laxity of the exhalants which constitutes the hydropic diathesis. " It has been alleged," says Dr. Cullen, " 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 increase the secretion : but in many trials we have never found their operation in this way to be manifest, or at least to be any way? considerable. In one situation, however, it may have appeared to be so. When in dropsy bitters moderate that exhalation into the cavities 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."§ 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 Digby, have occasionally preferred those of silver. Iron has gene- rally been abstained from as too heating, though recommended by Grieve,|| Richard,U and Rhumelius.** Such a combina- tion may take place from the first. Bitters, their pecu- liar adap- tation to cases of dropsy. Balsamics and aro- matics. Metallic Oxydes. * Prax. Hist. Lib. vm. Obs. 53. § Mat. Med. ii. p. 58. * Journ. de. Med. xxix. MP. t Mondschein, p. 82. I Martius, Obs. 54, || Med. Com. Edinb. ix. u. 75. ** Medic. Spagyr. tripart. n. 169. cl. vi.] EXCERNENT FUNCTION. [onn. n. 257 Where the disease is evidently dependent upon some visceral ob- Gen. i. struction, mercury offers a fairer chance of success than any other ifya?o%L metal; and in this case has often been pushed to salivation with coiiuiari*. the most salutary result. Du Verney employed it to this extent in drop'J" an ascitic patient, whom at the same time he tapped; and by this m^1™"!;, double plan effected a cure ; allowing a regimen of wine and stimu- visceral' " lant meals during the process.* And Rahn assures us that in one t"™™0" case the disease, though it several times recurred, was in every in- Ht0^ stance put to flight by a ptyalism excited by mercurial inunction.! may bTai- But where the system is in a state of great general debility, such a lowed" solution of the fluids will only add to the weakness and increase the disease. Small doses of calomel steadily persisted in will be here our safest course, with a nutritious and generous diet of 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. We have however observed that dropsy occasionally ensues from an undue excitement of the absorbents, and is even accompanied with inflammatory action. And in this case a free use of the lancet Yonesec' should precede every other remedial method; and will sometimes, what'cases as when the stimulus is a retardation of blood in the veins and a con- U8eful- sequent accumulation in the arteries, effect a cure of its own accord. It should be, nevertheless, remarked that dropsies of this form are rather a symptom of some other misaffection than an original or idiopathic disease. We have thus far contemplated dropsy as an idiopathic disease, Cellular dependent chiefly on constitutional debility : but there are cases in fJunTuse- which it occurs as a transfer of morbid action in some other organ fnl some" of the system than the cellular membrane, or whatever other part trans3fe'r8o*f may be the seat of the hydropic affection ; and in such cases it is ™°n'bid ac" often salutary, and answers the purpose of a counter-irritation, and especially in fevers and inflammatory attacks. "I have," says Dr. Parry, " so often known constitutional maladies suspended, and life evidently lengthened and rendered more comfortable, by the coming on of various dropsical effusions ; and, on the contrary, so many persons suffer aggravations of disease or even death, very shortly after the spontaneous disappearance of dropsy, that I cannot avoid considering that effusion as a salutary process rather than as an actual disease. "| I have dwelt the longer on this species because the general ob- These re- servations which it suggests, as well in respect to its causes and pVabieTo history as to its mode of treatment, apply in a very considerable ™°^the degree to all the rest; concerning which we shall now have little species, and more to do than to enumerate them and point out their distinctive j° m1nd°rne characters. * Mem. de. Paris, 170S, p. 174: t Medic. Briefwechse), B. i. 865. X Elements of Pathology, &c. Vol. ii. 8vo. 1815. Vol. V —33 2oS cl. vi.J ■■< CR1TICA [ord. u. SPECIES II. HYDROPS CAPITIS. DltOPSY OF THE HEAD. WATER IN TIIE HEAD. EDEMATOUS INTUMESCENCE OF THE HEAD : THE SUTURES OF TIIE SKILL GAPING. sSec^" ii TlIIS disease lias ueen strangely confounded by nosologists and Disease of-'practical writers with that inflammation of the brain which appa- founded rently commences in its substance or lower part, and producing with effusion into the ventricles, distends them, and thus unites the symp- irXmfna- toms of fever and great irritability with those of heaviness, and at tion of the length of stupor. The accumulation of fluid is here only an effect, that called and follows upon inflammation of the brain as in any other part, ternanl'-"' ann* *s on^v to De removetl Dy removing the inflammation. It is drocepha- ordinarily denominated, however, acute or internal hydrocephalus ; The two I"11 Dr. Cullen has correctly distinguished it from proper hydro- diseases ccphalus or dropsy of head by placing it in a different part of his minated by classification, and assigning it a different name. In his view it is uut'th'o lat- apoplexy, and he has hence called it apoplexia hydroccphalica. In terimpro- the present work it occurs under the name of cephalitis profunda, ed'by him and in treating of it as a cephalitis the author has submitted his an apo- reasons for not regarding it as an apoplectic affection. Dropsy of The disease before us is common to children. A few singular chiefly"1 cases are, indeed, recorded of its commencing in adult age,* and common to producing an enlargement of the scull by a morbid separation of butsomo- the sutures, but these are very rare. That it does, however, occur in"adSuitUnd Wlth°ut sucn separation and enlargement, and that too occasionally a?e. in every period of life, has been proved by a multitude of examina- tions after death, that have shown the ventricles of the brain dis- tended with fluid, and producing a considerable pressure upon the brain. Yet where no such enlargement of the skull 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. Like other Dropsy of the head, like that of every other organ, is a disease of disease of debility, and, as we have already observed in the introductory re- debihty: marks to the present genus, may proceed from a relaxed condition of the secernents of the brain, a torpitude of its absorbents, or from bot the both. The causes of this morbid state we are rarely able to ascer- thTiocaf tain : yet in some families there seems to be a peculiar predisposition weakness t0 j^ since it occurs in many of the children born in succession : babhfot and it may sometimes be connected with a scrophulous diathesis. traefd. The immediate seat of the dropsy varies considerably : for some- Sent of the dropfy varies con- * Hildan. Cent. ui. Ob». 17. 19. fidcralilv • cl, vl] EXCERNENT FUNCTION. [ord. ii. 2,59 times the fluid accumulates between the bones of the cranium and Gen- '• the dura mater ; sometimes between the dura mater or the other Hydrops"' membranes and the brain, and sometimes in the ventricles or con- capitis. volutions of the organ. With the deficiency of tone there is also ihe°head. not unfrequently some deficiency of structure or substance : and it w^l^ is in consequence of this that the fluid, when morbidly secreted or illustrated.' collected in one part, spreads without resistance to another. A °ften con- deficiency of structure or substance is sometimes found in the brain witifa de- itself and sometimes in the cranium. If it occur in the former a ficiency°f path may be immediately opened for the morbid fluid, accumulated or sub- in the ventricles or in any other interior part, to reach the mem- ^"brai" branes and distend the skull: and if in the latter, it may even pass or the beyond the skull, and separate and distend the integuments. I thewa- have seen instances of large perforations produced in different mam- 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.* 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 in- stance,! from Betbeder ;J or have had their place supplied by a membrane covering the entire range of the sinciput, an example of which will be found in Vesalius.§ The dropsical fluid is also said by many writers of high authority Pr?.p3ic?! to originate in some cases between the integuments and the bone, io origi- and to be confined to this quarter ; and hence, the disease has been °^J0^' divided into external and internal dropsy of the head. It is possi- tween the bie, indeed, as Van Swieten has justly observed, that since water menfsand may be collected in the cellular membrane of the whole body, such thned j""6' an accumulation may take place in the integuments of the head.ll confined to But the pretended cases are so rare that Van Swieten himself, quarter: Petit,1T and many other writers of high credit, have doubted whether whence ex- such a form of the disease has ever actually occurred. Yet, should internal" it occasionally take place, there can, I think, be no question that it dhr°phi£1^ ouodit rather to be regarded as a variety of anasarca or cellular such accu- dropsv, than hydrocephalus or dropsy of the head properly so called, ma^take Celsus has been quoted upon the occasion as confirming the exist- Place but ence of this external modification, and applying to it the name of rare; and hydrocephalus : but this is to misunderstand him egregiously. In ^"^f the passage referred to he is speaking of internal diseases of the rat1'^ a head alone, of cephalaea, and other aches produced by w-ine, or Sonof a indigestion, by cold, or heat, o^the rays of the sun, sometimes ac- if^l™ companied with fever, and sometimes without; sometimes affecting than pro- the whole of its interior, and sometimes only a part :—" modo in ofrthe°Pby toto capite, modo in parte." And he then adds, " prater ha?c ^^ Cel6us al- * Act. Helvet. i. 1. f Comment, in Hydrop. Sec. 1217. „-?'° ; Histoire de I'Hydrocrphale de Begle, p. 36. modifica- j> De Corp. human, labrica. Lib. i. cap. 5. tkn>. ji Comment, loc. citat. KIR. ^T Academ. des Sciences, Mem. p. 1-1, 2\j0 cl. vi.] ECCRITICA. K°- TU Gbk. I. etiamnum invenitur genus, quod potest longum esse : ubi humor Hydrops cutem inflat, eaqueintumescit, et, prementi digito, cedit: ofyo*e Dro^'of Gr8eci apellant."* It is manifest, therefore, that the hydrocephalus- the'hYad. here noticed, like the other diseases with which it is associated, is an Scad! internal affection of the head : and this idea is still farther confirmed by the treatment which he shortly afterwards proceeds to prescribe for it. Honce It is hence highly probable that the cases which have been called been' called external dropsies of the head, have consisted of internal accumula- eitemai tions spreading to and distending the integuments through channels moT'pro'- that were not ascertained, and on this account not supposed, to bably ac- • . cumula- cai&i. tions tom- Were the distinctions of external and internal dropsy of the head wtthin?8 necessary to be preserved, it would be far more accurate to limit distinction tne former to those modes of the complaint in which the water is might be confined between the calvaria and the membranes, and the latter necessary, to those in which it originates in the cavities of the brain : but as and of ad- we can rarely, if ever, determine the limits of the collection by the vantage: .•'..... . . . J . , but can symptoms, it is a distinction which cannot be supported, and would definiteeor OI*ten lead us into error. of real use. The form of the disease, however, which occurs between the cal- cursYe-0 varia and the dura mater is by no means common, and hence sel- oMvaria0 ^om hkely to lead us astray. So little common, indeed, is it, that and the Dr. Golius, who probably had more practice in this complaint than any other physician of ancient or modern times, expressly declares that " he never met with an example of it, and that he knows there are many physicians of extensive practice who have seen as little of it as himself."! Ihr°psyd°f Hydrops capitis frequently commences in the fetus, and some- LftenMund times renders the head so large as to retard the labour, andl greatly fetus.8 harass the delivery. Blanchard gives a case in which four pounds illustrated, 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 resistance increases, the sutures give way generally, and the tumour frequently disappears and is lost in the general «well. dobiifty'bo11 The brain often exhibits, as we have already observed, some mis- confmed to formation or defect, which of itself may constitute a remote cause: nentevec3e-r~ but the proximate cause is a debility of the local secernents, ab- selsof tlie the secre- * De Medicin. Lib iv. cap. u. lion b!i. v^?nj L**A' Go.lis. ausubender Arztes und Directors des Institutes ftir Kranke S" SSlfeijK.? W^l^^- AbhandluDSe* -ber vorzuglicheren Kr**- cl. vi.] EXCERNENT FUNCTION. [ord. h. sorbents, or both. If the debility be confined to these, or the defect Gen. i. in structure do not interfere with the proper developement of the if™^11' mental or corporeal powers of the sensorium, the infant may live capitis!1 and even thrive in every other part, while the water continues to fhe^Ld. accumulate and the head to become more monstrous, and even in- ^aneerad" supportable from its own weight: for, provided the pressure applied may'pro- be very gradual, and unaccompanied with inflammation, the brain, tlT^ch like the stomach and intestines in dropsy of the belly, may be interfe-. drowned in water for even twenty or thirty years without serious [^1* mischief.* Michaelis relates the case of a patient twenty-nine °IJ°^'_ years old, whose appetite and memory were good, and the pupils of ers: 'a°nd~ the eyes natural, though the disease had continued from birth.! j^Jrup6- And in treating of vascular osthexy I had occasion to notice, from wards ot" Dr. Heberden, the history of a patient who, with about eight ounces years. of water in the ventricles of the brain, as appeared on opening £exdempli* 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 age of upwards of fourscore years with an apparently sound constitu- tion, 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- if the in> tend to the other parts of the brain, and to parts that are immediately ^nd'to '* connected with the mental faculties ; or the defects of structure otner parts, that are so often combined with dropsy of the head may extend to binedwlth the same r and in such cases the hearing, sight, or speech may be. 2b- CL.VI.J ECCRITICA. lom- lL Ge«.i. the white as of the gray portion, is found in this ™*™«^£a ,fp,EC-1L and in a few instances a very considerable portion of it £ abso ■ SaftT and carried off, the remaining part being nothing more.than a.pulpy tiTheed.' mass or pouch. " When the cranium " says Dr..BaiUe ^s y TheU" ™ch enlarged in hydrocephalus, the brain is thinned b> ^rp 016 hettdl into a pulpy bag, and the corpus callosum is burst so that the water deposited in the ventricles comes in contact with the dm at mater^at the upper part of the cranium. In this way an hydrocephalus originally internal becomes in part external." „:„„„,« S,nguiar Yet even here we have, sometimes, striking and most singular Smes proofs that the remedial power of nature » »te^nj|fe e^S ™^e by obtain a cure, or to render the disease compatible with lite, ana™ .323!.* the general faculties of the sensorium. There "™J^£* cure, or nitration of this remark in a case, related by Dr. Donald Monro, Sethe ^SX^Tr^c^M. It is that of .umild whichaTthe age SSffiTSfc" of a year and a half, was brought into St. George s Hospital with Exem'pit' a head much enlarged from the disease before us. She was feverish fied' 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 mea- sured 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 and 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,! Additional In the following case the efforts of the remedial power were less iiiustra- 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 have 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 boy, not less than seven years of age when he first became affected. The pupils, from an early stage, were considerably dilated and the pulse was somewhat irregular ; he complained of pain towards the back of his 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. But 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 * Morb. Anat. Fascic. x. PI. in. p. 213. t Medical Transactions, Vol. n. p. 359. •l.vl] EXCERNENT FUNCTION. [ord. n. 263 intellect continued unimpaired, the frontal and parietal bones, from Gen- I- the force of the accumulated fluid in every direction, were separa- Hydfo^11' ted from each other, to a distance of from half to three quarters ^''j8- of an inch, notwithstanding that they had been firmly united at their the°heyad. respective sutures before the commencement of the disease. S/aa" Nearly a pint of water was found in the ventricles upon exami- nation. We have observed, that in many cases the bones of the skull B°™* become peculiarly thin and pellucid, or are altogether deprived of tEened* their calcareous earth, and reduced to cartilages. But where the {JJ"**^ instinctive or remedial power of nature, which is always labouring dered thiu- to restore morbid parts to a state of health, or to enable them in counted" their altered condition to fulfil their proper functions, has succeeded ^e'^"fan- in rendering the diseased brain still capable of exercising some oftageof this its faculties, a supply of phosphate of lime, is also, in various in- Process- stances, provided for the bony membrane; which not only re-assumes its ordinary firmness, but has sometimes exhibited a density far beyond the usual proportion and commensurate with the magnitude of the skull; while the cervical vertebrae have been equally strength- Cervical ened for the purpose of bearing so enormous a load. Hildanus invigorated gives a case of this kind in a youth eighteen years old, who had nl0br°i10nnpro" laboured under a dropsy of the head from his third year. The illustrated: skull was of an immense magnitude (immensce magnitudinis) a3 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 skulls of this kind," says the Remark of Baron Van Swieten, " should be disinhumed in their burial-ground ^"upon"6" by posterity, there would certainly not be wanting persons who would tms fact- 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 ordinary proportion : but if the bones should be separated and single, there could be no appeal to this distinctive mark."! The disease is always dangerous from the difficulty of determining Prognostics. its extent and what degree of cerebral disorganization may ac- company it. Where, however, it js limited to a weak condition of the excernents of the brain it is often remediable and admits of a radical cure. But where, on the contrary, no favourable impression can be made on the organ, 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 sometimes enduring life for twenty or even thirty years| before he is released from his sufferings. In a few instances it is observed by Dr. Comdet that coma, a dilated pupil, and other symptoms resembling acute hydrocephalus, as it has been railed, or profound cephalitis, accompany the disease from its com- * Observ. Chirurg. Cent. in. Obs. xix. p. 199. t Comment. Tom. iv. Sect. 1217. p. 12S. r Van, Swieten, Comment, loc. citat 2b4 cl. vi.j ECCRITICA. [OUD. H. Gek.I. mencement :* but I believe the pulse will, in such instances, rarely Hy'drop,11' be found to betray that irritable irregularity in the beat which has capitis. already been noticed in the cephalitic disease. On opening the the°held°f head twelve or fifteen pints of fluid have often been evacuated ; and 2eaherad" occasionally not less than twenty-four or twenty-five pints,! which Prodigious have the singular property of not jellying even on exposure to fluid some- neat. J inXS. Tne water has sorr»etimes heen found lodged in a cyst, and in a few instances the cerebrum itself has formed a sack for containing Whether fc Morgagni asserts that the disease is more common to girls than most com- P °_ , 2 j u mon to to boys.§ I do not know that the remark has been confirmed by £[Xor any collateral authority. Remedial 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 pur- Drastic purges can rarely, in this form of the disease, be carried beVep'end" to such an extent as to be of essential service, on account of the ed upon in ear]v period of life in which it commonly shows itself. For the this species. ^ r . . J .. ., Diaphore- same reason diaphoretics nave not been generally recommended, of use.rely or °ften found serviceable when ventured upon. Diuretics have Diuretics been more frequently had reecu-'se to ; and particularly, the digita- mmegene- lis. Dr. Withering was favourable to its use, but it has commonly, ployed"1 as m otner forms of dropsy, proved more injurious than beneficial. Best inter- The best internal medicine is calomel, in small doses, in union cine^caio- with some carminative for the purpose of keeping up the action of mel.^n, 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 observed under parenchymatic cephalitis.il Where the disease has been unaccom- panied 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 manner 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 increased bulk of the head attracted their notice, which was soon afterwards suc- ceeded by the symptoms just adverted to. The complaint had increased, the symptoms were more aggravated, and the skull, within six months, had become as large as that of an adult, when the mercurial process was commenced, accompanied with a free fo- * Memoire sur l'Hydrencephale, Geneva, 1818. t Bonet, Sepulchr. Lib. i. Sect. xvi. Obs. i—Eph. Nat. Cur. Dec. m. Ann. i. Obs. 10. X Hewson on the Lymph. Syst. Part. n. p. 193. § De Sed; et Carts. Morb. Ep. xn. Art. 6. II Vol. ii. n. 262. n.. vi.j EXCERNENT FUNCTION. [oiu>. n; 2b5 mentation of the head with the solution of the acetate of ammonia, Gen. r. and an occasional use of purgatives. In ten days there was an h Pd^3IL evident improvement: the child was less languid, and feverish, and capitn." showed less desire to rest his head perpetually on a chair. The £e°E£a.f skull no longer augmented ; the mental faculties which had begun Water in to discover hebetude regained vigour, and the patient, now in his Treatment. twentieth year, is an under-graduate in one of our universities, fexdcmpli" exhibiting a developement of talents that has already obtained for Successful him various prizes, and gives a promise of considerable success terminallon' hereafter. The bulk of his head is at this moment very little larger Head but a than it was at six years of age : a curious fact in pathology, though af twenty" by no means uncommon : since where the disease forms space years old. enough for a perfect growth of the brain, the calvaria ceases to than at "*' expand, and the head becomes once more proportioned to the rest of the body. The external means employed for diminishing the contained fluid External have consisted in local stimulants, as different preparations of am- StoWng monia, blisters, and cauteries, and puncturing the integuments. the contauT- All local stimulants have a chance of being useful where the dis- Local ai- ease is seated near the surface, or between the membranes and the "Eon"^ cranium, for they tend to excite the absorbents to an increased de- "iceabie." 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. Blister- ing 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 Evacuation success by a lancet: and, where the sutures gape very wide, and tL% tie the integuments are considerably distended, this remedy ought 1»ncet: always to be tried. The brain, however, like every other organ, tried" ° ■when it has been long accustomed to the stimulus of pressure, cannot eVvacuat0edbc suddenly lose such a stimulus without a total loss of energy ; and gradually, hence, as it is necessary in many cases of dropsy of the belly to and why" stop as soon as we have drawn off a certain portion of water in order to avoid faintness, it is found equally necessary to evacuate the water from the brain with caution and by separate stages ; for where the whole has been discharged at once, the sensorial ex- 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 operation, Operation i , •, • en v -a j« • does not indeed, is very tar from succeeding in every instance : for in some always cases there is so much internal disease or even disorganization, saun^Tehd; 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 perforation made, and even repeated and repeated again if a fresh flow of fluid jgp^cdcif should demand it: for the disease has occasionallv been found to necessary ■«- _ t- r>. several A o.T, V r—M times in success 260 cl. vi.] ECCRITICA. [okd.lt, Gen. I. Spec. III. Hydrops capitis. Dropsy of the head. Water in (he head. Treatment. Advanta- ges of this plan exem- plified from Vosc. Compres- sion re- commend- ed through the whole course of the dis- ease, but generally mischiev- ous. Tet may be of great use after evacuating the water. yield to a second or third evacuation, where it has triumphed over the first. Dr. Vose of Liverpool, has published an instructive case of tlu^ kind in the ninth volume of the Medico-Clnrurgical 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 orifice 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 extremely 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 bistoury about six weeks after, when eight ounces of fluid were drawn off with little constitutional disturbance ; which was succeeded only nine days later by a third operation, that yielded, by the introduction of a groved director, twelve ounces, without any interference with the general health whatever. A copious and vicarious discharge of serum from the rectum took place shortly alter 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 diminished in size, and a complete cure was at length effected. Formey,* Pitschel,! and several other writers, have recommended 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 injured 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 torpid 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 SPIN^E. DROPSY OF THE SPINE. SOFT FLUCTUATING EXTUBERANCE ON THE SPINE J GAPING VER- TEBRAE. Gen. I. This is the spina bifida of authors, so called from the double sprinaCwU' channel which is often produced by it through a considerable length fida of au thors, why £0 called. * Ad. Rivierii, Observ. Medic. Cent. v. t Auat. and CEir. Ajyneak. Presd. 1784. n. vi.] EXCERNENT FUNCTION [ord. it. 26? of the vertebral column : a natural channel for the spinal marrow, Gen. I. and a morbid channel running in a parallel line, and equally de- Hydrops"1' scending from the brain, and filled with the fluid which constitutes g»nas- the disease. theTpme. It is sometimes local, but in most instances is connected with a ^fdSeale morbid state of the brain, and directly communicates with it. In explained. this last form it may be regarded as a compound dropsy of this organ, the accumulating water working its way down towards the foramen ovale in consequence of its dependent position, or a defi- ciency in the substance of the brain in this quarter, instead of up towards the fontanel. In both cases the surrounding dura mater gives way, and, in the last, forms a sinus, which, as it descends, winds itself through any accidental opening that may exist in or between the bones of the vertebras, and distends the superincumbent integuments into the same kind of tumour 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 ^{J3^^. disease of fetal life ; in many instances, however, the tumour does but the tu- not show itself till some weeks, or even months, after the birth of aTeTmn6" the child. The degree of danger, as justly observed by Dr. Olli- show itself vier,* must depend upon the structural defect, or other mischief rnonfcaf- that exists in the brain or the substance of the spinal marrow. It g^^ea has sometimes appeared as a local affection in adult age, and has a local af- admitted of a cure ; but, from its usually occurring in the earliest aedc„°ts of and feeblest stage of life, and often before the sensorium is fully cure: ^ut developed, so as, indeed, to prevent its developement in a perfect connected form, it is rarely remediable. We observed in the last species that swe'rfO0s9ome the bones of the cranium are often found imperfect ; and it is hence mischief in not to be wondered at that the bones of the vertebras should exhibit aned hence a like imperfection in the present, and allow a protrusion externally. J^^g" Fieliz gives a case in which the whole of the spinous processes The whole were deficient, and the dropsy extended through the entire length {j^^l1" of the spine.! been found6 The integuments are here thinner and more disposed to burst than deficient. in the head, and hence, if the tumour be left to its natural course, ^?na^ it commonly continues to enlarge till it bursts ; while, if it be tion when opened, the child, in most cases, dies from exhaustion and deliquium, \a1erl7oSO as in dropsy of the head, provided the water be evacuated entirely ; itself. 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- h°™ f« thing, however, beyond support may be safely ventured upon, for a sion may gentle compression, answering the purpose of a truss, and giving bo usefu1- the support of artificial vertebrae, may be tried with propriety, and, * De la Moelle Espiniere, et de ses Maladies, &c. SvO. Paris, 1824. + In Richter, Chir. Bibl. Band. ix. p. 185. ri68 CL. VI, ECCRITICA. ! ORD. Li. Gen. 1. Spec. HI. Hydrops spins. Dropsy of the spine. Artificial adhesion of the sides of the sac. Has some- times ter- minated favourably under dif- ferent methods. Life has been pro- tracted during the disease to adoles- cence. if found to do no mischief, it should bc gradually increased. Sir Astby Cooper has also recommended a much bolder practice; that of endeavouring to procure an adhesion of the sides of the sac, so as to close the opening from the spine and to put a radical stop to the disease. There is here, however, much danger from con- stitutional irritation, yet this eminent and judicious surgeon is well known to have succeeded in one instance. 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 re- cord of a successful termination upon the employment of different me- thods. Thus, Heister, who in his day also recommended compres- sion, gives an example of its having radically yielded to this plan, in union with spirituous liniments ;* and Fantoni,! and Heilmann,| describes each of them, an instance of a perfect cure upon opening and evacuating the cavity. In all which instances, however, 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 Acrel notices others who survived till seventeen,§ but with paralytic sphinc- ters of the anus and bladder: and CoAvper speaks of one who at- tained the age of thirty. SPECIES IV. HYDROPS THORACIS. DROPSY OF THE CHEST. sense of oppression in the chest ; dyspnoea on exercise, or decumbiture; livid countenance; urine red and spake'; pulse irregular ; edematous extremities ; palpitation, and startings during sleep. Gen. I. Spec.IV. Hydrotho- rax of au- thors. Subdivi- sions of Sauvages. Hydrops mediastini, H. pleurse, H. pericar- dii, H. pul- monalis. 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 considerable number of species under it, derived from the particular part or cavity of the thorax which is occupied, or the peculiar nature of the effu- sion ; as hydrops mediastini, pleurae, pericardii, hydatidosus ; to which he might have added pulmonalis, as the water is, perhaps, * Wabrnehmung. B. II. t In Pacchioni Animadrers. cit. I Prodrom. Act Ham. p. 135. Morgagni De Sed. et Caus. § Schwcd. Abbancll. B. x. p. 291, seq. r.L. vi.] EXCERNENT FUNCTION. [oEJ>. u. 263 .sometimes effused into the cellular texture of the lungs. But as Gen- *• these can never, with any degree of certainty, be distinguished from nJfropSIV' each other till after death, and as such distinction could make no ^oracis. essential difference in the mode of treatment, it is unnecessary to the°che«t. notice them, and is scarcely consistent, with an arrangement founded ^gnsiodis- upon symptoms alone. Those who are desirous of examining into criminate the curious, and often contradictory signs by which these several each othS. forms of pectoral dropsy have been attempted to be discriminated by supposed. ,• * .. \ J • , , r-.-TT.«-i , . distinctive Various writers, may turn with advantage to Sir L. Maclean s work symptoms upon the subject, where he will find them selected with much patient u^d by" study, and accompanied with many judicious remarks.* In the Maclean. present place it may be sufficient to observe 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 conse- quence of cellular dropsy, it is in a greater or less degree common to the whole. Even the distinction of Avenbrugger into dropsy of Distinction one side, and dropsy of both sides of the chest, is of little practical brugger- importance. " It is," observes M. Corvisart in his comment on the f™™£'{;" Inventum novum, " a mere difference of quantity ;" and would, in Corvisart. his opinion, be better expressed by the terms partial and complete. The complaint originates with little or no observation and con- ^ncement tinues its course imperceptibly; there is at length found to be some of the dis- difficulty of breathing, particularly on exertion or motion of any ea kind, or when the body is in a recumbent position, usually accom- panied with a dry and troublesome cough, and an edema of the ankles towards the evening. Then follow, in quick succession, the Progress. symptoms enumerated in the definition, several of which I have drawn directly from my friend Sir L. Maclean's very accurate ar- rangement of them. The difficulty of breathing, becomes, at length, peculiarly 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 anx- iety, the livid hue of his cheeks is intermixed with a deadly pale- ness, 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 insensibility. The disease is often connected with some or- Often con- ganic derangement of the heart; and M. Corvisart conceives that withV several of the above symptoms only belong to it when such a con- faannic de" nexion exists, and the dropsy is merely symptomatic. He objects otf™m even to the signs of starting in sleep, anxiety of the praecordia, ina- now'iar bility to lie down, and irregular pulse :—which he affirms indicate s?me.ofr alone an anterior organic disease of the heart or large vessels, symptom's They are, nevertheless, symptoms which have so strikingly occurred Sced'by to myself in cases of idiopathic dropsy of the chest, as well as to Ms fact. great numbers of the first authorities in pathology, that I cannot con- cur with M. Corvisart in expunging them from tlie list of ordinary signs. I agree with him, however, in the remark that if the effusion Dj8til!c- be confined to one side, the side thus surcharged becomes more of thegiimi- tation of the disease ' Inquiry into the Nature. Causes, and Cure of Hydrothorax, p. 52—70, 8ro. 1810. l° °"c side. 2Y0 CL. VI.] rC'CRITICA. [ord. f~> Gr.w I. (Spec. IV Hydrops Iboracis. Dropsy of the chest. Use of per (Mission and medi- nte aus- cultation. In what s'age doubtful. Termina- tion. Causes ge- neral and particular. Hydrops Iiydatido- !3US of Pouvngcsi The only decisive sign, a fluctuation of water. rounded, and the intercostal spaces augment in size as the water accumulates ; while the edema of the extremities is confined to the same side. Percussion, and the use of the stethoscope are here of considera- ble importance in the earlier stages of the disease, though of little or none afterwards. A slight degree of percussion, with the hand applied to one or both sides, as the case may be, will develope a slight fluctuation as well as a sound more obscure than belongs to a state of health; and the stethoscope will manifest the latter sign still more distinctly. But when the cavity of the pleura is filled, or nearly so, whether on one side or on both, no sound whatever will be returned, nor fluctuation felt; and hence, though it will be ob- vious that the patient is labouring under some severe disease of the chest, we must have recourse to other diagnostics than these to as- certain its precise nature. For a brief description of the compara- tive value and mode of employing the two methods of percussion and mediate auscultation, the reader is referred to the treatment of phthisis in the third volume of this work.* 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 i.c hence, in some cases, of long continuance, while in others the patient 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 seine 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 num- ber 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 bc found in other complaints of the chest as w^ell as in dropsy, more particularly in asthma and empyema. And hence, in determining tho presence of this disorder, we are to look for them conjointly, and not to depend upon any one when alone. Even when associated, we are sometimes in obscurity : and the difficulty of indicating the disease by any set of symptoms has been sufficiently pointed out by De Haen ;t while Lentin,+ Stoerck,§ and Rufusll have given * Cl. in. Ord. iv. Gen. m. Spec. X In. Blumenbach Biblioth.in. I! A<1 River. Obserr. M<"1 t Hat. Med. P. v. p. 97. § Ann. Med. u. p. 266, u.. vi.J- EXCERNENT FUNCTION, [okd. u. 271 instances of its existence without any symptoms whatever: and Gen. I. Morgagni with a few or none.* Bonet observes that dyspnoea! is u'f^Jy' not an indication common to all cases, J and Morgagni, that startings 'horaci*. during sleep, or on waking, do not always accompany the disease, SffiS. and may certainly exist without it. Hoffman and Baglivi 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 most of the symptoms jointly, at the age of about sixty, and was sup- posed 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.§ The general principles to be attended to in the mode of treatment, Medical are the same as have already been laid down under hydrops cellu- General'"' laris: for, as already observed, the causes are similar, and only p,'^'108 varied by an accidental deposition of the morbid fluid in the chest, fail down. in consequence of a peculiar debility in the thoracic viscera, or of some organic misaffection ; and hence, Dr. Ferriar employed elate- Elaterium. rium, equally in both affections, and in the present disease with a degree of success that chiefly brought it once more into popular use. The squill is here a more valuable medicine than in most Squill pe- other species ; as, independently of its diuretic virtue, it affords valuable. great relief to the dry and teasing cough, and in some degree, per- haps, to the pressure of the fluid itself, by exciting the excretories of the lungs to an increased discharge of mucus. Digitalis, as in Fox-glove other species of the same genus, is a doubtful remedy ; its diuretic efficacy.' effects are considerable, but, however cautiously administered, it too often sinks the pulse, and diminishes the vital energy generally ; and is particularly distressing from its producing nausea, and endan- gering 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 attentively observed by every one who prescribes it. And under the following provision, which he immediately lays down, there can be no difficulty in consenting to employ it. " If these be carefully watched, and tlie medicine be cautionary withdrawn as soon as any of them are materially affected, I hesitate lfvl?e ot not to affirm that no serious inconvenience will ever ensue from it, during and that it may be administered.with as much safety as any of the Us usc' more active medicines in daily use."II 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. * De Sed. et Caus. Morb. Ep. xvi. Art. 2. 4 6. 8. 11. t Ep. cit. Art. 28. 30. } Sepulchr. Lib. H. Sect. I. Obs. 72. 84. § Nov. Act. Acad. Nat. Cur. Tom. iv. 4to. Noriinb. fl Inquiry into the Nature, &c. oi Hydrothorax, p. Hi, o^o Gen. I. Spec. IV Hydrops thoracis. Dropsy of the chest. Venesec- tion, in what cases ser- viceable. Rarely to be employ- ed in idio- pathic af- fections- Opium mostly in- jurious alone: but beneficial with squills or ipecacuan. External revellents. Paracen- tesis : of early origin. How cm- ployed by Hippo- crates. Objections to its use: mostly a mere pal- liative : uncertain of obtain- ing evacua- tion from various causes. CL. VI.] ECCRITICA. [ord. ii. The strong symptoms of congestion under which the heart seems, in some instances, to labour, have occasionally induced practitioners 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 ;| Zacutus Lusitanus to both, and employed it in connexion with diuretics and tonics.| 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 ad- vised that a small perforation should be made in one of the ribs, and that the trocar should enter through this for amen. § 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 uncer- tainty 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 duplicature of the mediastinum, or the cellular texture of the lungs, it is obvious that the operation must be to no purpose. And yet, 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 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 * Clinical Experiments, p. 346. * Prax. Admir. Lib. i. Obs. 112. t Opp. p. 10S. 5 TlsptEdmsIlaOm; Lib. I III. p. 544. cl.\«.J EXCERNENT FUNCTION. [oitn. u. 273 should have the good fortune to pierce the cyst by accident. And, Gem. j. in a few instances, again, the fluid, which has at all times a striking uj^t%iV' tendency to become inspissated, has been found so viscid as not to thoracis. flow : of which Saviard has given us a striking example* th^chesu A considerable pause is necessary, therefore, before tapping is ^een^e J° decided upon : nor ought it ever to be employed till the ordinary ed wTth°r internal means have been tried to no purpose. But where these An'd'oniy have been tried and without avail; and more especially where we aftet intet- have reason to ascribe the disease to local debility or some local dL'have obstruction rather than to a general decline of the constitution ; faiUd- 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 Trochar place of introducing the instrument is between the fourth and fifth applied'.0 e of the false ribs, about four fingers' breadth from the spine. Du Verney, however, recommends between the second and third, at the false ribs ; and, in different cases, there may be reason for even a greater latitude than this. • In a case in which all the precautionary steps just mentioned had preceded, and where a fluctuation was clear, Dr. Archer of Dublin drew off eleven pints at once by tapping, and the patient found in- stant relief, and was tolerably well for at least three years afterwards ; but whether the complaint then returned we are not informed.! On the Continent the operation of tapping is far more frequently More ire- tried than in our own country : and the German Miscellanies are 2sedonthe full of cases of a successful event. In the volume of Nosology I continent: have given an account of many of these ; in several of which the more nu- quantity of water evacuated appears to have been very considerable. ^J™^ a Thus, in one instance, a hundred and fifty pounds were discharged successful at a single time : in others, between four and five hundred pounds Quantity by different tappings within the year : and in a single example nearly of fl.uid . seven thousand pints, in eighty operations, during a period of twenty- often very five years through which the patient laboured under this complaint; enormoUB- 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. In the Berlin Cure effect- Medical Transactions there is a case of a cure effected by an acci- ag„t.y acci" dental wound made into the thorax by which the whole of the water escaped at once. J In a few rare instances we have reason to believe that the disease Disease has has ceased spontaneously, judging from the trifling remedies that Cea8eedmeB were employed at the time : as, for example, the specific of eighteen spontane- ounccs of dandelion juice taken daily, which, according toHautesierk, ou succeeded radically in one patient, or the use of small doses of squills alone, which, in the hands of Tisset, was equally fortunate in another. * Recueil d'Observations Chirurgiques, &c. Pari§, 1784. 1 Transact, of the King and Queen's College, Dublin, Vol. II. p. I t Act Med. Berol. Vol. x. Pec. i. p. 44. Vol. V.—35 274 cl. vi.; ECCRITICA. io:*'- " SPECIES \. HYDROPS ABDOMINIS. DROPSY OF TIIE BEIiLY. TENSE, HEAVY, AND EQUABLE INTUMESCENCE OF THE WHOLE BELLY : DISTINCTLY FLUCTUATING TO TIIE HAND UPON A SLIGHT STROKE BEING GIVEN TO THE OPPOSITE SIDE. Gen. I. This is the ascites of nosologists. It is sometimes a result of A?eueaef' general debility operating chiefly on the exhalants that open in the authors, internal surface of the sac of the peritonaeum and the abdominal variable*11 muscles : sometimes occasioned by local debility or some other diseaM.th° 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 of Atonic dropsy of the belly. the constitution. p Parabysmica, Preceded by or accompanied Parabysmic dropsy of with oppilation or indurated the belly. enlargement of one or more of the abdominal viscera. y Metastatica. From repelled gout, exanthems Metastatic dropsy of the belly. or other cutaneous eruptions. a h. afcdo- In the first variety, the fluid is found in the cavity of the ab- xtonicai domen, or between the peritonaeum and the abdominal muscles. It dropiy of ls Pr°duced by any of the causes of general debility, operating on the belly, an hydropic diathesis ; and is frequently a result of scurvy, or va- rious fevers. ^P'u^a- In the second variety, the organ most commonly aflected is rabysmica. the liver, which is occasionally loaded with hydatids, and has some- micadro" times weighed twelve pounds. The gall-bladder is often propor- of the tionally enlarged and turgid, and has occasionally been found with an obliterated meatus, full of a coffee-like fluid, and together with its contents has weighed upwards of ten pounds. The accumula- tion has also sometimes been discovered in the omentum,! or sides of the intestines.J In this second variety the disease is often de- * De Sed. et Caus.Morb. Ep. xxxvm. Art. 49. pt^|2Haen-Bat' Med* P* ,v'P*96* SenberUch,Pr. deHydrope Omenti Saccato * Frank, in Commentation. Goetlins:. vn. 14. ql.vi.] EXCERNENT FUNCTION. {ord.ii. 37* nominated an encysted dropsy ; a term, however, which will quite * H- *"<*<>- as well apply to dropsies of the ovaria, the Fallopian tube, and even «bS£ the uterus and scrotum, as to that of the liver. Parabys- In the thihd variety the fluid is commonly deposited in the Sfo.ef>p*y cavity of the abdomen ; and is far more easily removed than in JliTabdo- either of the others ; often yielding, indeed, to a few drastic purges "lina,l8 me" alone ; except where, as sometimes happens in metastatic dropsy MetMta'ic from repelled gout, the constitution has been broken down by a tEfi&g* long succession of previous paroxysms. Under the veil of dropsy, pregnancy has often been purposely Pregnancy: disguised ; and, sometimes, on the contrary, where pregnancy has und«aled been ardently wished for and has actually taken place, it has been dropsy, or mistaken for a case of ascites : while, in a few instances, both have for"u.ken co-existed : Mauriceau, indeed, mentions a case of pregnancy re- fo-exilteS curring a second time along with dropsy :* and in an hydropic dia- thesis there is a general tendency to the latter whenever the former makes its appearance ; for the exhalants of the abdomen are easily thrown into a morbid condition, and the pressure of the uterus, as it enlarges, weakens and torpefies their action. If dropsy occur at not always a period of life when the catamenia are on the point of naturally £n8/uis°hdis" taking their leave, and where the patient has been married for many ^tween years without ever having been impregnated, it is not always easy, from the collateral signs, to distinguish between the two. A lady Exempii- under these circumstances was a few years ago attended for several fied- months by three or four of the most celebrated physicians of this metropolis, one of whom was a practitioner in midwifery, and con- curred with the rest in affirming that her disease was an encysted dropsy of the abdomen. She was in consequence put under a very active series of different evacuants ; a fresh plan being had recourse to as soon as a preceding had failed ; and was successively purged, blistered, salivated, treated with powerful diuretics, and the warm- bath, but equally to no purpose : for the swelling still increased and became firmer; the face and general form were emaciated, the breathing was laborious, the discharge of urine small, and the appe- tite intractable ; till at length these threatening symptoms were followed by a succession of sudden and excruciating pains, that by the domestics, who were not prepared for their appearance, were supposed to be the forerunners of a speedy dissolution, but which fortunately terminated before the arrival of a single medical at- tendant, in giving birth to an infant that, like its mother, had won- derfully withstood the whole of the preceding medical warfare with- out injury. In all common cases, the best means we can take to guard against deception, are to inquire into the state of the menses, of the mammae, and of the swelling itself. If the menses continue regular, if the Ordinary mammas appear flat or shrivelled with a contracted and light- auunoti"© coloured areola ; and if the intumescence fluctuate to a tap of the of dropsy. fingers, there can be no doubt of its being a case of dropsy : but ehM«te« if. on the contrary, the mammae appear plump and globular with a distinctive Traite" tie* Maladies des Femmrs Grosses, 11. p. 59—204, preg- nancy. 216 CL. VI.] KCCRITIf A [OKI i. II. y H. ahdo- minalis mc tastaticn. Metastatic dropsy of the belly. Case truly distressing when the two unite. Scarifica- tion. Tapping. In what way to be performed. Ordinary causes of dropsy of the abdo- men, those of cellular dropsy. Why the present species pro- duced by these causes rather than cellular dropsy. Why more frequent. General symptoms. Peculiar symptoms. Signs of encysted dropsy, broad and deep-coloured areola ; if we can learn, which, in cases where pregnancy is wished to be concealed, we often cannot do, that the catamenia have for some time been obstructed ; and if the swelling appear uniformly hard and solid, and more especially it it be seated chiefly just above the symphysis of the pubes, or, provi- ded it be higher, if it be round, and circumscribed,—though we may occasionally err, there can be little or no doubt, in most instances, of the existence of pregnancy. The most difficult of all cases is that in which dropsy and pregnancy take place simultaneously. It is a most distressing combination for the patient; and is usually treated with palliatives alone till the time of child-birth. Chambon advises that in urgent cases the legs and feet should be scarified.* But sometimes there is danger of instantaneous suffocation from the rapidity with which the dropsy advances, and the disproportionate dilatation of the peritonaeum, the abdominal muscles, and the integu- ments. M. Scarpa has noticed such cases, and recommends im- mediate tapping, and that the trochar be introduced between the edge of the rectus muscle in the left hypochondrium, and the mar- gin of the false ribs ; in which situation it will run the least risk of in- juring the uterus.t The re-action, however, which takes place in the abdominal muscles and organs thus suddenly set at liberty, is apt to bring on labour-pains and consequently to produce a mis- carriage : and on this account the present author would recom- mend that the fluid should be drawn off at intervals, and not wholly at a single sitting. The ordinary causes of dropsy of the abdomen are those of cel- lular dropsy, of which we have treated at considerable length already, and to which the reader may therefore refer himself. The only difference being, as in dropsy of the chest, that the excernents of these cavities, are, from particular circumstances, more open at the time to the influence of whatever may happen to be the cause than the excernents of the cellular membrane, or of any other part of the system. From the extent, however, of the abdominal region, and the connexion of its cavity with so many large and important viscera, and especially with the liver, we can be at no loss in ac- counting for a more frequent appearance of dropsy under this spe- cies than under any other. The general symptoms, moreover, are those of cellular dropsy. The appetite flags, there is the same aversion to motion and slug- gishness when engaged in it, the same intolerable thirst, dryness of the skin, and diminution of all the natural discharges. The peculiar symptoms, as distinct from cellular dropsy, are the gradual swelling of the belly, and, as a consequence of this, a dry, irritable cough and difficulty of respiration. It is often as difficult to determine whether the water be seated in the cavity of the abdomen or in the liver, omentum, or any other cyst, as in making a like distinction in dropsy of the chest. But generally speaking, if we have previously had reason to suspect a * Maladies des Femmes. Tom. i. p. 28. 1 ^ulla Orfividaijza susseenita de Ascite. &c. Freriso. 1917. cl.vi.] EXCERNENT FUNCTION. [ord. ii. 277 diseased condition of any of these organs, if the abdominal swelling JpEIf- £ *, be local or unequal, and the constitution do not seem to enter Hydrops readily into the morbid action, and the remaining functions retain a abdominis. ill. ,-, iin i i Dropsy ol healthy vigour, we may suspect the dropsy to be of the encysted the beiiy. form. While, on the contrary, if the animal frame evince general gushed"" weakness, if the limbs be edematous, if the appetite fail, and the frorn dr°P" secretions be concurrently small and restricted, there is good reason cavity of for believing that the fluid is effused into the cavity of the perito- J^|n*bdo" naeum. The treatment of ascites, as to its general principles and plan, Medical must be the same as that already laid down for anasarca or cellular Tapping ' dropsy : but here, instead of evacuating the water by scarification, jcan*fica-an we can often very advantageously, and more easily than in any of the tion. preceding species, draw it off at once by tapping. Where, indeed, WateHs en- tile dropsy is of the encysted kind, our efforts will often prove in £ygredtio^e vain ; for we may either miss the proper viscus, or the fluid lodged often un- in the separate vesicles of a vast aggregation of hydatids, amount- BUCce3Bfu1, ing sometimes to seven, eight, or nine thousand at a time,* cannot be set free. But where it lies in the peritonaeal sac alone, or on B1uttnghe3ni. the outside of this sac alone, we can often afford very great relief tona;ai sac by this simple process, and sometimes an effectual cure. It ought, {^j-Jj"1/^ therefore, by no means to be delayed, as it often is, till the debility »° jj8 §«- from being local has become general, nor can the operation be too eaViy'in the soon performed after a fluctuation is distinctly felt, and the swelling de^eflauSctua-f" from its bulk has become troublesome to the breathing, and inter- tion is felt. feres with the night's rest. Nor should we be deterred if the first evacuation do not fully succeed. On the contrary, if the general £{££$£ strength seem to augment for some time after the operation, the require to appetite to improve, and the usual symptoms of the disease to ,erepeat diminish, we may take courage from our first success, and augur still more favourably from a second or even a third attempt if it should be necessary. Various cases have fallen to the lot of the author in "which a radical cure has only been completed in this manner : nor are instances wanting in which the patient has only 8nnaJnthat recovered after the twelfth time of operating. Hautesierk gives times. an instance of cure after sixty tappings within two years and a gJJ ^j^ half, in conjunction with a steady use of aperients and tonics :| in^° d and Martin, in the Swedish Transactions, relates another instance Thatf? of an infant of four years old restored ofter a second use of the trocar, in conjunction with a like course of medicines. The sup- ^rrobnadndbae^e port of a broad belt or bandage should always be had recourse to passed afterwards, which should be drawn as tight as the patient can bear tisht- it with comfort, for the pressure will tend to prevent a re-accumula- tion. In a few instances indeed, it has proved stimulant enough to excite the • absorbents into rapid action, and carry off the water without the operation of tapping.J Internal evacuants therefore, as far as the strength will allow, and tonic restoratives generally, should be called to our aid through the tions. * Commerc. Nor. 1731, p. 271. t Recueil, ir. t Has«tm, Anmiaire Medico-Cln'rnrgric&l. Internal evacoa- ?.'<$ cl.vl] ECCRITICA, Gex. 1. Spec. V. Hydrops abdominis. Dropsy of t lie belly, Treatment. The thirst may be quenched by an in- dulgence in subacid drinks. Allicea for ordinary food, and asparagus. Tapping does not always ra- dically suc- ceed : and why. But still useful as a palliative- Quantity evacuated sometimes enormous. Exempli- fied. Operation often re- peated on the same person. Exempli- fied. Has been carriad off sponta- neously. entire process of cure, as already recommended under hydrops ceiiuiaris. The thirst, which is often unconquerable, and the most distressing of all the symptoms, may be allayed, as we have already pointed out, by a free use of subacid drinks, the desire for which is by no means to be repressed, as the absorbents of the skin are always stimulated by the irritation of an ungratified desire to imbibe far more fluid from the atmosphere than any indulgence in drinking can amount to : as ordinary food, the alliaceous plants which give an agreeable excitement to the stomach, and at the same time quicken the action of the kidneys, will be found highly useful: and asparagus, which in an inferior degree answers the last of these purposes, may make a pleasant change in its season. After all it must be confessed that tapping is often employed with- out radical success, for the disease, under all its modifications, is too often incurable. Yet even in the worst of cases it has its advantage as a palliative ; and it is no small consolation to be able to procure temporary ease and comfort in the long progress of a chronic but fatal disease. The quantity evacuated by the operation of tapping has, in some instances, been enormous. It has often amounted to eight gallons at a time, and Dr. Stoerck gives an instance of twelve gallons and a half.* Guattani relates a case in which thirty pints of an oily fluid were, in like manner, evacuated by a single paracentesis. This disease was produced by an aneurismal affection,! and it shows great irregularity of action in the absorbent system : for while the absorbents of the peritonaeal sac were in the utmost degree dull and torpid, those of the surface were in a like degree irritable, and drank up all the animal oil from the cellular membrane, as well as all the moisture they came in contact with from the atmosphere. The operation has frequently been repeated forty or fifty times upon the same patient; and sometimes much oftener. In the Edinburgh Medical Communications is a case in which it occurred ninety- eight times within three years.J And in a foreign Journal of repute is another case in which the operation was repeated a hundred and forty-three times, though the total quantity evacuated is not given.§ Dr. Scott of Harwich performed the operation twenty-four times in only fifteen months, and drew off a hundred and sixteen gallons in the whole. || Occasionally, both abdominal and cellular dropsy have been car- ried off by a spontaneous flow of water from some organ or other. In the latter species most frequently by a natural fontanel in some one of the extremities, as the hand, foot, or scrotum.If In the former by a spontaneous rupture of the protuberant umbilicus, of which the instances in the medical records are very numerous :** And hence many operators, taking a hint from this spontaneous * Ann. Med. i. p. 149. t De Aneurismatibus. X Vol. iv. p. 378. § N. Samml. Med. VVahrnemunxen, B. in. p. 94. || Edinb. Med. Comment. Vol. vi. p. 441. 7 Riedlin, Lin. Med. 1696. p. 258.—Schenck, Lib. in. Sect. ii. Obs. 136. ex Hol- lerio. Obs. 140. 141. ** Desportes, Hist, de Malad. de St. Dominiques ii. 122.—Schenck, Lib. in. Sect. n. Obs. 147.—Forestus, Lib. xix. Obs. S3. cl. vi. j EXCERNENT FUNCTION. [ord.it. 279 mode of cure, have preferred making an incision into the umbilicus Gen- '; with a lancet to the use of the trocar. Paullini relates a singular Ay^S^' mode of operation, and which, though it completely succeeded, is abdominis not likely to be had recourse to very often. The patient, not ScTJiiy' submitting to the use of the trocar, had the good fortune to be Ha^h™"'' gored in the belly by a bull; the opening proved effectual and he cured by recovered.* dent."1 There are also a few instances of a subsidence of the accumula- sometimes tion upon a spontaneous efflux of some other kind ; especially of byTvica- blood, and chiefly from the hemorrhoidal vessels.! Where, indeed, ch°ars„dis* as has sometimes happened, abdominal or cellular dropsy, or both, Venesec-- have been produced from inflammatory oppilation, on suddenly Uon' catching cold, free venesection has proved the most effectual, and sometimes the only means of carrying it off, which in a few instances it has, with a general freedom of action to the kidneys, as well as to other organs almost instantaneously.^ SPECIES VI. HYDROPS OVARII. DROPSY OF THE OVARY. HEAVY INTUMESCENCE OF TIIE ILEAC REGION ON ONE OR BOTH SIDES : GRADUALLY SPREADING OVER TIIE BELLY ; WITH OBSCURE FLUC- TUATION. There is the same difficulty in distinguishing this disease from Gen« '• pregnancy as in dropsy of the belly : and, consequently, the same M*y be mistakes have occasionally been made. There is also quite as much mistaken difficulty in distinguishing it from the parabysmic variety of abdomi- nancyTor nal dropsy, especially when the liver is the organ enlarged and filled *fVabt?omi- with hydatids. Yet in this last case, the confusion is of less conse- nai dropsy. quence as the general mode of treatment will not essentially vary, cwe^ne** Pregnancy, when it first alters the shape, produces an enlargement mistake of immediately over the pubes, which progressively ascends, and when importance, it reaches the umbilicus assumes an indefinite boundary. In the fXhlix' atonic or common variety of abdominal dropsy, the swelling of the sisns °( belly is general and undefined from the first. And in dropsy of the D?Jin-nCy' ovary or ovaries, it commences laterally, on one or both sides, ac- f"nhl0nfs cording as one or both ovaries are affected. And itis hence of the dropsy of utmost importance to attend to the patient's own statement of the ths ovary" origin of the disease and the progressive increase of the swelling. It is generally moveable when the patient is laid on her back ; and as the orifice of the uterus moves also with the motion of the tumour, by passing the finger up the vagina, we may thus obtain another *■ Cent. ii. Obs. 10. t Saviard, Observ. Chir. Eugalemis, p. 150. F.dinb. Med. and Surg-. Journ. No. lxxi. Dr, Graham. 280 cl. vi.J ECCRITICA. 1°){U-"• Gen. I. Spec. VI Hydrops ovarii. Dropsy of the ovary.' Sometimes found in pregnant women: but more frequently in barren. distinctive symptom. Where there are several cysts in the ovary, we may perceive irregularities in the external tumour resembling, to the touch, those of scirrhus. This disease is sometimes found in pregnant women, but far more commonly in the unimpregnated and the barren. It is also met with in the young and those who regularly menstruate, as well as in those whose term of menstruation has just ceased. The accumu- lation of fluid is often here also very considerable. Morand drew Found also off four hundred and twenty-seven pints, within ten months ;* and young as Martineau fonr hundred and ninety-five within a year ; and from the wen as in same patient six thousand six hundred and thirty-one pints by eighty Quantity punctures within twenty-five years.t con^idara- The disease commences, and indeed often continues for years, bi«. without much affection of the general health ; yet it is insidious, tie observed and the constitution at length suffers and falls a prey to it. bufpreys Internal medicines have been rarely found efficacious, and when upon and tried must consist of those already noticed in the treatment of cel- lular dropsy. Tapping affords the same ease as in abdominal dropsy, and the operation is to be performed in the same manner. I had lately a lady under my care for six or seven years, who required the operation to be performed at first every six months, afterwards every three months, and at length every month or six weeks. She rose from it extremely refreshed, and in good spirits ; and often on the same evening joined a party of friends, and was sometimes present at a musical entertainment. In about six years, however, her health completely gave way, and she sunk under the disease. So little, however, is the general health interfered with for the first year or two, that the patient occasionally becomes pregnant, while the accumulation continues to increase, and often produces a living offspring. Sir L. Maclean has given an interesting case of this kind, in which there was not only an extensive dropsy, but an abscess of the ovary, and a discharge of pus as well as of water on tapping which was performed five times during a single pregnancy. The patient passed easily through her labour, but died within five months afterwards upon a bursting of the abscess into the peritonaeal sac. On examining the body, two pints of " a thick, brown, well digested pus were found to have escaped into the cavity of the abdomen, and three pints more in the ovarian sac. The" opening was large enough to admit of three fingers ; and the external surface of both the large and small intestines was found inflamed, and verging in some places on gangrene." This my learned friend ascribes to the influence of the pus that had escaped and was in contact with them :| but as the fluid is said to have been " well digested pus," the inflammation is, I think, more probably to be attributed to sympathy with the lacerated ovarium in its actual state of irritation from so large a rent, and so much larger an inflamed surface in its interior. at last un- dermines the gene- ral health. Medical treatment. Internal medicines. Tapping: Pregnancy occurring during tin existence of disease. Exempli- fied from Maclean. Fluid often lodged in cysts or hy- datids. The fluid is in this species also, sometimes lodged in a cyst, * Mem. de 1'Acad. de Chir. ii. 448. | Phil. Trans. 1784. p. 471. I Enquiry into the Nature, &o. of Hydrothorax, Appx. p. L 8yo. 1810. OC cl. vi.J EXCERNENT FUNCTION, [ord. ii. 281 casionally in many cysts, or perhaps hydatids, and there is great Gen-*• difficulty in ascertaining its exact situation, and consequently in Hydrops puncturing it, and especially in evacuating the water where there is °varii- more than one cyst. A distinguished and skilful friend of the au- the°ovIry. thor's not long since made an attempt on a lady, who had been ^t^uii affected with the disease for some years ; yet unfortunately not a Hence drop of serum ensued, but instead of it a pint of blood. The swel- f uuyl ff1' ling of the abdomen has since increased to an enormous size ; Punct™ins internal medicines have proved of little avail, and she has not con- fully. sented to another trial of the trocar. It was probably from an equal Hence the want of success that Tozzetti long since declared the opera- declared"1 tion to be of no avail ;* and that Morgagni denounced it not only ^J T0°ofettl as useless but mischievous.f La Dran endeavoured to effect a no use- permanent cure afterwards by incision and suppuration as in the CureICby in- radical cure for scrotal hernia. Other practitioners have used in- flamma- jections of port wine ; and others again have forced a tent into the wound made by the trocar, or some other incision, These have sometimes succeeded ; but a dangerous inflammation is too apt to follow, and occasionally death itself. J Dr. Percival relates a case Cure by of cure produced by vomiting ; in which a salutary transfer of ac- voimt,DG* tion seems to have taken place.§ Extirpation of the diseased ovarium was rather proposed than Extirpa- practised by the surgeons of the preceding century. De Haen p'osedbut regarded the operation as doubtful ;|| and Morgagni asserted it to obJ«ctedto. be impossible.IT L'Aumonier, however, chief surgeon of the Rouen hospital, successfully extracted the organ upwards of fifty years ago; and a few other practitioners have operated with a like favourable issue since : and especially in several parts of America. Thus Dr. Performed Smith, of Yale College, Connecticut, has completely succeeded in fuijy?88" removing the organ, notwithstanding the operation was impeded by numerous adhesions :** while Dr. M'Dowal of Kentucky has not only, in several cases, extirpated with a full restoration to health, a dropsical, or otherwise diseased ovary, but laid open the peritonaeum to a great extent for extirpating other morbid humours in the abdomen, ft * Osservazioni, &c. t De Sed. et Caus. Morb. Ep. xxxvm. Art. 68, 69, X Denman, Introduction to the Practice of Midwifery. Ch. in. Sect. xn. § Ep. II. p. 156. || Rat. Med. P. iv. c. iii. § 3. TT De Sed. et Caus. Morb. Ep. xxxvni. Art. 69, 70. ** American Med. Rec. 1822. It Edinb. Med. Journ. No. ixxxi. p. 250. Vol. V,—>: 2£2 cl. vj.T ECCRITIC A [OUD. U- SPECIES VII. Gen. I. SpecVU. Speeies rarely met with. Tapping may be tried but its success doubtful. Quantity of fluid •xeseds that of the last. Exempli- fied. Causes, progress and inter- nal treat- ment as under the last. HYDROPS TUBALIS. DBOPSY OF THE FALXOPIAN TUBE. HEAVY ELONGATED INTUMESCENCE OF THE ILEAC REGION, SPREAD- ING TRANSVERSELY ; WITH OBSCURE FLUCTl ATION. Tins species is not common. Dr. Baillie, however, among others, has particularly noticed and described it in his morbid anatomy, in a case referred to in the volume of Nosology. Its mode of treatment is that of dropsy of the ovary. Tapping may be attempted, but as the water lies frequently in the hydatid-vesicles or distinct sacs, success is doubtful. The quantity collected is for the most, part larger than in the ovarium. Munnik mentions a case in which the distended tube contained a hundred and ten pints of fluid ;* Harder one in which the fluid measured a hundred and forty pints ;t and Cypriani another that afforded a hundred and fifty pints at a single tapping.]" Weiss describes a case of complicated dropsy distending both the ovarium and the Fallopian tube.§ The causes, and progress, as well as general mode of treatment are those of dropsy of the ovary. Its chief distinctive symptom is the elongated line which the swelling assumes and the direction it takes towards the ileac region on tlie one side or on the other. SPECIES VIII. HYDROPS UTERI. DROPSY OF THE WOMB. HEAVY, CIRCUMSCRIBED PROTUBERANCE IN TIIE HYP0GASTKIUM, WITH OBSCURE FLUCTUATION ; PROGRESSIVELY ENLARGING, WITH- OUT ISCHURY, OR PKIiGNANCY ; MOUTH OF THE WOMB THIN AND YIELDING TO THE TOUCH. Gen. I. Sauvages makes not less than seven species of this disease. Hydrlm"' wmcn ne cans hydrometra, and which with him occurs as a genus. tr« of sau- The distinctions, however, are of too little account to call for such mfKith!?0 a subdivision ; and one or two of the spe-ic? have beer, by many roe: :: l'.;• „X... ; * J vaaMci: ; f Ap-.t,.- '.; 1 :■:. £ > jistola I : iain. cxhibeas 'stelus hciuar.i ii l? "^*2dl. t<.-~v: tnrser^.'ih.^Siolien Ktankhcii. «-■?. P.vr.' c>£. vi.] EXCERNEiVT FUNCTION [oed. n. 283 writers regarded as doubtful : particularly the hydrometra gravida- g^yjff rum, or dropsy of the womb during pregnancy.* Dr. Cullen con- Hydrops ' ceives it to be altogether unfounded, and hence makes the symptom J^ of of citra graviditatem a pathognomic character of the complaint, the womb. But to this subject we shall have to return presently. The disease is rarely however to be met with in the cavity of the uterus, and when this is the case the orifice is perfectly closed. It often is much more frequently to be found in a particular cyst, or the walls cysts: of an hydatid, or a cluster of hydatids, or between the tunics of the organ. Carron ascribes it in various cases to a debility of the Supposed uterus produced by a chronic leucorrhoea.! Other writers to the cause* stimulus of pent-up coagulated blood, sometimes assuming an en- cysted structure.^ It is for the most part the result of a scirrhous or some other morbid change in the organ, producing debility and occasionally fever. A membranous or cellular dropsy is the variety most commonly assumed, in which the uterus is sometimes distended to an enormous size, and the abdomen seems to be labouring under an anasarca. The water when in the cavity of the uterus, may often be evacua- ted by a canula introduced into the mouth of the organ ; and if tins should be prevented by a scirrhus, cicatrix, or tubercle lying over its mouth, a rupture of the sac in which the fluid is lodged may sometimes be produced by a violent shock of electricity passed through the hypogastric region, hard exercise, or emetics. A sudden fall has often had tlie same effect. Tozzetti relates a case of cellular dropsy of the womb which extended down the thigh and leg on one side ; and disappeared by a spontaneous discharge of the water from the cuticle of the leg affected.^ The uterus has also been said to be sometimes affected with dropsy in consequence of a conveyance of the water accumulated in the cavity of the abdomen in dropsy of the belly, into the uterine eavity by means of the fringy termination of the Fallopian tubes. Of this cause, however, there does not appear to be any satisfactory proof. " Yet I must confess," says Dr. Denman, " I have seen gome cases of water collected, and repeatedly discharged from the uterus in the state of child-bed, which I was unable to explain on any other principle."!! Possibly, in this last case, a better explana- tion might have been sought for in an irritable state of the vessels that throw forth the liquor amnii during pregnancy itself, and which, under this kind of stimulus, may have secreted it to excess. This, in effect, is the commonly supposed cause of a dropsy of J™?9/ oT the uterus while in a state of pregnancy ; which, however denied while in a by some writers, appears to be very sufficiently established, and to pregnancy be even capable of removal by the operation of paracentesis, ■cconnted LangioH and Lamper** recommend this mode of treatment, and Scarpa gives an instance of its curative effect. " In October 1808," Mode of says he, " my colleague Nessi successfully punctured the dropsical ™rpU8fix9*vrxa " inflo" Gen. II, " flatu distendo." It has often been made a question by what 0er^|r"cof means the air is obtained in various cavities, in which it is found in lerm. great abundance ; for we cannot always trace its introduction from in'various without, nor ascribe it to a putrefactive process. Fantoni found air ^ric9en. seated between the tunics of the gall bladder, and Hildanus in the trance can- muscles. " In one instance," observes Mr. J. Hunter, " I have dis- "od from*' covered air in an abscess which could not have been received from without. the external air; nor could it have arisen from putrefaction."* The by jP°i?im case is singular and well entitled to attention, but too long to be secrete"^ copied. From this and various other circumstances, Mr. Hunter from 'he. conceived the opinion that air is often secreted by animal organs, or {heCt>?ood. separated from the juices conveyed to them : and he appeals, in con- ^factsfn firmation of this opinion, to the experiments of Dr. Ingenhouz upon connrma- vegetables. I have not had an opportunity of reading these experi- opinion."'13 ments, but that such a sort of secretion exists in plants must be obvious to every one who carefully examines the inflated legume of the different 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 other facts the economy of numerous animals will perhaps answer the purpose J,™ thePs°me- much better, as leading us more directly to the point. The sepia derivable officinalis, or cuttle-fish, and the argonauta Nautilus, the ordinary r«ai ph>- parasitic inhabitant of which—for we do not know the animal that cuttlefish rears the shell,—has a very near resemblance to the cuttle-fish, and Nautilus. b.£ suspected by Rafinesque, and since determined by Cranch, is a species of ocythoe,j introduce air at option into the numerous cells of the back-bone, and thus render themselves specifically lighter whenever they wish to ascend from the depths of the sea to tfie sur- face ; 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 Sound or capable of supplying this organ with air, first for the pin pose of3.'^adsder 2bS cl. vi.j ECCRITICA. [ord. U. Gex.II. balancing themselves, and next apparently for that of raising Ihem- Emphyse- selyeg towards the surface. In all these cases the air thus introduced inflation. antj accumulated, appears to be a direct secretion : at least we dropsy. 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, Searched in an(j as a geCretion, Dr. Baillie was induced to regard the air accu- phys'em'a'- mulated in one or more emphysematous affections that occurred in t?oUnsfffeC" his practice.* niicroseo- Mr. Bauer has lately shown that a gas is constantly shooting forth menu'of1" in small bubbles from the roots of plants into the slimy papula? by tiieTrma- wnicn tnev are surrounded ; and that it is by this mean that the tion of ve- slimy matter becomes elongated, is rendered vascular, and converted down'or into hair or down. Mr. Brande has also shown that gas, meaning hair. hereby carbonic acid gas, exists in a considerable quantity in the menu'of blood while circulating in the arteries and veins, and is very largely bhTod1,8 °" poured forth from blood placed, while warm, under the receiver of showing the an air pump, so as to give an appearance of effervescence. He airln'thu0 calculates that two cubic inches are extricated from every ounce of fluid. blood thus experimented upon, the venous and arterial blood con- niation of taining an equal proportion. And Sir Everard Home, has hence these8facts? ingeniously conjectured that it is by the escape of bubbles of this gas through the serum, in cases of coagulated blood, that new ves- sels are formed, as also that granulations are produced in pus; from which it appears that the same gas escapes with equal freedom. Preceding These results of Mr. Brande, are in perfect accordance with the ofPHaieents well known experiments of Dr. Hales and Baron Haller, upon the connmecT' same subject, which of late years appear to have been too much by those of neglected, if not discredited. The former asserts that in distilling blood, I)avy' a thirty-third part of the whole proved to be air : and the latter con- firms the assertion ; " utique," says he, " fere trigesima tertia pars totius sanguinis verus est aer." The inquiry has since been fol- lowed up by Dr. Davy, who has not only confirmed many of the same results but given an accurate analysis of the air thus, in various cases, accumulated.! From all which we may reasonably conjec- ture that the body of air found in many cases of, perhaps all, the species emphysema, is produced, like other fluids found in the dif- ferent cavities of the animal frame, by a process of secretion. These species are three, and are as follows : 1. emphysema cellulaee. cellular inflation. 2.--------ABDOMINIS. tympany. 3.--------UTERI. inflation of the womb. There are probably many others—but these are the only one>- which have been hitherto distinctly pointed out. * Transact, of a Society for the improvement of Medical and Chirurgical Know- ledge. t Observations on Air found in the Pleura, &c, Phil. Trans. 1823. vi.. vi.J EXCERNENT FUNCTION. |ukd. ii. 269 SPECIES 1. EMPHYSEMA CELLULARE. CELLULAR INFLATION. 1'ENSE, GLABROUS, DIFFUSIVE INTUMESCENCE OF THE SKIN, CRACKLING BENEATH THE PRESSURE OF THE FINGER. This is the pneumatosis of Sauvages and Cullen, and consists in Gen. II. a distention of the cellular membrane by air instead of by water, as The pneu' in hydrops ceiiuiaris or anasarca. The distention is sometimes mat°9'8 of J r some un- limited to particular parts of the body, and sometimes extends over ters. 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 : but 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, with Traumatic Emphysema. sense of suffocation. f3 A veneno. From fish-poison or other venom ; Empoisoned Emphysema. with extensive signs of gangrene and putrescency. For the first of these varieties there is no great difficulty in £reE4 ^J? accounting. If a wound so far penetrate the chest as to enter any nere tho- part of the lungs, and divide some of the larger branches of the TrCaumalic bronchiae, the inspired air, instead of being confined to its proper ^"y*- channels, will rush immediately into the chest and fill up its whole pathology. cavity; as it will also frequently 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 Description. 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 pur- pose ; his cheeks are livid, his senses soon become stupefied, the heart palpitates violently, the pulse is rapid but small ; and, without speedy relief, death must inevitably ensue. The distress is more- over sometimes aggravated by the excitement of a cough, m the fits of which, if any considerable blood-vessel have been burst, blood is expectorated along with the rejected mucus. It is this form of em- [;;~ (. physema which constitutes the pneuma-thorax of Itard and Laennec, i,ard and or the pneumato-thorax, as it is more correctly called, of Dr. John {;^™eaCu, Daw, who has described two cases in which the communication ii. >r»x or 290 CL. VI.] KC CRITIC A. [ord. ii. Gen. II. Spec. I. a E. cellu- lare A vul- nera tho- racis. Traumatic emphyse- ma. Exempli- fied by n singular seeins to have been produced by a suppurated tubercle that formed an opening from some branch of the bronchia; into the sac of the ease pleura. Mr. Kelly, in the Edinburgh Medical Commentaries, has given a very singular case of this affection from a like cause in which the inflation extended widely over the body. The patient, almost fifty- seven years of age, had long laboured under a chronic cough and diflicultv of breathing. The emphysema began to appear on the second day after a most violent fit of coughing, laborious respira- tion, and pain in the side. It soon 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 con- ceived that air had entered from without into the cellular membrane by means of some wound in the side ; but no such injury or any other channel of communication could be discovered. The symp- toms, however, were so 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 conse- quence tapped ; when upon withdrawing the perforator, such a blast of wind issued through the canula, as to blow out a lighted candle three or four times successively. The patient immediately became easy and free from oppression, and his pulse fell from above a hun- dred strokes in a minute 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 otherwise. 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 pain in 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 ;t in a very putrid diseased state, with some tubercles on the external surface of the right lobe; there was extensive adhesion to the pleura, particularly at the place where the pain had been felt most keenly before 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 conjec- ture 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 he perform- chest, by an artificial opening, the operator cannot do better than commended follow the example of Mr. Hewson who employed a scalpel, and by Hewson. introduced 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 ca.s<. Explana- tion of the ahove I'araceii'e hi. how to * riiil. Trans. 1823, ut supra. f Edin. Med. Comment. Vol. n. p. 4"l~. cl. vi.] EXCERNENT FUNCTION. [ord. n. 291 because here the integuments are thin ; and between the seventh Gen. ii. and,eighth, or the eighth and tenth in the latter, for the purpose of PEC' " avoiding the pericardium. The inflation which follows so suddenly and so extensively in the s e. ceiiu- . i • . i • n n . • • ^.lareave- second variety, or upon the introduction of fish-poison, or that of nono. several species of the mushroom or numerous other edible venoms ^"'"e. into the stomach, it is not so easy to account for. In most of the ma from cases there is so violent and general a disturbance of every function, Ge'nerai as to produce extreme and instantaneous debility ; all the precursors description. of putrescency are present, and speedy dissolution is threatened. 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 Production body have a power of secreting or separating air from the blood, as plained and we have endeavoured to show in the introductory remarks to the ^counted present genus, how much more readily may we suppose such a sepa- ration to take place in proportion as the organs approach that pre- cise state in which the gases of the blood extricate themselves spon- taneously 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 aromatics. In few words, we never cease to find a free extrication of air Hence gan- whenever the body or any part of it is running rapidly into a state cause of of putrefaction : and hence another cause of cellular emphysema, """,]" and a cause that is perpetually occurring to us in gangrene. scma. SPECIES II. EMPHYSEMA ABDOMINIS. TYMPANY. TENSE, LIGHT, AND EQUABLE INTUMESCENCE OF THE DELTA" ; DIS- TINCTLY RESONANT TO A STROKE OF THE HAND, Tins disease is the tympanites of authors, so called from the Gen.ii. drum-like sound which is given on striking the belly with the hand. y*™'JJ' There have been many occasions of observing that the Greek panites of termination itis or ites, is, for the sake of simplicity and perspicuity, au confined, in the present system, to the different species of a single <*onus of disea^s, that of nrpiirsitA. of which we have treated 292 cl. vi.J KCCIUTICA. ORD. H ma abdo- minis. Tjmpany. Tympa- nites intes- tinalis of Sauvages. -the only as an idio- pathic af- O'Ction. Spec li' a,rcaJy :* aml ,icncc^ as wel1 as f°r oluer reasons sufficiently ob- Emphyse-' vious, 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 of'cluai|1',es tenti°n 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, in which interrupted. In this view of the case, however, tympany, instead of Sfoe°Jeeii a being entitled to the rank of a distinct genus, is nothing more than a tomeo7mp" svmPtom or sequel of some other enteric affection, as dyspepsy, some other colic, worms, or hysteria: and hence the remedies applicable to a(rcct.on. thege afe w]ia(. j^. Cullen recommends for tympanites—namely. avoiding flatulent food, laxatives, and tonics. The dis- Mr. John Hunter seems to have conceived that a tympany of the rx^Vas7 stomach or intestines may exist as an idiopathic complaint. " I am ™"$™ref 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 secre- tion. 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."! 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 distentions voluntarily, which it is difficult to account for except by a voluntary power of secreting air for this purpose, or forcing it down the esophagus, which will be still less readily allowed. Mor- gagnij 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 peri- tonaeal 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 ascertained, its cure must be attempted by the remedies for flatus of any other kind : but at present the only disease we can fairly con- oniy known template as entitled to the name of tympanites, or emphysema aiXminiiT 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, u from several dissections it is unquestionable that such a dis- ease has sometimes truly occurred: nor can we suppose such accu- Opinion supported by facts, and the opinion of other pa- thologists. The ques- tion not fully set- tled : and hence the that exist- ing in the Bac of the peritonae- um. Even this a rare dis- ease, hut stated'to have oc- curred hy high au- thorities. * Vol. II. Cl. in. Ord. n. Gen. vn. p. 252. t Ou the Animal Econom. p. 206. 4to. 1792. I De Sed. et Caus. Morb. Ep. xxxviu. Art. 23.—Collect. Soc. Med. Havn. n. p. 73. Jf Litre, Mem. de l'Acad. des Sciences, 1713. p. 235. < l. vi.J EXCERNENT FUNCTION. [ord. ii. 293 rate and cautious pathologists as Heister,* Lieutaud,t and Bell,} Gen- w- who have respectively given examples of it, to have been successively jf^'J.1, deceived upon the subject. Admitting it to be produced by secre- ma "Mo- tion, its occasional causes are still very obscure. It has been said Tympany. 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 Ordinary air from the umbilicus by an outlet produced by an abscess or ulcera- curean es- tion of this protuberant organ, or a sudden and fortunate rupture of C?P£ °[nthe its integuments. Morgagni and several later writers§ give us well accidental authenticated cases of an occurrence of the first of these, and wUhjchhns Stoerck of both.|| We are thus led by nature herself to try the occ.urred in effects of tapping, or making an artificial opening into the cavity of ways. the abdomen in the case of wind-dropsy, as well as in that of water- ^ng^'Jj-^ dropsy : and here, from the protruded state of the umbilicus, the and the lancet may conveniently be introduced at this point. The belly may'be"3 should, at the time of the operation, be well swathed with a broad B"5,lctuJed" girth, which %iay be tightened at option, and should be kept as tight the time to as the patient can bear it, as well for the purpose of general support be 8wathet! as for that of expelling the air within, and preventing the entrance of air from without. Van Swieten dissuaded his pupils from this operation ;1T and Operation Cembalusier,** and a few others have since asserted that it does not vTn°Swie-y answer. But in most of these cases we have reason to believe that 'ej| *nd the seat of the disease was mistaken, and that the flatulency existed not an- in the intestinal canal rather than in the peritonasal sac. "uTproVa- Antecedently, however, to the operation of the paracentesis, we b'y toe may try the effect of sending shocks of the electric aura through dfsaea°se the abdomen. Cold fomentations, moreover, or even pounded ice [™^ken may be applied externally, and gelid drinks, reduced nearly to the cases re- freezing point, be swallowed copiously at the same time. This plan shocks°of is said to have answered occasionally.tt And it is obvious that a electricity, *i • i i •. .• j coldfoinen- tonic regimen, with free exercise, and particularly equitation, and, unions, where it can be had recourse to, sea-bathing, should be entered fc°"anedd upon as soon as the tympany is dispersed. gelid There is a\ singular case of flatulent distention inserted in the compiica- Edinburgh Medical Essays, by Professor Monro, which is called a Nominal tympany, but does not seem to have been exterior to the intestinal inflation, canal ; and hence, if a tympany at all, must have been produced by reUntiyPi!ot a a secretion of air into the stomach or bowels, as conjectured by Mr. J^1 ^™; J. Hunter. The patient was a young woman aged twenty-two. lated'by The inflation continued for at least three months, the belly being Monro' sometimes so extremely distended as to endanger its bursting, and sometimes considerably detumefied, at which last period a variety of * Wahrnehmungen. 1. Art. 15. t Hist. Anat. v. p. 432. I On Ulcers and Tumours. Vol. n. i> Guisard, Pratique de Chirurgie. Tom. i. p. 134. || Ann. Med n. p. 190. 193, 194. IT Ad Sect. 1251. ** Pneuraatopathol. p. 603.—Dusscau, Journ. de Med. 1779. If Theden, N. Bemerkungen und Erfahningen, n. p. 25L 2Q4 cl. vi.j ECCRITICA. [ord. ii. Gen. ii. unequal and protuberant balls were felt all over the abdomen, and EmEhC'J-' seemed to indicate so many inteslinal constrictions. The patients maabdu- appetite continued good, she was vcrv costive, and menstruated only Tympany, at intervals of several months. She was at length attacked with borborygmi, and a day or two afterwards had such explosions of wind xm x«< kxto>, 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 srraiiuallw* SPECIES III. EMPHYSEMA UTERI. rVFL.ATJ.ON OF THE lVoiHB. LIGHT, TENSE, CIRCTTVISCRIKED PROTUBERANCE IN TIIE HYPOGAS- TRICS ; OBSCURELY SOXOPOUS ; WIND OCCASIONALLY DISCHARGED THROUGH THE MOUTH OF THE UTERUS. Gen. II. This is the physoinetra of Sauvages and later nosologists. Like ThTpiiyen- tne last species, it is by no means a frequent complaint, and not easy metra of to be accounted for except upon the principle of a secretion of air ; An unfre- and hence the existence of this species as well as of the last has Suint and" Deen denied by several writers who do not happen to have met with hence'de- examples of it. The description given of it is somewhat obscure some wn- in most of the pathologists, but there seems, upon the whole, suf- fers, ficient reason for admitting it into the list of morbid affections. Description " It has been said," observes Dr. Denman, " that wind may be y iirnan. co|iec{ecj arRj retai,ie(j in the cavity of the uterus till it is distended in such a manner as to resemble pregnancy, and to produce its usual symptoms; and that by a sudden eruption of the wind, the tumefaction of the abdomen has been removed, and the patient immediately reduced to her proper size. Of this complaint I have never seen an example : but many cases have occurred to me of temporary explosions of wind from the uterus which there was no power of restraining."t History of The uterus is one of those organs referred to under our last accuratefy species, as supposed by Mr. John Hunter to have a power of sccre- examined ting or separating air from the blood : and as he has examined the Hunter. subject with critical accuracy in direct reference to the present com- plaint, his remarks are particularly entitled to our attention. " 1 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 esca- ping 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 cxtraordi- * Edin. Med. Essays. Vol. i. Art. xxxi. t Introduction to the Practice of Midwifery. Chap. in. Srri. y. cl.vi.] EXCERNEXT FUNCTION. [ord. n. 295 nary, made me somewhat incredulous ; but rendered me more inqui- Gen. ii. sitive in the hope of being enabled to ascertain and account for it: imphyse-' and those of whom I have been led to inquire, have always made the ™nfla"^'of natural distinction between air passing from the vagina and by the the womb. anus : that from the anus they feel and can retain, but that in the vagina they cannot ; nor are they aware of it till it passes. 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 between the vagina and rectum, and was allowed to examine, but discovered 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 op- portunities of inquiring of a number of women concerning this cir- cumstance, and by three or four have been informed of the same fact, with all the circumstances above mentioned."* The only difficulty in the case is the means by which air can thus % what become accumulated in the cavity of the uterus ; for admitting this air becomes fact, of which there can no longer, I should think, be any doubt, we PentuP- • i . ,. „J . Byspasm, can easily conceive a distention to the utmost power of the organ in or a coagu- consequence of an obstruction of the mouth of the womb from bioodfor spasm, a coagulum of blood, or any other viscid material. And other vis- hence, in all the cases of this disease which have descended to us, rial seated we find such a closure described as existing whenever the organ has ^0l^h of been examined. Thus, in the instance related by Eisenmenger,t lhe womb. we are told that the uterus was completely impervious ; and a like us ra e ' account is given of a similar instance recorded in the Ephemera of Natural Curiosities. PalfinJ gives a case in which the obstruction proceeded from an hydatid cyst that had fixed at the mouth of the uterus, and Fernelius§ another in which the obstruction, and con- sequently the inflation, returned periodically. Dr. Denman intimates Pains, that this affection is sometimes accompanied with spasmodic pains, those of"§ resembling those of labour ; and the same remark will apply to dropsy labour, of the womb which so much resembles it. The fact is that the counted for uterus, when once enlarged by whatever means, and stimulated, has a natural tendency to run into a series of expulsory exertions-in order to free itself from its burthen, and to excite all the surround- ing 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 : ^"atment. and hence the mode of treatment in the disease before us is obvious. As an occasional discharge of wind from the vagina affords tempo- rary ease, we should take a hint from this effect : and endeavour, first, to evacuate the confined air entirely, by a canula introduced into the os tincae; and secondly, to invigorate the weakened organ by the use of some tonic injection, as a solution of catechu, alum. white vitriol, or diluted port wine. * Animal Economy, p. 406. 4to. 179-2. t Collect. Historia foetus Mussi-pontani, &c. X Description des parties de la femme qui servent n la generation. Leid. l'OJ- !j Patholog. Lib. iv. Cap. .w. 296 ECCRITICA. [ORD. *». GENUS III. PARURIA. MISMICTURITION. MORBID SECRETION OR DISCHARGE OF URINE. Gen. III. Origin of generic term. Range of the divi- sion. Dysuria, why not employed. The term paruria is a Greek derivation from vupx, perpcrain . and ov%ta, " mingo." The genus is intended to include the ischu- ria, 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 widely different parts of the general arrangement. Thus, in Cullen, dia- betes 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 paruria, 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 : 1. PARURIA INOPS. 2. ------- RETENTION1S. 3.------- STILLATITIA. 4. —-----MELLITA. 5,-------INCONTINENT, 6.------- INCOCTA. 7. ------- ERRATIC A. DESTITUTION OF URINE. STOPPAGE OF URINE. STRANGURY. SACCHARINE URINE. INCONTINENCE OF URINE UNASSIMILAT ED UR1 NE. ERRATIC URINE. General character of the species. 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 :Vorn 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 In have for its object a separation of the excess of azote from the b!n.,roc that is thus thrown upon us: and, as the excretories of the skin and Diapho- of the kidneys are so perpetually assisting each other^ in almost every te,ics' way, excite the former by active diaphoretics to take upon them- selves for a time the office of the latter, and carry oftthe urea that should be discharged by the kidneys. We shouid next endeavour to restore the' kidneys to their natural Diuretics action by gentle stimulants or diuretics, as the alliaceous and sili- quose plants, especially horse-radish and mustard, the aromatic resins 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 cantharides, or the spirit of nitric ether. Stimulants may, at the same time, be applied externally as the stimulants. hot-bath, or strokes of the electric or voltaic fluid passed through the loins ; to which may succeed rubefacients and blisters. In the mean while the alvine canal should be gently excited by Aperients. neutral salts ; and juniper-tea, broom-tea, or imperial, may alter- nately form the common drink. The juice of the birch tree (betula Diuretic alba) will often, however, prove a better diuretic than any of these. ai>ozen,s- It is easily obtained by wounding the trunk, and when fresh is a sweetish and limpid fluid, in its concrete state affording a brownish 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 ha? a fair claim. ECCRITTCA. ORD. Jl. SPECIES II. PARURIA RETENTIONS. STOPPAGE OF URINE. URINE TOTALLY OBSTRUCTED IN ITS FLOW : WITH A SENSE OF WEIGHT OR UNEASINESS IN SOME PART OF THE URINARY TRACT. Gen. III. This is the ischuria of many writers, and though, like the preceding Thelschu- species, it is equally without a flow of urine, it differs very widely riaofma- from it in other circumstances. In paruria inops the excretories of i/ow^is0-™' the kidneys are inactive, and, consequently, no urine is produced. frorr!"theed ^n tne sPecies before us the secernents possess an adequate power, preceding 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. Renal stoppage of urine. & Dreterica. Ureteric stoppage of urine. y Vesicalis. Vesical stoppage of urine. ^ Urethralis. Urethral stoppage of urine. o P. reten- tionis re- nalis. Renal stoppage of urine. Causes. Progress of the disease. Sometimes suppurates. Pain and sense of weight in the region of the kidneys, without any swelling in the hypogastrium. With pain or sense of weight in the region of the ureters. With protuberance in the hypogastrium ; frequent desire to make water ; and pain at the neck of the bladder. With protuberance in the hypogastrium ; frequent desire to make water; and a sense of obstruction in the urethra, re- sisting the introduction of a catheter. Obstruction of urine may take place in the kidneys from a variety of causes, as spasm, calculous concretions, inflammation or abscess ; and the tumour or swelling which occurs in any of these states, may be so considerable as to prevent 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 kidneys, however, lie so deep, and from their minuteness are so completely buried in the loins, that the intumescence which pro- duces the obstruction is often imperceptible to the eye, or even to the touch. At times, however, the organs become 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 * Cabrol. Obserr. p. 28. ol. vi.] EXCERNENT FUNCTION. [ord. n. 301 little inflammation, proceeds gradually, and does not enter into a sup- Gen. hi. purative state, the organ not unfrequently becomes much more «fp";".' enormous, and has sometimes been found to weigh from thirty-five tionis fe- te-forty pounds.* a In this condition there is no difficulty in conceiving a total ob- '^mme struction to the flow of the urine even when elaborated in sufficient sometimei abundance. But the kidney, on the contrary, sometimes wastes Jarabys- away, instead of enlarges, and this so much as to become a shri- j^etiin veiled sack, and not exceed a drachm in weight; and as the sinus wastes"1 of the kidney contracts with its body, the organ at its extreme point away< is sometimes found imperforate : and hence how small soever may be the quantity of fluid which in this morbid condition may be sepa- rated 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 B p reten- may be as numerous and nearly of the same kind as when the kid- .^ic'a.'116' neys are at fault: for here also we occasionally meet with calculous Urete^c concretions, inflammation, and spasm : to which we may add gru- urine/86 ° mous blood, viscid mucus, and a closed orifice in consequence of ^nTas'in Ulceration. the prece- Vesical retention of urine is produced by inflammation, pres- rimyva sure upon the neck of the bladder, irritation, or paresis. Pressure y.p-.reten- upon the neck of the bladder may be occasioned by distention of the sicaiis. rectum from scybala, or other enterolithic concretions, flatus, in- ^ppiage of flammation, or piles ; or by distention of the vagina from inflamma- "rine- tion, or a lodgment of the menstrual flux in consequence of an im- perforate hymen. Irritation may be excited by a calculus, or too Voluntary long a voluntary retention of urine, as often happens on our being so uer^on oF closely impacted in large assemblies or public courts, or so power- fully arrested by the interest or eloquence of a subject discussed in such places, that we cannot consent to retire so soon as we ought: whence the sphincter of the bladder from being voluntarily, becomes at length spasmodically, constricted, and the urine cannot escape. It sometimes happens under the last circumstance that, from the pres- Bladder sure of the urine against the sides of the bladder, the absorbents are .^"^3 stimulated to an increased degree of action, and a considerable por- relieved by tion of the surplus is thus carried back into the vessels, and perhaps abaorpUon- thrown off by perspiration, so that we are able to remain for a very long term of time after the bladder has become painful from over- distention. Atony or paralysis of the bladder by which its propulsive power Atony of is destroyed, is a frequent cause ; whence, as Saviard has observed, ^ea cause" it is often met with in paraplegia :f and, as Morand remarks, on in- juries to the spine. J And hence, I have occasionally found it an at- tendant upon severe and long protracted attacks of lumbar rheuma- tism :§ as most practitioners have probably done on injuries to the kidneys, ureters, urethra, prostrate gland, or penis. It is said, Repelled eruptions * Commerc. Liter. Nor. 1731. p. 32. 1737. p. 326. t Observ. Chirurgiqnes. J Vermichte Schriftcn, B. n. *> See also Snowden, in the London Medical Journal 3U2 cL. vi.] ECCRITICA. L°1{U- "■ Gen. HI. Spec. II. y P. reten tion is ve- sicilis. Vesical stoppage of urine. irritation of teething. 0 P. reten- tions ure- thralis. Urethral Stoppage of urine. Causes. Danger from re- tained urine at all limes two-fold. Retention has some- times last- ed long without evil: ac- counted for. Instance of vicarious discharge by skin: by the sto- mach : nostrils: Quantity ret nued sometimes very con- siderable. moreover, 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 ; thougii I have witnessed it in infancy from the irrita- tion of teething where dentition has been attended with difficulty. In urethral retention of urine, the causes do not essentially vary from those already noticed ; such as inflammation, the lodg- ment of a calculus , viscid mucus; and grumous blood. To which are to be added the ligature of a strangulating phimosis ; irritation from a blennorrhea 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 con- tinued 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 dis- tressed 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. Tne retention, however, has occasionally continued for a con- siderable period without mischief. It has lasted from a week to a fortnight.J Vlarcelius Donatus gives a case of six months' stand- ing ;§ and Paullini another of habitual retention.il But in all these an observant practitioner will perceive the two following accompa- niments : firstly, a constitutional or superinduced hebetude of the muscular coat of the bladder so as to indispose it to inflammation ; and secondly, a resorption of the urinary fluid, and its evacuation by some vicarious channel, as already remarked under paruria inops. We have there stated that the two most commonly substituted out- lets are the excretories of the bowels and of the skin. Dr. Percival gives an instance of the latter in which the perspirable matter was so much supersaturated with the ammoniacal salt of 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. M Sometimes it has been thrown out from the stomach in- termixed with blood, in the form of a haematernesis ;** and some- times from the nostrils with the same intermixture in the form of an epistaxis.tt 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.JJ 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. Vikio in the Journal de Medicine, in which it equalled six- teen pints. * Morgagni, De Sed. et Calls. Morb. Ep. XM. Art. 4. t Nov. Act. Nat. Cur. Vol. v. Art. 68. X Eph. Nat. Cur. passim. Cornar. Obs. N. 21. § Lib. iv. cap. 27, 28. || Cent. n. Obs. 26. H Edin. Med. Com. Vol. v. 437. "♦Act. Nat. Cur. in. Obs. 6. tt Eph. Nat. Cur. Dec. n. An. iv. Obs. 63. XX Petit, Traite, &c. ffiuvres Posthumes, Tom. in. p. 2. See also Spec. mi. r. the present Genus, p. erratir.a. cl. vi.] EXCERNENT FUNCTION. [ord. ii. 303 In all the varieties thus pointed out the mode of management Gen. hi. must be regulated by the cause as far as we are able to ascertain it. par(l>Ci re- If we have reason to believe the suppression is strictly renal from Jfntiunw. the symptoms just adverted to, and particularly from ascertaining of urine. that there is no water in the bladder or ureters, in most cases, proems' whether it proceeds from inflammation or stone, we shall do right Treatment to employ relaxants, and mild aperients : and, where the pain is vio- stoppage of lent, venesection succeeded by anodynes. But it sometimes hap- unne- pens that the obstruction is produced by a parabysmfo enlargement or coacervation of the substance of the kidney without inflammation. 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 be- come a substitute for the diseased, and perform double duty ; and we may here attempt a resolution of the enlargement by minute doses of mercury continued for some weeks, unless salivation should ensue, and render it necessary to intermit our practice. A mercu- rial 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 J/6*,™*"^ obstruction is confined to the ureters. The passage of a calculus stoppage of is the chief cause of this variety of retained urine : and, independently unne' of the sense of pain and weight in the region of the ureters 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 re- laxants are here the chief, if not the only, means we can rationally employ ; 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 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 cretensis or wild-carrot, had a wider and better founded fame, both as a diuretic and lithontriptic. Dr. Cullen employed them for the latter purpose but without success. The suppression is seldom total; for the opposite ureter is rarely so much aflected by sympathy as to be spasmodically contracted, and equally to oppose the flow of the urine. The most common variety of this disease isJhat of vesical re-Treatment tention, or a retention of the water in the bladder This is usually stoppage of produced by inflammation or spasm by which the sphincter of the unue- bladder becomes contracted, and rigidly closed. Inflamma- tion is to be relieved by the ordinary means ; and, in addition to these, by anodyne clysters, and fomentations, a warm-bath, warm liniments, especially of camphor, or essential oil of turpentine, and blisters to the perinaBiim. 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 304 cl. vi.j ECCRITICA. LORU. Gen. III. Spec. II. Paruria re- tentions. Stoppage of urine- Treatment. Camphor. Mucilagi- nous di- luents. Terebinthi- nate oils. Taraxa- cum. Bougie to be employ- ed with Puncture of the blad- der when necessary. Treatment of urethral stoppage •jf 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 perineum, or, which is better, 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 affords when employed singly. If the retention proceed from Spanish 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 multitude of other com- plaints 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 hungaricum which is an exudation from the tops of the pin us 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 leon- todon Taraxacum, of Linnaeus. It was at one time regarded as a panacea, and prescribed for almost every disease by which the system is invaded, as gout, jaundice, hypochondrias, 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 unquestion- ably diuretic powers, and hence, indeed, its vulgar name of piss-a-bed. If the joint use of these means should fail, the water is usually 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 neck of the bladder is often so considerable, a3 to prevent an introduction of even the smallest of them. Wherever an instrument of this kind can be introduced, by far the most effective and convenient will be found the urinary siphon already described in treating of inflamma- tion of the bladder.* And this instrument may be of still further and very important use as a mean of throwing tonic or stimulant injections into the bladder, whenever this organ is incapable of con- traction from debility or a paralytic affection. If, however, this instrument should not succeed, if the inflamma- tion should increase, and the distress be alarming, nothing remains but to puncture the bladder, either above the pubes, in the perinaaum, laterally, or posteriorly through the rectum, for the operation has been performed 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 applica- tion of a bougie. In the last case the bougie, if it pass without H. ;rt. Ord, n. Gen cl. vi.] EXCERNENT FUNCTION. [ord. ii. 305 much pain, should be continued daily, and progressively enlarged in Gen. hi. its size. It has often been employed with a tip of lunar or alkaline Panfrfa "'- caustic: and in many instances with perfect success : but very great ^tio™s- caution is requisite in the use of a caustic bougie ; and even in the 2,ase °' hands of the most skilful it has sometimes proved highly mischiev- upp|diewith ous. When a simple bougie is employed, Ferrand* advises that, if caustic re- the water do not flow immediately, it should be re-introduced and EaWe11" circum- left in the urethra ; and I have myself advised such a retention of the cir' . t . , ' J spection. oougie-catheter through an entire night with considerable advantage ; simple for the water which would not flow at first has gradually trickled, remain"^ and given some relief to the over-distended bladder, which has £°au[1,juhrta hereby progressively recovered its tone and propulsive power ; so wheVtha ' that the water before morning has been propelled in a stream. But ha^mt'e this is a plan only to be pursued where the organ has too little irritability. instead of too much irritability, and consequently where there is no danger of inflammation. SPECIES III. PARURIA STILLATITIA. STRANGURY. painful and stillatitious emission of urine. This is the dysuria of Sauvages and later writers. In the pre- Gen. III. ceding species there is an entire stoppage of the urine ; in the pre- ^yfuria of sent it flows, but with pain and by drops. Several of the causes Sauvages are those of paruria retentionis; but others are peculiar to the an species itself; and, as they are accompanied with some diversity in the symptoms, they lay a foundation for the following varieties : x Spasmodica. Spasmodic strangury. 0 Ardens. Scalding strangury. y Callosa. Callous strangury. ^ Mucosa. Mucous strangury. s Helminthica. Vermiculous strangury. £ Polyposa. Polypose strangury. The first variety is characterized by a spasmodic constriction * ?■ *ma-- - , . ■ tl,la spas- of the sphincter, or some other part of the urinary canal, catenating modica. with spasmodic action in some adjoining part. The spasmodic st?angury.° actions of which this variety is a concomitant are chiefly those of hysteria, colic, and spasm in the kidneys. It is hence a secondary Mostly a affection, and the cure must depend on curing the diseases which ^ycnap^*e" have occasioned it. Opium and the digitalis will often afford speedy tion. relief when given in combination. * Blegny Zod. Ann. 1681. Vol. V.—39 3UG cl. vi.j ECCRITICA [ord. li Gen. III. Spec. III. 3 P. stilla titia ar- tlens. Scalding dysury. Dysuria primaria of Sauvages. Exciting causes. Treatment. Mucila- ginous di- luents. Alkekengi or winter- cherry. Cj.mphor. Neutral aperients. y P. stilla- titia cal- losa. Callous Btrangury. Most com- monly seated in the bulb or prostate. 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 oi dysuria primaria. It is excited by an external or internal use ot various stimulants as acrid foods, or cantharides taken internally ; and is accompanied with a sense of scalding as the urine is discharged. 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 tho 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 : upon which subject Dr. Perceval has penned the following note in his Commentary to the volume of 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 ne- cessary, 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 membrane of the urethra producing a permanent stricture. Some interesting examples of this may be seen in Dr. Baillie's Plates of Morbid Anatomy.t 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,! though it may take place in any other part. * Manardus, Epist. Libr. xm. N. 12. * Vol. v. Blenorrhoea luodes, p. 55. 1 Fascic. vm. PI. iv. v, cl.vx] EXCERNENT FUNCTION. [ord.ii. 307 M. Ducamp has invented an ingenious instrument for determining Gev- J||- the exact point, consisting of a sound graduated into inches, half v p.stW inches, and lines, which at once determines the distance of the ob- ,1^ cal~ struction from the orifice of the urethra. In five cases out of six Callous However he found the obstruction seated not higher up than from slransury- four and a half to five and a half inches, and he is inclined to think that this is rather higher than occurs in general,* which is contrary Mischiev- 1 I ■ • A ■ ^.1 • OUS reSU'tS- to the ordinary calculation in our own country. A stricture oi tins kind " consists," says Dr. Baillie, " of an approximation, for a short extent, of the sides of the canal to each other. Sometimes there is a mere line of approximation, and not uncommonly the sides of the urethra approach to each other for 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 ap- proximated so nearly by its tumefaction that the stricture "will only allow a bristle to pass through it: and hence ulcers are occasionally formed in the prostate gland, and fistulas in the perineeum ; and the cavity of the prostate is enlarged from distention, in consequence of the accumulation of urine behind the ulcer; of all which Dr. Baillie has also given examples. Ma!"yPdis-" The pain in micturition is sometimes peculiarly distressing ; the tressing, limbs tremble, the face becomes flushed, and the feces issue at the same time, so that the patient is obliged to pass his water in the ™0ddJ^d position in which he goes to stool. M. Ducamp gives the case of hernia. a merchant labouring under this complaint, in whom the violent straining produced a large inguinal hernia : and refers to others who were afflicted with stricture of the rectum from the same cause.* When the prostate, or urethra, is thus highly irritable, palliation Remedial only can be resorted to ; but where the thickening is recent and there s^ufui1 use is little irritation, a skilful use of a bougie will sometimes afford "j^0^8 temporary relief; after which, by gradually employing those of larger viceabie. diameter, the stricture will often give way and the canal widen so as to allow the water to flow with considerable comfort. M. Ducamp objects to the use of bougies from the mischief they produce when unskilfully applied* But the objection is too indiscriminate; and the plan is, after all, less adventurous than any application of caus- tic, although in the more cautious but more complicated way pro- posed by himself. I had lately a patient under my care, who was illustrated. so grievously afflicted with this variety of strangury about six years before, from two distinct strictures, as never to make water other- wise 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 him- self to bougies of increasing diameter he can now bear the intro- duction of a moderately sized one with ease ; the water flows freely, though in a small stream, and he is able to go into company and to * TraitS des Retentions d'Urine, &c. Paris. 8vo. 1822. 308 cl. vi.J ECCRITICA. I0™- "■ travel without inconvenience. He siill finds it necessary, however, that the bougie should occasionally be continued, and it is, I believe, 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 blenorrhoea. It is often, however, produced by cold, and ,in this last case forms the catarrhus vesictea of various authors : so denomi- nated from its being conceived that the bladder and urethra are af- fected in the same manner as the nostrils in a coryza. The con- striction therefore depends upon an excoriated or irritable state of the urethra, or neck of the bladder, and, at times, of the mucous membrane of the bladder itself.* 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. A very severe case of this kind occurred not long since to the author, in a lady of the middle of life, who had about three months before suffered much from a laborious labour in which a dead child was brought into the world by the use of the single blade. The bladder, irritated in the course of the labour, long continued irregular in its action, but at length appeared to have recovered its tone. A sudden exposure to cold brought back the irritability, the mucous discharge was con- siderable, and the micturition so constant and painful, that for two nights in succession the patient evacuated the bladder or strove to evacuate it nearly forty times each night. The plan above recom- mended was diligently pursued, and at night the body swathed with flannel wrung out in hot water, with an outer swathe of a towel. Forty drops of laudanum were given at bed-time, and repeated doses of tincture* of hyoscyamus in the day. On the third day the disease subsided, and vanished in the evening. If this variety con- tinue long it is apt to produce an obstinate and very narrow stric- ture, of which ulceration and fistulae 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 : and a like fact is alluded to by Dr. Frank, though he does not seem to have witnessed it himself. | They are described as of dif- ferent forms in different cases, sometimes resembling the larves of insects : sometimes distinctly 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, * Tacheron. Recherches Auatomico-Pathologiques sur la Medicine Pratique. In loco. t Dec. i. Ann. ix. x. Ob?. 113. Dec. n. Ann. i. Obs. 104. Ann. vi. Obs. 81. Dec. in. Ann. i. Obs. 82. Ann. n. Obs. 203. I De. Cur. Horn. Morb. Epit. Tom. v. p. 79. cl. vi.] EXCERNENT FUNCTION. [ord. ii. 309 but did not seem to have been dead long. The patient had for Gen- ni« several years been in the habit of discharging urine mixed with f p^tii"1' blood, but unaccompanied with pain either in the bladder or urethra. «»*.»* he>- During the whole of this time he had been feverish ; and gradually ver'micu- lost his appetite, found his strength decay, and had become tabid ''J,"*;'"*11" and hectic ; from all which he speedily recovered as soon as this Sometimes cause of irritation was removed.* Mr. Demet has lately given a Nefarious. similar case, but of a more complicated kind. The patient was a singular man of fifty years of age who had through a great part of his life Demet. been subject to anomalous pains in the lumbar region, and abdo- men, and in adolescence to a frequent nasal hemorrhage. One day, at the period now spoken of, after passing much blood by the urethra, he voided by the same channel, a round worm fourteen inches in length, of the size of a goose-quill; after which he found himself greatly relieved, and the haematuria ceased. In the course of three months this man passed by the same passage fifty worms apparently of the same species, but of different sizes. He had notice of their forth-coming by a sense of heat in the urinary canal, and a slight febrile excitement which went off as soon as the worms were ejected. They were uniformly dead when discharged.! We have also an example of a like vermicule, highly gregarious, illustrated and of considerable length, in an interesting paper of Mr. Law- /encein n rence, inserted in the second volume of the Medico-Chirurgical *'a"|ular 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 three or four worms of a non-descript kind, and continued to discharge more, especially when their removal was aided by injections into the blad- der, or the catheter had remained in the urethra for the night. The evacuation of these animals continued for at least a twelvemonth. 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 from 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 va- Explained . ■ n i ..u 1 n analogical- rious species of worms, and even worms themselves, are occasionally iy. found in many ani-nal 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 strongy- lus.t And in like manner Dr. Frank assures us, that he has found asca- ridcs both in the bladder and kidneys of dogs, particularly in poly- pous concretions in these organs.§ Dr. Barry supposes his isolated worm to have travelled in the form of an ovum as far as to the ex- tremity of an exhaling artery opening into the bladder; to have found, in this place, a proper nidus and nourishment for the purpose of being * Edin. Med. Ess. Vol. v. Part. ii. Art. lxxii. p. 289. t Diet, des Sciences Medicales. Art. Cas. Rares. X Hodgson on the Diseases of Arteries. £ De Cur. Horn. Morb. Epit. Tom. v. p. 76. 310 ex. vi.]* ECCRITICA. [ord.il Gen. hi. hatched into a larve or grub, and of growing to the size it had as- fp";,"1, sumed when thrown out of the urethra ; and, in consequence of this litiahei- progressive growth and the proportional dilatation of the vessel in Vermicu- which it was lodged, he accounts for the discharge of blood without lousstran- ^n jf a worm reach the bladder alive and full of eggs, we have ^ p stiiia- no difficulty in accounting for a succession of progenies. posaP°ly Strangury is also someti lies produced in consequence of the blad- Foiypous (jg,. or urethra, or both, being obstructed by the formation of a poly- rangury. ^^ excrescence which has occasionally shot down to the external extremity. Only to b« Dr. Baillie's Morbid Anatomy furnishes several examples of this eaiiydbyacx- variety ; which, in most cases, is oniy to be radically cured by an tirpation, extirpation of the substance which produces the obstruction,* wher- be'fald hold ever it can be laid hold of. When small, however, and in the form When °f caruncles, these excrescences have sometimes separated sponta- ■m.,11, has neously, and been thrown out by the urethra with very great relief to tim.Vgpon- the sufferer, and have been followed by a perfect cure.t taneousiy Upon this variety my venerable friend Dr. Perceval has added the exfoliated. I . .■'.•' •*-, i vr i Singular following note in his manuscript Commentary on the Nosology, fustrition from which the present work has been so often enriched : " It might from Per- not be amiss to insist on a case which sometimes deceives young practitioners : ischuria cum stranguria. A copious draining of urine took place for several days in a patient with a swelled belly. Death supervening, the bladder was found distended to an enormous bulk, Excres- ana< tne Parietes of the abdomen wasted. Two excrescences near cences the neck of the bladder internally had almost closed its outlet, and Tdcerate3.68 interfered with the action of the sphincter." Where the irritation is considerable these excrescences sometimes ulcerate, and form iimgous sores, with great distress and gnawing pains that shoot into the hips and posterior muscles of the thighs, though the exact mis- chief cannot be ascertained till death; of which Mr. Bingham has given an example in his ingenious dissertation.! SPECIES IV. PARURIA MELLITA. SACCHARINE URINE. IRINE DISCHARGED FREELY, FOR THE MOST PART PROFUSELY ; OF A VIOLENT SMELL AND SWEET TASTE ; WITH GREAT THIRST, AND GENERAL DEBILITY. Gen. hi. Tms is the d'abetesi diabetes Anglicus, or diabetes mellitus of Spec, iv." authors ; from hxGnnif, importing " a siphon,'' or rather from h»- Diabetes of authors. . _, „, * Fascic. ix. Plate m. t Fabri6. Hildan. Cent. iv. Obs. Lin. Art. Nat. Cur. Vol. i. Obs. xm. t Practical Essay on the Diseases and Injuries of the bladder, &c. by Robert Bmyham, 1822. ex. vi.J EXCERNENT FUNCTION. [ord. n. 311 Gxna, "transeo." Diabetes among the Greek and Roman, and, Gen. ill. indeed, among modern physicians till the time of Willis, imported S;1^ simply a flux of urine, either crude or aqueous, for no distinction » eiiita. was made between the two, and both were named indifferently dia- „rine. betes, dipsacus from the accompanying thirst, urinary diarrhoea, '^™\oo%* urinal dropsy, and hyderus {vhpa), or water-flux.* The writers senV0 among the ancients who seem chiefly to have noticed it are Galen, Luting a Aretaeus, and Trallian ; and the reader who is desirous of knowing j?ruuxd°for what they say, and is not in possession of the original authors, may aqueous turn to Dr. Latham's Treatise upon the disease! who has translated "nylirfd. the whole with very great clearness and fidelity. The form of dia- Synonym*. betes, to which we are now directing our attention, Galen describes ByC!" as having a resemblance to lientery, from the rapidity with which j|r water" the solids and fluids of the body seem to be converted into a crude Treated of and liquid mass, and hurried forward to the kidneys ; and to canine AreTsus0' appetite, from the voracity and thirst which are its peculiar symp- ™d Ttal- toms. He supposes a high degree of appetency or irritation to exist Description in the substance of the kidneys, in consequence of which it attracts a^pifcl- the matter of urine with great vehemence from the vena cava ; and ble to the an equal degree' of atony and relaxation to exist in its orifices or disease. pores, so that the same matter flows off unchanged as soon as it reaches them.| This general view of the subject was adopted with a few addi- Galen's tions by Aretaeus, and without any by Trallian ; and seems to have adopted by descended with little variation, as we have just observed, till the time |!c8BSs0urg" of Willis, who first called the attention of practitioners to the curious till the tim« and important fact that the urine of diabetic patients, seems in many who first8' cases, to contain a saccharine principle. These cases, however, pointed out were not, at that time, duly distinguished, and hence, in Sauvages, ence of a who was well acquainted with Willis's discovery, diabetes signifies pimple"* equally an immoderate flux of urine from hysteria, gout, fever, spi- Yet no pro- rituous potation, as well as urine combined with saccharine matter : tio» was" though the only relation which the last has to the rest is that of its being 3^„b\a usually secreted in a preternatural quantity : but as even this last and others. quality, though mostly, is not always, the case, it should be distin- guished by some other name than that of diabetes, and form a dis- tinct 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 How.d,is- latter sense, and employs it as that of a genus, justly allows but one by Young: species to the genus, the diabetes mellitus of Cullen, and describes ^pid^"" the diabetes insipidus under the genus and species of hyperuresis cuiien aquosus. The distinction indeed is so clear, and has been so gene- ^ hi*ahy- rally admitted for nearly the last half century that it is wonderful p6™1^ Professor Frank, with all his fondness for generalization, should Confused have turned to the erroneous view of the early writers, and again fionTf1'2* confounded genuine diabetes with hyderus or water-flux, the enu- Frank. resis of most writers. There is great doubt whether this last ever Whether the last ex- ists as an * Galen. 4e Crisibus, Lib. 1. Cap. xn. idiopathic t Facts and Opinions concerning Diabetes, Svo. 1811. anection. t De Loc. Affect. Lib. vi. Cap. ill. iv., compared with De Crisibus, Lib. 1. Cap. 312 cl. xi.] ECCRITICA. Loud. *- Gen. III. exists as an idiopathic affection. Cullen himself, indeed, candidly Spec. IV. expresses the uncertainty of his mind upon the subject: " Almost moima! ai| the cases of diabetes of late times," he observe*, " exhibit sac- saccharme charine urin6i ita ut dub,uin sit, hii alia diabrtis idiopathic*- et per- manentis species revera detur." If such be found it will probably be nothing more than a variety of the next, species in the present arrangement, parukia inconitinkns : while the honeyed diabetes or saccharine urine ought to be studied as a distinct affection. Pathology The pathology of this disease is still involved in a considerable involved0m degree of obscurity : for though anatomy has pointed out a few obscurity. morbij changes that exist more or less extensively in the urinary or digestive organs, and chemistry has sufficiently 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 satis- Seat of the factory opinion upon the subject. Even the seat of the disorder is* sub°ec7of to the present hour, a point of controversy ; and as its seat, together discussion, 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. Deseription Saccharine or honeyed paruria is rarely, though sometimes,* origin. 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 par- ticularly 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 descrip- tion 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 body, with a similar sort of halitus exhaling from the lungs, and with a state of mind dubious and forgetful : the patient being dissatisfied, fretful, and distrusting, ever anxious indeed for relief, but wavering and un- steady in the means advised for the purpose of procuring it."t Progress. In the mean time the kidneys discharge a fluid usually very limpid, though sometimes slightly tinged with green, like a diluted mixture of honey and water, and possessing a saccharine taste more or less Urinary powerful. The quantity, in a few rare instances, has been found secretion not much increased beyond the ordinary flow, but for the most part sometimes . J , i /> i " only slight- the secretion is greatly augmented, and not unrrequently amounts to creased, but f°rtY or upwards of forty pints in the course of a day and night, j often very The pulse varies in different 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 * Latham's Facts and Opinions, p. 176. t Facts and Opinions concerning Diabetes, &c. p. 1. I Frank, De Cur. Horn. Morb. Epit. Tom. v. p. 44. f^.vi.] EXCERNENT FUNCTION. [ohd.ii. 313 hypochondria, a symptom which Aretaeus notices as one of the earli- Gen. III. est that appears ; the uneasiness extending still lower till, as the same f.frurta1^ writer remarks, a sympathetic smarting is felt at the extremity of the ™em'a\ penis whenever the patient makes water. urine me The flesh wastes rapidly ; and, as the emaciation advances, Termina- " cramps," says Dr. Latham, " or spasms of the extremities some- Uc 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 often become edematous, and the skin cold and damp : the diabetic discharge is then frequently much diminished, and issometimes even found to become more urinous for a few hours before death closes the distressing scene." A pulmonic affection occasionally accompanies or precedes the occasional attack ; Dr. Bardsley, indeed, affirms that he does not recollect a S!""' case that was entirely free from this symptom. And it is probably Pulmonis a. ■ in . i n • i n i , , ■ ; affection. on this account, as also from the feverish state of the pulse, which by some writers has been supposed to partake of a hectic character, that by MM. Nicolas and Gueudeville the disease has been denomi- nated Phthisurie sucrie.* The state of the bowels is extremely Costiveness variable, though there is commonly a troublesome costiveness ; some- ter^on"." times, indeed, so much so, that the feces are peculiarly hardened sti"»te- and scybalous : which is well described by a patient of Dr. Latham's, in a letter of consultation ; " The heat of my body," says he, " I suppose arises from a most determined costiveness 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."| In a few instances the disease seems Son^etItmSs to beconnecteu with family predisposition. Mr. Storer has noticed withafa- a case of this kind in his communication with Dr. Rollo ; and ™jgp0suion. M. Isenflamm has given the history of seven children of the same parents who fell victims to it in succession. J Professor Frank, who, during a practice of twenty years in Ger- Skin arid many, met with but three cases of this complaint, though afterwards an scai' with seven in the course of eight years in Italy, adds to the preceding symptoms that the skin is scaly as well as arid.§ The real nature of the fluid evacuated has been very sufficiently Nature of determined both in our own country and on the Continent by che- equated: mists of the first authority, who have concurrently ascertained that, destitute of whilst it is destitute of its proper animal salts, it is loaded with the iaits'°and new ingredient of saccharine matter. saccharine1 Dr. Dobson from a pound of urine collected an ounce of saccha- matter. rine substance ; and Mr. Cruikshank, from thirty-six ounces Troy, pr0vedby obtained, in like manner, by evaporation, not less than three ounces experiments and a quarter : which, from the quantity discharged by the patient, and Oruik-, shank. * RGcherches et Experiences Medicales et Chimiques sur la Diabete sucree, ou la Phthisie sucree. 8vo. Paris, 1803. t Facts and Opinions, &c. p. 185. I Versucheiniger practichcr Anmerkungcu iiber die Eingeweide, &c. Erlang. 17S4. § De Cur. Hotn. Morb. Epit. Tom. v. p. 39. Mannb. Svo. 1793. Vol,. V.—lO rfU cl. vi.] KCURlilCA [ord. n. Gen. III. Spec. IV. Paruria mellita. Saccharine urine. Frank. Absence of snimal salts proved by Nicholas and Gueu- ■■•eville. Later ex- periments of Dupuy- tron and Thenard: of Henry. Results of dissection. Morbid state of kidneys as detected by Cruik- shank, The same as detected by Baillie. would have amounted to not less than twenty-nine ounces every twenty-four hours. A patient, however, under Dr. Frank, but who was in the last stage of the disease, evacuated his urine in a much higher degree of concentration ; while the general amount was not more than in a state of health, for from two pints the saccharine matter obtained weighed not less than six ounces.* Cheyreul has shown that by concentrating this morbid urine and setting it aside we may obtain a deposite of sugar in a crystallized state. The absence of animal salts has been ascertained not less satis- factorily. MM. Nicolas and Gueudeville showed, by a series of ex- periments 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 dis- agreeable odour.f The same results have since been obtained by MM. Dupuytren and Thenard by experiments still more satisfac- tory. They also found an albuminous substance in the urine which is always discharged in a sensible form when the disease begins 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 somewhat 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 chemist. 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 of the cryptae 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 appear- ances after death,'|| in which he tells us that " The veins upon the surface were much fuller of blood than usual, putting on an absorb- ent 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 kidneys 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. Tt is difficult to speak very accurately about nice differences in degrees of sensation unless 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 * De Cur. Horn. Morb. Epit. Tom. v. p. 47. Mannh. 8vo. 1792. | Rgcherches et Experiences, ut supra citat. X Transact. Vol. x. § On the Lacteals and Lymphatics, p. C9. |j Transactions of a Society for the Improvement of Medical and Chirnreical Knowledge, &c. v.L. vi.] EXCERNENT FUNCTION [ord. ii. 316 two infundibula in both kidneys, but there was no appearance of Gen. Hi. ulceration in either." pJruna.IV' These premises, taken conjointly or separately, according to the j"^1^ light in which they may be viewed by different persons, open an urine."' abundant field for speculation concerning the nature of the malady : hyp0Xas« and'hence, an infinity of hypotheses have been offered of which the more or following are the chief: piffifngto I. The disease is dependent upon a morbid action of the sto- 9,e PreceJ- , _ , f .., . * . ... ., , ing facts. mach, or some of the chyhlacient viscera, which, necessarily, there- fore, constitute its seat. II. The disease is dependent upon a dyscrasy or intemperamelit of the blood, produced by a morbid action of the assimilating powers. III. The disease is dependent upon a retrograde motion of the lacteals, 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, l Hypoths- has been by far the most commonly received, and is, perhaps, the ""action1 most prevalent in the present day. It is derived from observing the mfa^e0Brl°" increased action which exists in the stomach, and probably also in chyiifacient. the collatitious viscera, in conjunction with the untempered fluid scopeaof which is discharged by the kidneys, whose morbid crasis is referred the arei- to these organs. But even here there has been much difficulty in men ' determining which of the digestive viscera is principally at fault. Dr. Mead having remarked that the disease is frequently to be traced Supported among those who have lived intemperately, and particularly who by ead have indulged in an excess of spirits and other fermented liquors, ascribed it to the liver, and the idea was very generally received in his day. Dr. Rollo has since, and certainly with more plausibility, ™& Rollo fixed the seat of the disease in the stomach, and confined it to this organ : conceiving it to consist " in an increased action and se- cretion 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 se- condarily." According to this hypothesis the blood is formed imperfectly objections. from the first, and the morbid change of animal salts for sugar is the work of the stomach or its auxiliary organs, which are immedi- ately 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 Trans- actions.* Prior experiments had, indeed, been made under the superintendence of Dr. Rollo, which induced those engaged in them to conjecture that some small portion of sugar might exist in the blood : but those trials led to no definite conclusion, and did not * Vol. f i. 1811. p. ?«. 316 ;l. vi.J i;<( iUTi^A. IOKD. If. Willis : Supported by Syden- ham : l*^"-1"-satisfy the experimenters themselves. The results of Wollaston Paruria ' have ^ince been confirmed by other experiments of Nicholas, Sorg, Salctrine T1Ve"a^ and B0St0C^ , u .. urire. II. The second hypothesis, or that which regards the disease as sis"rPatIie~ dependent upon a dyscrasy or intemperament of the blood, pre- morbid ac- duced by a morbid action of the assimilating powers, is of parallel tion of the , • , , ,. , , , , , • -V stomach or date with the preceding, and has had the successive support ol many viscera"61" of the ablest and most distmguisl'ed pathologists from its origin to n. Hypo- our own day. It was first started by Dr. Willis and immediately dyscrasy of followed upon his discovery of the saccharine property of diabetic started°by urme-> wno tnus expresses his opinion of the seat and nature of the disease in his treatise upon this malady :—u Diabetes is rati.or an immediate affection of the blood than of the kidneys, and thence derives 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 inter- mittent, and have been unskilfully treated, and especially old per- sons, sometimes fall into a diabetes, from a cude or debilitated condition of the blood. And hence, he tells us in his letter to Dr. Brady, Regius Professor of Physic in the University of Cambridge, that " the curative indication must bo. completely directed towards invigorating and strengthening the blood, as well as restraining the preternatural flux of urine." Thus advanced and advocated by two of the brightest luminaries that have ever enlightened the medical world, it cannot be a matter of surprise that this opinion should have been extensively adopted. In truth it was espoused on the Continent as well as at home, and, in 1784, gave birth to M. Place's able dissertation at Gottingen :* and continued to be the prevailing opinion till the appearance of Advocated Dr. Rollo's work, to which we have just adverted ; and even since \/ho differs the appearance of this work, it has been still warmly and abl> fn°.™ Useri- maintainec' by Dr. Latham, who, while he pays all the homage to tial point of Dr. Rollo's labours and abilities to which they are entitled, and though0^' scrupulously adopts the genorol principles of his practice, opposes accedes to his doctrine of a morbid condition of thestomrch.t which, as well as generally!06the kidneys,J he believes to be perfectly sound in its action. "I must take leave," says Dr. Latham, " to differ in opinion most materially from Dr. Rollo, who seems to consider this most enor- mous appetite as such an evil in diabetes, as to endeavour, by every possible means, to repress it, having founded his theory principally * Diss, de vera Diabetis canssa in defectu assimilationis qurerenda. Goett. 1784. t Fact* and Observations, kn.p. 230. t Id.n. 110. and very gonerally adopted, abroad as well as at home. cl. vi.] EXCERNENT FUNCTION. [ord. ii. 31^ upon the idea that on this action of the stomach depends the evo- Gen. Iir. lution of sugar with the whole train of consequent symptoms : ?"riaIV# whereas, I consider the appetite, however great it may be, and meiuta. which I would never check by medicines, as a natural sensation, urine a"ne calling into its full exercise that organ through which the constant J^/oTa waste of the body must be directly supplied, and without which the dyJrasyof patient must soon inevitably perish : and I look upon the more the bl"od' moderate appetite which takes place usually in a few days after a strict conformity to animal diet, as the surest sign of convalescence, inasmuch as I hold it in proof that the blood being thereby rendered firmer in its crasis, there is less disposition in it to be decomposed, and, consequently (as is the fact) that there must soon be a dimin- ished discharge of nutritious matter from the kidneys." An opinion promulgated and maintained in succession by authori- The obier* ties so high, and names so deservedly dear to the healing art, preceding1" ought not to be lightly called in question : but it is as difficult to ey^|t1h°gPl. reconcile the present notion as the preceding with the existence of piicahie to the ordinary salts and the non-existence of sugar in the blood ofthepresenU diabetic patients. Dr. Latham, however, has argued the point with 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 sub- stance itself be not discoverable in it, being " so weakly and loosely oxygenated as to be again readily evolved by the secretory action of the kidneys, not from any fault in the kidneys themselves, but from the regular and natural exercise of then- function, in separating from the imperfect blood such matters as are not properly combined with it."* III. A bold and plausible effort was made, between forty and in. Hypo- fifty years ago, to get rid of the stumbling-block of the absence of retrograde sugar from the blood by showing that nrovided it wen once formed motion of , ° , ,. . ■' , . - . _ . ...... the lym- by the digestive organs, there is no necessity for its travelling in this phatics. direction. This hypothesis was v.rought forward by that very acnte y'"^^^. and ingenious physiologist, ..1 . Charles Dai win, in an essay pre- sented to the iEsculapi, n Society of Edinburgh in 1773, that ob- tained for him an unanimous grant of the prize-medal for the year : an honour dearly earned, as almost immediately afterwards he fell a martyr to his indefatigable pursuits, while on the verge of gradua- ting. In this essay he endeavoured to account for the disease of saccharine urine by a retrograde motion of the lyn.phatics of the kidneys. Having endeavoured to establish the general principle Scope of of a retrograde lymphatic action, he proceeds to remark, that all ar( 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 =een from the glow on the skin, and the increase of strength and * Vt supra, p. 97, 318 cl.vl] ECCRITICA. [ord. n, Gen. III. activity: but when, says he, a greater quantity of this inebriating Pa7u£a material is drunk, at the same time thnt the lacteals are quickened meiiita. in their power of absorbing it, the urinary branches of the absorb- Sacchanne \ » .' -' urine. ents which are connected with the lacteals by many anastomoses, thes^o?0" have their motions inverted, and a laige quantity of pale, unanimal- retrograde ize(i urine is hereby discharged. Where, continues Mr. Darwin, the iym- this ingurgitation of too much vinous spirit occurs often, the urinary phatics. branches of absorbents at length gam a habit of inverting their motions whenever the lacteals are much stimulated : and the whole or a great part of the chyle, is thus carried to the bladder without entering the circulation, and the body becomes emaciated : 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. Supported This hypothesis, for, ingenious as it is, it has never been entitled thor ofau to a higher character, became at one time also very popular, and Zoonomia. wag SUppOFted by the talents of the celebrated author of Zoonomia, icidentai the father of its ingenious inventor. A few singular facts which •IveM'a11 nave occurred since the decease of both these writers, seem at first colourable sight to give it a little colourable support: such as the rapid passage support o^ certain substances from the stomach to the bladder apparently according to the experiments of Dr. Wollaston and Dr. Marcet, without their taking the course of the circulation ; and M. Magen- die's experiments upon the lymphatic system, and the doctrine he These facts has founded upon them. These, however, the author has examined fn themed w*tn some attention in the Physiological Proem to the present class, Proem to and has endeavoured to reconcile them with the ascertained and class"*8" 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 warm imagi- nation, or those who are fond of novelty, the soberer physiologists objections have never been made converts to it. " In the diabetes," says Mr. crmk-y Cruikshank, " it has been supposed that the chyle flows retrograde shank. from the thoracic duct into the lymphatics of the kidney, from them into the cryptae, so into the tubuli uriniferi, thence into the infundi- bula, 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 retro- grade into the lymphatics of the kidney and not into 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 occasions, preternaturally 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 Further the kidneys."* Even Dr. Wollaston prefers a state of doubt con- byJWoi-t0 cerning the course pursued by the above-mentioned substances to ta*ton. an acj0ption of this conjecture, notwithstanding the ready solution * On tTie Lacteals and Lvmphatics, p. 69. cl.vi.] EXCERNENT FUNCTION. [ord. ii. 319 it offers to his experiments. u With respect," says he, " to Dr. Gen. III. Darwin's conception of a retrograde action of the absorbents, it is paruii'a so strongly opposed by the known structure of that system of ves- g^j^g sels, that I believe few persons will admit it v> be in any degree urine- probable."* gtfjft Professor Frank seems to have been equally struck with the ret™*Tnadg plausibility of the hypothesis arc! the objections to which it is open, ihe iym- And hence, without abandoning it, he endeavoured to mould it into $*"$» a less objectionable form. - He gives up the doctrine of a retrograde modifica- , -ii • iii- • a i • ,l 1 tion of the motion, but still conjectures that the disease is seated in the lym- hypothesis, phatic system generally with v-"hiuh the urinary combines in excite- ment ; and consists in a stimulation of both these systems by some specific virus, formed within, or introduced from without, and opera- ting with a reverse effect to the virus of lyssa or canine madness ; so that while the latter engenders a hydrophobia or dread of liquids, this excites an inextinguishable desire of drinking; and he par- ticularly alludes, in illustration, to the virus of the dipsas or serpent of the ancients, which was proverbial for producing this effect; and hence, as we have already observed, gave rise to one of the names by which this disease was distinguished in earlier ages. He sup- poses that from the irritability thus induced in the lymphatic sys- tem, every other part of the general frame is exhausted of its nutri- tion and healthy power ; and that the fluids thus morbidly carried off are hurried forward, and especially that of the chyle, and of the cutaneous exhalants, to the kidneys, which concur in the same dis- eased action, and constitute the flow of urine, and especially of saccharine urine by which the disease is peculiarly characterized.! But this is rather to make an exchange of difficulties than to free The diffi- the explanation from such impediments : and, in truth, to render the £","•£■ machinery still more complicated than under Mr. Charles Darwin's ^n«*j hands. Upon this view of the subject the kidneys play merely an and tie ' under-part, and are only secondarily affected ; yet' admitting tlie ^com- real seat of the disease to be the lymphatics, why the urinary secer- plicated. nents should thus make common cause with them in the general strife in which they are engaged rather than those of the intestines, the skin, or any other organ, we are not informed. Nor have we any lamp to explain to us the nature of the specific poison here adverted to ; or the path by winch the chyle must travel to the kid- neys without passing through the general current of the blood. IV. We come now to the fourth hypothesis to which the disease J^iiypo- before us has given rise, and which places it primarily and idiopa- primary thically in the kidneys. These form, indeed, the most ostensible seat, ^^ and hence, as we have already seen, they were the first svispected, ;hetid- and were supposed Vy the Greek writers to be in a sute of great 0rf|inated relaxation and debility, and hence also of great irritability. To this withUw irritability was ascribed their morbid activity, and the accumulation writers: of blood with which they were overloaded: while their weakened and relaxed condition allowed the serous or more liquid parts of the * Phil. Trans, ut supra. 1811, p. 105. + De Cur. Horn. Morb. Epit. Tom. v. p. 54. Mannh. 8ro. 1792, J,20 cl. vi.J ECCRITICA. L"*D- n- Gem. III. Spec. IV. Faruna mellita. Saccli. riuu urine IV. Hyp..- thesis of i primary diseased siatc of i.-k kidneys nsptc;ally Galen, and best confirmed by the ■ymptop'.a of the dis- ease and the ap- pearances on dissec- tion. Ilai hence been daily gaining ground in our own country and ahro :d The mor- bid stale ol the kidneys rat<'.y re- garded as inflamma- tory: though by some writers as spasmodic, among the last are Camerari- us, Richter, Gueude- vilie, and Cullen. Hence dia- betes placed by Cullen in in his Class Neuroses. His reason for so do- ing. This reason un- satisfacto- ry : and apparently ■q to him- self: whence he ascribes the seat of the disease elsewhere to the assi- milating powers. blood to p t:-.s 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 hentery. Such was the explanation of Galen: and of all the hypotheses before us there is no one that si ems to be so fully confirmed, as well by the svmptoms of the disease during its progress, as by the appet.i.mce- it ofleis upon dissection. The anatomists have hence generally adopted this opinion, which is to be found in Bonet,* i<"vsch,t and Cruikshank ;J ami in proof that it has of late been giuiing additional ground among physicians and medical practi- tioners in general, as well on the continent as in our own country, it may be sufficient to refer to the writings of Richitr, the works of M*l. Nicholas and Gueudeville, and MM. Dupuytren and Thenard, already quoted from, and the communications of Mr. Watt, Dr. Henry, and, still more lately, of Dr. Satterley ; several of whom, however, conceive the stomach or some other chylifactive organ to be affected at the same time secondarily or sympathetically. 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. The latter seem to reason from the pai'i 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 hypochon- drias • other organ or part of the system. But in the disease before us, we are contemplating a in the pre. primary excitement, a morbid action originating and seated in the st^Vethe kidneys Themselves. And surely when we reflect upon the prodi- excitement gious quantity of serum the excretories of the cellular membrane whence"^ are capable of separating and carrying off from the blood in cellular ^* expecta1 dropsy,' and those of the more limited range of the pleura or the still larger peritonaeum in dropsy of the chest or of the belly, there can be no Argued difficulty in conceiving that the emunctory of the kidneys, whose fr°m the. function, when in health, consists in eliminating a very large portion the excited of the more attenuate parts of the blood, should, when in a state ofYhHei- of morbid and increased action, be capable of secreting quite as luiar mem- prodigious an excess of fluid as is found secreted in any kind of dropsy"1 j 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 hyderus (bfopos), or water-flux, as also hydrops matellce, or urinal dropsy. This analogy will be still more obvious from our following up the Analogy common forms of dropsy to their ordinary consequences, and com- ^th"/^- paring them with the consequences of diabetes. As the watery twee" sac- parts of the blood in cellular or abdominal dropsy are drawn off with urine ifnd great rapidity and profusion to a single organ, every other organ be- dr°Psy' comes necessarily desiccated and exhausted ; the skin is harsh and dry, the muscles lean and rigid, the blood-vessels collapsed, 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 in- tolerable thirst which oppresses the fauces and stomach, ajid urge* Voi,; V.—il i22 cl. vi,j ECCRITICA. [onv. U. Gem. III. them by an increased action to satisfy the general demand. Thitf F«PwialV* « a necessary effect of so profuse a depletion, be the cause what meiiita. it may : and we have reason, therefore, to augur a priori that ir?1oc such an effect must follow in this form of the Greek hydlhus or SL"olni »ater-flux. That it does follow we have already seen ; and we are primary hence led almost insensibly to adopt, in its fullest latitude, the correct rt'tteo? the doctrine of Dr. Latham, that "the increased appetite in this last iidneys. disease, however great it may be, is a natural sensation, calling into its foil exercise that organ through which the constant waste of the body must be directly supplied, and without which the patient must soon inevitably perish."* Aenknoa%vn Erom a morbid excitement, then, a weak and irritable inflamma- symptorus tion, if I may be allowed the expression, of the kidneys alone, we Murine are a°Ie to account, not only for all the local symptoms of an enor- nwy anso mous flux of water, lumbar, or hypochondriac pains, and occasion- inorbui ex- ally fulness, and the post-obit appearances of distended or " pre- thekidne°a ternaturally enlarged arteries," as observed by Mr. Cruikshank, alone. " blood-vessels more crowded than in a natural state, so as in some parts to approach to the appearance of inflammation," as observedr by Dr. Baillie, "ossified arteries," as observed by Mr. Gooch, and " a glutinous infarction of the parenchyma of the kidneys," as ob- served in other cases by Plenciz ;t but also for all the constitutional symptoms of a dry, harsh, and heated skin, general emaciation, and sense of exhaustion, depression of animal spirits, great thirst and voracious appetite. In dropsy, indeed, the appetite is not uniformly voracious, nor is it always so in diabetes : but that inanition of almost every kind has a tendency to produce this symptom, whero the tone of the stomach is not interfered with or has re-established itself, is manifest from its occurring so commonly after severe fa- tigue, long fasting, protracted fevers, or any other exhausting state of body. And hence the very existence of the symptoms in diabetes is a direct proof that the action of the stomach, instead of being morbid, is perfectly sound, though inordinately excited. The asser But the grand question, it may, perhaps, be said, still remains un- nwed°.f.ra touched. How are we to account for that crude, fused, or dissolved dissolved state of the blood, which appears so conspicuously in diabetes, and biood°cx- which reduces it from an animalized to a vegetable crasis? Now amined. Up0n this point, let us fairly put to ourselves this previous question : Does such Does such a state of the blood appear at all ? and is it in fact re- exist? duced or changed in any respect from its animalized character ante- Facts iiius- cedently to its arrival at the morbid organ of the kidneys ? So far as the con- we have been able to obtain information from chemical experiments, irary. t[,e bi00d! of a diabetic patient continues in full possession 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, dissolved, and colourless state, it discovers that very condition which we should anticipate as a natural consequence of a very copious abstraction of its serous or more liquid principles. For we are told, without a * Practical Treatise, &o. 1. p. 41T. + Acta et Obsrrvan .ru■» Mt<'. ;■ O..VI.] EXCERNKaT FUNCTION iono.ii. j£3 dissentient voice, by those who have drawn blood freely and repeat- Gen. hi. ,€dly during the disease, that it has the general appearance of treacle ; ?* wf*IV' thicker than natural from the drain of its finer parts, and darker JV^1',*-. from a closer approximation of its red corpuscles, little capable of urine.3" coagulability from its loss of coagulable lymph, and hence not sepa- [^"of'a jating by rest into a proper serum and crassament. And we are primary told farther that wherever venesection has been serviceable, and the s'ateTf Hw renal flux has diminished, the latter instantly assumes a greater tlisposi- kidney £ion to coagulate, and loses tlie darkness of its hue. The chief reason, after all, for supposing that this change from an J*ow far - _ • r i . i 1 i jf • i-i ,he present animalized to a vegetable, or rather from an uric to an oxalic charac- morbid ter, takes place in the blood itself, is from the difficulty of conceiv- lf.1^! ing how it can take place in the kidneys : the difficulty of explaining neys £?ay u ■ /, .J n i- i °-be sufficient now an organ whose common function is to secern alkalies, and an to produce acid strictly animal, should be brought to secern an acid directly ^ ^^ vegetable. But, in the first place, is the difficulty one which is that takes diminished by transferring this wonderful change of action to tlie f^rte.'"*a assimilating powers, or to the stomach, or to any other organ ? For Tlj® diffi^ let us lay the fault where we will, we are still involved in the dilemma lessened by of supposing that an animal structure whose healthy function con-"l^g8/"/^ jsists in the formation of ammonia, has its action so perverted by totheassi the disease before us, as to produce sugar in its stead. And hence, p^'wersf 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 is that supports the latter. There are, however, if I mistake not, various pathological and Thoejibject -physiological facts perpetually occurring before our eyes, which if geL'reHy. properly applied, may at least reconcile us to this supposed anomaly, if they do not explain its nature: a very few of which I will briefly advert to. We see a tendency in most animal organs to produce sugar under Sugar po- particular circumstances, whatever be the character of their ordinary mott organ* secretion ; and this both in cases of health, where we have no l.ndf ***' n - ft -l-in-i >• ticmar cur- grOUnd for supposing an imperfectly animahzed fluid ; and in cases rumstance* of disease where such a change may perhaps be contended for and heaith'sna supported : and we see this also, and equally, under an animal and disease: a« under a vegetable diet; in some instances, indeed, most so where ananimai the former predominates. No one, if he did not know the fact, ^J,^1" would predict that the breast of a healthy woman, which forms no The female sugar at any other time, would become a saccharine fountain im- sit™ J* * mediately after child-birth ; and still less so that an animal diet, or die,j!u'i*)TO" a mixed diet of animal and vegetable food, would produce a larger sugar unde- abundance than a vegetable diet alone : and least of all, that t11'|1a""inv^. woman's milk produced by animal food would yield more sugar in a stable diet , ,,,, *, ,i Bnd more in given quantity than ass s, goat s, sheep s, or cow s ; and less caseous proportion matter than any of these quadrupeds,* though this last is the only J^™?8' matter of a strictly animalized quality which milk of any kind peds: white . • J rtyieldsleii .Contains. caseous oi animalized * Experiment des MM. Stipriaan, LivUcitts, et D. Bond*, in Mem. de la Society rcau^ ,4e Med, aParK 17SP 334 v-l. vi.] ECCRITICA. [OBD. II, P mellita. Saccharine urine: IV. Hypo- thesis of a primary diseased stale kidneys SugaT pro- duced by the saliva- ry glands and lungs, when in a morbid state. Oxalic acid of sugar se creted from the skin. Gastric juice neu- tral in om- nivorous animals; alkaline in graminivo- rous, and acid in car- nivorous. Gen. III. This, however, is a natural proepss. Yrt under the action of a pTrEUrYaIV' morbid influence sugar is often produced in other organs, while 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 of the represented as having the sweetness of honey. Pus, under various circumstances, evinces a sweetish taste, and hence the occasional sweetness of the sputum in consumptive patients. So in fevers of various kinds, as we have already had several occasions to observe, and particularly in hectic fever, the sweat throws forth a vapour strongly impregnated with acetous acid. Even the cerauien some- times both smells and tastes sweet; a fact noticed by Hippocrates, «r the basis 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 bc 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 Brugnatelli,t coincide with those of Carminati and Macquart. It is unnecessary to pursue these illustrations any further. Can- didly reflected upon they cannot fail, I think, to diminish in a con- siderable degree, the repugnance which the mind at first feels in admitting a secretion of sugar by an organ, whose common func- tion is so inaccordant with such a production . and consequently they co-operate 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 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 * Vol. i. p. 86. t Sagsio d'un Analisa Cliemica di Succi gastrici. Vide Crell, Beitrasr. zu dem. Chem. Annal. 1787. ' 6 I See Case in Latham's Tracts, &c. p. 142, a« also the remarks already quoted from Dr. Bardsley. Henco the difficulty diminished in conceiv- ing that the kidneys may in a morbid state se- crete sugar. General re- Bull of the inquiry. Predispo- nent and occasional causes. Whatever debilitates the system becomes a predispo- nent, and only re- quires an exciting cause. Old age: a broken con- stitution : intempe- rance : a diseased liver: diseased lungs: atonic gout; chronic car- buncles or Other ill- conditioned ■ores. The last particularly cl. vi.j EXCERNENT FUNCTION. [ok©, ii. 325 to the following passage in Cheselden: " There is sometimes a Gen. hi. large kind of boil or carbuncle in this membrane, which first makes faru^'aIV' a large slough and a number of small holes through the skin which meiiita. in time mortifies and casts off, but the icnger the slough is suffered urine!"11"16 to remain the more it discharges, and the more advantage to the IV- .Htp°" patient: at the latter end of which case the matter has a bloody primary tincture, and a bilious smell, exactly like what comes from ulcers in tllte^t the the liver ; and both these cases are attended with sweet urine as kidneys. ,,j, pointed out Ul DIABETES. * to the au- ln concurrence with this remark of Cheselden, Dr. Latham in- H10r bv Ltt" . ^ than1 in a forms me in a letter as follows : " I have a patient at this moment, passage whose diabetes was first observed after a long confinement from se°denthe" carbuncle : he is upwards of seventy, and is moreover afflicted with confirmed a mucous discharge from the internal coats of the bladder." Not pfactkes"" 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 immediate 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 abcesses had formed, not only in that arm but in other parts of the body : that his health from that time had decayed, 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 earthen pot over the glazing, and affording an infinity of pure saccharine 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."t How far the grand agent in this change of renal action, admit- whether ting the disease to be seated in the kidneys, is to be ascribed to a mate'eause change in the quality or intensity of the nervous power transmitted be£e £n"5e to it, or, as the chemists call it, in the state of the animal electricity mai eiectri- of the organ, to which power Dr. Wollaston has referred the pro- cuy; duction 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 dis- ease which i have endeavoured to support. "Since," says Dr. as conjee- Wollaston, 'k we have become acquainted with the surprising woWs'ton. chemical effects of the lowest states of electricity, 1 have been in- clined to hope that we might from that source derive some explana- tion of 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 tlie 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 prussiate of potash, of sugar, or of other substances may * Anatomy, 8vo. p. ISS, t Pacts and Opinions, p. 134, S26 cl. vi. j ECCRITICA. {<»»• v Gbk. Ill, Spec. IV. Paruria mellita Saccharine urine. Great di- versity in th« propo- sed plans ol medical treatment. At first eight most confused. but redeem- able from this charge when close- ly exami- ned: different views hav- ing led to different in- tentions as follow. I. To invi- gorate the different organs and consolidate the blood. The object of the Greeks and pursued to a late period. Willis: Sydenham- Madicines chiefly em- ployed. equally be effected by the same power as acting cause, still the channel through which they are conveyed remains to be discovered by direct experiment.1'* Whilst such is the diversity of opinions which have been held concerning the pathology of honeyed paruria. it cannot be a matter of much surprise that the proposed plans of treatment should also exhibit a very great discrepancy. On a firsi glance, indee-.i, and without keeping the grounds of these distinct opinions in view, nothing can be more discordant or chaotic than the remedial processes proposed by different individuals. Tonics, cardiacs, astringents, and the fullest indulgence of the vo- racious 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 re- spective courses, they are free from the imputation of absurdity. These intentions have been chiefly the following : I. To invigorate tiie debilitated organs whether local or general, 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 in- crassating and moderately cooling diet; by refreshing cordials, and by proper and seasonable hypnotics." Hence aggluiinants of all kinds were called into use, as tragacanth, gum arabic, and the albu- men 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. Sydenliam carried the tonic and cardiac part of this plan considerably further than Willis : for while the latter chiefly limited his patients to milk or a farinaceous diet, the former allowed them an animal diet, with a vinous beve- rage. " Let the patient," says he, " eat food of easy digestion, such as veal, mutton, 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 within the last thirty years. The chief tonic medicines being the warm gums, or resins, astringents and bitters. Alum and alum-whey appear 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. lierz] on the continent. Dr. Brisbane, and Di. Oostendyk,J on the contrary, assert that in their * Phil. Trans. 1811. p. 105. | Sell. Neuc. BeitrUge, p. lZf * Sascrnl. auserl. Abhandl. fur Prnct, aerzte. B. j. n°... cl. m.j EXCERNENT FUNCTION, [ord. tt. 32? hands they were of no use whateyer. Sir Clifton Wintringham Gen. hi. applied alum dissolved in vinegar, as a lotion to the loins. The pf*^1^ other astringents that have been chiefly had recourse to are lime- Meiiua. water, as noticed already, chalybeate waters, kino and catechu in urine,"w° tincture, powder, and decoction ; none of which, however, seem to f^xoTnr^ have been eminently serviceable. While cantharides as a local as- gome tho tringent has been exposed to a very extensive range of experiment oigaLTand both at home and abroad. Dr. Morgan gave it in the tincture, Dr. c^"s°.lid^Uf 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 dissatisfied with cantharides as with alum, and declares that all astringents are hurtful, as Amalus Lusitanus* asserted long before, that they are of no use. The practice of Professor Frank seems to have been as feeble as p«>bie his hypothesis. Thoiigh he notices the above remedies, together process o? with various others, he seems to place more dependence upon a Fiank> blister applied to the os sacrum, or the internal use of assafcetida, valerian, and myrrh, than upon any other course of medicine what- ever : telling us, towards the close of his chapter, that a pupil of his employed the vesicating plaster as above with a happier success than any other plan, and hereby succeeded in restoring two diabetic patients to former health : while, for himself, in true diabetes mellitus, after alum, tincture of cantharides, Dover's powder with camphor, decoction of bark with simarouba, and myrrh with sulphate of iron (sal martis) had completely failed, he has obtained a manifest de- crease of urine by assafcetida, with valerian and a watery infusion of myrrh : and at length by the aid of cuprum ammoniacale, given twice a-day in doses of from half a grain, to a grain, acquired for his patient a restoration to perfect health, which he confirmed by a generous diet. There is here, however, nothing mentioned of the saccharine property of the urine, but only an allusion to its excess ; and it is hence highly probable that the case or cases alluded to were rather examples of enuresis than paruria mellita ; and the rather as the hyderus of the Greeks or insipid water-flux, forms a species of diabetes in his arrangement. II. A second intention of pathologists in the present disease has n. To add been that of adding to the deficient animal salts, and resisting the dentani- secretion of sugar, by confining the patient to a course of diet and J™} £jj»t medicines calculated to yield the former, and to counteract the latter, the secre- This intention may have been indirectly acted upon by some part j,'°rn of ,u" of the process we have just noticed, and particularly by the dietetic '"directly^ plan of Sydenham : but it is to Dr. Rollo that the medical world is a^an'of y immediately indebted for its full illustration, and the means of car- ^prp^: rying it Erectly into effect, which consists in enforcing upon the pa- buton'y tient an entire abstinence from every species of vegetable matter, byrRono: and consequently limiting him to a diet of animal food alone : some ^''^jf form of hepatised ammonia being employed as an auxiliary in the tice. mean time. Narcotics, as under the preceding intention, are also * c?nt.T.Cur.S! 328 cl. vi.J ECCRITICA. |ohu. ii. Gkn. hi. occasionally prescribed by Dr. Rollo : and, in accordance with hiri r"riaIV' doctrine that the stomach is the chief seat of morbid action, and mellita. that the thirst and voracity are indications of such action, the aid of saccharine &n emet;c [s occasionally called in to allay the high-wrought ex- uTomadd citement. to the ieti- From this last part of Dr. Rollo's curative method Dr. Latham mai salts" appears to dissent upon the ground, and in the present author's and resist opinion a correct ground, that the increased action of the stomach tion*ofro proceeds from a sound instead of from a morbid appetency : but to checking tne injunction of an exclusive use of animal food, and a total absti- the vigorous nence from fermented and iermentable liquors, he accedes, with a full sto'mech for conviction of its importance, and without permitting the smallest de- fd°b °La°8 viation. And as Dr. Rollo, with a view of completing the intention tham; tho of supplying tho readiest means for a recruit of the deficient animal RoUo£ plan salts, prescribed hepatised ammonia as an auxiliary, Dr. Latham, aoceded to. for the same purpose, prescribes phosphoric acid, having observed in aoidon ' various cases of the disease an evident deficiency in the supply of ground re- phosphate of lime ; whence, indeed, the destruction that is occa- <-ommend- sionally met with of the fangs of the teeth, together with their alveo- lar 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 general nature of the disease ; and, in every view of it, it is more likely to be of service than Dr. Rollo's hepatised ammonia, or, perhaps, than How far alkalies of any kind. For while, like the last, it has been suggested with'thc11 upon the principle of supplying to the kidneys the deficient mate- protedsed rjjjg Upon which they are to work, it has a claim to attention as a cure. ° 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 con- ceal the following paragraph of a letter in direct allusion to it, ad- dressed to me by Dr. Latham, while the first edition of this work was in the press, containing with much candour, his present opinion upon the general line of practice he thus undertook to recommend How far to the publif, little less than twelve years before. " The expe- oi'auoceM. rience," says he, " which I have had in diabetes since the publica- tion of my observations on that disease, does not excite, in any de- gree, a wish to alter the opinions which I had then formed concern- ing 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, I urge my patients to persevere in its use, and am certain that it may do some- thing more than produce a mitigation of the thirst, which circum- stance of itself would be sufficient to maintain it as a remedy, even if it went no further in effecting a cure." shorten- "'" ^ome °*" the indications of the disease, however, have given flammatory rise to a much bolder intention. \Vre have already seen that, from ?t;Vnpy.f the a few of its symptoms, and the appearances discoverable on dis-rr cl. vi.J EXCERNENT FUNCTION. [okd. u. ^20 tion, there is reason to apprehend an irritable and inflammatory state Gen. hi. of the kidneys ; and it has hence been attempted to cut short the pfrnfj*aIV' complaint, and, so to speak, to strangle this condition at its birth, by 5?eUiJia'. copious and repeated bleedings. Le Fevre appears to have adopted „rine. and acted upon this principle almost as early as the beginning of £r,ea'n,ent\ tlie preceding century ;* but he does not seem to have obtamed any ?hort the in- considerable number of converts to his opinion ; and it is to Dr. Watt gia^onhe of Glasgow, that we are principally indebted for whatever advan- k« (ions. Furthor il- lustrated. IV. To subdue the irritation by a quick repetition of powerful narcotics. This plan also par- tially pur- sued by Willis and Sydenham. Tried in Conjunction with dia- phoretics by M'Oor- miek. Tried sim- ply and most pow- erfully by Warren. Summary of his ex- periments. Ipecacuan in union with lauda- num, a clog upon the latter. castor-oil, and for a part, if not the whole period, a grain of calomel and a dose of compound powder of ipecacuan every night, the quantities 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 con- clude that these instances were accompanied with a more than ordi- nary degree of irritability or inflammation. "This," says Dr. Satterley, " is the extent of my experience respecting bleeding" in diabetes : an experience that fully warrants my asserting the safety, and I 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,! and more lately by Dr. Marsh of Dublin, as communicated in a recent volume of the Dublin Hospital Re- ports ;J but I am not aware that narcotics alone have been relied upon, or their effects completely ascertained before the late experi- ments of Dr. P. Warren, an interesting statement of which he has communicated in the same work that contains Dr. Satterley's prac- tice in venesection.§ 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 satisfactorily that what- ever 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 far enough to pro- * Dissert, tie Diabetis Curatiooe, &c. XDubliBHospital Reports, V<>1. in. 8yo. 1822. t Vol. ix. Art. li. p. 56. 5 Vide supra. <-T, vi.} EXCERNENT FUNCTION. [ord. ii. 331 duce a permanent effect on account of the nausea or vomiting oc- Gen. m. casioned by the ipecacuan, from which symptoms no benefit what- £^;IV' ever appeared to be derived. In his first case, therefore, he soon melli'*-. trusted himself to opium alone, and persevered in the same practice urine. ann° through the second. T^ealment' These patients also were in the prime or middle of life : the one subdue the aged twenty-two, the other thirty-eight: and both had been declining by^quick for some months antecedently to their applying to St. George's 07e0^°"ful Hospital for relief. The first seems to have been worn down by narcotics. 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 diet animal regimen was of advantage, but certainly not alone capable thucase of effecting a cure ; for in every instance the quantity of urine in- *° httv* creased and became sweeter, whatever the diet employed, as soon use; but as the opium was diminished. Dr. Warren, however, is inclined to *®c £*",. think that it was of no avail whatever ; and, consequently, the eluded by second patient had no restriction upon his food, whether animal or arren* 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 General re- persons of very different ages, constitutions, and habits, and hence, investiga- in different cases, demands a different mode of treatment: and that "p™,.'"*9" the morbid action is seated in the kidneys; with the irritable, and, treatment. 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 particu- larly to a secretion of saccharine matter, is much less than under any other kind of regimen, though, from idiosyncrasy or some other cause, this rule occasionally admits of exceptions. It appears also that the + Med. Transact. Vol. iy. Art. xyi. p. 188. 33i cd. vi.] ECCRITICA. Lokd. n- mellita. Saccharine urine. General result of the inves- tigation. Gen. HI. irritation is in some instances capable of being allayed, and at length pPruCi*IV* completely subdued by a perseverance in copious doses of opium, probably by an exhaustion of the general excitability; and in others by a free use of the lancet, leading more rapidly to a like eflect. 1 he 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 particu- larly the astringents ; those mostly so, that are conveyed to the kid- neys with the least degree of decomposition. And hence the ad- vantage 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. CoTehicum The colchicum autumnale, since its revival has been had recourse to by several practitioners; and in some cases apparently with far more success than opium. How advantageous soever the plan of sanguineous depletion may be found occasionally, it is clear that it cannot bc 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 sufficiently 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, 1 think, capable of throwing a considerable light upon the subject. In healthy urine, the predominant principle is that of uric acid, in dia- outamnale. Sanguine- ous deple- tion cannot form a general practice, and why. Where it may possi- bly prove successful. Explana- tion at- tempted by what means ani- mal diet proves be- neficial. * Medical Journal, vol. \)n. cl. vi.] EXCERNENT FUNCTION, [oitn.ir. 333 betic, that of saccharine or oxalic. The uric acid, indeed, exists Gkn. m. so largely in sound urine as to be always in excess, as we shall have f *"£"Iv" occasion to observe under lithia or urinary calculus. It is not nieiiita? only a strictly animal acid, but, till of late years, was supposed to ^nc,h*ril1* exist in no other urine than that of man ; though it has since been Uc»«™> re- found, but in a smaller proportion, in the urine of various other ani- invesUgl. mals. Whatever then has a tendency to reverse the nature of the tion- 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 as by taking off from the kidneys a source of irritation, and hereby dimin- ishing the quantity of the secretion, as by contributing to the sound- ness of the urine itself. Now the physiological fact I refer to is, Singular that animal food has a direct tendency to induce this effect : for Dr. ?iC°ritive Wollaston has satisfactorily ascertained that a greater quantity ofot thi8 tiric acid is produced in the dung of birds in proportion as they feed effeCU 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 INCONTINENS. INCONTINENCE OF URINE, FREQUENT OR PERPETUAL DISCHARGE OP URINE, WITH DIFFICULTY OF RETAINING IT. This is the enuresis of most of the nosologists, and admits of Gbn. HI. four varieties from diversity of cause and mode of treatment, with SpEC-v* often a slight diversity in some of the symptoms. x Acris. From a peculiar acrimony in the Acrimonious incontinence fluid secreted. of urine. 3 Irritata. From a peculiar irritation in some Irritative incontinence of part of the urinary channel. urine. v Atonica. From atony of the sphincter of Atonic incontinence of the bladder. urine. o Aquosa. From superabundant secretion : Flux of aqueous urine. the fluid limpid and dilute. In the first variety, proceeding from a peculiar acrimony of*1! Pineon* the prvrpted fluid, the cause and effect are mostly temporary; as SK1'" 334 oTthe0ff glands, the skin, at the navel, and by a fistulous opening into the salivary perinasum, and has sometimes been found, on post-obit examina- •kin, navel, tions, filling the ventricles of the brain. Mr. Howship relates a sin- ventrtcieTof gular case *n which the secretion was discharged alternately, and the brain, in an almost incredible deluge each time, from the kidneys and the Sternatfiyd bowels, with long intervals of suppression, occasionally extending from bow- t0 six weeks or two months ; an examination by the catheter prov- kidneys in ing that no water existed in the bladder during these periods. At -U8hn«s.ve one OI* these irregular tides twenty-two quarts were passed by the bladder in occasional spasmodic gushes within three days ; and at another two gallons of urine were passed daily by the rectum for four days in succession. The patient was a lady twenty-four years old at the commencement of the disease, which, at the time of writ- ing, had continued, with little variation, for nearly four years, appa- rently without much serious inroad on her constitution.* It does not seem to be accurately ascertained whether the discharge from the bowels was genuine urine or a substituted fluid. The volume of Nosology gives a reference to cases and authori- ties illustrating each of these forms of discharge : and others are probably to be met with in other writings. * Practical Treatise, &c, on Complaints that affect the Secretion of Urine. 8vo. 1823. "'•vi.] EXCERNENT FUNCTION. [ord.ii. 339 GENUS IV. LITHIA. URINARY CALCULUS. MORBID^SKCRETiON OR ACCUMULATION OF CALCULOUS MATTER I> THE URINARY CAVITIES. Lithia is a Greek term from A/da?, whence >.i6txa> " calculo laboro." Gen. IV. It has often been written lithiasis, which is here exchanged for &" generic lithia, since iasis, in the present arrangement, is limited, as a termi- term- nation, 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- Synony- nus, and that of calculus or sabulum, as employed by Celsus and nthus and Pliny, sufficiently evince the elementary principles of which the '«*«»•»• Greeks and Romans conceived urinary calculi to consist. The Subject lit- mistake is not to be wondered at when we reflect that it was not bychemi- till about thirty years ago that these principles were detected with cul analr any degree of accuracy ; and that we are indebted to the minute late years. and elaborate experiments of Fourcroy and Vauquelin for an analy- sis 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 va- rious other animal chemists to produce all the success we could de- sire. So generally was the belief that the calculi of the bladder were formed in the same manner and consisted of the same materi- als as the stones of the mineral kingdom, that Dr. Shirley published 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- compound pound fluids of the animal system : and consists of various acids, {Jfurine.* and alkalies, the former, however, bearing a preponderancy, with a certain proportion of calcareous earth, and other materials which it is not necessary to dwell upon at present. The acid first discover- Phosphoric ed in it was the phosphoric, which was traced by Brandt and tChomyfir8t Kunckel, whence the experiments of Boyle from which he obtain- discovered. ed phosphorus. The important discovery of uric acid was reserved when'first for Scheele, who detected it in 1776 : as he did also benzoic acid, discovered1. chiefly confined to the urine of children. Proust has since proved Carhonic that it contains also carbonic acid, and a peculiar resin like that of andothw' bile ; and other acids, in smaller proportion, have more lately been substances. ascertained by Thenard and Berzelius. Hence the calcareous earth Hence^e (hat is separated by the kidnpvs. as we have had occasion to observe earth of the 340 ex. vi.] . ECCRITICA. [ord. 11. Gen. IV. that it is also by most other organs of the body in a state of health Urinaary or of disease, is productive of numerous compounds, as carbonate caicius. 0f lime, phosphate of lime, oxalate of lime : together with com- Jrodoctive pounds still more complicated by an intermixture of the lime with r^uscom- the urinary alkalies. But as, in a state of health, the urine is al- nounds. ways found to contain calcareous earth under some form or othei, earfharT in a morbid state it is also found to contain magnesian earth more iTrodienl' or less united ^vitn the other materials, both acid and alkaline. In Many of many cases moreover, the natural acids, or the natural alkalies are cSsse-0' secreted in excess, in others in deficiency. And from all these cir- creted in^ cumstances it is easy to conceive that a very great variety ot con- fn de^ciV cretions or calculi may at times take place either in the kidneys or Hence the in the bladder. How far these varieties extend, has, perhaps, not varieties of folly been determined to the present day, but the number which has mosUnnu- been detected and analyzed is now very considerable and has been Arra^e- increasing ever since Dr. Wollaston's valuable essay on this subject, mem at- which appeared in the Philosophical Transactions for the year 1797, w'oiias'to'o! and laid a foundation for the arrangement. Among those which have been subsequently ascertained, a few, and especially the cystic And pursu- oxyde, have been discovered by himself; and the whole are thus cet, who" enumerated by Dr. Marcet in a still later production of highly dis- enumerates tinguished merit.* 1. Lithic calculus, composed chiefly of lithic follows. or uric acid. 2. Earth-bone calculus, consisting chiefly of phos- phate of lime. 3. Ammoniaco-magnesian phosphate or calculus in which this triple salt obviously prevails. 4. Fusible calculus, con- sisting of a mixture of the two former. 5. Mulberry calculus, or oxalate of lime. 6. Cystic calculus, consisting .of the substance called by Dr. Wollaston cystic oxyde. 7. Alternating calculus, or a concretion composed of two or more different species arranged in alternate layers. 8. Compound calculus, the ingredients of which are so intimately mixed as not to be separable without chemical analysis. 9. Calculus from the prostate gland, of a peculiar kind, and consisting, according to Dr. Wollaston, " of phosphate of lime not distinctly stratified, and tinged by the secretion of the prostate gland." The two not hitherto described are, 10. Xanthic oxyde, making an approach to the cystic calculus, but giving, which that does not, a bright lemon residuum on evaporating its nitric solution. And 11. Fibrinous calculus, so called from its possessing properties exactly similar to those of the fibrine of the blood, and no doubt formed by a deposite from this fluid. of these, Of these a few only are commonly found in the kidneys, though foundT/the most °f those which are found in the kidneys are found also in the kidneys, bladder, and in reality constitute the common nuclei of the calcu- aDu many - ■• _ *. _ of them not lous concretions ot this last organ ; the augmentation resulting from btedder'. 'he Ptner constituent principles of the urine, gradually separating, and incrusting them as they lie in the bladder in an undisturbed state. The symptoms, moreover, of renal and vesical calculi differ as Essay on the Chemical History and Medical Treatment of Calculous Disorders. cl. vi.] EXCERNENT FUNCTION. [ord. ii. 341 widely as their component parts, and hence point out the necessity g.en. IV. of subdividing the genus into the two following species : Urinary Calculus. 1. LITHIA RENALIS. RENAL CALCULUS. 2. ----— VESICALIS. VESICAL CALCULUS. SPECIES I. LITHIA RENALIS. RENAL CALCULUS. PAIN IN THE LOINS, SHOOTING DOWN TOWARDS THE TESTES OR THIGHS, INCREASED ON EXERCISE J URINE OFTEN DEPOSITING A SABULOUS SEDIMENT. The calculous matter of the kidneys sometimes passes off in minute Gen. IV. and imperceptible grains with the urine, which are only noticed by J?™0' \' their concreting or crystallizing about the sides of the vessel that the species receives it; and sometimes collects and forms very troublesome cxi)lained- spherules or nodules in the substance or pelvis of the kidneys : thus offering the two following varieties : x Arenosa. Pain slight, and unfrequent; Urinary sand. free discharge of sabulous granules. & Calculosa. Pain mostly severe and con- Urinary gravel. stant ; sabulous discharge small and seldom or never ; calculus varying in size, of- ten large and obstructing the pelvis or ureter of the kid- ney. Urinary sand, or the sabulous matter deposited on the sides or a L. rena- bottom of a receiving vessel, is of two kinds, white and red : and u^y065' it is of great importance to distinguish the one from the other as sand; of they proceed from very different causes, and require a different, ,Xic0and and, indeed, opposite mode of treatment. Mr. Brande has publish-teQ. ed an excellent treatise upon this subject in his Quarterly Journal ; and in the remarks about to be offered upon this species, I shall avail myself in no small degree of the benefit of his labours in con- nexion with those of Dr. Marcet to which I have already referred. The urine, in a healthy state, is always an acid secretion, and it White mi- is the excess of its acid that holds the earthy salts in solution. If, Heaithyd' from any cause, it be deprived of this excess, or, in other words, the «'ne d- secretion of its acid be morbidly diminished, the earthy parts are no tains an ex- lonir^r held in solution, and a tendency to form a white sand or ^'^^j. U2 CL. VI.J ECCRITICA. [ord. Ii. Gem. IV. c^lcvreous dei-osite immediately commences. And that this is A^reni. the real source of its production is manifest from the simple expen- areno.a. ment of mixing a little alkali with recently voided urine ; lor tne ■in'r* alkali has no sooner exercised its affinity for the acid than the urine hoiid/tbe throws dovv'" a white powder. And hence a like deposite will not earthy salts unfrequently take place upon using magnesia too freely. irStobT A knowledge of the cause of this modification of urinary sand A^earufy PUtS US at °nCe int° an eaSy m°de °f CUrinS !*i a mOUC »°WeVCl' parts .epa- which was first pointed out to the world by Dr. Wollaston. It con- become'1 de- sists in introducing into the system some other acid as a substitute the8ifor,mIof for tnat wnicn is wanting to the kidneys. All the acids seem to UiteTri- answer this purpose, but as the sulphuric usually sits easier on the rZJated. stomach than any other of the mineral acids, it is entitled to a prefer- Easy mode ence ; and the more so on account of its superior tonic powers, and UusTv'ii8 consequently its better adaptation to the chylifactive organs, a de- fion8ofU" biJ"y which is no unfrequent cause of the complaint. The vegeta- some other bie acids, nevertheless, may be interposed, with the sulphuric, or, Aiucids where the stomach is very delicate, entirely supersede their use. wiiianswer. Of these the citric is the pleasantest and can be persevered in for the longest period of time, especially in the case of children. The tartaric, however, and especially in the form of creme of tartar, has the advantage of gently operating upon the bowels which is always Carhonic a beneficial effect. Carbonic acid whether taken in the form of effervescing saline draughts, or simply dissolved in water by means of Nooth's apparatus will also be found a useful and pleasant auxili- Acescent ary. The general diet should be of the same description, and be dl0t' as largely as possible intermixed with salads, acids, fruits, and espe- cially oranges. Malt liquor should be abstained from ; and, if the habit of the patient require that he should continue the use of wine, Champagne or Claret should be preferred to Madeira or Port. if too large it, is possible, however, that this modification may be a result of too ofcaicare- large a secretion of calcareous earth, instead of too small a secre- te result ^on of acid ; yet the effect being the same the same mode of treat- aiiko. ment will be advisable. This acid Hut the acid may be in excess instead of in deficiency, or, which may be in J , 1 i excess in- is nearly the same thing, the natural secretion ot calcareous earth ficienc0/:^ may itself be deficient while tlie acid retains its usual measure : and in this case the acid itself has a tendency to form a deposite by crystal- Red urinary lizing into minute and red spiculae,—and hence the modification of suit ofYhTs. ked sand that is so frequently found coating the sides and bottom of chamber-utensils. u°id^-ir This, like the preceding, is sometimes voided in a concrete or crystallized state, or the urine may be voided clear, and the deposite not take place till some hours afterwards. The last is ordinarily the result of some temporary cause, and is of no importance as it disappears with the cause that produces it. The first is of more serious consideration as it indicates a lithic diathesis that may lead to a formation of large and mischievous calculi, and is a pretty cer- tain harbinger of the variety we shall have to notice under the name of gravel. fiohai?i™ nates are equally effectual. And, as the latter are far less apt to S disagree with the stomach than the former, they have very generally jj^0^ taken their place. Of the alkalies and alkaline carbonates, soda that aika- has commonly been found to answer the purpose best. It is, indeed, nates"™&» chiefly effectual in its pure state, but it is most convenient to use it in ^£tual- a milder form ; and of all the forms it offers that of soda-water is the pleasantest, and may be persevered in for the longest period of time. Nevertheless there are some constitutions in which potash and its carbonate prove more effectual than soda, a remark for which we are indebted to Sir Gilbert Blane, who, on this account, has oc- casionally given it the preference, and for the sake of rendering it Sometimes more palatable has sometimes partly saturated it with lemon-juice or ™deradose citric acid ; and where there has been severe or protracted pain pro- J^'l™ ducing considerable irritation, has united it with opium.* A drachm opium. of the carbonate of either of the fixed alkalies will form a moderate dose for an adult, and may be repeated two or three times a-day, taken during the effervescence produced by the addition of half an ounce of lemon-juice to the menstruum, which may consist of two ounces of water sweetened with honey. Ammonia and its sub-carbonate have been had recourse to, and Ammonia with great advantage, where symptoms of indigestion have been carbonate. brought on by the fixed alkalies ; and particularly in cases in which red gravel is connected with gout, and the two diseases show a dis- position to alternate. Magnesia is also of considerable use, as has been lately shown by Magnesia. Mr. Brande in two excellent papers upon this subject, published in the Philosophical Transactions.t Taken in free and frequent doses it has often succeeded in checking the tendency to a formation of sand and gravel, and has kept many individuals free from this com- plaint for very long periods of time who have been constitutionally predisposed to it. Nevertheless it is not calculated to supersede the use of the alkalies, but may be employed as a convenient adjunct, or supply their place for a time, when the patient has become tired of using them. There is some doubt as to the manner in which the acids em- Whether ployed to correct a secretion of white sand, and the alkalies that of andaika- red, fulfil their object; whether indirectly, by a peculiar action on the ?jjjirgg|lv chyiifacient organs so as to render the fresh supply of nutriment by influ-" more easily disposed to yield an acid in the one case, and less easily gl°cIJ1,aBc^* in the other ; or directly, bypassing unchanged along the current of &c, ordi * Transactions of a Society for improving Medical and Chirurgical Knowledge, {lie bla^ddc:. Vol. m. p. 359. i Phil. Trans. Year 1810, p. 136 ; 1813, p. 213. 314 ct. vi.] ECCRITICA. [out- Gen. IV. Spec. I. o L. renalis arenosu Urinary sand. But alka- line carbo- nates are no solvent uric acid: and hence tlie proba- ble action is an indi- rect influ- ence. Beneficial use of as- tringents. Supposed by Oe Heucher to possess an expulso- ry power: probable mode of action, as pointed out by Cullen. jS L. rena- lis calculo- sa. Urinary gravel. Sometimes very large and o.uiet. Only threo of Marcet'e classifica- tion of cal- culi ever found in the k'ul- thc blood and arriving at the kidneys in their proper forms. There is a difficulty attending both these views ; but as uric acid, though soluble in the caustic alkalies, is found not to be soluble in their car- bonates and sub-carbonates, the benefit of alkaline medicines does not seem referrible to their solvent powers. And hence it is, on the whole, more probable that both acids and alkalies produce an indirect influence on the kidneys, as we have already had occasion to observe that animal food does in saccharine urine, by a peculiar influence on the chyiifacient viscera, or the nutritive materials during their sub- action. There is also another class of medicines which have long stood the test, and been proved to possess a truly remedial power in all uri- nary concretions of the kind before us—I mean astringents. So considerable is their efficacy that De Heucher ascribes to them an expulsory power, in his treatise entitled " Calculus per astringentia pellendus." Their real mode of action has probably been pointed out by Dr. Cullon in a passage in which he has anticipated much of the reasoning of the present day concerning the benefit of alkalies1, and has hereby given an additional proof of the strength of his judg- ment. Speaking of the leaves of the uva ursi, he says that this me- dicine, " Not only from the experiments of the late De Haen, but also from my own, I have found to be often powerful in relieving the symptoms of calculus. This plant is manifestly a powerful astrin- gent : and in what manner this and other astringents are useful in the cases mentioned may be difficult to explain: but I shall offer a conjecture upon the subject. Their powerful attraction of acid we have mentioned above, and that thereby they may be useful in cal- culous cases is rendered probable by this, that the medicines which of late have been found the most powerful in relieving the symptoms of calculus are a variety of alkalies, which are known to do this with- out their acting at all in dissolving the stone."* Their virtue as a stomachic tonic ought also to be taken into consideration as well as their absorbent power. The second variety of the lithic concretion we are now contem- plating, and which, from its tendency to form larger masses is usu- ally denominated gravel, is of far greater importance than the preceding, from the actual pain that is suffered in most cases, and the danger there always exists of the conversion of such nodules into calculi of the bladder. One of the largest and most extraordinary instances of this kind is to be found in the museum of the London College of Surgeons, belonging to Mr. Hunter's collection, by whom it was taken from the body of Mrs.-----, a niece of Sir Richard Steele, of the weight of seven ounces and a half. She was never known to have had a nephritic symptom till just before her death, when she was suddenly attacked with a violent pain which produced a fever that destroyed her. Of the eleven classes of urinary calculi enumerated by Dr. Mar- cet, there are rarely more than three that are found passing through the natural passages of the kidneys, though others are traced occa- " Mat. Med. Part. n. Chap. i. p. 13 ut. vi.J EXCERNENT FUNCTION. [urd. if. 3<13 Sionally as imbedded in the pelvis or substance, of the kidneys. Gen. lVa These three are the uric, oxalic, and cystic : and of these the two ^l&tce'J{ia last are very rare productions in comparison with the first. " Out caicuiosa. of fifty-eight cases of kidney calculi," says Mr. Brande, " fifty-one J™ei7 were uric, six oxalic, and one cystic." The phosphates seem never ^4'™^' to concrete so as to form calculi in the kidneys, for which it seems difficult to assign a reason. The uric calculi as voided immediately from the kidneys, are of a Unccaicuii, yellowish or reddish-brown colour, somewhat hard, and soluble in ^cai'cha- oaustic potash. They exhale the smell of burnt horn before the meter. blow-pipe, and, when heated with nitric acid, produce the peculiar red compound which Dr. Prout has called rosacic acid. The oxalic calculi vary considerably in appearance. They are generally of a grayish-brown colour, and made up of numerous small cohering spherules, and have sometimes a polished surface and resemble hempseeds. They are easily recognised by their insolubility in dilute muriatic acid : and by swelling up under the blow-pipe, and burn- ing into a white ash consisting of pure lime. The cystic calculi have a yellowish colour, and a crystallized appearance ; they are soluble in dilute muriatic acid, and in diluted solution of potash. Dr. Wollaston has remarked that when heated in the flame of a spirit-lamp, or by the blow-pipe, they exhale a peculiar fetid smell by which they may readily be characterized.* The usual symptoms by which this variety is marked are those of Symptoms pressure and irritation: as a fixed pain in the region of the affected ^,fiBw^"^ty kidney, with a numbness of the thigh on the same side, the pain " marked. alternating with a sense of weight. The pain is sometimes very acute and accompanied with nausea and deliquium, proving that the calculus has entered the ureter, and is working its way down into the bladder, after which the pain ceases till it reaches the urethra, or, by remaining in the bladder, it becomes incrusted with other materials, and forms a vesicular calculus. During the whole of the passage from the kidneys the urine is usually high-coloured, and de- posites a reddish or reddish-brown sediment, occasionally not unlike the grounds of coffee, and evidently giving proof of the laceration of blood-vessels by the angular points of the calculus. It is a very singular fact, and has been properly noticed by Dr. Heberden, that during the most violent pain at any time endured from this cause, there is rarely any acceleration of the pulse : in the same manner as the torture sustained by the passage of a gall-stone through the gall-ducts produces as little effect upon it. If, however, the flow of the urine be obstructed by the calculus, as sometimes happens, the ordinary constitutional symptoms take place which characterize that affection, as a general sense of uneasiness, heat, thirst, a quickened pulse, and other pyrectic concomitants ; sickness at the stomach, costiveness, sleepless nights, and at length coma, intermitting pulse, convulsions, and death : and all this even where the pain or weight in the loins is not peculiarly distressing. We have often had occasion to observe that where a morbid change Where the disease proceeds * Brande, Journal, &c. Vol. vm. p. 6?, Tie*™'* Vol. V.~ 11 ^4(i Gen. IV. Spec. I. 0 L. renalie riiicuiosa. l.'rinary gravel. venience fell in ma- ny cases. Illustrated. Proximate cause of uric calculi uric acid. That of oxalic and cyetic not so obvious. Predispo- sing and occasional causes. ''•] ECCRITICA. [ORD. II. Diathesis approaches thai of gont. Analogy traced out. Process of treatment. takes place in an organ very gradually, it may proceed to almost any extent without any acute suffering on the part of the patient, and sometimes without any suffering whatever. The same fact not un- frequently occurs in the disease before us, of which a remarkable instance is related by Dr. Marcet, in a patient who died of a dropsy in the chest, without having made any complaint of the state ol his urinary organs, ;.houoh one of his kidneys was found, on dissection, to be distended by a large collection o: calculi. The proximate cause of the formation of uric calculi we have already shown to be an excess of uric acid : that of the oxalic and cystic is not quite so obvious,"—a point, however, of less importance from the infrequency of their occurrence. The predisposing and occasional causes of all of them are too often involved in obscurity. In many persons there is an hereditary tendency to this complaint; general indolence or a sedentary life becomes a predisponent in others ; too large an indulgence in fermented liquors, and the luxu- ries of the table generally, forms a predisponent in a third class; but the chief cause of this kind we are acquainted with, is a want of constitutional vigour, and especially in the digestive organs ; and hence the periods of life in which this disease occurs most frequently are from infancy to the age of puberty, and in declining years: while it is rarely found during the busy and restless term of mature virility. It is for the same reason that the disease of gravel is so frequently connected with gout, which has a peculiar tendency to debilitate the digestive organs. " The calculous cachexy of the urinary system," says Dr. Swediaur, " often resembles the podagric cachexy, to which indeed it bears a strong analogy. Both are hereditary, occasionally endemic. As gout is for the most part observed in regions abound- ing in wines, lithia is chiefly traced where malt liquors are the ordi- nary beverage ; and hence in Europe we are not without examples of it, even in infancy. Almost all cases of gout, occurring after the middle of life, are combined with calculous urine ; while the last proves at times a metastasis of the first."* The process Of treatment must, for the most part, be derived from these causes. As a preventive of that modification of calculus which is by far the most frequent, we have already advised the use of alkalies and alkaline carbonates. Where the digestive organs are weak the diet should be light but generous ; warm and bitter tonics will always be found serviceable ; the bowels should never be suffered to become costive, and should occasionally be stimulated by brisk purgatives, which tend equally to remove acidi- ties from the stomach, and to stimulate the kidneys to a more healthy action. Indolence and a sedative life must give way to exercise, and especially equitation, which is by far the best kind of exercise for the present purpose, and whatever will tend to promote an in- creased determination towards the surface, and a frequent glow on the skin will prove a valuable auxiliary : for the skin itself becomes, in this affection, though rarely in paruria mellita, an outlet for the Nov. No»<«l. Metb. Syst. Vol. n 2-i9 cl. vr.j EXCERNENT FUNCTION. [ord. ii. 347 discharge of a redundancy of acid, as may be observed by the sim- GEN- Iv- pie experiment of tyeing a piece of paper stained with litmus about l^0" *' the neck ; which even in a state of common health, will often be J,"^3^. change! to a red colour by the acid thrown off in the ordinary course cuius. Of perspiration. Treatment. Of the mischievous effects of a luxurious diet, and the advantage Misrhiev- of abstinence, M. .iagendie has given a very striking example in °f3ae^xu- the case of a merchant of one of the Hanseatic towns who was nous diet habitually afflicted with the complaint before us. " In the year }™mn-l- 1814 this gentleman," he tells us, " was possessed of a considera- sendic- table fortune, lived in an appropriate style, and kept a very good table, of which he himself made no very sparing use. He was at this time troubled with the gravel. Some political measure unex- pectedly took place which caused him the loss of his whole for- tune, and obliged him to take refuge in England, where he passed nearly a year in a state bordering upon extreme distress, which obliged him to submit to numberless privations ; but his gravel dis- appeared. By degrees he succeeded in re-establishing his affairs ; he resumed his old habits, and the gravel very shortly began to re- turn. A second reverse occasioned him once more the loss of all he had acquired. He went to France almost without the means of subsistence, when his diet being in proportion to his exhausted re- sources, the gravel a second time vanished. Again his industry restored him to comfortable circumstances ; again he indulged in the pleasures of the table, and had to pay the tax of his old com- plaint."* It may at first sight appear a singular fact, but the remarks just Mariners offered will tend to explain it, that' mariners are rarely subject to ject to this stone or gravel. Mr. Hutchison has published a valuable article Explained. upon this subject in one of the volumes of the Medico-Chirurgical Transactions,? from which it appears that out of ninety-six thousand six hundred and ninety-seven patients, admitted in the course of sixteen years into the three grand coast hospitals of Plymouth, Hasiar, and Deal, not more than eight had laboured under either species of lithia. Whence it appears that the occupation, diet, ac- tivity, and regimen of a maritime life are the best preservatives against all such affections : such as an animal aliment largely combined with the alkaline stimulus of muriate of soda ; a farinaceous, for the most part, instead of any other vegetable diet; great exercise, and that free exhalation from the skin at night which is so well known to take place among sailors in the royal navy, in consequence of their being compelled to sleep closely together. And, as the disease appears to be equally uncommon in tropical climates, we have here an easy explanation of the cause of its infrequency. In our own country it appears from the tables of the Norwich hospital to be more frequent in Norfolk than in any other county of the same population. * Rechcrches Physiologiquea et Medicates stir les Causes, les Symptoms et le Traitement de la Gravelle. 8vo. Paris, 1818. t Trans, of the Medico-Chirurg. Soeiety, Vol. ix. 34S cl. vi.] ECCRITICA. l™*>- u' Gen. IV. it oniv remains to be observed that during the paroxysm of pain Lifhia'f' produced by the passage of a calculus through the ureter, our chief renaiis. object should be to allay the irritation and mitigate the distress. rlta* The warm-bath is here "a valuable remedy ; friction on the loins, Remedial1" with rubefacient irritants combined with narcotics, often afford re- process du- lief: but the present author has found most benefit from a flannel- Joiwm'of1" swathe wrung out in hot water and folded about the loins ; being i,ain- suffered to remain there for hours wrapped round, to confine the moisture, with an outer swathe of calico or linen. If these do not answer, opium, and in free doses, must be had recourse to. SPECIES II. LITHIA VESICALIS. STONE IN THE BLADDER. KRE4UENT DESIRE OP MAKING WATER, WITH A DIFFICULTY OF DIS- CHARGE ; PENIS RIGID, WITH ACUTE PAIN AT THE GLANS : SONO- ROUS RESISTANCE TO THE SOUND WHEN SEARCHING THE BLADDER. Gen. IV. The substances, vulgarly called stones in the bladder, are, for ^spec. n. tjie most part, of a very composite structure. They originate from stout* of a a nucleus which may consist of any morbid or foreign material that posfte0111 can accidentally obtain an entrance and a lodgment in the bladder ; structure: the body of the calculus being'formed out of such constituent parts of different of the urine as are most easily detached and attracted : which rounded" gradually incrust around it, and concrete into a mass for the most with an part far too large to pass through the urethra. rietyof nTa- The most common of these nuclei is a kidney-calculus itself, and Kidue' - consequently a crystallized spherule or nodule of uric acid ; and, calculus the where the acid is habitually in excess, the coating of the vesicular mon'nude- calculus may consist of this alone or chiefly : but, from the great us: and variety of materials, as earths, alkalies, and other acids besides uric, comprises8 «nd sometimes blood and mucus, which enter into the composition ■tona?lire °f tlie urine at tnis tirne' '* *s not °ften tnat a calculus of the bladder is a crystallization of uric acid alone. Materials In the introductory remarks upon the present genus, we observed found5ai- *'iat tne different kinds of calculi discovered in the human bladder Wo^Mwn ^acl keen treated of by Dr. Wollaston, as far as they were then into five di- known, in a very masterly essay upon this subject, published in the risiont. Philosophical Transactions for the year 1797 : he has since enumera- ted them as follows : 1. Uric acid calculus. 2. Fusible, triple, or ammonio-magnesian phosphate. 3. Bone-earth calculus, or phosphate of lime. 4. Mulberry calculus, or oxalate of lime. 5. Cystic oxyde. The cystic nxvdr* is not contained in the article "above referred to-. n. vi.] EXCERNENT FUNCTION. [ord. ii. 349 as not having been discovered at the time : but it has since been Gkn. IV. detected by tli< same excellent cj;ei.:ist, and name- di; above. ^"allli- W< n.ive nMj r#i> pi i'P(i rj-.ai .-trious ot!:er okt.ious masses have1"'1'8- . still inn:e '.atciy n«j-.v, as^ertanie'- r>\ i.ie a;.-a.:;.sts 01 ne. expen-ii,.,cudder. meiileiv, and ih,u ui- whole ■i'j.-.-.er, as a-r:isged b or. .Marcet, ^1raT1,a" amounts, m *ho :<:osenl 'lay. u- eleven or twelve. I >. ii names we sometimes have already give n, nor is it worti: while, m a work :U voted to prac- ;race " tical medicine, to notice them any further, as they are rarely to be met with in comparison with the tive arranged above, and, when met with, will not call for any essential ditierence in the mode of treatment. In effect, they have been found equally different in composition, Hence ca!- form, size, and colour ; from the weight of half a drachm to that of forms, several pounds ; purple, jasper-hued, red, brown, crystalline, cineri- coioursl"1 tious, versicoloured: in one or two instances covered with down,* Sometimes apparently produced from the surface of the bladder, from which, as ^ithdewn: we have already had to observe, hairs are occasionally discharges with the urine.t They have also been found solid, perforated, hoi- Sometime* low, compact, crumbling, glabrous, rough, and spinous,^- and, in a with iron. few instances, combined with iron.§ They seem sometimes to form very rapidly ; and, where the pa- Are some" tient has already discharged one or two, and the urethra has in con- duc.d very sequence become more than ordinarily dilated, they occasionally di^'hi'*^ pass off'in great numbers in a short space of time. We have'"great hence, in different professional journals and transactions, accounts Exempiiii- of a hundred and twenty voided in the course of three days ;|| two ed- thousand in the course of two years ;1f and three hundred of a pretty large size within the same term.** The largest discharged in this manner, which lias ever occurred to me in reading, weighed five ounces. Dr. Huxham describes one instance of such a fact ;tt and another is given in a distinguished foreign miscellany.jj By females they have often been discharged >•• the weight of two ounces and a half; and my excellent friend r. Yelloly mentions a calculus of nearly three ounces and a half in one case we are told of a stone thus evacuated that weighed iwelve ounces.|||| The general character of the uric calculus has been given chemical already. Its texture when formed in the bladder is commonly lami- of^^cal- nated ; and, when cut into halves, a distinct nucleus of uric acid is cuius. almost always perceptible. Its exterior is generally smoother than that of other calculi, except the calculus of bone-earth, or phos- phate of lime. If ^i The appearance of the second or fusible calculus is generally chemical white, and often resembles chalk in its texture. Strongly heated fnalwe'ca^ before the blow-pipe this substance evolves ammonia, and readily culus- * Blegny, Zodiac, Ann. iv. Febr. Obs. 4. f Gen. in. Spec. v. part, in cont. X Bartholin. Act. Hafn. Tom. ii. Obs. 85. I Act. Erudit. Leips.. 1627. p. 332.—Dotreus, Ep. ad Waldschmidt. p. 253. || Eph. Nat. Cur. Dec. hi. Arm. v. vi. p. 99. IT Griindlicher Bericht, von Blatterstein. ** Hildan. Fabric. Cent. i. Obs. 89. ft Hnxh. Vol. ill. p. 42. tt Sammluns;. Med. Wahrnerr ting. Band. vm. p. 258. §§ Trans, ot the Medlco-Chir. Society. Vol. vi. H fl Eph. Nat. Cnr. Dec. u. Ann. v. Obs. 71. fV. Brande's Journal, Vol. vm. p. 21*, 350 cl. vi.] ECCRITICA. [™r>- u. Gen. IV. fU3es ; whence the name assigned to it. It often breaks into tay- latWavcVi- ers' and exhibits a glittering appearance when broken. caiis. Tiiu third division, consisting of the iiojvf.-f.iuth calculus, or b\°"det. ' phosphate of lime unmixed with any o'.lier -substance, liar. 1 >;ue- rtarMto'c n,v>rtn smooth surr>,e ; and when sawn thr. >gh is found of a larni- bone-earu. naicd texture, ami easily separates into concentric trusts, f ms calculus is peculiarly difficult of fusion. Chemical The fourth division embracing the mulevrry calculus, or oxa- ^hX(rtry0f late of.ii.ne; is of a rough and tuberculatea exterior, and of a deep calculus, reddi^ i-brown or mulberry colour, probabiv produced by a mixture of blood that has escaped from some laceratedvessel, whence the name abS)?;ied to it. The nucleus is generally oxalic, and of renal origin ; but it is sometimes uric. It is also frequently enveloped by the fusiL-ie calculus, chemical The fifth, or cystic calculus has a crystalline appearance but of ofcryBCticr a peculiar greasy lustre,and is somewhat tough when cut. its colour calculus i9 a pa]e j.awn bordering upon straw-yellow. Itis very rarely to be met with. of uwbodv ^uVl are tfie na'cuu which arc principally found in the bladder ; of a calcu" an J we may readily conceive with what facility they are formed trated"*' there, when ao accidental tendency is given to tiiuir formation by a lodgment of any thing that may serve as a nucleus, by noticing the deposites of phosphates of lime and other materials that are per- pf.ttirUy incrustmg every substance over which a current of urine is frequently passing; as the public drains in our streets, which are daily exhibiting them in regular crystals. .Ordinary i he ordinary causes of renal calculi are necessarily those of fe^afcaicu- vesical calculi, but any local injury or infirmitv, which prevents the u those .>r urine from passing off freely from the bladder, accelerates their vesical;. . • . P * 1 . . ' «. but other formation and enlargement, not only by the confinement it causes fst'depond- but by the decomposition which rest soon produces, in which case eiituuon it becomes ammoniacal, and a larger portion of the phosphates will thebiad.ier. be precipitated. And hence, an obstruction in the urethra of any kind, uii: particular^ a diseased prostate, becomes a frequent auxiliary, an 1 sometimes even a primary cause of the formation of a stone wittiout any mischief in the kidneys, or any disordered secre- tion of urine.* u Th«» bladder," says Sir Everard Home, "never being completely er-mt'-ed, the dregs of the urine, if \ may be allowed the expression, being never evacuated, a calculus formed on a nucleus of the ammoaiaco-magnesian phosphate and mucus is pro- duced, when it would not have been produced under other circum- stances. 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 en- largement of the middle lobe of the prostate gland."! Difference It does not appear from the experiments or observations of Dr. In d!ffer"t Marcet, that a difference in the waters of different places is much, KoVaeem to if at al1, concerned in the production of calculous disorders: nor be a cause. * Brande's Journal, &c. Vol. vm, p. 210. % On the Diseases of the Prostrate Gland, Vol. i. p. 40. cl. vi.] EXCERNENT FUNCTION. [ord. ii. 351 have we any satisfactory evidence of their being more prevalent in GfiN« IV. cider than in ether countries, notwithstanding the genera! •■pinion LHhia've-" that they are so. Eut we are yet in want of sufficient data upon llf1!". .. .1 • i • , .,, , i . . r Sstorainthe this subject io speak with much decision. bladder. As the disease of store in iLe bladder is very generally a sequel Symptoms of calculi in tl e kidneys, th^ symptoms indicative of the preceding c'.i'suif'the species foirr, in .nost instances, the first symptoms <^ Jhc present, £"""££* Yet occa'iio i;t;!y, from causes we hvv" ju;.t poieteti out, the con- t'-rogressof cretion com.nonces in the bladder, and the symptoms of an affected ki-^'ey .-ire r.^t experienced. One of the first signs of a stone in the Pain at ihe bladder is an uneasy sensation at the point of the urethra occurring Srethra. ' in conjunction with a discharge of urine that deposites red or white sand, or after having occasionally voided small calculi or fragments of a larger. This pain is sympathetic, and proceeds from the irrita- cause ex- tion of the prostate or the neck of the bladder, agreeably to a law p nine ' 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 recipro- city of feeling than any intermediate part, and consequently partici- pate with more acuteness in any diseased action. This uneasy sen- sation at the point of the urethra, is at first only perceived on using any violcvit or jolting exercise ; or in a frequent desire to make £drimed™id" water, which is often voided by drops or in small quantities ; or, if or inter- in a stream, the current stops suddenly while the patient is still con- rupte y" scious that the bladder is not fully emptied, and has still an inclina- tion to evacuate more, but without a power of doing so. As the Tenesmus. stone increases in size there is also a dull pain about the neck of the bladder, the rectum partakes of the irritation, and produces a trou- blesome tenesmus, or frequent desire to go to stool. Where the pain JJjj"^ is trifling the urine is often limpid, as the saline or earthy materials limpid: from their confinement in the bladder arrange themselves around ?urbid.meS the growing calculus, and enlarge it by a new coating ; but where the irritation is considerable, there is often a mucous sediment in the water, and sometimes a discoloration from blood. The region of uneasiness extends its boundary, the stomach participates in the disquiet, sleepless nights ensue, with pyrexy, anxiety, and ('ejection of spirits : all which symptoms are increased ty exercise of every kind and particularly by equitation. Several of these signs may How di»- indicate a primary disease of the prostate or neck of the bladder, weToma but the occasional discharge of calculous fragments or deposit of j^™"fythe" urine loaded with uric acid or phosphate of lime, are- sufficiently prostate pathognomic. It is usual, however, in all such cases, to examine 8 an " the bladder by a sound, which commonly puts the question beyond all dispute : though if the calculus be lodged in a peculiar sac or stone not the fasciculi of the bladder, or lurk behind some morbid enlarge- co^aMe" ment of the prostate gland, the sound may not detect it, and the bythe experimenter may deceive himself and the patient in respect to the nature of the disease. The treatment of this malady offers two indications, a palliative T0^iatl?ent and a radical. and radical. 352 cl. vi.] ECCRITICA. [<>*»• "• Gem. IV. The palliative may be applied to relieve the actual symptoms, and Spec. II. t prevent a further enlargement of the calculus. JLitnia vcsi- f ^ • | j caii«. The symptoms vaiv gre;Uiv in dine '.it ;ases: partly, inueca, biB0ddr-r!"" from the size of the "calcuius itself, but quit- as much from tho Treatmin't constitutional irritability of tlie bladder and Wv particular quarter of of two it in which it is seated. In a few persons, the bladder has possessed Plan*reme- so little morbid excitement that stones of considerable magnitude dial of tho have been found in this organ after death without having produced sometimes any very serious inconvenience during life. If the calculus bo taHiiue*8 immediately seated on the neck of the bladder it is, however, almost trouble- impossible for the most impassive not to suffer severely at times. as^h'en But the stone has sometimes found a fortunate lodgment between hae«hlttfeder tne muscular fascicles of the bladder, where it has become imbedded irritability: as in a pouch, and a train of morbid symptoms, which have ante- haHod8gede cedently shown themselves, have gradually disappeared in proportion in a pouch. as this change has been effected. singular ^',r' Nourse showed to the Royal Society the bladder of a man examples of in which not less than six sacs or bags were in this manner produced SUCi) louff" ments. by a protrusion of the internal coat of the bladder through the mus- cular, and which contained altogether nine stones.* The stone9 are sometimes fixed so firmly that it is impossible to separate them by the forceps in performing the operation of lithotomy, without tearing the bladder or cutting one side of the sac; which last method M. Garangeot informs us he once tried with success. In several other cases, however, that he has described, the vessels of the bladder had spread luxuriantly over the stone, and apparently grown into it ; and the extraction was followed by a mortal he- morrhage.! Generally speaking, calculi when seated in pouches of this kind, continue without much disturbance for years, and some- times for the whole of a man's natural life, of which Dr. Marcet has given various striking examples in his treatise. may imUate Art cannot scoop out such convenient receptacles, but it may do any of these something to allay the irritability of the bladder when severely-ex- nrUabiiitj cited, and in this manner palliate the distressing pain that is often trjj.be taken enlured. 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. Plan for ^ Our next intention should be to prevent, as far as possible, an the enlarge- augmentation of the calculus already existing in the bladder. Sui."" *n or(ler to accomplish this, it will be necessary to inform our- iuchemical selves of its chemical constituents, for otherwise any method we may musrtabeefirst propose will probably do harm. From the remarks already made, ihe°precipi- ^ ls ODV'ous that the chief constituent principles of the calculi in tatoorcrys- the bladder, like those in the kidneys, are uric acid and bone-earth Lf ir^urine. or phosphate of lime. If the former predominate the urine will * Mtan. 4fi?. S>of. 3- f Mem. de l'Acad. de Chintrf/. Tom. i. cl. vi.] EXCERNENT FUNCTION. [obj>. ii. S5S often throw down a precipitate or incrustation of red sand, if the Gen. iv. latter, of white sand : and in the former case, as there is an excess T^fnfac* U* of uric acid, our remedial forces must be derived from the alkalies vesicaiis. and alkaline preparations to which we have already adverted under waddV" ^ the preceding species : in the latter case, as there is, in all proba- wbTre"!"-' bility, a deficiency of acid, we must have recourse to an opposite kaiies may mode of treatment, and employ the mineral and vegetable acids, *veh°*|ful: with a diet chiefly composed of vegetables as, reccommended above ac"Js. under renal calculus. But the calculus may consist of both, for it may exhibit, arid The calcu- often does, a nucleus of crystallized uric acid with laminae of phos- complicated phate of lime, magnesia, or some other substance : or, by carrying "f both: • .j p i » li one© giGftt eitner ot the above processes to an extreme, we may convert one caution ne- morbid action into another. For if, by the use of alkalies, we di- ^ee8f"y as minish too much the secretion of uric acid, we may let loose the skill- calcareous earth, which, in a healthy proportion, it always holds in solution, and hereby [increase the vesical calculus by supplying it with this material; while, on the contrary, by an undue use of acids where these are required to a certain extent, we may obtain a secre- tion of uric acid in a morbid excess, and augment the stone in the bladder by a crystallization of an opposite kind. Hence a very considerable degree of skill and caution is requisite in the mode of treatment, and the character of the urine should be watched per- petually. 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 colchicum Coichicum autumnale in many cases of gout, and the tendency there is in many 8U umna e' cases of this disease to form calculi in the joints, Mr. Brande has ingeniously thrown out the idea of trying the virtue of the colchicum in the disease before us, and hints that he has received from one quarter a very flattering account of its success, though not sufficiently precise for publication. If the reasoning pursued in examining the why not powers and effects of the colchicum in that part of the present work useful. 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 appeared that the colchicum does not act as a preventive, but as an antidote, 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 constitution 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 attacks, 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 Vnr. Y._-45 354 cl. w.j ECCRITICA [obd. li. Gen. iv. reader may turn to the genus osthexia* in a preceding Order of l"*'ll tnc Present Class. re"ic*i.*. There is something perhaps more plausible in the remedial regimen hirwcr'.thc proposed by M Magendie, who, on reflecting that azote is an essential Treatment, constituent of urea and uric acid, advises that the patient be confined rimenof to food that possesses no sensible portion of azote, as sugar, gum, Si .„'• ndie. 0ii_0iivei butter, and a vegetable diet generally :f thus treating it with a dietetic course directly the reverse of what is now generally pro- posed for paruria mellita, or diabetes. soundiKss From the whole that has been advanced not only under the pre- gcncrauy sent genus, but also under much of the preceding, it is obvious connected tnat the soundness of the urine keeps pace, in a considerable de- with sound- . „ , , •. -r „„ ne*s of sto gree, with the souudness oi the stomach and its auxiliary organs, •djolrirf and is dependent upon them : and hence in calculous concretions organs. 0f every kind it is of the utmost importance that the chyiifacient viscera, and the whole course of the intestinal canal, should be kept in as healthy a state as possible. iience to- Astringents and bitters offer to us the best remedies for this pur- "articuiariy pose. From the supposed absorbent power of the former, Dr. buters. Cullen, as we have already seen, ascribes to them much of the peculiar benefit resulting from the use of alkalies and magnesia, independently 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 its cor- recting acidity in the stomach ; J thus acting the same part as mag- nesia, and in many cases with greater potency. Solution of If such be the difficulty of preventing a calculus already formed hiaddeTim- in the bladder from enlarging, we may readily see how hopeless practicable, must be every attempt at dissolving the matter that has already Bnu why* become 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," says Mr. Brande, " independently of more urgent reasons. show the futility of attempting the solution of a stone of the bladder by the injection of acid and alkaline solutions. In respect to the alkalies, if sufficiently 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, therefore, be applied strong enough to dissolve any appreciable portion of the stone, and the uric nucleus always remains as an ultimate obstacle other diffi- to success."§ The greatest impediment of all, however, consists ueencoun- m tne difficulty of ascertaining the nature of the surface of the stone wred. that is to be acted upon, and the diversity of substances of which its * Supra. Cl. vi. Ord. i. t Recherches Pbysiologiquea ct MeMicakfl, &c. ut iupr* Mat. Med. Part u. Chaj). x. p. 402. § Journal; V >!. nil t>. 215. •x. vi.] E\CER\EYr ITNCTIxJN. four,, n. 355 various laminae very frequently consist; insomuch that had we glas-.s Ge.v. iv. that could give us an insight into the bladder and unfold to us the Lifh"*11 nature of the first layer, and could we even remove this superficial g^^,. crust by a solvent of one kind, we should be perpetually meeting bladder" "" with other crusts that would require other lithontriptics ; while the T:u*lmeut- very means we employ to dissolve them, by decomposing the prin- ciples 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 J^™"^, their day, we shall find that by far the greater number of them were ljthontrip- calculated to deceive either their own inventors, or the public, by a £"$"j\,i palliative rather than a solvent power. Some of them were olea- demulcent- ginous or mucilaginous ; others, that contained a considerable por- tivos'as'1 tion of alkali, contained also some narcotic preparation: while a "neu""s third sort seem to have acted by a diluent power alone, in conse- and benrf. quence of being taken into the stomach or injected into the bladder \™™e, and in a very large quantity ; and by these means all had a tendency to w0c8reed6t,oP" appease the irritation. Even Mrs. Stephens's rude and operose dissolve the preparations, which exercised so much of the analytical skill of Dr. ^1"% Hales, and Dr. Hartley, and Dr. Lobb, and Dr. Jurin, and many parties ap other celebrated characters of their day, were combined with opium pYen°g mt when the patient was in pain, and with aperients when he was d,cine3- costive; and through their entire use. with an abstinence from port wines and other fermented liquors, salt meats, and heating condi- ments, and with rest, and a reclined position instead of exercise : 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 general council.* How far filling the bladder with sedative or demulcent injections F,*a'ive , , . °.. . . . . ... . .. . ■> and tlemul- may succeed in diminishing irritation and alleviating pain, has not cent injee- pprhaps been sufficiently tried; but from the supposed success 0ftlons- many of the old lithontriptics employed in this way, and whose virtue can be ascribed to no other cause, it is a practice worth ad- venturing upon in the present age of physiological experiments. When, however, there is much disease of the prostrate or bulb of the urethra, the attempt should be desisted from, but wherever the sound can enter without much pain, we need pot 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- *.ery »"- lished in a professional journal of considerable merit, of the man- ner in which it is performed in the present era, and has been from and still time immemorial in the dominions of Muscat, beyond the moun- A7aCbiae. ii. 35) bladder, is introduced another instrument, made of steel and con- Gen- re- sisting of three elastic and curved claws capable of seizing and £$£' "' fixing the stone when projected. It consists also, besides such ^sicaiis. pincers, of a stillet of the same metal, at the extremity of which is the bladder. a circular saw, which can be worked upon the stone, and abrade it, Treatraent' till it is entirely comminuted, without injuring the bladder. It has already been tried on the dead, and in a few instances on the living body ; but its general success is still doubtful. " Yet," observe the Committee, ""notwithstanding its inefficacy in some cases, and the difficulty of its application in others, it cannot fail to form an epoch in the annals of the healing art, nor to be regarded as one of its most ingenious and precious resources." Some such machine seems to have been suggested by one or two individuals antecedently, but Dr. Civiale is unquestionably the first who has produced and made trial of it. 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 Lithotomy. other cases lithotomy offers the only mean 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. Enormous A stone from a quarter of a pound to half a pound, may, perhaps, caufuii in be regarded as the ordinary average : but they have sometimes grown BOme C8,cs" to a much larger size, and have still been safely extracted. The largest for which lithotomy seems at any time to have been performed 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 bc 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 pounds and a half, or seventy-two ounces, and seems to have filled nearly the whole of its cavity.]; • On Sir David Ogilvie. t Phil. Trans, year 1809. By Sir James Earle, presented to the College of Sur- geons. X Bresl. Sammlung. Band. n. 1724. 434. 11. CLASS VI. ECCRITICA. ORDER III. ACROTICA. DISEASES AFFECTING THE EXTERNAL SURFACE. Class VI. Ord. III. Origin of ordinal term. Excretories of tjje skin their exten- sive use: and sympa- thy with other or- gans : the fluids they con- tain hence constantly affected. Their mouths af- fected by external abrasion. PRAVITY OF TIIE FLUIDS OR EMUNCTORIES THAT OPEN ON THE EXTERNAL SURFACE ; WITHOUT FEVER, OR OTHER INTERNAL AFFECTION, AS A NECESSARY ACCOMPANIMENT. Acrotica is a Greek term, from xx.fos, " summits," whence *%i\«t»;, ijtas, " summitas," " cacumen." The excretories of the skin form a most important outlet of the system, and although the fluid they secrete is, in a state of health, less complicated than that of the kidneys, 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 na- ture, 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 excited and irritated : now dry and contracted, now relaxed and streaming 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 hardens 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 impres- sions or irritants with which the air is impregnated.* This defence, however, they frequently lose ; often from external violence, and * Lectures on the general Structure of the Human Body, and on the Anatomy and Functions of the Skin, &c. Bv Thomas Chevalier, F. B. S., &c. Lect. vi. vir. J^ond. !«??? ci,. vi.] EXCERNENT FUNCTION. [ojiv.ui. 359 often also from the acrimony or roughness of the materials that are 9)LASSTy/' thus transmitted to them, and which excoriate as effectually as fric- a epical tion, a keen frosty north-east wind, or the direct rays of a tropical Disec*?ne8 sun. And at times the absorbents of the skin are torpid or weak in the'ex'tCTnai their action ; and the finer parts only of the fluids that are secerned su0rmect-raeB are imbibed and carried off, while the grosser parts remain and ac- by torpi- cumulate in the cutaneous follicles, and become acrimonious from tude decomposition. And hence a great variety of superficial eruptions, papulous, pustulous, and ichorous, squammose, or furfuraceous. And not unfrequently there is a constitutional irritability of the skin s°™"/ames which not only renders it peculiarly liable to be excited by small mitabie.y causes in every part, but to sympathize in the morbid action through fy^^e its whole extent in whatever part it may commence : and hence the with re- spread of eruptions to a greater or less extent, sometimes, indeed, bid actions. over the entire surface. A knowledge of this fact is of great im- ™*rt"nt portance, for we can often avail ourselves of it in the treatment of doctrine. constitutional or organic affections of considerable severity or dan- ^abie'of ger, and by exciting a temporary irritation on the skin, mitigate or beins a?l«d entirely subdue the original malady. All the benefits derived from great ai- the eruptions produced by the tartar-emetic ointment,* blisters, sina- vantase pisms, and the entire host of counter-irritants as applied to the sur- face, are dependent upon this extensive and important principle in pathology. From these sources of affection a variety of complaints must ne- Hen<>e a ^ cessarily take their rise, none of them perhaps fatal to life, but many f^of dis- of them peculiarly troublesome and obstinate. They may be p\naCintcg°m" arranged under the following genera : % I. EPHIDROSIS. MORBIO SWEAT. II. EXANTHESIS. CUTANEOUS BLUSH. III. EXORMIA. PAPULOUS-SKIN. IV. LEPIBOSIS. SCALE-SKIN. V. ECPHLYSIS. BLAINS. 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. By Professor Frank they have been impetigines marshalled under the term impetigines, employed, but with a lati- entTwckiis! tude never assigned it before, as the name of a class, divided into the two orders of maculosjg and depascentes. * Lctterto C. H. Parry, M. D., F. R. S., on the influence of Artificial Eruption* in Certain Piseases. &c By Edward Jcnner, Esq. M.D- 4to. Lond. 1822. 360 cl. vi.] ECCRITICA. L0KD- Gem. I. Matter of sweat and perspiration nearly tho same. Whether there be persons who never perspire. All warm- blooded an- imals per- spire or have some vicarious discharge. Instanced in the dog- kind. Cutaneous exudation of lizards. Cold-blood- ed animals secrete but a small quantity of fluid. Thoso who ferspiro ittle, need but little supply of food. Proportion ■ of insensi- ble perspi- ration to rhe food. boruetiuiea secreted in cxcoss, and l.euce the present T-J1U8. GENUS I. EPHIDROSIS. MORBID SWEAT. PERPETUAL SECRETION OF CUTANEOUS PERSPIRATION. Ephiorosis (spttyt»Tis) 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 ani- mal soil. 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, I have known a New- foundland 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 lizard, 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 occasion- ally produces dangerous gangrenes. Generally speaking, 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 sedentary and inactive lives, recorded in the scientific journals of different coun- tries, a subject we have already discussed :* for the matter of insen- sible 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 insen- sible perspiration ; sixteen ounces during the two-thirds of this pe- riod allotted to wakefulness, and twelve ounces during the remain- ing 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 moist- ure, without any misaffection of the system. It is to this species * Vol. 1. Cl. i. Ord. i. Liniosis espa-i. i>. 106. vl. vi.J EXCERNENT FUNCTION. [oa». m. 351 i that the term ephidrosis has been usually applied and limited by no- g?n: f. sologists. Sauvages, however, has employed it in a wider signifi- Morbid0'11' cation, so as to include various other species, and perhaps correctly; sw"u' though Cullen inclines to regard all but the first as merely sympto- matic of some other complaint. The following appear to be those which are chiefly entitled to a specific rank : 1. EPHIDROSIS PROFUSA. PROFUSE SWEAT. 2. -------■---CEUENTA. BLOODY SWEAT. 3. --------„ PARTIALIS. PARTIAL SWEAT. 4.----------DISCOLOR. COLOURED SWEAT. 5.----------OLENS. SCENTED SWEAT. 6.----------ARENOSA. BANDY SWEAT. SPECIES I. EPHIDROSIS PROFUSA, PROFUSE SWEAT. CUTANEOUS PERSPIRATION SECRETED PROFUSELY. This is commonly a result of relaxed fibres : tlie moutlis of the Gbn' '• cutaneous exhalants being too loose and patulous, and the perspira- Pathology! bie fluid flowing forth copiously and rapidly upon very slight exer- jy,™1"** tions, sometimes without any exertion at all; as we have already sweating seen the urine flows in paruria aquosa. and the serum in various Sy'sii^t species of dropsy. It is the hyperhydrosis of Swediaur. exertions. There is here, generally speaking, less solution of animal oil than drowse? in perspiration produced by exercise or hard labour :* buv from the8 veu»aur- drain that is perpetually taking place, no animal oil accumulates, and the frame is usually slender. Corpulent persons also perspire Why co« much, but this is altogether from a different cause, being that of the corpulent weight they have to carry, and the labour with which breathing and p«»ona. every other function is performed in consequence of the general op- pression 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 Thowwno have frequently perceived that there is no particular liability to catch muXnot cold, notwithstanding this tendency to perspiration, and have very ^J^1*" often seen it suddenly checked without any evil; such is the won- liable to derful effect of an established habit. But the moment the general ^d^,"' health suffers, or the system becomes seriously weakened by its con- * Buchner, Diss, de Sudore Colliquative Hal. V757. Vol. V—16 362 cl. vi.J ECCRITICA. [ojh>. ui. Gen. I. Spec. 1. Ephidrosis profusa. Profuse sweat. The diathe- sis often pertina- cious, and changed with diffi- culty. Medical treatment. tinuance, the sweat is apt to become colliquative, and to terminate in a tabes or decline.* Tulpius gives a case of its continuing for seven years.! Astrin- gents of all kinds have been tried, but with variable effects. Dr. Percival relied chiefly on bark ; De Haen employed the white agaric,}, and in the Journal de Medicine,§ the same medicine is re- commended under the name of fungus laricis; it is the boletus laricit 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 mattress instead of a down bed at night, have proved successful on many occasions, and form the best plan we can adopt. SPECIES II. EPHIDROSIS CRUENTA. BLOODY SWEAT. CUTANEOUS PERSPIRATION INTERMIXED WITH BLOOD. Gen. I. Spec. It This species hitherto rarely de- scribed. Pathologi. eat expla- nation. Under what states of bo- dy the spe- cies oecurs, and from what causes. This species has not been very commonly described by nosolo- logists ; but the cases of idiopathic affection are so numerous and so clearly marked by other writers that it ought not to be passed over.H We have noticed a sympathetic and vicarious affection of this kind under the genus mismenstruation,1I 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 cuta- neous exhalants in like manner, evidently from weakness, and a re- laxation of their extremities, in connexion perhaps with a thinner or more dissolved state of the blood itself. None of these, however, are idiopathic affections. When the discharge shows itself as a primary disease, the cause has generally been some violent commo- tion of the nervous system forcing the red particles into the cuta- neous excretories, rather than a simple influx from a relaxed state of their fibres. And hence it has taken place occasionally during coition ;tt sometimes during vehement terror ; and not unfrequently during the agony of hanging or the torture.JI It is said also to have occurred in some instances in new-born infants,§§ probably from the additional force given to the circulation, in consequence of a full inflation of the lungs accompanied with violent crying. t See Vol. m.Cl. m. Ord. iv. Gen. iy. Spec. iv. f Lib. in. Cap 43. X Rat. Med. P. xn. Cap. vi. § 6. § Tom. xlvii. || Ploucq. Init. vn. 316. Tf Vol. v. p. 28 ** N. Act. Nat. Cur. Vol. iv. Ob*. 41.—Bresl. Sarurol. 1725.1. p. 183. tt Paulini. Cent. in. Obs. 46.—Eph. Nat. Dec. 11. Ann. vi. Appx. pp. 4. 43. o5. Tt Bartholinus. Lpist. 1. p. 718, H Eph. Nat Cur. Dec. 11. AnnTx. Obs fis ex.. vx.] EXCERNENT FUNCTION.- [orb. in. 363 SPECIES III. EPHIDROSIS PARTIALIS. PARTIAL SWEAT. CUTANEOUS PERSPIRATION LIMITEn TO A PARTICULAR PART OR ORGAN. There are some persons who rarely perspire, others who per- Gem. I. spire far more freely from one organ than another, as the head, or f^gufj1'* the feet, or the body. Such abnormities rather predispose to mor- examples bid affections, than are morbid affections themselves. Sauvages, in mafpewpi- illustration of the present species, quotes a case from Hartmann, oftRt,on- 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.t In this last case, it is probable that the kidneys became a substitute Expiana- 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 fit of hysterics. The sweat thus discharged from a partial outlet, is frequently fetid, as under the fifth species of the present genus ; and, ^vhere it is constitutional, it is often repelled with great danger to some more important organ. SPECIES IV. EPHIDROSIS DISCOLOR. COLOURED SWEAT. CUTANEOUS 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 Tni9 g'pe_ " already seen, it is sometimes intermixed with blood from violence, J~^*< or a relaxed state of the cutaneous exhalants. And where these, or causes like these, co-operate, we can readily account for the vari- ous colours it has sometimes exhibited as green, black, blue, saffron, or ruby,J m tne languaf?e °f Professor Frank, " color nunc pallide * Hartmanni, De Sndore unius lateris, 4to. 1740. f Collect. Acad. Vol. Hi. p. 677. 1 Swedianr. Nov. Nos- Meth< s?sU *• 219' 3q4 cl. vi.] ECCltlTICA. [ow>- Coloured sweat Gek. I. flavescens, nunc lacteus,vel croceus, sanguineus, ac interdum subvi- tlmJI' ridis, cceruleus, aut ater ;':* examples of all which are referred to discolor^ m th', volume of Nosology. 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 lim- pid parts are first absorbed and carried off. It is possible also that in some of the cases referred to, the stain may have been produced by inhaling a vapour impregnated with metallic corpuscles or some other pigment; and especially when working in metallurgical trades or quicksilver mines. SPECIES V. EPHIDROSIS OLENS. SCENTED SWEAT. CUTANEOUS PERSPIRATION POSSESSING A DEPRAVED SMELL. gen. I. The varieties that have been chiefly noticed are those of a sul- Spec. V. phureous scent; of a sour scent; of a rank or fetid scent; of a giveVrUeto violet,t and of a musky scent.J The rank or fetid scent is some* odours?7 °f timea partial; being only evacuated from particular organs as the feet and axillae. De Monteaux, however, has found the same thrown off generally :§ and as a symptom in atonic fevers it must have been witnessed by most practitioners, as also in several sordid cuta- neous 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 mor- Uode of bid state of the stomach, or of the cutaneous excretories ; and will treatment, often yield to a course of aperients or alternants, or 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 Green- land ; and acids a smell of acidity. Among glass-blowers, from the large quantity of sea-salt that enters into the materials of their manufacture, the sweat is sometimes so highly impregnated, that * De Cur. Horn. Morb. Epit. Tom. v. p. 27. Mannb. 8vo. 1792. t Paullini, Cent. i. Obs. 21.—Eph. Nat. Cur. Dec. u. Ann. v. Appx. p. 9. t Id. Dec. HI. Ann. ix. x. Obs. 96. § Maladies de Feromes, Tom. h. cl. vi.] EXCERNENT FUNCTION. [orp. in. 365 the salt they employ and imbibe by the skin and lungs, has been seen Gem. i. to collect in crystals upon their faces. A musky scent is not often F^hidrosii thrown forth from the human body, but it is perhaps the most com- g1^^, mon of all odours that escape from the skin of other animals. We sweat. discover it in many of the ape kind, and especially in the simia Jac- Jc^|nlu^ent■ chus; and still more profusely in the opossum, and occasionally in vapour is- hedge-hogs, hares, serpents, and crocodiles. The odour of civet is o'thef an!™ the production of the civet-cat alone ; the viverra Zibetha, and mnU- yiverra Civetta of Linneus, though we meet with faint traces of it in some varieties of the domestic cat. Among insects, however, such odours are considerably more common, and by far the greater number of them are of an agreeable kind, and of very high excel- lence ; for the musk scent of the cerambix moschatus, the apis fragrans, and the tipula moschifera, 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. SPECIES VI. EPHIDROSIS ARENOSA. SANDY SWEAT. CUTANEOUS PERSPIRATION CONTAINING A DISCHARGE OF SANDY OR OTHER GRANULAR MOLECULES. As the odorous particles of both animal and vegetable food are sGen'vt sometimes absorbed by the lacteals and impregnate the matter of pathoi'ogi-' perspiration, so at times are the more solid particles of the materials calti®*pla' employed in handicraft trades absorbed by the lungs, and equally thrown forth upon the surface. This, as observed under the last Exempiifi- species, is particularly the case with glass-blowers, upon whose fore- bfowef^"" head 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 atmo- sphere of the workshop in minute and imperceptible particles. But a reddish sandy material is occasionally found to concrete on J^."/*' the surface of the body under other circumstances, and which can- »andy not be charged to any material volatilized in the course of business.8Went- Bartholin, Schurig,* Mollenbroek,! and various other writers have How ac- given instances of this kind of crystallization, which seems to con-coun 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 sur- face, as it probably would otherwise have done in the bladder or the urinal. It is possible, indeed, that a man may hereby escape from * Litholog. p. 2S5. t De Vasis, Cap. xm. 36b ex. vi.J ECCRITICA. (OKD. III. aSc vi the faDrication of an ""nary calculus, or stone in the bladder : and Ephidroiii' were such a transfer at all times in our power, we should gladly avail s^ndy1*" ourselves of it in many cases of a lithic diathesis, and employ it as sweat. a preventive of urinary concretions. When the sand is troublesome f.m,edt°edbe from the quantity collected, the alkaline and other medicines recom- mended under lithia renalis* will easily remove it.t GENUS II. EXANTHESIS. CUTANEOUS BLUSH. SIMPLE, CUTANEOUS, ROSE-COLOURED EFFLORESCENCE, IN CIRCUM- SCRIBED PLOTS, WITH LITTLE OR NO ELEVATION. Gen. II. Exanthesis is a Greek compound from «| " extra" and xtim generic0 " floreo,'' superficial or cutaneous efflorescence, in contradistinction """• to enanthesis in Class hi. 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. EXANTHESIS ROSEOLA. ROSE-RASH. EFFLORESCENCE IN BLUSHING PATCHES, GRADUALLY DEEPENING TO A ROSE-COLOUR, MOSTLY CIRCULAR, OR OVAL ; OFTEN ALTER- NATELY FADING AND REVIVING ; SOMETIMES WITH A COLOURLESS UMBO J CHIEFLY' ON THE CHEECKS, NECK, OR ARMS. G*n. n. Roseola was sometimes employed by the older writers, though in Spec. a verv ioose sense, to signify scarlet-fever, measles, and one or two te'Jni'in0 other exanthems that were often confounded : but as it is now no used* for-"6 longer used for these, it may stand well enough as a name for the "»«'y- present species, which Fuller has described as a flushing all over the body like fine crimson, which is void of danger, and " rather a ludicrous spectacle than an ill symptom."J * Hist. Anat. Cent. 1.34. t Supra, p. 611. t Exanthematoloeia, p. 128,—Bateman's Synops. 95. cl. vi.] EXCERNENT FUNCTION. [okd. m. 367 As a symptom this rash is frequently met with in various mala- x» (ufeor il£,) " materia," " materies"— whence de- of the matter, make, or nature of; thus " papula or papilla," of tlie 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 Papula and pustula, which by Sauvages are degraded into mere difftulnt°f symptoms of diseases, and not allowed to constitute diseases of authors. themselves, are raised to the rank of genera by Celsus, Linneus, and Sagar, and, under a plural form (papulae and pustulae,) to that in what of orders by Willan. In the present system exormia and ecphlysis, •ense ap- intended to supply their place, are employed as generic terms, and present and run parallel with those papulae and pustulae of Willan, which are not aera'hfirfr essentially connected with internal disease ; and are only made use arrange- of instead of papula and pustula, first as being more immediately work." ' u 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 arrange- ment, import eruptions of pimples and pustules in their simplest state, affecting the cuticle, or at the utmost the superficial integument 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 separation, and perhaps impossible to draw it exactly, between efflorescences strictly cutaneous and strictly constitutional, from the numerous examples we meet with of the one description combining with or passing into the other. But a like difficulty belongs to every other CL.vi.l EXCERNENT FUNCTION. |Wm. 369 branch of physiology in the widest sense of the term, as well as to g^v*11- nosology ; and all we can do in any division of the science, is to PapXus lay down the boundary wkn as mu"Ji meet? and caution as possible,skin' and to correct it, as corrections may afterwards be called for. The species which belong ;.o this genus, or which, in other words, are characterized by a papulous skin not necessarily connected with an internal affection, are the following : 1. EXORMIA STROPHULUS. 2.--------LICHEN. 3. ------— PRURIGO. 4. ------— MILIUM. GUM-RASn. LICHENOUS RASH. PRURIGINOUS RASH, MILLET-RASH. SPECIES I. EXORMIA STROPHULUS. GUM-RASH; ERUPTION OF RED PIMPLES IN EARLY INFANCY, CHIEFLY ABOUT THE FACE, NECK, AND ARMS, SURROUNDED BY A REDDISH HALO ; OR INTERRUPTED BY IRREGULAR TLOTS OF CUTANEOUS BLUSH. Dr. Willan has observed, that the colloquial name of Red-gum, GEN- ^ applied to the common form of this disease, is a corruption of Red- R,d gum-" gown, under which the disease was known in former times, and by ,wa''j|gjer" which it still continues to be called in various districts ; as though Red-jown. supposed, from its variegated plots of red upon a pale ground to resemble a piece of rod printed linen. In effect it is written Red- gown inmost of the old dictionaries : in Littleton's as late as 1684, and 1 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: x Intertinctus. Red-gum. (3 Albidus. White-gum. y Confertus. Tooth-rash. ^ Volaticus. Wild-fire-rash. Vol. V.—4T Pimples bright red ; distinct; intermixed with stigmata, and red patches; some- times spreading over the body. Pimples minute, hard, whitish; surrounded by a reddish halo. Pimples red, of different sizes, crowding or in clusters ; the larger surrounded by a red halo ; occasionally succeeded by a red crop. Pimples deep-red, in circular patches, or clusters ; clusters sometimes solitary on each arm .or cheek ; more generally flying from part lo part. 370 cl. vi.j ECCRITICA. (okd. m. Gen. III. t Candidus. Pimples large, glabrous, shining ; of a Exwmia1' Palliu gum-rash. lighter hue than the skin : without balo Strophulus. or blush. Gam-rash. marks'to'*' Cenerally speaking, none of these varieties are of serious impor- re-pect of tance^ and all of them being consistent with a healthy state of all cause; tjlc functjon3 0f 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 prima: viae. The system, also suffers generally,in many cases, if the efflores- cence be suddenly driven inwards by exposure to currents of cold air or by the use of cold-bathing. Both these, therefore, should bo eaY treat-" avo^C(l while the efflorescence continues ; and if such an accident tn«tit. should occur, the infant should bc 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. Particular In the tooth-rash, strophulus confcrtus, there is no difficulty in E^strophu" tracing the ordinary cause. Yet this, also, has often been ascribed iu« confer- to a state of indigestion or some feverish complaint in the mother twth-rash. 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 dentition, since it always occurs during that process, and disap- pears 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 delicate state of the skin, and the strong determina- tion 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 often- times 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 papula) 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 cutaneous 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 + Bronzet, sur 1'Education ties Eulans, j». 187 ii-vi.] EXCERNENT FIXCTIOY [ord. hi. 371 by having an uniform red, shining surface without palulae, and being GEN- in. limited to the nates and thighs. vZfm,'*1' In like manner, those children are most liable to the strophulus f.,,1joph°gh13' volaticus or wild-fire-rash, who have a fair and irritable skin, though r'amaiinr this also occasionally catenates with a morbid state of the stomach E.'suorOiu- and bowels. It appears sometimes as early as between the third i'" voiati- and sixth month, but more frequently later. i,"l,™sh. This last is the erythema volaticum of Sauvages, the asstus vola- Erythema ticus of many earlier writers : whence the French name of feu jEetusvo- volage. All these terms have, however, been often used in a very i<"w"»- indefinite sense, and hence, also applied to one or two species of porrigo, and especially porrigo Crustacea or crusta Iactea.* And hence, Dr. Armstrong has described this last disease as a strophulus or tooth-rash.t The strophulus dlbidus, and strophulus candidus, are the two Particular ... • • n .1 • • n ■ v • • mi n a • remark* on slightest varieties of this species of indisposition. Ihe first is E.strophu- jchiefly limited to the face, neck, and breast, and often continues in 8°,"^"! the form of numerous, hard, whitish specks for a long time, which dus. on the removal of their tops do not discharge any fluid, though it is probable they were originally formed by a deposition of fluid, which 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 varieties occasionally co-exist and run into each other, particularly the first two.} SPECIES II. EXORMIA LICHEN. LICHENOU8 RASH. ERUPTION DIFFUSE ; PIMPLES RED ; TROUBLESOME SENSE OF TIX- GLING OR PRICKING. Lichen (*»/&*-•«) is a term common to the Greek phytologists ^ «£■ as well as the Greek pathologists. By the former it is applied to oigin'of that extensive genus of the algae, or rather to many of its species, ^J^1' which still retains the name of lichen in the Linnean system : and it is conjectured by Pliny that thejihysicians 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 tuber- cular lichens, which are found wild upon stones, walls, and the bark of trees or shrubs. Gorraeus, bowejpr, gives two other origins of the term ; one, of which he does not approve, from the eruption * Astruc De Morb. Infant, p. 44. t On the Diseases of Children, p. ^ t Underwood, on the Diseases of Children, Vol. 1. passim. A12 cl. vi.j ECCRITICA. Lord. 111. Gen. III. being supposed to be cured by its being licked with the human Spec. II. tongue . an(j tbe other, to which he inclines, from its creeping in a lambent or tongue-like form, over differci.t parts of the body. The derivation in both these cases being *«£•) u lambo," " lingo." It is a far more troublesome rash than the preceding ; fiom the severest modifications of which, however, it chiefly differs by the intolerable tingling or pricking which accompanies, and peculiarly characterizes it. The following are its chief varieties. Exormia lichen. Lichenous rash. , How far related to the prece- ding spe- cies. x Simplex. Simple Lichen. /3 Pilaris. Hair-Lichen. y Circumscriptus. Clustering Lichen. } Lividus. Livid Lichen. Tropicus. Summer-rash. Prickly-heat. £ Ferus. Wild Lichen. »? ^Urticosus. Nettle Lichen. General irritation ; sometimes a few fe- brile symptoms at the commencement; tingling aggravated during the night; pimples scattered over the body ; w hich fade and dosquummate in about a week. x'implcs limited to the roots of the hair ; desquammate after ten days ; often al- ternating with complaints of the head or stomach. Pimples in clusters or patches of irregular forms, appearing m succession over tho trunk and limbs; sometimes coalescing; and occasionally reviving in successive crop.:, and persevering for six or eight weeks. Pimples dark-red or livid ; chiefly scat- tered over the extremities j desquam- mation at uncertain periods, succeeded by fresh crops, often persevering for seve/al months. Pimples bright-red, size of a small pin's head; heat, itching, and needle-like pricking; sometimes suddenly disap- pearing, 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 elevated, reddish : intolerably itching, especially at night; irregularly subsiding, and re- appearing ; chiefly spotting the limbs ; occasionally spreading over the body with gnat-bite-shaped wheals: from the violence of the irritation, at times accompanied with vesicles or blisters, afTd succeeded by an extensive exfolia- tion of the cuticle. General remarks. Under this species, as under the last, we may observe that all the cl. vl.J EXCERNE-\T FUNCTION. [oeu. hi. 373 varieties are in their purest state simple affections of the skin, though Gen. m. occasionally, probably from peculiarity of habit, or some accidental |^'iaIL disorder of tlie digestive function, connected with the state of the '^hen. constitution or of the stomach or bowels. Dr. Willan, indeed, ™h.en°U8 makes it a part of his specific character, that lichen is " connected ^i,nec0e£ with internal disorder :" but his description is at variance with h.s necteYwUh definition ; for with respect to the first variety, or simple lichen, he border; expressly asserts* that it " sometimes appears suddenly without any though '•»<» manifest disorder of the constitution." While in regard to the tro- ^."e'riVd by pical lichen or prickly heat, one of the severest modifications under ™o!.enopi- which the disease appears, he states, and with apparent approbation, nion is du- from Winterbottom, Hillary, Clark, and Cleghorn, that it is con- Eu w?by sidered as salutary ; that even " a vivid eruption of the prickly heat quotations. 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, dz-c. is always a favourable sign, indi- cating the return of health and vigour ;"| that "it seldom causes any sickness or disorder except the troublesome itching and prick- ing ;"J that " it is not attended with any febrile commotion \vjiilst 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 intole- rable 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 remarks 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«E. Heiicn distinct red papula; about the cheeks and chin or on the arms, with simple* but little inflammation round their base : in the course of three or "^"V t. four day3 the eruption spreads diffusely over the neck, body, and and pro- lower extremities, attended with an unpleasant sensation of tingling 6re3S' which is sometimes aggravated during the night. In about a week the colour of the eruption fades, and the cuticle separates in scurf. All the surface of the body, indeed, remains scurfy for a long time, but particularly the flexures of the joints. The duration of the com- plaint varies ; and hence, in different cases, a term of from fourteen to thirty days intervenes between the eruption and a renovation of the cuticle. " The eruption sometimes appears suddenly without any manifest disorder of the constitution ;"*!" and sometimes 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 scarla- * Willan, p. 39. t Willan, p. 35, from Winterbottom. J Id. p. 59, from Hillary. 5 Id. p. 61, from Clart. § Id. p. 63, from Cleghorn. T Id. ut supra, p. 39. ** Willan. ,..37. 57-i cl. \-i-3 ECCRITICA. [ori>. nr. Gkn. III. Spec. II. a E. lichen ■implex. Simple lichen. Causes. Whether produced at an; time by some irritant floating in the air. Mode of treatment. tina : but its progress, and, indeed, the general nature of its symp- toms from the first are sufficiently marked to distinguish it from cither 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 varie- ties depend upon a peculiar irritability of the skin as its remote cause, and some accidental stimulus as its exciting cause. The irritability 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 chyiifacient 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 narcotic, or substance that disagrees with the stomach or the idio- syncrasy. Dr. Heberden has suggested another cause, as perhaps 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 various plants or insects ; and he particularly alludes to the delicate hairs of the dolichos pruriena or cowhage as occasioning the disease in the West Indies, from their attacking the skin in this manner impercep- tibly. But since general ablutions afford little or no relief, and all medicated lotions are even mor*e 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^an hardly be allowed to be the ordinary cause, though it may become an occasional ex- citement. The remedial process should consist in keeping the bowels cool and free by neutral salts ; a mixed diet of vegetables, ripe fruits, 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 sometimes proved ser- viceable, but not always ; and the red or black hydrargyri sulphu- retum has been thought useful by many : but the plan proposed by Mr. Wilkinson for the severer kinds of the disease, will here also be often found well worthy of trial; which consists in a calomel purge twice a week, and the internal use of the subcarbonate of ammonia in a dose of five or six grains, four or five times a-day.* Where the system is evidently in an impoverished state from pre- vious sickness, innutritive food, or any mesenteric affection, bark, the mineral acids, or the metallic tonics afford a reasonable hope oi * Remarks on Cutaneous Diseases. 1822. cl. vi.] EXCERNENT FUNCTION. [oxd. hi. 375 relief, and especially such preparations of iron as may sit easy on Gen. iii. the stomach. The hair-lichen,- and clustering lichen differ from the pre- si^[^hw ceding in little more than a difference of station or of form. Their Hair lichen. causes or mode of treatment run parallel, and it is not needful to £irc3UI|tt!hen enlarge on them farther. oci'iptU"in The livid-lichen is evidently connected with a weak and de- iiChoi'nns bilitated habit. Its papula: are often interspersed with petecchiae, f^ji^""1 sometimes, indeed, with purple patches or vibices, and manifest a Lividiicheni 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 *roJpi1c'„g"n antiquity and is equally described by the Greek and Arabian/writers. Prickly The latter denominate it eshera, which is the plural of sheri, Epical literally papula:, and hence tiiepapuljs, or papulous bisorder, by ^'^ ot way of emphasis. And this term, softened or corrupted into essera, 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 valued friend Dr. James Johnson, who 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, u cock-roaches, ants, and the nu- merous 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 un- seasonable hours. Many a time have I been forced to spring from table and abandon the repast, which I had scarcely touched, to writhe 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 1 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 indescri- bable ; being compounded of pricking, itching, tingling, and many other feelings, for which I have no appropriate appellation. * Vol. in. Class, in. Ord. iv. Spec, x 876 cl. vi.j ECCRITICA. [oiid. ih. Gen. III. Spec. II. r. E. lichen tropicus. Prickly heat. Tropical lichen. Agony of the smart- ing ex- plained. i, E. lichen terus. Wild lichen. Agria of Celsus. " 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 seen, and but too sensibly felt! " Prickly heat, being merely a symptom, not a cause of good health, its disappearance has been erroneously accused of producing much mischief; hence the early writers on tropical diseases, harping on the old string of * humoral pathology,' speak very seriously of the danger of repelling, and the advantage of ' encouraging the eruption, by taking small warm liquors, as tea. coffees, wine-whey, broth, and nourishing meats.' " Indeed, I never saw it even repelled by the cold bath ; and in my own case, as well as in many 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 I never had reason to suppose that its disappearance occasioned them. I 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 con- stitution 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." In this species, as also in the next, it is obvious that the extremi- ties of the nerves which accompany the cutaneous papillae, are in a peculiar state of irritation. And when we reflect that the organ of the skin possesses the most acute sensibility of any of the structures of the body, and suffers more pain than any other part under amputation; and when to this we add that the nerves are uniformly most sensible at their extremities, we can be at no los« to account for the mad- dening distress which is hereby produced.* The wild lichen, or lichen ferus, is particulaHy noticed by Celsus 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 description of a variety of papula of a milder kind, which Willan supposes, and with some reason, to be the clustering. " Altera autem est, quam 'Ayeix* Graeci appellant: in qua similiter quidem, sed magis cutis exasperatur, exulceraturque, ac vehemen- tius et roditur, et rubet, et interdum inter pilos remittit. Quno minus rotunda est, difficilius sanescit: nisi sublata est, in impetiginem vertitur."t This variety, however, in its general range, its vehe- mence, and protracted duration, approaches nearer to the nettlo- * linstock, Elementary System of Physiology, p. 85. Pro. 1F.4 * Oe JMnlirip*. Lib, v. I'aii xxviir. cl. vi.J EXCERNENT FUNCTION. [ord. iii. j;: lichen than to any other: yet the pimples are larger, more clustered, g,en. HI. and more apt to run into a pustular inflammation, so as often to {E.Ehcht!; produce cutaneous ex ulcerations and black scabs ; and hence the |<"u»- remark of Celsus that it is disposed to terminate in an impetigo, or, hehen. as others have it, in psora or lepra. A.8.'ia *f mi ' r . . , .. Celsus. Ihe urticose or nettle-lichen is, perhaps, the most distressing >?E. iich»« form of all the varieties, if we except the tropical: and like the Non- tropical, notwithstanding its violence, it is often totally independent !i,c.h'n- c xv .• i JS x ... i n ■ T"e most ot any constitutional affection. I can distinctly say from various irouuie- cases that have occurred to me, that even where the patient has thT^ecIe", been worked up to such a degree of madness as to force him against but not ne- his own will into a perpetual scratching, which greatly exasperates connected it, still the constitution has remained unaffected, the pulse regular, c^jfjVjoa. 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 systen, 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. I freely confess that I have been more Most in- perplexed with this obstinate and intractable variety, which has, in medical* m some case9, irregularly subsided for a few days or weeks, and then ueatment. reappeared with more violence than ever, than I have been with almost any other complaint that has ever occurred to me. The subcarbonate of ammonia, as just referred to, has sometimes been serviceable, but by no means always. A tepid bath and especially of sea-water has sometimes also been useful, but I have often found even this fail; and have uniformly observed the bath mischievous when made hot; for the skin will not bear stimulation. The by- ?'?"»« drocyanic or prussic acid in doses of four minims, two or three nci times a day, has occasionally also subdued the irritability, though in a few instances it has produced more mischief than it has removed. 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 I 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 inefficacy 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. Mr. Wilkinson recommends that the itching parts be frequently moistened with a lotion consisting of a scruple of subcarbonate of ammonia, and acetate of lead dissolved in four ounces of rose water and be slightly touched every day, or every other day with aromatic vinegar diluted with one third part of water* I have said that the wild lichen in ita severity and duration offers -How j.r a near resemblance to this. This former, however, is more apt to [^11,1° lichen. * Remarks on Cutaneous Diseases, p. 25. 1S-2 Vol. V.—IH 47S cl. vi.] ECC1UTICA. L0BB- m- Gen. m. run into a pustular inflammation, though in the nettle-lichen we S^ sometimes find a few of the vesicles filled with a straw-coloured lichen. fluid, but which are not permanent. There is also a greater tcn- ™sCh.enous dency to some constitutional affection in the wild than in the nettle Treatment, modification, and particularly to a sickness or some other disorder ot the stomach upon repulsion by cold. Under the nettle-lichen tne patient seldom finds the stomach or any other organ give way, and will endure exposure to a sharp current of air with a lull feeling Ot refreshment, without any danger of subsequent mischief. Singular There is a singular modification of this disease described in a letter tTe0ndd.e-a" from Dr. Monsey, of Chelsea College, to Dr. Heberden, in which MorsEl/7 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 intolera- ble 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 mueh, 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 him- self 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 he was attacked with this disorder." Sisguiari- That this case is to be regarded as a peculiar form of the present ease ex- species, the extraordinary irritation and intolerable itching of the plained. gkm geem to vouch for sufficiently. It discovers, however, a cu- taneous 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 mid- dle of the day, the pungent heat of the sun, he was incapable of en- during both, till, by a certain length of exposure to this conjoint sti- mulus, the cutaneous nerves became torpid, which it seems they did in about half an hour; when the affection we arc told " graduallv 'vout off." vl. vi.J EXCERNENT FUNCTION. [0Bd. in. 379 A daily exposure to the same exhausting power would, in all pro- **en. HI. bability, soon have rendered the torpitude habitual, or at least have Enormia"' reduced the cutaneous sensibility to its proper balance, which, after ^"j*"- all, forms the real cure in the West Indies, and in most of the chro- rash.en° nic cases of our own country. This, however, does not seem to Tl*&tminU have been thought of: but, after having tried a long list 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 BJn*ficif calomel, of which he took five grains every night with a purge of calomel. rhubarb or cathartic extract the ensuing morning for nearly a fort- night in succession : and having thus transferred the morbid irrita* bility of the skin to the intestinal canal, the disease left him. SPECIES III. EXORMIA PRURIGO. PRURIGINOUS BASH. ERUPTION DIFFUSE ; PIMPLES NEARLY OF THE COLOUR OF THE CU- TICLE ; WHEN ABRADED BY SCRATCHING OOZING A FLUID THAT CONCRETES INTO MINUTE BLACK SCABS ; INTOLERABLE ITCHING, INCREASED BY SUDDEN EXPOSURE TO HEAT. In the symptoms of a papular eruption, and an intolerable itching, Gen. III. this species bears an approach towards the preceding ; but it differs |*£CfarIIL from it essentially in the colour of the papulae, and in the nature of related to the itching, which is often far more simple ; and, when combined with a sense of stinging, gives a feeling 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 :— K Mitis. Pimples soft and smooth ; itching at Mild Prurigo. times subsiding ; chiefly common to the young and in spring time. a Formicans. Pimples varying from larger to more ob- Emmet-prurigo. scure than in the last; itching inces- sant, and accompanied 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 to adults. y Senilis. Pimples mostly larger than in either of Inveterate prurigo. the above, sometimes indistinct, giving the surface a shining and granulated J so CL.vi.: ECCRITICA. |oi:».ui. Gen. III. appearance ; itching incessant: eom- Spec. hi. mon to advanced years, and nearly in- Exormia prurigo. veterate, Pfuriginous rash. . General [n a]j tne varieties the itching differs in its extent; being some- rem 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 :f 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 en- tirely, differ from them in being limited to particular parts ; as prurigo podicis, p. praeputii, p. urethralis, p. pubis, p. pudendi muliebris. clTJe?1 d ^ common cause of this species in all its varieties, though by no ordfnary" means the only cause, is want of proper cleanliness of the skin and abode* of apparel ; and hence it is found most frequently in the hovels of the poor, the squalid, and the miserable. Yet as it is 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 the mouths of the cutaneous exhalants be- Tarticuiar comes an active irritant, must be admitted. One of these condi- csuse*. tjong appears to be a skin peculiarly delicate and sensible, which is mostly 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 offish alone has sometimes excited such a habit : and an ha- bitual addiction 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. Thepapnias Where the rash continues long and becomes pertinacious, the nicformex- papulas form minute exulcerations, degenerating, in the first variety, ulcerations. jnto a Specjes 0f contagious itch, and in the second, into a running which scall; which last, in the third or inveterate variety, sometimes forms bec^m™6" nests ror va"<>us parasitic insects,! and especially for several species uests for of the acarus and pediculus, to which Dr. Willan adds the pulex. Be"sBMCthe In treating of intestinal animalcules, we had occasion to observe pedicuiS^ tDat " *ney aPPeari from the luxuriance of their haunts and repasts, Often alter- to be, in various instances, peculiarly enlarged and altered from the fodrrafromr structure they exhibit out of the body ; whence a difficulty in deter- ance^f"'" mining'in manv cases, the exact external species to which a larve, their re- worm, or animalcule found within the body may belong. "§ This Fiiustration. remark applies with peculiar force to the parasites detected in the diseases before us, some of which grow to such an enormous size, * Sitonus, Tr. 34, Loescher. t Journ. Med. Tom. lxxxv. X Sommerj Diss, de affrctibus pruriginosis Spjifnu.—J.oesoher. Diss, de pruxitu senili totius corporis. Witeb. 1728. 6 Vol. i. Helminthia erratica, p. 530. UL.VI.J EXCERNENT FUNCTION. [okd.ki. 361 and with such altered characters from rioting on so plentiful a gjjrjg; supply of juices, that it is by no means easy to recognise them. Dr. Exormia Willan describes an insect of this kind found in great abundance on £,™rr'|*oug the body of a patient suffering under the inveterate prurigo, which rash. he at first took for a pediculus, though from the nimbltness of its motions, as well as from other characters, he at length ascertained it to he a pulex, not described by Linneus : more probably, from the causes just stated, so altered in its form, as not to be easily referred to the species io which it really belongs. Thorough and regular ablution and cleanliness are here, therefore, Medical peculiarly necessary, and these will often succeed alone, especially in the first variety. If they should not, sulphur and the sulphureous waters, as that of Harrowgate, taken internally and applied to tlie skin itself, have sometimes been found serviceable. Fossile alkali combined with sulphur and taken internally with infusion of sassa- fras or juniper tops is peculiarly recommended by Dr. Willan. Small doses of the blue pill, as three or four grains every night, B1.u» pi" combined with a like proportion of the extract of colocynth is often cynth. found serviceable, and especially where the complaint is obstinate and has become chronic. Where it is of fresher origin washing the {j*'"1""10! parts affected with a diluted solution of ammonia or potash, as for monia for a example, a drachm of sal volatile or hart's-horn, to an ounce ofofpotash. water ; or half a drachm of the liquor potassae to the same propor- tion of water. This will produce a new excitement or counter- stimulus ; and the specific irritation will be generally lost in the Mode of common, which we may rest from as soon as necessary : a remark a l0n' which it may be advantageous to bear in mind through most of the cutaneous affections before us, as in numerous instances they will yield, if early attended to, under a like treatment, and it is for the same reason that they have often given way to an occasional use of aromatic vinegar, or a diluted solution of nitrate of silver. In a very obstinate and chronic case, Mr. Wilkinson tells us that he de- rived very great benefit from a free use of an ointment consisting of equal parts of sulphur and tar united by means of lard, with two drachms of hydrosulphuret of ammonia, and four ounces of chalk to every pound and a half. This was liberally applied over the whole extent of the eruption every day, and washed off every other day. Plummer's pill and the arsenic solution, however, were em- ployed internally in the mean-while ; and the parts occasionally washed with undiluted aromatic vinegar, or else a solution of nitrate of silver, previous to the application of the ointment.* If the con- stitution have suffered from a meagre diet, or be otherwise ex- hausted, 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 pe™^™'8 of the third, this pertinacious and distressing complaint bids defi- penina- ance to all the forms of medicine, or the ingenuity of man : and 1 striking n- cannot adduce a stronger illustration of this remark than by re- instiation. ferring to an attack which it lately made on one of the brightest * Iteraarks on OntanewTs Diseases, p. SO. 182?. 382 cl. vi.] ECCRITICA l°K*>- **r Gen. III. ornaments of medical science in our own day, whose friendship Ir'mia11' allows me to give the present reference to himself. It is now some- prurigo. thing more than four years since he was first visited with this formica- Pruriginous ^ hvA co]our>ess rash which afrected the entire surface, but chiefly e»urVeaof the leS3 : and he has since tried every mean that tfle resourceS °f medicines his own mind or the skill of his medical friends could suggest, yet lain."1 for the most part without any thing beyond a palliative or tempo- rary relief. The tepid bath produced more harm than good, though several times repeated: Harrowgate water internally and exter- nally had recourse to was of as little avail: acids and alkalies, sepa- rate or conjoined, in whatever way made use of, failed equally, nor did purgatives or diaphoretics or any of the alterative diet Gold spring drinks, or the alterative metallic preparations answer better. The lothm and* coldest spring water employed as a bath or lotion, and free doses of free doses opium as a sedative, were the only medicines from which he at any serviceable. time derived any decided relief, and these constantly afforded it for a short time. In the middle of the coldest nights of the preceding winter, and the still colder nights of the winter before, he was re- peatedly obliged to rise and have recourse to sponging with cold water, often when on the point of freezing. The opium he took never effected real sleep, nor abated the complaint, but generally threw him into a quiet kind of a revery which produced all the re- freshment of sleep : and to obtain this happy aphelxia or abstrac- tion of mind he was compelled 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 was not a little .Animal spi- singular ; for first, in the midst of the disttaction produced by so per- fected: "nor Petual a harassment, and the necessary restlessness of nights, neither appetite, his animal spirits nor his appetite in any degree flagged, but, upon the whole, rather increased in energy, and his pulse held true to its proper standard. And next, though opium was wont to disagree with him in various ways antecedently, it proved a cordial to him through the whole of this tedious affection without a single unkindly con- comitant, and never rendered his bowels constipated. From the long continued excess of action there was at length an evident de- ficiency in the restorative power of the skin; for two excoriations arising from the eruption, degenerated into sloughing ulcers. At the distance of about nineteen or twenty months from the first at- tack, he began to recover ; the skin which had been so long in a state of excitement lost its morbid sensibility, and became torpid: • he had rarely occasion to have recourse to cold ablutions, but dared not trust himself through the day without a dose of opium, as an exhilarant, though the quantity was considerably reduced. For many months also he took 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 irritation. And it is possible that half the wells, which in times of superstition were dedicated to some favourite snint. and ctill retain cl. vi.} EXCERNENT FUNCTION. [nu». hi. 383 his proper name, derive their virtue from this quality rather than Gen- *jL from any chemical ingredient they contain, which has often as little Exormia to do with the cure as the special interposition of the preternatural £™ri|jnoua patron. rash. I do not know that the prussic acid has hitherto been introduced Prufs»c into practice in this kind of rash : but as I have reason to think it has occasionally proved successful in the wild lichen as well as in various other disorders of the skin, accompanied with severe irrita- tion, it may be tried, with some hope, internally in doses of three J^™*,1,^ or four minims two or three times a day ; and, perhaps, not without naiiy, or a beneficial effect, in a dilute solution externally; for which, however, ^iiei-. the laurel water itself may form a convenient substitute. SPECIES IV. EXORMIA MILIUM. MILLET-RASH. PIMPLES VERY MINUTE ; TUBERCULAR ; CONFINED TO THE FACE J DISTINCT ; MILK-WHITE ; HARD ; GLABROUS ; RESEMBLING! MIL- LET-SEEDS. This species is taken from Plenck who denominates it gratum sive G*^ J*** milium. It is a very common form of simple pimple or exormia, Grutum of" and must have been seen repeatedly by every one, though, with the Plenck' exception of Plenck, I do not know that it has hitherto been described by any nosologist. It has a near resemblance to the white-gum Diancet« of children, as described by Dr. Underwood, the strophulus albidus str°jjhul.us of Willan, and the present system. But the pimples in the milium Tn what' are totally unattended with any kind of inflammatory halo or sur- eieptnt.*^ rounding redness : and are wholly insensible. They are sometimes solitary, but more frequently gregarious. It is a blemish of small importance and rarely requires medical interposition : but as it pro- ceeds from a torpid state of the cutaneous excretories, or rather of their mouths or extremities which are balled up by hardened mucus, stimulant and tonic applications have often been found serviceable, jfeedtiea2lrt as lotions of brandy, spirit of wine, or tincture of myrrh, or a solu- tion of sulphate of zinc with a little brandy added to it. When this species becomes inflamed it lay3 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.* * Vol. u. p. 223. obi CL. Vf. j ECCRITICA. [WRW. 111. GENUS IV. LEPIDOSIS. SCALE-SKI!*, EFFLORESCENCE OF SCALES OVER DIFFERENT PARTS OF THE BODV, OFTEN THICKENING INTO CRUSTS. Illustrated. Ges. IV. Lepidosis is a derivative from ;«*• Eph. Nat. Cur. Dec. in. Ann. n. Obs. 121. cl. vi.] EXCERNENT FUNCTION. [ord. iii. 385 the hair has followed the same course. Sometimes, indeed, a habit Gen. iv. of recurrence has been established and the whole has been thrown scaie-sfcfni off and renewed at regular periods * in one instance once a month.j In the genus before us the exfoliations are of a more limited kind, M,inu!e M: _ j • , •>•••/., foliations in ana in some instances very mmute and comparatively insignificant, the present In the severer forms, however, the true skin participates in the S9nu*- morbid action, and the result is far more troublesome. The species it presents to us are the following: 1. lepidosis pityriasis. dandhiff. 2. •-----~- lepriasis. lbphosy. i DRY SCALL. \SCALY TETTER. 4.--------ICTHYIASIS. FISH-SKIN. 3. --->----PSORIASIS. SPECIES I. LEPIDOSIS PITYRIASIS. DANDRIFF. J TATCHES OF FINE BRANNY SCALES, EXFOLIATING WITHOUT CUTI- CULAR TENDERNESS. This species is the slightest of the whole: its varieties are as follow: Gek. IV. 0PEC* l« x Capitis. Scales minute and delicate ; confined to Dandriff of the head. the head ; easily separable. Chiefly common to infancy and advanced years. 4 Rubra. Scaliness common to the body generally ; Red dandriff. preceded by redness, roughness, and scurfiness of the surface. y Versicolor. Scaliness in diffuse maps of irregular out- Motley dandriff. line, and diverse colours, chiefly brown and yellow ; for the most part confined to the trunk. Pityriasis is a term common to the Greek physicians, who concur import «rf in describing it, to adopt the words of Paulus of iEgina, as " the w^'fi separation of slight furfuraceous matters (mrvea}** futtm), from ^^"w- the surface of the head, or other parts of the body, without ulcera- an writers. tion." 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 confounded with porrigo ; or, in other words, the dry and * Gooch, Phil. Trans. 1789. t Eph. Nat. Cur. Dec. ui. Ann. i. Ob». 1S4. Vol. \\—49 386 VI.j ECCRITICA. [ord. Ill* Mode of treatment G*n. rv. branny scale with the pustular scab ; which, however, there is no Le'fdos.s' difficulty in accounting for, since the first variety, whose seat is also Pityriasis, in the head, has a tendency, if neglected, and the minute and scurfy How du- scales grow thicker and broader, and crustaccous, to degenerate tingui»hed jnto porriginous pustules. from pur- ' or ngo. The first variety, or dandriff of the head, when it attacks riasiseoT infants, exhibits minute scales, and when it appears in advanced pitis. age, scales of larger diameter. It shows itself at the upper edge of thenbead.°f 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 exfoliations, somewhat larger, flat and semipellucid. Sometimes, however, they cover nearly the whole of the harry 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 at- tacked 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 situ- ation 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 general health in a perceptible degree from the suppression which takes place in the perspiration, and the consequent dryness, stiffness, and soreness of the skin ; and the general itching which hence en- sues 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 tho skin, and produce a gentle diapnoe. With this external remedy Dr. Willan advises we should unite the com- pound decoction of sarsaparilla, and antimonials, which operate towards a like effect. The tinctura hellebori nigri in small doses has also sometimes been found useful: and, where the irritability of the skin is not very great, Dr. Bateman was in the habit of using a gently astringent lotion or ointment, consisting of the acetate 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 discoloration 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 auction" mueosum, or adipose colorific layer of the skin in this than in any wuco^m ?t*ier afl~ection 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 extravasated Relation to blood. And, were it not for the furfuraceous scales which determine 8 L. Pityri- asis rubra. Red dand- riff. Modo of treatment y L. Pityri- asis versi- color. Motley danflrift". Striking cl.vi.J EXCERNENT FUNCTION. [orb. m. 387 its real nature, this affection would belong to the genus epichrosis Gem. IV. of the present order. There is no elevation ; and the staining J?"pit£ rarely extends over the whole body. Dr. Willan tells us that it sel- riasisverai- dom appears over the sternum or along the spine of the back. I had MoUey lately a patient, however, in a gentleman about forty years old, who ^""^8 was suddenly attacked with a discoloration and branny efflorescence epichrosis. of this kind, which extended directly across the spine over the loins, *"« p*w and very nearly girded the body. It continued upon him for about t|>cspine, .1 ... ° , . J . , . ,. . . " , , ,. hut some- three years without any constitutional indisposition, or even local dis- times. quietude, except a slight occasional itching, and then went away as ci0m$!fied. 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 oth»r detergents of various kinds, but without any effect what- ever. This variety of dandriff generally continues for many months, is of long and not unfrequently, as in the present case, for several years, ance^ome- Being altogether harmless, it requires no medical treatment. times for The pityriasis nigra of Willan referred to by Bateman, but only pityriasis. glanced at by either of them, so far as I have seen it, is rather a ^j* °f modification of the genus epichrosis, and species Pwcilia, under which it will be noticed. It is a cuticular discoloration but without cuticular exfoliation. SPECIES II. LEPROSIS LEPRIASIS. LEPROSY. patches of smooth, laminated scales ; OF different sizes, and A CIRCULAR FORM. This genus constitutes the vitiligo of Celsus. The term lepria- Gen. IV. sis is a deriviative from XtTreos " scaber, vel asper ex squammulis $**£."' decedentibus ;" with a termination appropriated, by a sort of com- celsus. mon consent, to the squammose tribe of diseases.* Lepra, which generic.0 is the more common term, is derived from the same root: but £p™'iagis lepriasis is preferred to lepra as a more general term, and hence why prefer better calculated to comprise the different varieties of this species rD,9^i^.pra" so generally described or referred to by the Greek and Oriental tions have writers, but whose descriptions, not very definite when first written, Juhfoo6" at least with a few exceptions, have been rendered altogether in- Jj^^ definite and incongruous in modern times, from a misunderstanding both in an- or confusion of the names under which the descriptions are given. m0d.rpn It is to this cause we must ascribe it that even in the learned epitome lin>e». of Dr. Frank lepra is made to include diseases so different, as genuine leprosy in all its forms, ichthyiasis, elephantiasis, and * S^p the Author's volume of Nosology. Prelim* Hits, p- 60, 388 cl. vi,] ECCRITICA. [ORD. Ill- Gen. IV. Spkg. II. Leprosia lepriosi*. Loprosy. B axeman fully sensi- ble of this. Description of this and various cognate diseases in the Leviti- cal code ex- act and ad- mirable. Three of them dis- tinctly be- long to the present species: Berat, Boak, and Tsorat. The same three equal- ly noticed and descri- bed by Ara- bic and Greek wri- ters, but with much confusion of termi and symp- toms. Boak a slighter and uncontami- nating be- rat: the bonk of the Arabi- ans and Al- phos of tho Greeks. Berat lebe- na of the Hebrew* the beras bejas of the Arabians. The berat cecha of the He- brews the Arabian beras sa- ved; the melasofthe Greeks. Whence the existing confusion has arisen. elephantia, which he distinguishes from elephantiasis from its locality and a few other symptoms.* The embarrassment, therefore, which Dr. Bateman felt upon this subject when writing on the genus elephantiasis, and which haa been noticed already,t he was equally sensible of when he came to lefra, 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 subject on their quitting Egypt, and which they seem to hav6 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 (mn3) or " bright spot ;" one called boak (pna) which also imports bright- ness, but in a subordinate degree, being " a dull-white beras," not contagious, or, in other words, not rendering a person unclean, or making it necessary for him to be confined ; and two called tsorat (fljny) " venom or malignity :" the one a berat lebena or " bright- white berat,"§ 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.IT 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 T will presently point out, that without thus turning back to" the primary source it is difficult to unravel them or under- stand 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 XtTpx Ax mm) Beras asved, Arab. Melas (M«Aaes) Auct, Gr. Cels. Dusky or black leprosy. Candida. Berat lebena. Hebr. (rm1? mm) Beras bejas. Arab. Leuce (Amhmj). Auct. Gr. Cels. Bright-white leprosy. on the face: not con- Gen-iv/ Spec. II. taglOUS. Leprosis Scales glabrous, dusky or £p™8£ livid, without central de- pression, patches increas- ing in size ; scattered, or confluent. Contagious. Scales on an elevated base, glossy-white with a deep central depression; encir- cled with a red border ; patches increasing in size: hairs on the patches white or hoary; diffused over the body. Contagious. All these, at least in their origin, are strictly cutaneous affections: a l. Lepri- though we shall presently have to observe that the last two when ojj^jjjfj}* they become inveterate, sometimes seem to affect the habit; and it duii-whito is hence possible that the first may do so in a long course of time if lePro*y- neglected. It is on this account that the boak, common or dull-white leprosy 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 distinguished 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 accumu- lation 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- heavers, dust-men, laboratory-men, and others who work among dry, powdery substances, and are rarely sufficiently attentive to cleanliness of person. In the common, and,perhaps, in all the varieties, the scaly patches History of commence where the bone is nearest to the surface, as along the the dlsoase- skin about the elbow, and upon the ulna in the fore-arm, on the scalp, and along the spine, 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 Progress, usually affected at the same time and in the same manner; but, contrary to the erysipelatous erythema and some other maladies of the skin, the parts first affected do not run through their action and heal as other parts become diseased, but continue with little altera- tion, till, from medical application or the natural vigour of the con- stitution, returning health commences ; wheli all the patches assume a like favourable appearance at the same time, those nearest the 3»2 a,. \j. ECCRITICA [obd. im. Gen. IV. extremities, and where the disease, perhaps, first showed itself, «SLSLe5ri- going off somewhat later than the rest. The scaly incrustations asis aibida. sometimes extend to the scalp, and a little encroach on the forehead wMteTep- and temples ; but it is very rarely that they spread to the cheeks, andtenni- chin, nose, or eyebrows. The eruption is seldom attended with nation. pain 0r 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 temperature in the atmosphere. tv^s'* icTf*'6" ^e nave 8a"* tnat tms va"ety ls strictly a cutaneous eruption, cutaneous and rarely, if ever, affects the constitution. It is in consequence fmpo°fa'nce! regarded as of but little importance in the Levitical code, which frointned contemP^ate9 lt as not penetrating below the skin of the flesh, and Levitieai not demanding a separation from society. " If a man or a woman," account: savs tj,e jewish law, " have in the skin of their flesh a berat, a white berat, then the priest (who after the manner of the Egyptians united the character of a physician with his own,) shall look ; and, behold, if the berat in the skin of the flesh be dull, it is a boak cedsus°m 8row^n8 in *he skin: he is clean."* Not essentially different Celsus, " the vitiligo, 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 periods. The bright-white when it has once made its attack, does not so easily quit its hold. The cure of the two former is not difficult: the last scarcely ever heals."t Hence ma- We may hence distinctly affirm that the variety of the dull-white contagious! or common leprosy, is not contagious : and had it been so among the Jews, Moses would have condemned the patient to a quarantine opinion of under this form, as well as under the two ensuing. Dr. Willan, indeed, 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 Though the idea of its being contagious. In reality, although in most coun- are often tries where leprosy is a common malady, places of separate resi- fouedtaTaU dence are usually allotted to those who are affected with it under tiievarie- whatever modification it may appear, this has rather been from an prosent8is erroneous interpretation of the Jewish law, and an ignorance of the often re- exceptions that are introduced into it. The lepers of Haha, a garded as • ■ i r> i i ii.ii.-i not conta- province in the barbary states, though banished from the towns, are fi'iustrated seen m parties of ten or twenty together, infesting the roads, and in the Bar- approach travellers to beg charity. In Morocco they are confined ary states. ^ & geparate qUarteri or banished to the outside of the walls. They are, according to Mr. Jackson, but little disfigured by the disease, except in the loss of the eyebrows, which the females en- deavour to supply by the use of lead-ore ; while they give an addi- tional colour to their complexion by the assistance of al akken or rouge. otheTtrib s ^n ^e manner' Niebuhr asserts that one of the species of leprosy ' to which the Arabs are subject, is by them still called Boak ; but " Levit. Cap. xm.36, 39. t De Medicina, Lib. v. Cap. xxvui. Set. 19. cl. vi.J EXCERNENT FUNCTION, [ord. iii. 39$ that is neither contagious nor fatal. Upon which remark his anno- Gen.IV. tator M. Forskal adds, " the Arabs call a sort of leprosy in which /i^yj various spots are scattered over the body Behaq ; which is without ft«'» a»>"i«- doubt the same as is named pn3 (bohak or behaq) in Ley. xiii. *Z?\l-°T They believe it to be so far from contagious that one may lie with prosy- the person affected without danger. "On May 15, 1763," says R«** •*« he, " I saw at Mokha a Jew who had the leprosy bohak. The Tonuf' spots are of unequal size : they do not appear glossy; they are al Mece«- hut little raised above the skin, and do not change the colour of tlie hair : the spots are of a dull white inclining to red."* The nigrescent leprosy forming the second variety, is improperly & h Lepri- called black, though it was so named by the Greeks. The colour, cmw?6"" as repeatedly described by the Jewish legislator, is rather obscure, ^J**.0* darkling, or dusky. The term is nm (cecha) whence the Latin rosy. csecus : and it immediately imports obfuscous, or overcast with gc^rn,] shade or smoke. The character in Celsus is in perfect accordance tbeLe»iti- with this, as he explains to us that fjuXxt, or " niger," in its applica- character tion to this variety, imports "umbras similis," "shade-like,'" or byCe,1,u,• "shadowed." The hue is tolerably represented in Dr. Willan's plate, but better in Dr. Bateman's, in which it has been retouched. The natural colour of the hair, which in Egypt and Palestine is H«'r <"» u» black, is not changed, as we are repeatedly told in tlie Hebrew code, changed in nor is there any depression in the dusky spot; while the patches, co!o<«' instead of keeping stationary to their first size, are perpetually en- larging their boundary. The patient labouring under this form was pronounced unclean by the Hebrew priest or physician, and hereby sentenced to a separation from his family and friends : and hence there is no doubt of its having proved contagious. Though a much a soverer severer malady than the common leprosy, it is far less so than the preceding leuce or third variety : and on thisaccountis described more briefly v">ety, but in the Hebrew canon. In our own quarter of the world the exfo- the*ubse- lialed surface in the nigrescent or dusky leprosy remains longer ?t8°charac- without new scales, discharges lymph, often intermixed with blood, «<» as it ap- and is very sore. When it covers the scalp it is particularly trou- ow^coun-' blesome. With us itis chiefly found among soldiers, sailors, sculler-,r*- men, stage-coachmen, brewers, labourers, and othjers whose occupa- tions are attended with much fatigue, and 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 consenuence of the increased excitement and irritability of the G™*f' . skin in the not and sandy regions of Egypt ami Palestine, there is, liontoail however, afar greater predisposition to leprosy of all kinds, than in [fees**'£,;_ the cooler temperature of Europe. And hence, under the next '"'j°e>£t_ variety, we shall have occasion to observe, from the Levitical ac- e/cViniates! count, that all of them were apt to follow upon various cracks or blotches, inflammations or even contusions of the skin. The bright-whitt lkt-rosy, is by far the most serious and obsti- a'6ig cane,{|?" nate of all the forms which the disease assumes. The pathognomic da. * lteisebeschieibung nach Arabien und andcrn unliegenden Lendern. Band. Ko- J^* cp" neiihag. 4to. 1774. Pathogno- V0Tj. V.— SO mic§ " 391 cl. vi.] ECCRITICA. [oun. m. Gen. IV. characters dwelt upon by the Hebrew legislator in deciding it are, yl*L«p}{- " a glossy-white and spreading scale upon an elevated base, the e»is candi- elevation depressed in the middle but without a change of colour, Bright- the black hair on the patches, which is the natural colour of the hair whiteieP- -n Palestine, participating in the whiteness, and the patches them- poieted out selyes perpetually widening their outline." Several of these cha- i"uieai law. racters taken separately belong to other lesions or blemishes of the these'mken s^n as wen*' am* tneref°re none of tneni were to De taken alone : separately and it was only when the whole of them concurred that the Jewish other bi'^n- priest, in his capacity of physician, was to pronounce the disease a Uhes: when tsorat (ryj'-ix) or malignant leprosy. We have said that in lepriasis, have con- the rete mucosum, or colorific adipose layer of the skin is peculiarly forniiDf'a affected, and we have here a still more distinct proof of this asser- psorat or tion in the change of the hair, the colour of which is derived from leprosy*" 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 iclithysiasis, forming the fourth species of the present genus, we shall find is occasionally deposited on the surface in prodigious abundance. Lebr°bf ' Common as this form of leprosy was among the Hebrews, during received by and subsequent to their residence in Egypt, we have no reason to brow^ft-om Relieve it was a family-complaint or even known among them au- ^e natives tecedently : and there is hence little doubt, notwithstanding the con- SJP ' fident 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 Predispo- skin : m the production of which there are no causes more active nenicauses:or powerful than a depressed state of body and mind, hard labour under a burning sun, the body constantly covered with the excoria- ting dust of brick-fields and an impoverished diet; to all of which the Israelites were exposed whilst under the Egyptian bondage. producing a It appears also, from the Mosaic account, that in consequence of duposiiion6. these hardships there was, even after they had left Egypt, a general predisposition to the tsorat or contagious form of leprosy, so that it often occurred as a consequence of various other cutaneous affec- tions ; sometimes appearing as a berat lebena (rush mm), or bright white leprosy, and sometimes as a berat cecha (nno mm), dusky Lesions and leprosy, according to the peculiar habit or idiosyncracy. The l0™eted cutaneous blemishes or blains which had a tendency to terminate in harbiu- leprosy, and which were consequently watched with a suspicious eye from the first, are stated by Moses to have been the following : 1. Shaat (nxc).* Herpes, or tetter, ovh,, Sept. an irritated cicatrix. 2. Saphat (nnflD).t Psoriasis, or dry scall.— Dry suhafata, Arab. * Levit. Cap. xiii. 2. 10.19. 43. + id. v. 2. ft, 7. r. BUS] as gers vi.]-' EXCERNENT FUNCTION. |W m. 395 3. Nctek (pn3;. Porrigo, or humid scall. Gen. iv. Porrigo. Cat. vers. Jun. /,?£/£ ctTrcmel. Moist sahafata, nsiseandi- Vt da. 4. Berat (mm).t Leuce, bright-white ^cale ; ^" leP" the critical sign of con- tagious leprosy. 5. Boak (pm).J Alphos,dull-w!.itescale: the critical sign of unconta- gious leprosy. 6. Nega (;♦«)•§ Ictus, blow or bruise : * been tried in any quarter. I have already had occasion arsenic. 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 * Levit. cap. xiii.v. 10.14, 15. f Id. v. 11. I Christian Researclies in the Mediterranean, p. 65. 8vo. 1822. § Iceland; or, the Journal of a Residence in that Island. cl. m.J EXCERNENT FUNCTION. [obd. hi. 397 at his leisure. But, with the exception of arsenic, the remedies <*EMp 1V' proposed by the Asiatics are trifling and little worthy of notice. y "uj* In Europe the mode of treatment has, indeed, been far more com- j™ «*ndi- plicated, but 1 am afraid not much more skilful or successful: con- Bright- sisting, till of late years, of preparations quite as insignificant as any ^flep" that occur in the Arabian writers, and often highly injurious by their T'catment stimulating property. Of the insignificant the simplicity of modern tui onTte practice has banished by far the greater number : and it is now, per- f^jl•,.. vinegar. with a third part water. As internal medicines the most useful seem to have been the sola- Soianum 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 Odhelius 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 uimus warmly recommended by various writers, for this, as well as nume- camPestrw' 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.t * Linnsus, Diss. de. Ledo. Palustri. Upsal. 1775.— Abhandl. derKom'gl. Schwed. AeademiederWissenchaffeu. Band. xli. p. 194. t Medical Transactions, Vol. n. p. 203. • JUS CL. vi.j ECCRITICA. [OBD. III. Gen. IV. Spec. II. Leprosis lepriasis. Leprosy. Treatment. CEnanthe crocata. Arsenic. Syrnptomi of over- dose. The renanthe 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 its 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 celery, water-parsnip, or various other herbs, has frequently proved fatal a few hours after being swallowed, exciting convulsions, giddiness, loeked-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, howewer, eat it with impunity, though it is inju- rious 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. But by far the most active and salutary medieine 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, or till the patient appears to "be over-dosed, when he will exhibit several or all of the following symptoms: head-ache, a pain and often a sense of inflation in the stomach and bowels, cough, restlessness, irritation in the skin gene- rally, redness and stiffening of the palpebral, soreness of the gums, and ptyalism. SPECIES III. LEPIDOSIS PSORIASIS. DRY-SCALL. PATCHES OF KOUGH, AMORPHOUS SCALES ; CONTINUOUS, OR OP INDE- TERMINATE OUTLINE : SKIN OFTEN CHAPPY. Gen. IV. Spec. III. Origin of generic term, which was for- merly used in a differ- ent sense. Proper root the Hebrew tsorat. How de- rived b^ Ihe lexico- graphers. Psoriasis is a derivation of -^u^x, "scabies, asperitas," with a terminal itis, as in the preceding species. The primary term 4'6>?e6. 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 jnx (tsora,) "to smite malignantly,or with a disease," whence njnx (tsorat) im- ports the leprosy in a malignant or contagious form, but not in an uncontagious. The lexicographers not hitting upon the proper origin of J>«f* have supposed it to be derived from 4,et" (P3ao,) which means, however, unfortunately," tergo. detergo." " to cleanse. ^~ vi.J EXCERNENT FUNCTION. [oud.'iii. 399 purify, or deterge,"—instead of "to pollute:" but as one way of Gen. iv. cleansing is by scraping, and, as persons labouring under psora ?"?J."' scrape or scratch the skin on account of its itching, the difficulty is P«>.'iasis. supposed to be hereby solved, and psora is allowed to import deriva- Drysca" tively, what, upon this explanation, it opposes radically. The actual origin of the term, however, is of little importance. It was mostly employed by the Greek writers, and has-been very its present generally so in modern times, to import a dry scall or scale, for the use" terms are univocal, the Saxon sceala or scala being the origin of the former, and denoting the latter, of a rough surface and indeterminate outline, as expressed in the specific definition. Psoriasis, as thus interpreted, is the dry Sahafati of the Arabian Synony- writers, the nnSD Saphat of the Levitical code, as already explained ; fSe^ry111" the Arabic being derived from the Hebrew root. It embraces the Sahafati of following varieties : Wans.™ x Guttata. Drop-like, but with irregular margin. In Guttated dry scall. children contagious. 0 Gyrata. Scaly patches in serpentine or tortuous Gyrated dry scall. stripes. Found chiefly on the back, sometimes on the face. y Diffusa. Patches diffuse, with a ragged, chapped, Spreading dry scall. irritable surface : sense of burning and itching when warm : skin gradually thickened and furrowed, with a powdery scurf in the fissures. Extends over the face and scalp. ^ Inveterata. Patches continuous over the whole surface ; Inveterate dry scall. readily falling off and reproducible with painful, diffuse excoriations. Extend to the nails and toes which become convex and thickened. Found chiefly in old persons. t Localis. Stationary and limited to particular or- Local dry scall. gans. In the first or guttated variety, tlie patches very seldom ex- a.L fsoria- tcnd to the size of a sixpence ; and are distinguished from those of Gunated1"' leprosy by having neither an elevated margin nor an-elliptic or cir- Dty 8?an< cular form, often spreading angularly, and sometimes running into Hon.,p" 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 re-appears in the spring ensuing. In children, probably from the greater sensibility of the skin, this variety of scall spreads often with great rapidity, and is scattered over the entire body in two or three days. The second or gyrated variety runs in a migratory course, and BL/Ptou*. apes the shape of earth-worms or leeches when incurvated, with Gyfated*19' slender vermiform appendages. Not unfrequently the two endsD'^c"^L meet, and give the scall an simulated figure like a ring-worm, par- tion. 400 cl. vi.J ECCRITICA. [ORU. III. Gen. ivr ticularly about the upper part of the shoulders or on the neck, in S*cc. HI. whjcj, case they are sometimes confounded with shingles or some other modification of herpes. ^•Psoria- fta spreading scall commences commonly on the face or tern- Sprc'adTnj pies, as the first of the preceding does on the extremities, and the se- DeKrip1-1' cond on the back. It is sometimes confined to a single patch, which tion. 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 aggra- vation or extension, of it at the vernal periods. Itis at times preceded by some constitutional affection; and at times seems to produce the Raker's same. When limited to the back of the hand, this, like some other forms of lepidosis, is vulgarly called the Baker's Itch. On the hands1 and arms, and sometimes on the face and neck, it is peculiarly trou- blesome to washerwomen; probably from the irritation of the soap they are continually making use of. & L.Psoria- The inveteracy of the fourth variety seems principally to spring bw invote- from tjje general torpitude and want of power in the class of persons invoterate whom it chiefly attacks, which is those who are in the decline of n'escrip-' life. It is accompanied with painful excoriations, in many instances non- occasioned by the pressure of some parts of the clothing against the sores, or by the attrition of contiguous surfaces, as of the nates, groins, thighs, and scrotum. At an advanced period of 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 very profuse discharge of thin lymph from the surface : after which the discharge itself thickens, from an absorption of the finer parts, and forms a dry, harsh, and almost horny cuticle, which progressively separates in large pieces. At first, this variety intermits in the sum- mer, but at length becomes permanent and intractable. «L. Pac-ria- The local variety is found chiefly on the lips, eyelids, prepuce, Locau'ry scrotum, and inside of the hands. It is peculiarly common to shoe- Bcaii. makers, and artificers in metallic trades, as braziers, tinmen, and sil- shoemukers versmiths ; probably from filth and the irritation of the substances uTrgic a","- tIley make USe °f- zans. The dry scall, under one or other of the above forma, is one of scan h7on9 the most frequent cutaneous diseases in this kingdom, and the first otSIefver' var'etr' guttated or drop-scall, psoriasis guttata, is sometimes conta- common, gious in irritable skins, and especially among children. Several of first somet these modifications are also found, occasionally, as symptoms or se- tin.es con- quels of lues, particularly tlie first three ; but are in every instance dis- oftenUa tinguisbable by the livid or chocolate hue of the scales. orsTuei ^s cutaneous sordes, in connection with a peculiarity in the con- of other stitution of the skin, and especially in connection with a meagre diet, MedwSnto' indolence, and want of exercise, appears to be the general cause of treatment, this as well as many other, perhaps most other simple cutaneous Cleanliness, ,. ., n . • • i <• „• • r . pure air, eruptions, the first principles ot a curative intention must consist in b« nui"'^' washing and softening the skin by warm bathing, regularly persevered tive food, in-; and m improving the diet, and exciting to a life of more activity. !.aii.ToS: Beyond this the common treatment of psoriasis should be, with little ol. vi.j EXCERNENT FUNCTION. (oAb. m. 4f>i exception, that of lepriasis : and hence the alterant and stimulant ft*N- iv, ointments of sulphur and tar in equal proportions ; lotions of diluted £ "p^"!- aromatic vinegar, or nitrate of silver, and the sulphureous waters of ■*j<*«i»- Harrowgate, Croft, Sharpmore, Broughton, Wrigglesworth, and scaii! 'y other places, used both externally, and internally, will succeed better ^"'^[ors, than common spring or river-water as detergents. Chalybeate me- chaiybcatu dicines, and particularly chalybeate waters, have been powerfully generally" recommended by Dr. Willis and many others: but, excepting where utcful- the disease is combined with a languid circulation, as in the inveterate form, and demands excitement, these do not appear to be of any cer- tain efficacy. Bleeding and the repetition of purgatives are of no Bleeding •1 i.L U • • , i ,» » i i UIU' r«P8»'- avail though a common practice with many, and founded also on the ed purges authority of Dr. Willis. " Strong mercurial preparations," observes of no avai1. Dr. Willan, " are of no advantage, but eventually rather aggravate the complaint." Nor do the fresh juices of the alterant plants, scurvy-grass, succory, fumitory, or sharp-pointed dock, appear to be of any material benefit. The solution of arsenic, however, has seemed at times to restore the habit to a healthy re-action. A gentle purgative should open the course of medical treatment; to which should succeed an internal use Of the fixed alkalies with pre- Alkalies, cipitated sulphur, and decoctions of elm-root, sarsaparilla, sassafras, B"teranV mezereon, or dulcamara ; and where the skin is very dry an antimo- d^e^,m,eks*, nial at night, or five grains of Plummer's pill, the compound submu- antimoniau riate mercurial pill of the London College. Yet here, as in the pre- °[8™erseX ceding species, the most effectual remedy, in obstinate cases, is the solution. arsenic solution, with an abstinence from fruits, acids, and 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. How far the sulphureous vapour-batli may succeed in any of the Sulphur varieties of this as well as of the ensuing, and of several other spe- bath*, * cies, has not hitherto been sufficiently determined. M. Gales ofalPa,ls' Paris, and, in consequence of his recommendation, M. de Carn of Vienna; Vienna, have tried it upon an extensive scale, and .apparently with considerable success.* But, as in most other cases of a new inven- tion, it is represented as being successful in such a multiplicity of dis- eases, and diseases essentially dissimilar, that its very popularity abroad has operated against a free and decisive trial of its pow- ers among the more cautious practitioners of our own country. A ^J0^^ few institutions, however, I am glad to find, are at length founded an both in this metropolis and in Dublin for the laudable purpose of car- rying on a full investigation; so that we shall soon be enabled to draw a correct estimate.! * Ueber Kraetzc, und derem bequemste schnell-wirkendeste und siefcerste Ueilart, &c. von D. Karsten, &c. &c, Hanover, 1818. . ^jl-Wv. t Observations on Sulphureous Fumigation as a Remedy in Rheumatism aso. dis- eases of the skin. By W. Wallace, &c. Dublin, 1620. 102 «-l. m.j r.ccurncA. LOK1>-ln- SPECIES IV. LEPIDOSIS ICHTHYIASIS. FISH SKIN. THICK, INDURATED INCRUSTATION UNCASING THE SKIN TO A GREATER OR LESS EXTENT ; SCALINESS IMPERFECT. Uen. IV. The specific term is derived from i%8vs "piscis" with the terminal Spec. IV. adjunct of the preceding species. The word is commonly written, Seafie0f but less correctly ichthyosis, since, as I have already observed, the lerm- suffix iasis is by general consent applied to all species appertaining to the genus or tribe of diseases before us. Pathoiogi i In treating of the genus parostia* as well as in various other nation1.a places, I have had occasion to observe that the calcareous earth 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, to give them increased size and solidity in adolescence, and to maintain their firmness in mature life, is, in many cases, secreted irregularly ; some- times in oxcess, sometimes in deficiency, and sometimes 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 secre- tion may not be much disturbed as to its quantity or quality, in the process of carrying off the waste matter the finer parts alone are re- moved in consequence of the debility of the absorbents, and the bones become brittle and easily broken. Analogical jn tne genus litiiia we have seen that one of the outlets for the connexion . n , . % ■ with lithia. discharge of the waste calcareous earth is the kidneys : 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 to form calculi. with paru- We have also seen under paruria err atica 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 calcareous de- posites in gout, and the calcareous scurf which is often accumulating on the head of those who perspire much. Uarthy se- In the disease before us, the cutaneous excretories throw forth such thiss0pDac?es an excess of this earthy material, that it often encases the entire body Jorthine*> nke ashe^ » and the cutis?the rete mucosum, and the cuticle being cess, some- equally impregnated with it, the order of the tegumental laminae is to'encaseVt, destroyed, and the whole forms a common mass of bony or horny a^haMe" coriunl'gener.alIy scaty or imbricate, according as the calcareous theintegu- earth is deposited with a larger or smaller proportion of gluten, in mony instances of enormous thickness, and sometime? giving rise t. in. ,'iF.v. iv. There is a remarkable passage in theLettrcs Kdifianles ct Curi- LrEido*,«V' euses, of the Jesuits, which intimates that this disease is by no means ifhthyioiiis. uncommon among the inhabitants of Paraguay ; the words, which Baid7obe" have bcen quoted by M. Buffon and Dr. Willan, aro as follow: indigenous « ]j re0-ne parmi eux une maladie extraordinaire : c'est une cspece nmoDg tho , , » r . , , , „ *. inhabitants de Lepre qui leur couvre tout de corps, et y forme une croute sem- g!wy.ra blable a des ecailles de poisson: cette incommoditc ne leur cause au- cunc douleur, ni meme aucun autre derangement dans la saute".* This stntc- There is perhaps no part pf the world where wc should sooner ex- uisinVriV pect to meet with this, and indeed various other species of squam- mose or leprous affections of the skin, considering the sultry heat of the atmosphere, the rankness of the perspiration that issues from the bodies of the natives, and their deficiency in personal cleanliness ; yet I do not know that the same account has bcen given by any other travellers, and have looked in vain over Estafia and Dobrizhoffer : nor does this particular incrustation of the skin seem to be prevalent in other inland countries exposed to the same jexcitements, though most of them exhibit squammose disorders of the surface of some kind or other. ™r- Leicestershire heifer which was publicly exhibited, and of which the author presented a description and a drawing to the Royal So- ciety. The whole of the skin was covered with a thick, dry, chalky scurf, often producing an itching; and wherever the skin was -* Recrteii des Lettres, &c. xxv. p. 122. f Phil. Trans. Vol. i.xxxi. 95. .aMfpfidn^i'-Te1""' SlT '' **"' '* °!>S' 30~See a,so JIist- deIa S- menos we ought to read E. Herpes zoster. Shingles. Zona ignca. Orijin. Descrip- tion. Gen. V. ulcerative ring-worm of Dr. Bateman is, perhaps, a modification of j?"iierpaathis variety : it is of tedious and difficult cure, but is limited to hot Exodcna. climates. tatt'er!0 Where this variety is connected, as it is sometimes found to be, modified1-184 witn the stiUe of tne constitution, and particularly of the stomach, rion called and the patches are accompanied with a sensation of actual burning or scalding, so as to resemble a more papulated form of measles, like the measles of this modification, they are denominated nirles in some parts of Scotland. The third variety, herpes zoster, is the zona ignea of many writers, both which terms imply a belt or girdle, and are evidently given to the eruption from its ordinary seat and course as surrounding the body. The Latin word for these is cingulum, and from cingulum our own shingles has been derived in a corrupt way. A slight constitutional affection sometimes precedes the appear- ance of this form, as sickness and head-ache, but by no means generally; for in most instances the first symptoms are those of heat, itching, and tingling in some part of the trunk, which, when examined, is found to be studded with small red patches of an irregular shape, at a little distance from each other, upon each of which numerous minute elevations are seen clustering together. These, when accurately inspected, are found to be distinctly vesicu- lar ; in the course of twenty-four hours they enlarge to the size of small pearls, are perfectly transparent, and filled with a limpid fluid. The clusters are of various diameter, from one to two, or even three inches, and are surrounded by a narrow red margin, in consequence of the extension of the inflamed base a little beyond the congre- gated vesicles. During three or four days other clusters continue to arise in succession, and with considerable 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 commonly passing round the waist like half a sash, but some- times, 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, tlie walls of the utricles being thickened by the exsiccation 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 Complaint considerable, is pitted with numerous cicatrices. The complaint is littil'mpor^ generally of little importance, but is sometimes accompanied, es- tance. pccially on the decline of the eruption, with an intense deep-seated But is said pain in the chest, which is not easily allayed by medicine. By some terminated authors, as Hoffman and Platner, it is said to be occasionally malig- fataiiy in nant and dangerous, and Languis alludes to two cases in noblemen babij mis- that terminated fatally.* The disorder, however, seems in thest. Mken. instances to have been of a different kind from shingles, and to have depended upon a morbid state of the constitution.! This affection is found most frequently in the summer and autumn. Progress. Termina- tion. L'Hst. Med, p, 110. t Plurabe, on Diseases of tlie Skin, p. HO. 8vo. W '■i» vi.J EXCERNENT FUNCTION. [ord. nt. 411 when the skin is most irritable from increased action ; and in per- Gen. v. sons of a particular diathesis, disposed to herpes, rather than to any ^"iierS", other form of scaly eruption. Under these circumstances slight ^,er exciting causes will produce it, as exposure to cold after violent lona'0' exercise with great heat; cold cucurbitaceous vegetables, or other jgj^; c. substances that disagree with the stomach ; inebriety ; or even a sing and sudden paroxysm of passion or other strong mental emotion, of cause!,0"81 which Schwarz tells us that he had seen not less than three cases.* 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 affections.t It >>"'jl c°n!" does not seem to be contagious, though asserted to be so by some {hough ns- writers. " In the course of my attendance," says Dr. Bateman, ?er,Bd.to " at the Public Dispensary during eleven years, between thirty and some wii- forty cases of shingles have occurred, none of which were traced to ters- a contagious origin, or occasioned the disease in other individuals." The ring-worm is a still slighter variety of herpes than shingles, 5 & Herpes both with respect to disquieting symptoms, and range of the dis- Rto^vorni ease. Here the vesicles are restricted to the circumference of the ^"crip" herpetic patch, thus forming an annular outline ; the central area, however, in some degree participating in the inflammation, becomes roughish and of a dull red colour, and throws off an exfoliation as the vesicles decline, leaving a red and tender surface beneath. The process is completed in about a week : .,but a fresh crop qf Terinimi herpetic circles often spring up in the neighbourhood, or in some other part of the body ; and, as such crops are occasionally repeated many times in succession, the course of the disease is not unfre- quently protracted through a long period, and migrates over the entire surface from face to foot. Yet no other inconvenience attends it than a disquieting itching and tingling in the patches. It is found Found . most frequently in children, and, though deemed contagious, affords chi?dre>"' no real ground for such an opinion. It has, indeed, been traced in Pr°°ably some instances, in several children of the same school or family at gious. the same time ; but perhaps only where the same occasional cause, whatever that may be, has been operating upon all of them : while in most instances, the examples have consisted in single patients who have not been debarred communication or even sleeping with their school-fellows or other branches of a family. The rainbow-worm or tetter is of rare occurrence, and was by « e. Herpes Dr. Willan at first mistaken for an exanthem, in consequence of his R"9inbo>,. having only seen it in its earliest stage : on which account in the J£rn,,k first edition of his Table of Classification he called it a rain-bow by'wiun rash. The error has been corrected by Dr. Bateman, to whom we for a ta,h- are indebted for the first accurate description of it. Its usual seat Usual set is on the back of the hands, or the palms and fingers, sometimes on the instep. The patches are very small, and at their full size do not exceed that of a sixpence. Its first appearance is that of an OnS,». efflorescence, but by degrees the concentric and iridescent rings r°s"' * Diss, de Zona Serpigines^. Hal. 1745. + Bateman on Cutaneous Diseases, p. 227. Svo. 1813. H2 tt. xi.] KCCKIT1CA [ord. in. Only found in young poisons. i, E. Herpes localis. Local tet- ter. qt" the lip : mouth: Cen. v. become distinctly formed and vesiculated, and even the area partakes rEPEuCo'rpes of the vesication and becomes an umbo. The utricles are distended 'ris.-. in about nine days, they continue stationary for two days more, and Rainbow- . . . J J , t irvJ rPli« worm. then gradually decline, and disappear a week atterwards. tne Dcc[ine' central vesicle is of a yellowish-white colour ; the innermost ring of a dark or brownish-red ; the second of nearly the central tint; the third, which is narrower than the rest, is dark-red ; the fourth, or outermost, which does not appear till the seventh, eighth, or ninth day, is of a light red-hue, and is gradually lost in the ordinary colour of the skin. This variety has only been seen in young persons, and is uncon- nected with any constitutional affection. Its exciting cause is not known : though it has occasionally followed a severe catarrhal affection, accompanied with hoarseness. It has also occasionally recurred several times in the same person, always occupying the same parts and going through its course in the same periods of time. The local ring-worm is accompanied with a considerable sense of heat and itching or tingling irritation in the region in which it originates. That of the lip renders the adjoining parts hard, and tumid, and painful, and especially the angle of the mouth ; the form is usually semicircular ; and though the herpes does not spread to >in the any considerable distance, it is sometimes lound at the same time within the mouth, forming imperfect rings on the tonsils and uvula, and producing an herpetic sore throat. It usually appears, however, as a symptom or sequel of some disease of the abdominal viscera, and sometimes proves critical to them. It terminates, as in other cases, in ten or fifteen days in dark thick scabs, which form over a red and tender new cuticle. The local ring-worm of the prepuce is apt to be mistaken at first for a chancre, and still more so, if, under the influence of this mis- take, it be treated with irritants ; for the base will then become much more thickened and inflamed, and the natural course of the vesicles will be interrupted. If the eruption be left alone, it will prove itself in about twenty-four hours by the enlargement and dis- tinct form of the vesicles, and their assuming an annular line. They die away after having run their course, as in the other varie- ties. The exciting cause of this is not known. It has been ascribed, however, by Mr. Pearson, to a previous use of mercury. Like several of the other modifications it has a tendency to recur, after it has once shown itself. No internal use of medicine is necessary in tlie treatment of any of the varieties of herpes, except where the constitution becomes affected from the irritation ; and in such case, a gentle purgative or two should be administered at first, and a plan of tonics be laid down afterwards, the diet being simple and plain. External applications are almost of as little avail, for the eruption must have time to run through its course, and if this be interrupted we shall certainly prolong the period, and add to the irritation. Stimulating ointments and lotions were in use formerly, but they .nave now been "judiciously laid aside as only tending to exacerbate .of the pre- puce : apt to be mistaken for a chan- cre. How to be distinguish Mil. General medical treatment vl. vi.] KXCERNENT FUNCTION. [ord. hi. 413* tlie affection. Where from the viscosity of the discharged fluid the Gen. V. vesicles are apt to adhere to the clothes or whatever covering they rfcph^v"" come in contact with, they may be covered with a layer of cetaceous Herpes. cerate on lint: but a layer of lint alone will be most useful in the Treatment. local variety of the prepuce, as even oleaginous applications are apt to irritate the disease in that quarter. Dr. Frank affirms that herpes is sometimes congenital, sometimes hereditary, and sometimes epi- demic : but as he has blended herpes with porrigo, and has not indicated the particular forms of disease he alludes to.it is no easy task either to confirm or oppose the remark.* SPECIES III. ECPHLYSIS RHYPIA. SORDID BLAIN. ERUPTION OF BROAD, FLATTISH, DISTINCT VESICLES ; BASE SLIGHTLY INFLAMED : FLUID SANIOUS ; SCABS THIN AND SUPERFICIAL : EASILY RUBBED OFF AND REPRODUCED. For a distinct arrangement of this species in medical classifica- Gen. V. tion, we are altogether indebted to Dr. Bateman, who has denoini- R£pfa0r' nated it rupia, from 'pviros, " sordes," as indicative of the ill-smell Bateman. and sordid condition of the diseased parts: and in his Delineations has given two very excellent and instructive coloured plates of its appearance under different modifications, 'r^re?, however, with its Name why aspirate and the ordinary power of the v should be rendered in Latin c characters rhypia as now given, and only altered for the sake of greater correctness. The species offers three varieties as follow : x Simplex. Scab flat; livid or blackish ; Simple sordid blain. shape circular. 6 Prominens. Scab elevated, conical, and Limpet-shelled blain. blackish ; shape, limpet- shelled. y Escharotica. Sanious discharge erosive, Erosive blain. producing gangrenous es- chars. The vesicles under this species never become confluent: their fee™£l progress is slow, and leads to an ill-conditioned discharge which concretes into thin, superficial, and chocolate-coloured scabs, of the distinctive characters noticed above. When the ulcers under the scab, in the two first varieties, heal, they still leave the surface of a livid or blackish colour, as if from a pigment in the rete mucosum. * De Cnr. Horn. Mth milia" wrists, the ball of the thumbs, and the fingers. It is, however, scabies. distinguishable from the former by being unaccompanied with fever g^aWe"1" 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 inflammation, or subsequent ulceration. The sensation, moreover, to which it gives rise, is that of a smarting or tingling rather than of an itching. The eruption is irregularly successive, and has no determinate Progress. 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. J^™1 The re-action of a cold-bath, in most cases, increases the irritation : lr< and hence a tepid bath is the 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 coarser 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 eczema impetiginodes of Dr. Bateman is an eczema set down Eczema on an impetiginous habit of the skin, and is hence a mixed com- dmBp0fSin° plaint. His eczema rubrum or mercuriale has already been described Ratemas-. as an erythema.* * Erythema ycsiculare, vol. H. p. 234. llti CL. VI.J KCCUIT1CA. [ORD. ill- GENUS VI. ECPYESIS. HUMID SCALL. Gen. VI. Origin of the genoric term. How dis- tinguished from em- pyesis. Origin of the old English term scall. ERUPTION OF SMALL PUSTULES DISTINCT OR CONFLUENT ; HARDE.V ING INTO CRUSTULAR PLATES. Ecpyesis is a Greek term from tyuxvu, "suppuro." It is here used in contradistinction to empyesis already employed* to import deep-seated suppurations ; and consequently is intended to describe pustular 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, which he has correctly defined " elevations of the cuticle with an inflamed base containing pus." The old English term for ecpyesis or pustula in this sense of the word is scall, from which 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 nnSD (saphat),- as we have already observed when treating of lepra, and the latter, or the eruption before us, Arabic and pnj (netek).| The Arabians, like our own ancestors, denomina- BynonyWm. ted both these by a common name (sahafata) from (sahaf), squammae, Saphata or rather from the Hebrew nnsD (saphat) : distinguishing the one from the other, like our ancestors also, by the adjuncts dry and' humid : so that the sahafata of the Arabians is a direct sononym of the old English or Saxon scale. In our established version the Hebrew pro (netek), which imports the eruption before us or humid scall, is by mistake rendered dry scall, which, as remarked above, Ecpyicsis is a nn3D (saphat). The expletive dry does not occur in the original, and that pro (netek) denotes humid scall rather than dry scall 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 removal by shaving camiot be accomplished, or ought not to be attempted. It is distinctly, therefore, a porrigo or scabby scall, and is thus verbally rendered in the Latin version of Tremellius and Junius, 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 honeycomb-scall, and scalled-head. &exvrpt.x, by which netek is rendered in the Septuagint, is literally crust, a very significant term in common use to express the peculia* the netek of the Lfiviti- eai code: which is rendered porrigo by several of the Latin versions. Thrausma «vhat. Vol, III p. 54, Lr-yiticas xiii. S0r31. U1.VT.J UXCEUNENT EUNCTION. [onu. m. 4T, nature of the scab that hardens on the porriginous sore. Tetter, a Gen. vi. corruption from the French dartre, or the Greek Atins, has of late Humid'8' years been used synonymously with scall, and has almost supplanted fjfi£t it: but the proper meaning of dartre, or tetter, is herpes, to which, whence de- in this work, it is confined, an excoriating eruption of a vesicular ^vcd• or ichorous kind. The species that belong to this genus are the following :— 1. ecpyesis impetigo. running scall. 2«--------porrigo. scabby scall. 3.------ecthyma. papulous scall. 4.------scabies. itch. All these specific terms have been very loosely employed, and in ;411 lUt!"' j.n. • •{. . mi . .• terms hare very different significations by most writers. They are here limited been loose to the definite senses assigned them by Dr. Willan ; and, with the ^ii^rwcSy. 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 hi modern times, as will be further noticed hereafter. SPECIES I. ECYPESIS IMPETIGO. RUNNING SCALL. PUSTULES CLUSTERING, YELLOW, ITCHING ; TERMINATING IN A FELLOW SCALY CRUST, INTERSECTED WITH CRACKS. The specific term is a derivative from impeto " to infest;" it is Gen1, vr. used in its ordinary and restrained sense as opposed to the unautlio- Spec« *• rized latitude assigned to it by Professor Frank, who, as already ob- served, employs it as the name for art entire class, and the following are the varieties the species offers us : x Sparsa. Clusters loose ; irregularly scattered ; Scattered humid Scall. chiefly over the extremities; often suc- ceeded by fresh crops. a Herpetica. . Clusters circular, crowded with pustules, Herpetic Scall. intermixed with vesicles ; Often with exterior concentric rings surrounding the interior area as it heals; itching accompanied with heat and smarting. Chiefly in the hands and wrists. y Erytliematica. Pustules scattered ; preceded by erythe- Erythematic Scall. matic blush and intumescence ; often by febrile or other constitutional affee Vol. V.—5* 116 CL. \I.'j ECCRITICA. L"«"-ul Gen. VI. Spec. I. Ecpyesis impetigo. Running Scall. } Laminosa. Laminated Scall. e Exedens. Erosive Scall. £ Localis. Local humid Scall. lion. Chiefly in the face, neck, and chest. Pustules confluent; chiefly in the ex- tremities ; the aggregate scabs form- ing a thick, rough, and rigid casing around the affected limb, so as to im- pede its motion ; a thin ichor exuding from the numerous cracks. The purulent discharge corroding the skin and cellular membrane. Confined to a particular part; mostly the hands or fingers ; and produced by ex- ternal stimulants, as sugar or lime. Clencral remarks. a E. Impe- tigo spsrsa. Scattered humid scall: has been confounded with porri- go und BCiibies. How distin- guishable. y E. Impe- tigo erythe- matica. Erylhoma- tic varioty, humid strall. How distin- guishable from erysi- pelas. t E. Impe- tigo lami- nosa. Laminated humid b'.-a The differences are sufficiently clear from these definitions. The first variety, or scattered humid scall, has sometimes been con- founded with varieties of porrigo and scabies, constituting two sub- sequent species of the present genus. It differs from porrigo, how- ever, in having the purulent discharge succeeded by an ichorous humour soon after the eruption has shown itself, and in the posses- sion of a thinner and less extensive scab. It differs from scabies in its more copious exudation of ichor, when the latter is secreted, in the magnitude and slower progress of the utricles, and in the sen- sation of heat and smarting, rather than of itching which accompa- nies it. And differs from both in being uncontagious. The erythematic form commences with the ordinary signs of an erysipelas, as'a redness and puffy swelling of the upper part of the face, with an edema of the eye-lids ; and the irritation is some- times accompanied- with some degree of pyrexy for two or three days. But a critical eye will easily perceive that, instead of the smocth polish of the erysipelas, there is a slight inequality on the surface as if it were obscurely papulated, and in a day or two the disease will show its true character by the formation of numerous psydracious pustules over the inflamed and humid skin, instead of the large irregular bulloe of the erysipelas. The pustules are formed with a sense of heat, smarting and itching, and, as they break, they discharge a hot and acrid fluid, which adds to the irritation and ex- coriation of the surface. In this painful condition the face, or other part, remains for ten days or a fortnight, when the discharge begins to diminish, and to concrete into thin yellowish scabs. Fresh pus- tules, however, arise in the neighbourhood, and the disease runs on from one to two or three months, according to the irritability of the skin and its tendency to be affected by continuous sympathy. It lias sometimes perambulated the entire surface from head to foot: during the whole of which course the constitution is scarcely dis- turbed, or in any way affected. The laminated humid scall is sometimes conjoined in the lower limbs with cellular dropsy, and produces severe ulceration : and its casing or incrustation occasionally extends to the fingers and toes, and destroys the nails, being succeeded by nails of an im- perfect fabrication? thick; noich! Mannh *•« 179?. °;/ a,,vnr Voi. V.— ft-J 126 GL. VI.J ECCRITICA. [OKD. UI. Gkn. VI. Spec. Ii. Ki'pywis t'omgo. Scabby •rail. Treatment. Disease icated un- der the cu- ticle. Secretion peculiarly acrimoni- ous and ex- cites iensi- bility in the part. This sensi- bility to be fitst remo- ved, and afterwards depilato- ries- Mercurial prepara- tions : other me- tallic depi- latories. Most of theae will answer in slight casus: hut in severer eases ni- trate ot silver. Where porrigo has become chronic, the irritation must be diminished ?tadv«''y. itffected 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 appear- ance among children at school, but is not confined either to schools or to childhood ; for I had not long since 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 lo the entire patch. This material affords no nutriment to the bulbs of the hair, and seems sometimes to be acrimonious ; whence tlie 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. Different 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 tricolor. 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, I 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 the 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 the morbid vessels, and changes their action. It often excites a slight vesication or soreness on the surface, and it is in most instances necessary to push it to this point. And when this stimulant astringent has answered its purpose, the decalvate plots should for some weeks afterwards be daily washed with the acetated solution of ammonia, or aromatic vinegar. 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,* * Mir*>. hi. 427 Sennert,* Stoll,t and Morgagni,| have given examples of epilepsy, Gem. vi. apoplexy, and even death itself following upon a sudden retrocession Ecpyesis of the eruption. In the Berlin Medical Transactions there is a case £°|£f°* pr two of amaurosis produced by a metastasis of this disease.§ e-.aii. " One of the best medicines for the present purpose is the arsenical solution. The cure is generally protracted by a strumous diathesis. reutmeiil. SPECIES III. ECPYESIS ECTHYMA. PAPULOUS SCALL. PUSTULES LARGE J DISTINCT J DISTANT J SPARINGLY SCATTERED ; SEATED ON A HARD, ELEVATED RED BASE ; TERMINATING IN THICK, HARD, GREENISH, OR DARK COLOURED SCABS. Ecthyma from ttetvtu, "to rage, or break forth with fury," was Gen. VI. used by the Greek writers synonymously with exormia, in the sense ofigin'of of papula : to which effect Galen " apertum est ab txSveiv, quod est the specific fgoftt*», id est erumpere, derivatum esse e%6vt*.x 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 stimulating applied externally in the form of fotfons, ointments, or powders. None of ti:em are contagious, and in this as well as in their approaching more nearly to a papulous or broad pimply cha- racter, especially that of the small-pox, they differ essentially from the preceding. Nutritious food alone, with pure air and regular exercise, are often sufficient for a cure. But as this species is mani- festly dependent upon a debilitated or cachectic state of the consti- tution, 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 affection, or rather a sequel of some long or chronic disease of an exhausting nature, and always disappears in the train of its cure. SPECIES IV. ECPYESIS SCABIES. ITCH. ERUPTION OP MINUTE PIMPLES, PUSTULAR, VESICULAR, PAPULAE, IN- TERMIXED OR ALTERNATING ; INTOLERABLE ITCHING ; TERMINA- TING IN SCABS. FOUND CHIEFLY BETWEEN THE FINGERS OR IN THE FLEXURES OF THE JOINTS ; CONTAGIOUS. Gen. VI. This disease is peculiarly complex ; but the specific characters Spec. IV. nOW given embrace the modifications which constitute its chief varie- ties, and which are as follow : Papularis. Rank itcJ & Vesieularis. Watery Itch. Eruption of miliary, aggregate pimples ; with a papular, slightly-inflamed base, and vesicular apex ; pustules scantily interspersed ; tips, when abraded by scratching, covered with a minute, globular brown scab. Eruption of larger and more perfect vesicles, filled with a transparent fluid, with an uninflamed base ; intermixed with pustules ; at times coalescing and forming scabby blotches. M..vi.] EXCERNENT FUNCTION. [ord. m. 429 y Purulenta. Eruption of distinct, prominent yellow Gkn. rv. Pocky itch. pustules, with a slightly inflamed base; fjjj^j7- occasionally coalescing, and forming Scabies. irregular blotches, with a hard, dry, Ilch' tenacious scab. «r Complicata. Eruption complicated of pustular, vesicu- Complicated itch. lar, and papular pimples co-existing ; spreading widely over the body ; occa- sionally invading the face ; sometimes confluent and blotchy. e Exotica. Eruption chiefly of rank, numerous pus- Mangy itch. tules with a hard, inflamed base, ren- dering the skin rough, and brownish ; itching extreme ; abrasion unlimited from excessive scratching. Produced by handling mangy animals. That all these affections are not distinct species of a common ah the va- genus, but mere varieties of a single species, is manifest from the Sometimes fact that in different individuals, or under different conditions of the ™"h "other skin, every variety, even the mangy itch itself, will produce every ea other variety, while all of them in some instances co-exist, and are destroyed by the same means. The above English names for the The above first three are those in common or vulgar use, and it would be dif- naines'have ficult to find names more appropriate. The pocky itch is so de- !,een,Ions nominated from the resemblance of the pustules to minute small- use, and pox, and not from any supposed connexion with syphilis. It gives ap®opt"aie. the largest pimples of all the modifications, as well as the most Pocky itch purulent, but it has never the hard base of either the small-pox or the u?eTesem-m ecthyma or papulous scall we have just noticed, nor has it the hard ^san" °[M raised border or round imbedded scab of the last, and hence is to smaii- easily distinguished from both. The two former varieties are far no*'from more readily confounded with some varieties of prurigo and of a»ysuppo- lichen, and especially in consequence of the black dots on the tips lion with " of the papulae, and the long red lines common to all as produced xhefirst by scratching. But they are distinguished by the greater simplicity ™& seeona of the itching sensation, which, however intolerable, is not com- approach bined with tingling or formication ; and by their being highly con- ^-^J™^. tagious which the others are not. Yet from their general resem- r}go and blance, all these have, by many writers, been confounded, and by H.nv'djstiii- others who were fully sensible of their distinction, been incorrectly guishdbie. described under scabies or psora as a common name. As a primary disease, itch is, in every instance, the result ofKcn P"ma. personal uncleanliness, and an accumulation of sordes upon the gersona? skin, though the most cleanly are capable of receiving it by con- ""^Xugh tact: and it always appears most readily where close air, meagre the cleaned diet, and little exercise are companions of personal filth ; for here, c'eive'uby as we have already had frequent occasions of observing, the skin is contact. more irritable, and more easily acted upon by any morbid cause. Like many other animal secretions the fluid hereby generated is c,ose inter* contagious; and, on close intercourse, but not otherwise, and chiefly cesscryfor 430 gl. vi.] ECCRITICA. [on». nr. Gen. vi. in the warmth of a common bed, or of a bed that has been slept |™ce\Jv- in before by a person affected with the disease, is capable of com- scabies. munication. Where the cutaneous irritation hereby produced is contagion general to the surface, and has been suffered to remain without When chfo- check, or with little attention, for a long time, a sudden suppression nic, the irri- of the irritation by a .speedy cure, like the sudden suppression of a produces to long standing ulcer or issue, is often attended with some severe »>e dimin- internal affection ; in one instance, indeed, related by Wantner, it bydeg°reeys. was succeeded by mania. And in camps and prisons, where the uvular c"* constitution has been debilitated by confined air, and innutritious cumstances diet, the eruption has sometimes been known to assume a malignant ed aamahg- character ; of which Baliinger gives us an example, the whole sur- aoterChar **ace °ftne kody, m tne instances to which he refers, having exhibited a sordid tesselation of crusts, excoriations, and broad livid spots, with an indurated base, accompanied with fever at night and severe head-ache. By what! Whenever an organ is weakened in its action it is extremely apt organ8be- to become a nidus for worms or insects of some kind or other to dusfor1 ni Durrow m- Hence the numerous varieties of helminthia or invermi- worms or nation in debility of the stomach or other digestive organs ; and insects. hence the lodgment, 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 especially in warm climates, the appearance almost every morning of innumerable grubs or maggots, of which we have frequent ex- amples in the wounds inflicted on the backs of the negro-slaves in Hence these the West Indies by severe flogging. A similar deposite of eggs, rometiraes a., c a., Sfe 6 V 66 ■ found in or apparently ot the genus acarus or tick, is sometimes found in itch* pustu]e«h pustules, or in the immediate vicinity of them. And hence itch has, by Wichmann, Frank, 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 Doctrine of peremptorily denied the existence of such a fact in any case.t Dr. Frank confides, indeed, so implicitly in the acarus as a cause of itch, as to affirm that where this insect does not exist, the eruption is nothing more than a spurious itch ;J and, as he further affirms that the disease is sometimes epidemic, he endeavours to account for this fact by supposing that the atmosphere, in particular 6tates of constitution, favours the production of the itch-acarus, as of earth worms and intestinal worms, far more than in other states. The explanation now given constitutes, however, tlie actual history, and But not ne- readily reconciles these conflicting opinions. Such insects are not connected always to be traced, but they may be seen occasionally : and with the wherever they appear they are not a cause but a consequence of the disease. Remedial There are few complaints that have been treated with so many rroceig. J ♦Wichmann, Aetiologie der Kriize. Hanov. 1786__Roohard, Journ. de Med. Tom xli. p. 26. t Sager, Baldinger N. Maga. B. n. 484.—Hartmann, Diss. Quwrtiones super Wichmanm jEtiologpa Scabiei. Fr. 1769. ' t De Cor. Horn. Morb. Epit. Tom. iv. p. 165, 166. vl. vi.j EXCERNENT FUNCTION. [orb. hi. 4S1 remedies, and none with so many pretended, specifics. Sulphur, Gen. VI. zinc, acids of all kinds, bay-berries, white hellebore, arsenic, alum, 1™^" muriate and other preparations of quicksilver, alkali, tobacco, and Scabies. tar, have all been used externally in the form of lotions or ointments ; Pretended andjsulphur and sulphuric acid have been given internally, and been J*™2Xi«"" strongly recommended both in Germany and in our own country for their success. Sulphuric acid was first used in the Prussian army in sulphuric 1756, by Dr. Colthenius, chief physician ; after which Professor ™* inter_ Schroeder of Gottingen, employed it very freely, and asserted that he "* never failed herewith to cure the itch in fourteen days at farthest.* Dr. Linckius, in the Nova Acta Naturse Curiosorum, gives an Epidemic account of an epidemic itch which raged very generally around itch» Nuremberg about the middle of the last century, and resisted all the usual means of sulphur, lead, turpentine, arsenic, mercury, human and animal urine, chalybeate waters, lime-water, and drastic purgatives, and only yielded to diuretics urged to such an extent as «ur«f! »nIy to irritate the urethra with a considerable degree of pain. The irritant Si- medicine he employed was a sub-nitrate of pot-ash, obtained by uiet,CB- deflagrating 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 sediment.f It is very possible that all of these have been successful under ah the peculiar degrees and modifications of the complaint. For the itch jnbedfearJijay is not difficult to cure, and seems only to require an application that have suc- will excite a new and more healthy action in the cutaneous vessels, umesfas The simplest and most certain cure is to be obtained by the sulphur '*?* "'no* ointment, of which that of the London College gives as good and cure. as simple a form as any. On the Continent they usually combine cjpieft0Pbe with the sulphur an equal quantity of powdered bay-berries, and of attended to. sulphate of zinc, which is mixed up into an ointment with linseed pies/cure or olive oil. This form was first proposed by Jasser, and under the afone'0rUr name of unguentum Jasserianum has maintained an unrivalled with bay- character for the last half century.J The offensive smell of the gufphate of sulphur, whether in the simple ointment or Jasser's compound ?inc; ,asin preparation, is very much diminished by adding to the materials a ointment. 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. Perhaps, however, the neatest as well as the most Sulphur fu- rapid mode of cure by sulphur is that of fumigation as long ago misaUon- proposed by Professor Frank,§ though lately brought forward again as a new discovery. It has been successfully and commodiously applied by M. Gales of Paris, and since extensively employed over Germany by Dr. de Carro of Vienna and Dr. Karsten of Hanover. || The patient, for this purpose, is enclosed naked in a commodious Mode of box with a neck-opening for his head to rise above it, and a stool usinsiu * See Dr. FJelonich's Dissertatio de Olei Vltriolis usu &c. Hal. 1762. t Therapeia Scabie epidemical per Diuresin, &c. Tom. iv. I Schmucher Vermischte-Chirurgische Scriften. (Band. in. p. 185. Franck. 1783. 8vo. i Ubi supra, Tom. iv. p. 174. j| Ueber Kraetze, und derer bequemste, schneil-wkendeste und sicherste Hetlart, &r, HanoF. 1818, 432 cl. vi.J ECCRITICA. [ORl>. Ill Sec iv t0 Slt uPon" The box is numerously perforated at the bottom, and Ecpyesis ' the sulphureous fumes are communicated to the interior of the box, ftchbe8' DV means OI* these perforations; the sulphur being placed on a stone hearth below, and volatilized by a fire underneath it. He must remain in this state for half an hour or an hour ; and as he is hereby thrown into a considerable degree of perspiration, it is better for him to be put into a warm bed immediately afterwards till the perspiration has subsided. Other cutaneous complaints have yielded to the same process. These are- the safest and most effectual applications, and should Mercurial be employed wherever practicable. But where there is an impracti- to be pro- cability the most elegant modo of treatment is to be obtained by a rerred. mercurial lotion made by dissolving a drachm of muriated quicksilver in half a pint of water, and adding two drachms of crude sal am- moniac, 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. Mode of About eight and forty hours' steady use of this lotion or the sul- ofPth« ° phur ointment, will generally be found sufficient to effect a cure ; ointment. a^er 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 im- pacted sordes will hereby be removed, and the ointment or lotion will have a chance of taking a greater effect. Where the constitu- tion has been influenced, aperient and alterative medicines will also be necessary, and ought not to be neglected. juice of tho In India a pleasant and easy cure is said to be effected by wearing tree!" ' linen that has been dipped in juice expressed from the agreeable fruit of the bilimbi tree (averrhoa Bilimbi. Linn.), which has also the reputation of being an antidote in many other cutaneous disor- ders : but I cannot speak of its effects from any personal knowledge. Has ceased How far scabies may, under any circumstances, cease naturally thedrCrnorbid I cannot say : we are informed, however, by Bennet, that a case action. which had resisted all remedies was cured by a phthisical expectora- tion which continued for a month.* * Young, on Consumptive Diseases, p. 171. vi.J EXCERNENT FUNCTION. [ord. m. 433 GENUS VII MALIS. t'UTANEOUS VEKMINATIOX. THE CUTICLE OR SKIN INFESTED WITIt»ANIMALCULES. Malis and Maliasmus {ptxXii, imcMxo-w) are Greek nouns import- Gen. VII. ing cutaneous vermination. In the present system, the genus is de- p^lSs' signed to include both the malis and phthiriasis of Sauvages and several other writers, which are very unnecessarily divided. Com- Extensive mon as this disease is to man, it is still more so to animals of per- ™SaI haps every other class and description, from the monkey to the fish- oilman-0-0 tribes, and from these to the lowest worms. All of them are infested wa'is, 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 and plants: 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 ^l""'/^. botanical writers, were significantly called dodders, from a term . 111. 436 animal in its size. To determine the time of pregnancy and pro- Gen vrr. portion of increase, this indefatigable physiologist took two females a u^l] and placed them in a black silk stocking which he wore day and cuIi hu~ night that they might have the full benefit of feeding upon him. He common found that in six days each laid fifty eggs without exhausting its store, p7osde;gi0Ug and that in twenty-four days the young were capable of laying eggs fecundity. themselves : and, carrying on the calculation, he estimates that the two females conjointly might produce eighteen thousand in two months. The largest animalsof this kind were discovered by Linneus in the warm caverns of Fahlum in Sweden. It has been observed, pediculus however, by many entomologists, that those which conceal them- ^j1™^0" selves in clothes, forming the pediculus vcstimentorum, are, in some 'n differ respects, a different animal from the lice of the hair, or p. capitis. ^™^l 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 cover- ing. 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. Swediaur tells us that he once saw a young woman, thirty years Singular of age, a patient in the Westminster Infirmary, who was covered cattonfiom very generally with minute pustules and tubercles produced by an swed.aur. unlimited assault of these animalcules oyer the whole body ; and supposes that universal phthiriasis was by no means an unfrequent disease among the ancients.* The pediculus pubis is distinguished by the cheliform structure B m. pedi- of its legs, whence its name of crab-louse : its antennas consist of crllb-hDiwe.' five articulations. Its excrement stains the linen and appears like diluted blood. It is a frequent cause of local prurigo : for these a frequent animals burrow in the skin, and, being almost unknown among ^"prurigo: 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 disco- lorations 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 be- comes offensive to them, and they quit the person who is labouring under it; various infectious fevers seem to produce this result. It is affirmed by some writers that the pediculus capitis or huma- The com nus, has been found useful in epilepsies, diseases of the head, and in ^Xve scrophula, and that the worst consequences have arisen from drying ^n.»«[»] the little ulcerations they produce. In Russia and other parts of the nnn7scrPoS-'e" Continent, where thia kind of uncleanliness is, perhaps, less attended pi™'*- to than in our own country, all this may have occurred ; for we have already had occasion to observe that any cutaneous irritation, whether * Nov. No- Gen. VII. from scabieg, porrigo, or any other excitement, maintained till it has BSMEp'J.'- become habitual, should be suppressed gradually, or we shall endan- cuius pubis. ger a transfer of the morbid action to a part of far more importance. but com-3"' Upon the whole, however, such remarks are only apologies for filth ^mafks aw and indolence, as we are in no want of much more effectual cutane- oniy apoio- ous irritants, where such means are called for, than can be obtained gies for . tilth from so disgusting a source. Remedial The most fatal poisons to all these vermin are the mercurial process. Gxydes, staphisacre, menispermum, rue, opium, 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 destroyed by calomel mixed with starch powder, and applied by a down puff. SPECIES II. MALIS PLTLICIS. FLEA-BITE* CUTICLE INFESTED WITH FLEAS ; OFTEN PENETRATING THE CUTIS WITH THEIR BRISTLY PROBOSCIS, AND EXCITING PUNGENT PAIN ; EGGS DEPOSITED ON OR UNDER THE CUTICLE. Gen. VII. This species offers Us the two following varieties : Spec. II. x Pediculi irritantis. Infestment of the common flea, with a Common flea. proboscis shorter than the body; eggs deposited on the roots of the hair, and oh flannel. £ Pediculi penetrants. Infestment of the chigoe or chiggre, a Chiggre. West Indian flea, with a proboscis as long as the body ; often penetrating deeply into the skin, and lodging its eggs under the cuticle, particularly of the feet; producing malignant, occasionally fatal, ulcers. a m. puiicis The common flea infests not mankind only, but quadrupeds and common birds <>f a1' kinds. It is probable that it has many varieties, but these Extensive have not been ascertained by entomologists. Contrary to the econo- ran?e. my of the pediculus, the flea undergoes all the changes of the rneta- Ky.1 morphosing tribes of insects, being produced from an egg, which gives rise to a minute vermicle or larve, that is transformed into a chrysa- lis, and finishes in a winged animal. The eggs, in the summer months, take six days before they are hatched, the larve the same pe- riod before it becomes a chrysalis, the chrysalis twelve days before it assumes its perfect form : so that the entire process is completed in cl.vi.J EXCERNENT FUNCTION, [ord. in. 43T a little more than three weeks in the .summer, though a longer period Gen. vn. of time is consumed in the colder months. It obtains its nourish- aSMEpUl|ci's ment from the juices of the animal it infests, by driving its sharp pro- irritamis. b6scis under the cuticle. ■ fle0™"10" The chigoe or chiggre is thus excellently described by Catesby. ^g™!^3 " It is a very small flea found only in warm climates. It is a very ciug-oe or troublesome insect, especially to negroes and others that go barefoot i^leTcrip- and are slovenly. They penetrate the skin, under which they lay a tion nnd bunch or bag of eggs, which swell to the bigness of a small pea or tare, and give severe pain till taken out: to perform which great care is required for fear of breaking tlie bag, which endangers mor- tification 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 lazi- ness, 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. The cuticular or cutaneous halos, Psydrasia often accompanied with a slight elevation, of the skin, crowned with an^wnkm. minute vesicles or dandriff, produced by the present and various other bites or stings of insects, as that of the gadfly, harvest-bug or wasp, are called by Frank* and many other writers psydrasia or psydrasia;. Dr. Willan's definition of the term docs not widely differ from this explanation. SPECIES III. MALIS ACARI. TICK-BITE. CUTICLE INFESTED WITH THE TICK ; ITCHING HARASSING, OFTEN WITH SMARTING PAIN. The tick insect offers us the following varieties : x Acari domestici. " Observed on the head in considera- Gen. VII. Domestic tick. bie numbers.'-' This is not a com- Spec. III. mon variety, but Dr. Young has an example, and I have introduced the variety upon his authority and in his words. 3 Acari Scabiei. Infestment of the itch-tick; burrow- Itch-tick. ing under the cuticle in or near the pustules or vesicles of the scabs in those affected. * Tie Cur. Horn. Morb. Epit. Tom. iv. p. 181. Mannh. Syo. 1792. 48S cl. vi.J ECCRITICA. [ord. ui. Gen. VII. y Acari autumnalis. Infestment of the harvest-bug, less in *• pec. hi. Harvest-bug. size than the common mite ; inflict- T^ck-bh"1' ing its bite in the autumn, and firmly adhering to the skin ; itching intole- rable, succeeded by glossy wheals. General de- The acarus is a very numerous genus of very minute insects, in- acafus0" °f eluding, besides those enumerated above, a multitude of other spe- Dog-tick cies weji known to every one, as a. Ricinus or dog-tick, a Siro or tick"™ wy mite, a dysenteric or dysentery-tick, of which we have spoken already.* a M.Acarus The first in the above varieties is probably the a. Leucurus of Lin- Domestic8' neus, with a testaceous exterior, found frequently in the neighbour- A°kLeucu- h°°cl of gangrenous sores, and dead bodies. The second a. scabiei, rusofLin- or exulcerans, for though enumerated as two by Linneus, they are js*M Acarus the same animal, white with reddish legs. It burrows, not in, but scabiei. near the exulcerations of the itch, as already observed under scabies, as also in the neighbourhood of other exulcerations, and adds con- v M.Acarus siderably to their irritation. The harvest-bug is a globular ovate-red HUUvest-lis' msect' with an abdomen bristly behind. From the glossy wheals bug;, or 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 exposed to them. Where the punctures have taken place they are easiest relieved by a lotion composed of equal parts of the aromatic spirit of ammonia and water, which I have often found also highly servicea- ble in the bite of an animal that does not, indeed, harbour in the cu- ticle or on the skin, though he is as troublesome by his sudden and predacious sallies, I mean the gnat and the musqueto fly. wheal- worm. Remedial process. SPECIES IV. MALIS FILARLE. GUINEA-WORM. SKIN INFESTED WITH THE GUINEA-WORM ; WINDING AND BUR- ROWING UNDER THE CUTICLE, FOR THE MOST PART, OF THE NAKED FEET OF WEST INDIAN SLAVES; SEVERE ITCHING, OFTEN SUCCEEDED BV INFLAMMATION AND FEVER. Gen. VII. This worm is found chiefly in both the Indies, most frequently in Spec. IV. the morning dew ; often twelve feet long, not thicker than a horse- hair. It may be felt under the skin, and traced by the fingers, like the string of a violin : and excites no uneasy sensation, till the skin is perforated by the animal. It should be drawn out with great cau- tion, 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 * Vol. ii. p. 354. M. , and called c£es. Curative process employed at Sevue. SKIN INFESTED WITH TIIE HAIR-WORM ? CHIEFLY INSINUATING ITSELF UNDER 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 Etmuller 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-worm ; some of which are well known to infest other animals in like manner ; and especially the cyprinus alburnus or bleak, which, at the time ap- pears 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 cees, a corruption of ceddes, a provincial term for a bristle. It appeared from the first twelve 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, hoarsened, a diminution of the voice, and an inability of sucking. Friction with the hand over the body proved a certain cure, and brought forth a kind of dark rough filaments resembling * History of a case in which Worms in the nose were removed, &c. 8vo. I7R0. ct. xx.] EXCERNENT FUNCTION. [6rd. m. 441 hair, often not more than the twelfth of an inch in length, in some Gen- vn. cases furnished with a minute bulb at the extremity.* m^' VI' A decoction of the cocculus Indicus is serviceable in this and in |?rdii- most of the preceding species : but perhaps the most determinate worm. cure for the whole is to be found in the civadilla, supposed to be a ^fcai species of the veratrum, which I have already recommended in treatment. many cases. No insect or vermin of any kind is capable of resisting itsVdestruc« or living under the pungent and acrid aroma of its seeds when tive pun" 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 Requires used where the surface of the body is exulcerated. In porrigo, or ^'jote scabby scall, it has even proved fatal: and'* hence it is omitted in «ee. Rosenstein's third edition of his work " On the Diseases of Chil- dren," though recommended in the two preceding. GENUS VIII. ECPHYMA. CUTANEOUS EXCRESCENCE. SUPERFICIAL, PERMANENT, INDOLENT EXTUBERANCE ; MOSTLY CIR- CUMSCRIBED. Ecthyma is a Greek term from txQvts "educo, egero," in eon- GenVIH- tradistinction both to phyma " an inflammatory tumour," and £j,rnfr'J;0f emphyma " a tumour without inflammation," originating below the term. integuments. Extuberanees 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 im- mediate cause. The species of this genus are the four following : 1. ECPHYMA CARUNCULA. CARUNCLE. 2.--------VERRUCA. WART. 3. -------- CLAVUS. CORN. 4. ——--- CALLUS. CALLUS. * Hi«t. de la Societe" Royale, &c Ann. 1776. Vol. V.—56 442 a. vs.' ECCRITICA- l«mr. so. SPECIES 1 ECPHYMA CARUNCULA. CARUNCLE. SOFT, FLESHY, OFTEN BBNDULOUS, EXCRESCBNCB OF THE COMMOrN INTEGUMENT. Gck.viii. This species is found over the surface generally and occasionally, SPE.C. 1. ag a seqUe] 0f iues about the arms and sexual organa. Wnen _ * . T ...» -. ., found prin- From its shape or position it often obtains a particular name, as FicusT' flcus, when fig or raisin-shaped; encanthis, when seated on the Rncantbis, canthus or angle of the eye. These excrescences on their first formation seem to be produc- mere'euti- tions of the cuticle alone ; but by gradually thickening and a fresh rnnlurs,Ubot vascularity they come at length to be connected with the skin itself by degrees and, in some instances, even to proceed to the depth of the subjacent withtfw6 muscles, Thay are of very different degrees of hardness : being in cutis, or some instances not much firmer than the parts with which they are mnscies. Connected : whilst in others they are found to acquire the obduracy FoMisun- of a rigid scirrhus. Their colour also is very various : in some cases ey, colour, they are of a pale white, and in others of different shades of red. In ■Jze1!*'a 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. Remedial Where they are neither painful nor unsightly there can be no reason for attacking them, but in other cases they should be removed- Treatment. 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 escharotie. 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. ^s~^i.j EXCERNENT FUNCTION. [ord.hx 443 SPECIES IL ECPHYMA VERRUCA. WART. KIRM, HARD, ARID, INSENSIBLE EXTUBERANCE OF THE COMMON INTE- OUMENT : FOUND CHIEFLY ON THE HANDS. Warts are small sarcomata that offer the following varieties: Gem.VHL 6 Spec. II. « Simplex. Simple and distinct: sessile or Simple wart. pensile. p 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 gradu- Orfe"» «"«s ally become connected with the cutis by being supplied with minute pr°eww arteries that rarely extend far into its substance, as the surface, when of any bulk, is hard, ragged, and insensible. The extreme sensibility of the base of a wart renders its connexion with a subcu- taneous nerve highly probable. It is destroyed by ligature, the knife, escharotics, or powerful C""*3** astringents. Many of our common pungent plants are employed by the vulgar for the same purpose, and in various instances answer sufficiently- One of the most frequent is the celendine or chelido- cheiidoni- nium inajus, whose yellow acrid juice is applied to the excrescence o^ceu^-' daily or occasionally till it disappears. The pyrofigneous acid, py^'ft"": however obtained, answers the same purpose, as does the meloe one acid. proscarab&us, the liquor potassae or ammonias, mineral acids, muri- Savuie- aled ammonia. In Sweden they are destroyed by the gryllus verru- £eJ1£Joyei civorus, or wart-eating grasshopper, with green wings spotted with gryllus ve?- forown. The eommon people catch it for this purpose ; and it is ruci,r<>rtw- said to operate by biting off ihe_£xcrescence, and discharging a cor- rosive liquor on the wound. They often disappear spontaneously, Sometimes. jafid dieuce lay a foundation for being charmed away. spoXne- ousljr. 444 cl. vi.J ECCRITICA [°kd, m. SPECIES II. ECPHYMA CLAVUS, CORNS. GekVHI. Spec. HI. Originate as earun - eles and warts, and sometimes approach ichthyiasis cornea. Sometimes cast annu- ally. Mode of treatment. :{OT-NDT-K. \:^.--V, 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 tuber makes a nearer approach to some of the species of the genus lepidosis, especially l. Ichthyiasis cornea, and cornigera. In the ninth volume of me Transactions of Natural Curiosities, is a case of an annual 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 rather stimulating preparation, as the juice of squills, house-leek, or pars- lane, or the compound Galbanumor ammoniac emplaster. Gev.VHI. Spec. IV. Where chiefly seated, and how pro- duced. By burning sand? er other ac- cess of heat. Singula* ie fleet*. By mineral acids, used for this pur- pose ty SPECIES IV. ECPHYMA CALLUS, CALLUS. CALLOUS EXTUBERANT THICKENING OF THE CUTICLE ; INSENSIBLE TO THE 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 accustom 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 auch 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 sulphuric acid as to endure fire without pain. This acid is hence commonly employed by professed fire-walkers, and fire-eaters, the interior of «■-*. vr.J EXCERNENT FUNCTION. [ord. ni. 445 the mouth being hardened and seared in the same way as the soles Gen.VIII. «**.»*. * »%?■ In the Medical Museum is a singular case of this complaint as it 5aj}M- occurred in a young man, the cuticle of whose hands was so thick- fire-walk- ened and indurated as to render them of no use. He was by trade firr^.*^er3 a dyer; and the disease was gradually brought on by cleaning singula^ brass wire, with a fluid consisting of sulphuric acid, tartar, and alum. illustr*t,ofl- 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. MORBID HAIR. HORBID ORGANIZATION OR DEFICIENCY OF HAIR. Trichosis (Tei%urif) " pilare malum," is a term of Actuarius, Gen. IX. and other Greek writers from 6et% "pilus." Trichiasis is the generic0 more common appellation; but it has often been used in a some- ,;,"£ m^. what different and more limited sense. The terms athrix and dis- Jam. . trix, 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 £J?y«oi»gy body; it rises from a bulbous root of an oval form which fixes in rise like the cuticle or rete mucosum, and seems sometimes to shoot into the g^c'^i° cutis. The separate hairs are spiral and hollow, filled with a pulp, j>°m bui- furnished with vessels, and knotted at certain distances like some inthecuti- sorts of grass, and in some cases send out branches at their knots. cle- Their roots or bulbs are found over the whole surface of the body, Bulbs or . ...... roots lound though they only vegetate m particular parts, for which it is not easy over the to assign a reason. The hairs in the stems of the roots are facTboT nourished 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 particular or more dense, tlie hair is dry, crisp, and soon falls off: when not {£p|se*Ja. carried to the extremities, the stems or hairs become brittle, or split. ordinarily. The rete mucosum furnishes the hair with its colour : and as this becomes" olour. together with the nutritive mucus of the hair, diminishes, 8*'?, and i-ll> cl. vi.J ECCRITICA. LOIU)' m" w' Gen. IX. Trichosis. Moibid hair. perishes. Without nerves. Circulatisn how main- tained. Beneficial effects of combing the hair, and refresh- ment often and is at length altogether suppressed in old age, we see one reason 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 car- ried on in them in the same manner as in plants. JW combing we free the fluid from those obstructions which must necessarily be produced by their being bent in all directions : and hereby promote a circulation through the bulb, and relieve the head from accumula- tions : for though the vessels of the bulb are small they are nume- rous.* And we are hence enabled to account for the relief and obtained by refreshment which is often felt by a patient after the operation 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 injurious 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, how- ever, affirms that suddenly cutting off long hair has to his knowledge been injurious and attended with every appearance of plethora: while very thick hair may occasionally weaken by the undue warmth and perspiration it occasions. Next to the bones, hair appears to be the mo3t indestructible of the constituents of the body: and there are accounts of its having been found in old tombs after all the soft parts had entirely disap- peared. The hair of different individuals differs considerably in its thickness, in the proportion of ^i^ to j^-g of an inch in diameter: and it is no less variable in its other physical qualities, some kinds being much more dense and elastic than others, which Mr. Hatchett ascribes to the different proportion of jelly contained in it.f According to the experiments of Vauquelin, read to the Institute in 1808, human hair is not soluble in boiling water, but, when ex- posed to a greater temperature in Pappin's digester, it dissolves readily. From a solution of black hair, a black matter was de- posited, 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 alcohol evaporates. It is probable, therefore, that the black matter is gummy or albuminous; the white we are told resembles cetaceum in appearance though it differs in chemical affinity. Red oil obtained najr affords the white matter, and instead of the ffrayish-wreen oik Irom red ., . , -%it< > • , . hair. an oil as red as blood. White hair contains phosphate of mag- ivomVos" nesia, affording us another proof of the greater facility with which phate of calcareous matter is either formed or let loose in old age than in whence its any other period of life ;J and its oil is nearly colourless. Whei> Long hair whether productive of debility. SuddeRlj cutting c long bail lias been injurious and in- duced ple- thora. Indestrue- tibilitv. Difference in various nualiiies. Ci.emical properties of hair. Black oil obtained from black hair; iron, and sul- phur: as also a whit- ish and jrayish ^reen oil: l>lood-red solonir Parr, Med. Diet. Art. Pilus. Elementary System of Physiolo-jv, p. 91. 8vo. 1824. 3! Supra, p. 2P, &.. vi. j EXCERNENT FUNCTION. [ord. ui. 447 hair becomes suddenly white from terror, Vauquelin thinks it may Ge». IX. be owing to a sudden extrication of some acid, as the oxymuriatic Morbid* acid is found to whiten black hair; but it is suggested by Parr that hftir-' this may more probably be owing to an absorption of the oil of the *£&,*> hair by its sulphur, as in the operation of whitening wooljen cloths, J^y*" Dr. Bostock has more plausibly conceived that the effect depends o?h£ y upon the sudden stagnation of the vessels which secrete the colour- ™S ing matter, while the absorbents continue to act, and remove that ehanafcto which already exists.* e^Tri* These remarks will assist us in comprehending something of the nature of the following species of diseases which are included in the genus before us : 1. trichosis setosa. bristly hair. 2. -------- plica. matted hair. 3---------h1rsuties. extraneous hair. 4.--------distrix. forky hair. 5.--------poliosis. gray hair. 6.--------athrix. baldness. 7. ———---- area. areated hair. 8. ------- decolor. discoloured hair- s' ---— ■ sensitiva. sensitive hair. SPECIES I. TRICHOSIS SETOSA. BRISTLY HAIR. HAIRS OF THE BODY THICK, RIGID, AND BRISTLT. This is the hystriacis or porcupine hair of Plenck. It is in fact Gen. IX, a stiff corpulency of hair produced by a gross or exuberant nutri- Spec. I. ment, and has been sometimes limited to the head, sometimes to orPorcu* other organs, and sometimes common to the body. The remarks ^"m^ already offered will sufficiently account for its production. In the fifth volume of the Philosophical Transactions, we have illustrated 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.f * Elementary System of Physiology, p. 92. + See also Samml. Med. Wahrnemnna:. Rand. iv. p. 24<». 448 cl. vi.] ECCKITICA. [on*, hi. SPECIES II. TRICHOSIS PLICA. MATTED HAIR. HAIRS VASCULARLY THICKENED J INEXTRICABLY HARLED AND MATTED BY THE SECRETION OF A GLUTINOUS FLUID FROM THEIR ROOTS. Gen. IX. This disease affords a sufficient proof by itself, if other proofs were Affords'"' wanting, of the vascularity of the hairs. Vauquelin ascribes it to a proof of superfluous excretion of the fluid that nourishes them, but there In hklr" m must be something more than this : there must be also an intumes- aiso that cence or dilatation of the vascular tunic of the hairs, since their tubes "or7 capacity is always augmented, and in some cases so much so as to dilatable6 Perrr"*tne ascent of red blood ; in consequence of which they bleed whence an when divided by the scissors. ascent0ofa Most authors ascribe it to uncleanliness, which is no doubt the Common' orcunary exciting cause, though there seem to be others of equal eause,un- efficiency. It is also very generally affirmed to be contagious, and Whether"' •"■ flad hence added this character to the disease in the volume of contagious. Nosology. But, as Dr. Kerckhoffs strenuously maintains the con- Kerckhofis. 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 suffering from it in the most loathsome manner, I have here withdrawn the symptom. His exph- Dr. Kerckhoffs reduces plica to a much simpler principle than it the'disease, has hitherto been described under, and strips it of many of the most formidable features by which it has been characterized ; particularly its connexion with hectic fever or any idiopathic affection of the brain.* He regards it as a mere result of the custom common 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 woollen bonnet or Uncieanii- leathern cap. And hence, says he, while the rich are in general m™the on- exempt from the disease, it is commonly to be met with among the iy cause. p0or alone, who wallow in filth and misery, and particularly among the Jews, who are proverbially negligent of their persons. 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 excision of the matted hair. * Observations Medicates, Par. Jos. Rom. Louis Kerckhoffs. Medicine del»Arm«e4 «c. See Med. Tren*. Vol. *P- "»• Dresd. 1729. 4'to. II -Bpb. Nat. Cor, Pec, n. Ann. iv. Obs. 163. Apr 203. «r Cent. vi. Cur. fir. i.. vt.j EXCERNENT FUNCTION. [ord. iii. 451 feathers of the toucan grow naturally. Criniti and Bose found tlie Gen- *X. heart covered in the same manner.* Trichoma ' Of organized animal substances, hair, however, seems to be ori- Hirsuties. ginated more easily than any other : and this, too, without having, hair. at least in many cases, any apparent bulb or root to shoot from. JJJ^e We had lately occasion when treating of paruria stillatitia, to Hair origi- notice their discharge from the bladder as constituting one of the "asfiy than causes of this complaint. So in malis gordii| they have been JJ"^"-^ apparently solicited by friction, from different parts of the body of animal sub- an infant, with seeming relief to his distress. And under the genus Exempii- eccyesis,| numerous examples have been given of their formation fied- in various internal organs. It is on this account the hair and beard Whether .... n , • -ii n continues are said by writers of grave authority occasionally to grow for some to grow af- time after the death of every other part of the body ; of which tei dealh examples may be found in Heister,§ and Camerarius.P SPECIES IV. TRICHOSIS DfSTRIX. FORKY HAIR. HAIRS OF THE SCALP WEAK, SLENDER, AND SPLITTING AT THEIR EXTREMITIES. This is a common affection, and depends upon a deficiency in Gen. IX. the supply of proper nutriment from the bulb or root of the hair, in E^ned.' 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 be Remedial accomplished by cutting the hair short, and stimulating the roots by Proces» irritant pomatums, unguents, or oils. SPECIES V. TRICHOSIS POLIOSIS. GRAY HAIR. HAIR PREMATURELY GRAY OR HOARY. The specific term poliosis is a Greek derivative from mfos, <|JjM*' •; candidus," " canne,"—" white or hoary." origin'of' specific term. * Pr. Hist, de Anitomenls Messenii hirsuto corde, Paris, 1525.—Pr. Sistens, his- toriam cordis villosi, Leips. 1771. ..,,,.„„ t Supra, P. 440. J Supra p. 162, et passim. 8 Heist. Compend. Anat. || Camerar. Memorab. Cent. vi. p. 47. io2 CL. VI.J ECCRITICA. [0RI>. Ii.. «*N. IX, Spec.V. Trichosis PoiiosU. Gray hair. l'liyeiologi- cal expla- nation. 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 ex- plained 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 Schenck gives a case in which it appeared on birth.* It has sometimes been trans- mitted hereditarily :f and, in some 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 followed upon an obstinate cephalaea,§ and is said to have occurred after death.|l SPECIES VI. TRICHOSIS ATHRIX. BALDNESS. Gen. IX. Spec. VI. Alopecia of many au- thors but not of Cel- sus and Galen. Origin of specific term. Paug-saleb (>f the Ara- bians. DECAY A"VD 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 present 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 uXaTtvl " vulpes," a fox, this animal being supposed to lose its hair and become bald sooner than any other quadruped. The Arabian writers named it from the same source daus-saleb, literally, " mor- bus vulpis." The species admits of the.following varieties : *> * Lib. i. Obs. 3. ex Stuckio. | Eph. Nat. Cur. Dec. n. Ann. i. Obs. 69. eS^r^^C^HiK tS??' jjfe°«*» * ^rel Paris, § Journ. des Scavans, 1684. || Eph. Nat. Cur. Dec. n. Ann. i. Obs. 69. •-J-. vi.J EXCKRNENT FUNCTION, [ord. hi. 453 x Simplex. Hairs of the scalp of a. natural hue ; GEN« IX- Bald-head. gradually dying at the bulbs, or t"SbJL loosened by a relaxation of the *ln,rjx- J Baldness. cutaneous texture. /3 Calvities. Hairs gray or hoary : baldness Bald-crown. chiefly on the crown of the head ; and confined to the head. Mostly common to advanced age. y Barbae. Decay and fall of the beard. Bald-beard. The first variety is the defluvium capillorum of Sennert. a T. athrU; Whatever tends to give an established relaxation and want of tone Bald-head. to the cutaneous vessels becomes a cause of this affection: and it is hence a frequent sequel upon fevers of various kinds. It is also found as a symptom in tabes, phthisis, porrigo, and impetigo. General tonics and cold bathing form the most promising treat- ment where it is an idiopathic affection : and where it is a secondary complaint it must follow the fortune of the disorder that gives rise to it. The second variety proceeds from a cause precisely opposite B T. athrix to the preceding. Here the cutaneous secernents, instead of being B^iVd!cero'wn 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 their 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 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,* cephalaea, and worms.t This affection is far more common to males than to females ; it is More com- asserted by many writers that it never occurs in eunuchs,:}; and by ^"J'than Schenck that it never takes place in any persons before the use of to females; sexual copulation ; and hence ought not to exist in bachelors; and, ["occur6* provided the remark be well founded, on which I cannot speak 'l° ^"r®h8: from my own knowledge, might be employed as a test of their the use of .• sexual cq- continence. puiation. The most promising remedies are to be sought for in an external application of warm animal oils, and oily aromatic essences, as lavender-water. Baldness of the beard is not a common defect: but examples of it are referred to in the volume of Xosology. And a few rare Sornetimcs instances are to be met with of the baldness extending over every "eMhe part of the body. Professor Frank has given us a striking example £°d^]ar of this in a young man who about two months before he saw him instance. Gilbert. Adversus Pract. Prin.—Mcrlet. Diss. Ergo a Salacitate Calvities ? Paris, ■ii62. t Paullini Lanx Sat. Dec. iv. Obs. 9. * De Moor, Diss, in Hipp. App. vi. 28. L. B. I7SB— Schenck. L. i. Obs. 10. 1 d4 cL. vi.] KC CRITIC A. [ord. ur,. Gen. IX- had suffered a sudden falling off of the hair from the beard, head. ft t\ Athria eye-lashes, and pubes, while his fingers appeared dead as though calvities. destroyed by a dry gangrene, his voice, meanwhile was unchanged, crown. the full power of procreation continued, and with the exception of a slight debility which he had felt for a few clays, he was free from complaint. There was no perceptible cause, though thirteen years before he had laboured under syphilis.* SPECIES VII. TRICHOSIS AREA. AREATED HAIR. PATCHES OF BALDNESS WITHOUT DECAY OR CHANGE OF COLOUR IN TIIE SURROUNDING HAIR ; EXPOSED PLOTS OF THE SCALP GLABROUS, WHITE AND SHINING ; SOMETIMES SPREADING AND COALESCING, RENDERING THE BALDNESS EXTENSIVE. Gkn. IX. Tins species is taken entirely from Celsus, who gives two varie- speciesVd^ ties of Jt all«ost in the following words : lived from x Diffluens. Bald plots of an indeterminate Diffluent areated hair. figure : existing in the beard as well as in the scalp : obstinate of cure. Common to all ages. 3 Serpens. Baldness commencing at the oc- Serpentine areated hair. ciput, and winding in a line not exceeding two fingers' breadth, to each ear, sometimes to the forehead : often terminating spontaneously. Chiefly limited. to children. f'thVaio-" ^e FIBST variety forms the true alopecia of the Greeks, of peciaofthe which I have spoken already, and is so denominated by Celsus, swond va. Ga,eni and otfier Greek and Roman writers. The second is called riety their by them ophiasis from «^/$, " a serpent," in consequence of the ser- pentine direction in which the disease trails round the head. The Bpecies Dr. Bateman has described this species under the name of porrigo rigodejai- decalvans, while he admits that the surface of the scalp offers no Bateman- Por"gino"s or other eruption whatever, but "within these arese is smooth, shining, and remarkably white. It is probable, however," he adds, " though not ascertained, that there may be an eruption of minute achores about the roots of the hair, in the first instance, but has no which are not permanent, and do not discharge any fluid." It must nexion with °e obvious to every one that this fall of the hair has no connexion porrigo. * De Cur. Horn. Morb. Epit, Tom. ir, p. 124. M..VI.J EXCERNENT FUNCTION. [ord. in. 465 whatever with porrigo; depending upon a partial operation of the Gen. ix. causes that we have already noticed as giving rise to the two pre- T^isT^ ceding species of poliosis and athrix. Area- A frequent shaving of the entire scalp, with affusion of cold hair?" water, and the use of stimulant liniments, as aromatic vinegar, or a Kre0™e^al solution of two drachms of the oil of mace in three or four ounces of alcohol, will sometimes be found to produce a fresh crop of hair : though in mo6t instances, all applications are equally unavailable ; and even in successful cases it is usually many weeks or even months, and has been years, before the patches are duly supplied with hair. SPECIES VIII. TRICHOSIS DECOLOR. MISCOLT>URED hair. HAIR OF THE HEAD OF A PRETERNATURAL HUE. As the hair receives its tint from the pigment communicated to Gen. IX. the bulbs by the rete mucosum, whatever varies the character or J^^f**'. colour of this material, will vary also the colour of the hair. Some pianation -. of the causes of such variation we shall have to notice under the g"s!„ot nl"" ensuing genus; but there are others which are not so easily ex- ways mat* plained. 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 con- stituent, since it does not seem from the experiments of Vauquelin, that this is a result of the iron. The grayish-green oil which this excellent chemist has been also able to extract from black and other dark kinds of hair is another distinct principle : and, from an excess or deficiency, or a peculiar combination of the colorific constituents, we are able to account for some of the extraordinary hues which the hair is occasionally found to exhibit, though others seem to elude all explanation. The chief varieties they display are the following : x Ccerulea. Of a blue colour.* A Denigrata. Changed from another colour to a black.f y Viridis. Of a green colour. Of which we have had very numerous examples.\ £ Variegata. Spotted, like the hair of a leopard.§ Of this the examples are more common than any of the preceding varieties. * Paullini Cent. i. Obs. 93. f H. Cent. in. Obs. 59 X Bartholin. Hist. Anat.—Paullini Cent. i. Obs. 93. o E*h. Nat. d. Journ. July 1823, p. 481,—From Journ. of For. MeH No. \n c« vi.] EXCERNENT FUNCTION. [ord. hi. 457 GENUS X. EPICHROSIS. MACULAR SKIN. SIMPLE DISCOLORATION OF THE SURFACE. Epichrosis (e-rtxpue-is) 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 nosological system that suffers them to pass without notice is imperfect. Many of them, however, are not of serious consequence, and have been arranged by Professor Frank under ephilis, employed as a genus, and with a latitude beyond its ordinary use.* The following are the species that belong to it .- Gen. X. Origin of the generic term. Ephilis of Frank. 1. EPICHROSIS LEUCASMUS. 2.----------SPILUS. 3. --- 4. --- 6. — LENTICULA. — EPHEL1S. — AURIGO. — POJCILIA. — ALPHOSIS. VEAL-SKIN. MOLE. FRECKLES. SUN-BURN. ORANGE-SKI N. PYE-BALLED SKIN. ALBINO-SKIN. SPECIES I. EPICHROSIS LEUCASMUS, VEAL-SKIN. WHITE, GLABROI.■£, SHINING, PERMANENT SPOTS, PRECEDED BV WHITE TRANSITORY ELEVATIONS OR TUBERCLES OF THE SAME SIZE ; OFTEN COALESCING AND CREEPING IN A SERPENTINE DIRECTION ; THE SUPERINCUMBENT HAIRS FALLING OFF AND NEVER RESPROUTING. This is the vitiligo, or veal-skin of Willan, so called from the Gen. X. veal-like appearance which these spots produce on the general colour ^^j,^ of the surface. It is common to the different parts of the body, but or veai-sCi of Willan. * Dc Cur. Horn. Mori', Tom. iv. p. 77. Mannh. 8vo. P^- 45b cl.vi.J i'JCCRiTK A. [ord. u:. Gen. X. Spec. I. Epichrosis Leucasmus. Veal-skin. Leucasmus why prefer- red as a specific term. General character and de- scription. chiefly found about the face, neck, and ears. The term leucasmus (tevKxriM*). importing whiteness, is merely employed instead of vi- tiligo to avoid confusion as Dr. Willan has used vitiligo in a sense somewhat different from that of Celsus, or of any one who preceded him, though Professor Frank has made an approach to it by giving it the meaning of Celsus, importing a variety of leprosy, and after- wards confounding it with numerous other affections of the skin that have no possible connexion with it, of which the present forms one instance.* The size of these spots varies 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 ia being gTo^y from the action of a living principle. SPECIES II. EPICHROSIS SPILUS. MOLE. BRouN, PERMANENT, CIRCULAR PATCH; SOLITARY; SOMETIMES* SLIGHTLY ELEVATED, AND CRESTED WITH A TUFT OF HAIR. GEK. X. Spec. II. Origin of specific term- Produced by a partial change in the rete mucosum- This sub- stance ex- amined physiologi- cally. Improperly called rete mucosum. Detected by Maipighi: denied by Bichat: but con- firmed by Cruick- shank and others The specific term, from virihoi " macula," has been long in use. The blemish is common but unimportant. We have had much of late to observe concerning the rete mu- cosum, 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 ex- ternal 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. Its existence was first noticed by Maipighi who gave it the name of rete as thinking that through the structure of soft and uniform matter he could trace certain fibres, crossing each other in various directions, but which have not been ascertained since, not even in the skin of the negro in whom this layer is most conspicuous. In many animals, indeed, there is no rete mucosum whatever, and Bichat has expressed his doubts whether it has a distinct existence in any species, and conceives Maipighi was mistaken. But Cruick- shank appears to have confirmed satisfactorily the assertion of Mal- * Pe Cur. Horn. Morb. Epit. Tom. iv. p. P° corn- colour- •~l.vi.-J EXCERNENT J -UNCTION. [ord. hi. 45t pighi in the human form, and even to have traced it in some of the Gen- x- internal parts of the body, as well as in the skin r* and Dr. Gordon,! EpS after a scrutinous examination has added his testimony to the same ?Psius- fact.} Mole- It is in truth the common pigment or colouring principle of the The. skin, and hence differs very considerably in hue, as is sufficiently m°n * obvious in the respective individuals of the same country, but still pie of the more so in those of remote regions ; giving a white or fair hue to fer'j",g ?„' the inhabitants of the south side of the Caucasus and their proba- ^vjd^aiV'1 bie descendants the great body of Europeans, a black to the ne- and Gspe*- groes of Africa, an olive hue to the Mongo-Tartar race, a brown Siff^ent re- to the islanders of Australasia, and a red to the native tribes of sioDS> North America. S0ar In temperate climates, and in its purest state, it is a clear glossy ^ir £Ue> a white, and when reddened under a delicate cuticle, by the minute oiive.'a and innumerable arteries that are distributed over the surface of the a'red"' ™& body, it gives that rich but dainty tone of colour which constitutes cieargiossy i__ . r- 1 • white m beauty of complexion. temperate It sometimes happens, however, that persons who are perfectly o|.™*n"f fair in their general complexion, from an equal diffusion of this sub- mofcs in stance in its utmost purity, have a few small spots of a lighter or p^xionT deeper brown in the face, limbs, or body, from an occasional dash of brown in the rete mucosum, produced by causes which it is im- possible to unravel: and which, as we shall show presently, in other persons extends over the entire surface, and is consequently inter- mixed with the whole of the secretion : and it is this occasional dash that constitutes a spilus or mole. In treating of trichosis we observed that chemical analysis has proved that the hair, and conse- quently the rete mucosum which supplies it with pigment, is pos- sessed of a certain portion of iron : and it is possible that a con- centration of this mineral substance in the coloured part may con- stitute 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 Accompa- elevation, and additional closeness of structure, and not unfrequently "'°degatwitli an enlargement of the natural down into a tuft of hairs. a slight If this reasoning be correct, alkaline lotions (and all soaps are of anTtuf"^ this character, though not sufficiently strong for the present purpose,) ^{Jf- should form the best cosmetics. But the spots are rarely remove- ib""16 able by any means, and the less they are tampered with the better. Me°adtni°nft These differ essentially from naevi or genuine mother-marks, Moles in inasmuch as the latter are produced by a distention of the minute "pec"t d^er. blood-vessels of the skin, so that those which should contain only ^Jr™ colourless blood, admit the red particles, and hereby exhibit stains of mother- different shapes and ranges, and of different shades of crimson or mark8 purple, according to the quantity of red blood that is hereby suffered to enter, or the nature of the vessels that are distended. * On Insens. Porsp. passim. t Anat. p. 244. J Bostock, Elem. Svst. of Physiol, p. 79.—See also Ediu. Med, Journ. vol. xvrir. tj. 247. 460 cl. vi.] ECCRITICA \OP.V. HU SPECIES III. EPICHROSIS LENTICULA. FRECKLES. fUTICLE STIGMATISED WITH YELLOWISH-BROWN DOTS, RESEMBLING MINUTE LENTIL SEEDS ; GREGARIOUS ; OFTEN TRANSITORY. Gek. X. Lenticui.v is more generally written in modern times lentigo; it Lcmf-'o"1' i* here given as it occurs in Celsus. The root is the Latin term /en* p'haciaof a lentil-seed. The Greek word for which is a<"'s<>. the serum derives the yellow hue it so strikingly evinces on some rormVin occasions, except from the bile, it is difficult to determine. That aJaumUce' certain proportion of bile exists constantly in the blood in a healthy state is manifest, we have already observed, from the colour of the urine, and the tinge given to linen by the matter of insensible per- spiration : and that this proportion varies in different climates, and different seasons of the year, without producing genuine jaundice, we have observed also. And hence, infants under particular cir- cumstances, 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 peculiarly, readily takes off the saffron dye : and hence it often yields to a few brisk purges, and still more rapidly to an emetic. SPECIES VI. EPICHROSIS PCECILIA. PYE-BALLED SKIN. CUTICLE MARBLED GENERALLY, WITH ALTERNATE PLOTS OB PATCHES OF BLACK AND WHITE. PoiciLiA (irotKiXix) is a term of Isocrates, from «■«<*/*«;, " versi- Gkn. X. color" " pictus diversis coloribus;" whence Paicile, the porch or Spec. ^1. 11 /• i ci » 1 mi • • • Origin of picture-gallery of the otoics at Athens. 1 his species is new to specific nosological classification ; but the morbid affection has been long terra' known to physiologists, and ought to have had a niche in the cata- logue of diseases before now. This affection is chiefly found among negroes from an irregular chiefly secretion or distribution of the pigment which gives the black hue to a0mong the rete mucosum. In Albinoes, as we shall have occasion to ob- ne|r°^~ serve 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. * Svnops. >*05ol. Med. Gen, XCI, 5. f Nosolog. Method, in rebus 4b4 cl. vi.J ECCRITICA. [ono. hi. Gen. X. Spec. VI. Epichrosis. Poecilie. Pye-balled skin. Physiolngi- cally exa- mined Beautiful effect pro- duced by un inter- rupted and diversified distribution of the co- louring matter of the rete mucosum in animals and plants. Illustrated. in a Euro- pean. A diversi- fied colour sometimes hereditary. Pye-balled negroes. The black pigment sometimes gradually carried off, and a black man becomes a white. Exempli- fied. Hence a white pig- ment secre- ted as wuli us a black ■-moved What the cause of this interrupted distribution consists in, wc know not; but in several of the preceding species of the present genus, and particularly in moles and freckles, wc perceive a striking tendency to such an effect; and if wc turn our attention to the ani- mal- 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 Nosology, 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 dol- phin, 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, yel- low in the eagle, orange in the stork, and red in some species of the scolopax. It affords that sprightly intermixture of colours 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. While I am writing, says Dr. Swediaur, I have before me a friend who, after residing abroad for many years, at first in the East Indies, and then in the West, returned to Europe with a skin variegated with white spots like those of a tiger. In other respects he is well.* In some cases, a diversified colour of the skin appears to be here- ditary among mankind. Blumenbach gives an example of a Tartar tribe, whose skin was generally spotted like the leopard's, t Indi- viduals thus motley coloured are commonly called pye-balled ne- groes, or are said to have pye-balled skins. The Medico-Physical Society of New-York, has lately published a case communicated by Dr. Emery Bisscl, 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 the stomach, soon after an attack of acute rheumatism; which was shortly accompanied with other white spots in the vicinity that en- larged 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 ol the face and neck, with a few small patches on the arm. The skin as it became white, 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 mc/ely the black or dark-coloured pigment had been absorbed and carried off, but that a fair, whitish. * Nov. Nosol. Meth. Syst. Vol. ii. p. 204 + De Generis Hum Varietate NativA, ci.. vi.] EXCERNENT FUNCTION. ord. hi. 465 and glossy rete mucosum, like that secreted under the cuticle in Gen- x- white men, had taken its place* eS'oS" This extraordinary change, however, is sometimes produced far p>ceciI'i. iir. SPECIES VII. EPICHROSIS ALPHOSIS. ALBINO-SKIN. CUTICLE DTJLL WHITE: PUPILS ROSY : SIGHT WEAK, AND STRONGEST IN THE SHADE. Gen.X. This species occurs not among negroes only, as commonly sup- SpecioSVI1' posed, but among the inhabitants of Europe as well, and affords us common to the tne greater change in the colour of the skin, and the peculiar con- Negro trast it forms with the general cast of the negro-features. Term°nibi- The name of albino was first employed by the Portuguese, and delved'.'06 aPPned to such Moors as were born white, or rather who continued History of so from the time of birth, for the children of negroes have little dis- i»ease. coloration 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 peculiarities observed besides the hue of the skin, for their hair, in all its natural regions, was equally white, the iris of the eyes white, and the pupil whiteness rose-coloured. This whiteness of the surface, however, is not the paiVcast.' ?lear 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 individuals 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 individuals activity as other persons do in the brightest day-light. They are gree°iess ^s0 said to be less robust than other men ; and to sleep through the others. tha"day and £° abroad at night: both which last facts are easily ac- counted for, from the weakness of their sight, and the discomfort of the sun-beams to their eyes. d\tu°b°edti,n9 h wa,s at one time a subJect of inquiry whether these persons ribmoes Were a dlStmct Vanety of the human race' or merely instances of an were-not a Whistelo's Trial a-s referred to in p. 465 l. vr.] EXCERNENT FUNCTION. [ord. in, 46* occasional aberration from the ordinary laws that govern the human [\s jn the two adult albinoes whom he had examined at as also the _ r .' ,. . i. 1 i • red colour Chamoum, was equally owing to the want of the usual black pigment, pfis^first bas smce been confirmed by M. Buzzi of Milan, who has had an conjectured opportunity of dissecting an albino, and has proved that the pig- fcach,Us'ince mentum nigrum of the choroid coat, and also that portion of it which b^BuzLl^ ues be"'110*tne i"si and is called uvea, were totally wanting. J other »ni- We have observed under the preceding species, that other ani- ^with^i- mals are as richly supplied with a rete mucosum as mankind, and bmo hun as that they are indebted to it for their respective colours : and as man. 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- Exempiified sionally exhibit proofs of the same complaint. In accordance with owkfand this reasoning, M. Blumenbach has traced this affection in many rabbits. tribes, and especially in white dogs, owls, and rabbits : and Dr. in a spar- Traill has lately observed a case of the same disease in a young sparrow which he accidentally shot. This seems to have been a perfect 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 spar- row 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.§ * Nicholson's Journ. Nat. Phil. Feb. 1808. J Med. Bibl n 537 tJ M7.oenrtaf,i9?estT0riC^"!n^0n?.i-caJSOr3r%un,a varjetaparticolare de noniim bianchi. &c. Milan, 1784.—he Cat, Traite de la Couleur de la Peauhomaine. § Edm. Phil. Journ. No. Iv. p. 390, GENERAL, INDEX. The Numerals indicate the Volume ; the Figures the Page. The Classes and Orders are distinguished by Small Capitals ; and the Genera by Italics. A. Abortion, v. 118. Abscess, how distinguished from Apostera, ii. 192. "' of the liver, ii. 204. of the breast, ii. 214. Absence of mind, iv. 109. Abstraction of mind. iv. III. Absorbent system, physiology of, v. 181. whether veins are absorbents, v. 185. ' general effects from the union of this, and the secernent system, v. 189. Absorption in cataract, iv. 153. Acari malis, v. 437. Acarus dysent«riae, ii. 354 cutaneous, v. 437. Acid bath, i. 288. formic, in indigestion, i. 151. uric, produced more copiously from animal than vegetable food, v. 332. oxalic, predominant principle in dia- betic urine, v. 333. Aeidum abietis, i. 385. Acoroides resinifera of New-Holland, i. 148 Acrotica, v. 358. Acrotism, iv. 298. Acrotismus, iv. 278. Acupunctura, in neuralgia, iv. 198. JEdoptosis, v. 98. uteri, v. 99. vaginoe, v. 101. vesicae, v. 102. complicata, v. 102. polyposa, v. 103. ^Eora, iii. 204. JEsthktica, iv. 133. JEstus volaticus, v. 371. ^Kthusa Cynapium.or fool's parsley, i. 175. After-pains in labour, v. 160. Agallochum, or lign-aloes, i. 148. Agenesia, v. 86. impotens, v. S6. dys-spermia, v. 89. incongrua, v. 91. Vsria, v. 376. Agrypnia, iv. 325. excitata, iv. 325. pertsesa, iv. 327. Ague, ii. 69. quotidian, ii. 73. tertian, ii. 74. quartan, ii. 76. irregular, ii. 77. complicated, ii. 78. has raged in high grounds, while low have escaped, ii. 82. treatment of, ii. 82. Ague-cake, i. 314. ii. 79. Air, average of inspired, in a minute, i. 338. vesicles, i. 335. expired, i. 338. 342. whether secreted by organs, v. 292. Albino-skin, v. 466. Algor, iv. 185. 189. Al-gridi (Arab.), iii. 56. Al-jedder (Arab.), iii. 56. Alimentary canal, i. 35. comparative length of, ' l. 38. DISEASES OF, i. 40. Alkekengi, or winter-cherry, v. 306. Alopecia, v. 425. 452. 464. ' Alphabets, why they differ in different lan- guages, i. 372. mostly derived from the Phe- nician, i. 373. Devanagari, and some others not, i. 373. Alphos, v. 390. Alphosis, r. 466. Alternating calculus in the bladder, v. 340, Alusia, iv. 94. elatio, iv. 94. hypochondrias, iv. 99. Alysmus, iv. 331. Alyssum, iv. 270. Amaurosis, iv. 156. varieties, iv. 156. Ambition, ungovernable, iv. 84. Amblyaphin, iv. 180. Amblyopia, iv. 141. Ammoniaco-magnesian phosphate of the bladder, v. 340, 470 GENERAL INDLX. Amnesia, iv. 124, 125. Anacatharsis, i. 381. Anal hemorrhage, iii. 128. 130. Anaphrodisia, v. 86. 94. Anaptysis, i. 381. Antenna, iii. 141. Anas cygnus, i. 331. olor, i. 331. Anasarca, v. 24i. __ serosa, ii. 379. Anemone pratensis, iv. 147. Anetus, ii. 69. quotidianus, ii. 73. tertianus, r. 74. quarlanus, ii. 76. erraticus, ii. 77. complicatus, ii. 78. treatment of, ii. 82. Aneurisma, iii. 301. varieties, iii. 301. Anger, ungovernable, iv. 84. Angelica, i. 248. Angina polyposa, ii. 276. laryngea, ii. 273. Anhifimia, iii. 141. Anhelation, i. 400. Animals, lower oiders, propagable both by offsets and seeds, v. 6. Animation suspended, iv. 385. Ancea, iv. 131. Anthrace, iii. 65. 87. Anthracia, iii. 82. pestis, iii. 84. rubula, iii. 107. Anthrax, ii. 220. .,.-„, Antigua fever, compared with Bulam, n. 114. Antimony, glass of, cerated, ii. 370. Antipathia, antipathy, iv, 331. sensilis, iv. 332. insensilis, iv. 333. Anxiety, ungovernable, iv. 88. corporeal, iv. 329, 33], Aphis humili, i. 229. Aphrodisiacs, of little avail, v. 87. Aphonia, i. 354. elinguium, i. 355. atonica, i. 358. surdorum, i. 360. Aphoria, v. 94. impotens, v. 94. paramenica, v. 96. impercita, v. 97. incongrua, v. 98. Aphis, v. 7. Aphtha, iii. 33. Aphelxia, iv. 108. socors, iv. 109. intenta, iv. 111. otiosa, iv. 113. Apopsychia, iv. 353. Appetite, morbid, i. 103. canine, i. 103. depraved, i. 113. Apochysis, iv. 149. Apostema, aposteme, ii. 191. how differs from abscess, ii. 192. commune, ii. 193. Apostema, psoaticum, u. 20^. hepatis, ii. 204. __ empyema, ii. 205. vomica, ii. 208. Apoplexia, apoplexy, iv. 41L eutonic, iv. 422. atonic, iv. 422. 424. sanguine, iv. 422. serous, iv. 422. 424. Aqua regia bath, i. 288. iii. 262. obscura, iv. 149. serena, iv. 149. Arachnitis, ii. 254. Arctium Lappa, iii. 297. Ardor, iv. 185 188. Area, v. 454. Areca oleracea, i- 37. 244. 250. Malabar nut, i. 141. Arnica, i. 191. montana, iv. 451. Arqua, iv. 149. Arsenic, in intermittents, ii. 91. 93. in rheumatism, ii. 400. in consumption, iii. 194, in cancer, iii. 240. in syphilis, iii. 262. in elephantiasis, iii. 277. in nerve-ache, iv. 197. in rabies, iv. 269. in chorea, iv. 313. in epilepsy, iv. 382. in leprosy, v. 405. effects from an over-dose, v. 398. Artemisia santnnica, i. 244. Arteries and veins, ii. 6. Arteritis, ii. 141. 187. Arthrocace, iii. 332, Arthrosia, ii. 388. acuta, ii. 390. chronica, ii. 397. podagra, ii. 401. nydarthrus, ii. 424. Arthritis, ii. 388. Articular inflammation, ii. 388. Arum in hemicrania, iv. 345. Ascaris lumbricoides, i. 232. verraicularis, i. 235. Asclepias gigantea, iii. 277. Ascites, v. 274. Aspalathus, canadensis, i. 126. Asphyxia, iv. 278. 385. varieties of, iv. 385. how related to acrotismus, iv. 278. Asphyxy, iv. 385. Asplenium ceteracb, as a diuretic, v. 303. Asthma, i. 408. siccum, i. 413. humidum, i. 416. nervous, i. 413. Athamanta oreoselinum, as a diuretic, r. 303. meum, v. 38. cretensis, v. 303. Atheroma, v. 210. Atmosphere contaminated with febrile matter, sometimes affects birds, ii. 50 Atresia iridif. iv. 155. GENERAL INULX. 471 Athrix, v. 4bZ. Atriplex foetida, iv. 366. Atrophia, atrophy, iii. 136. Aura epileptica, iv. 377. podagrica, ii. 413. Aurigo, v. 462. Aurum fulminans, iii. 20. Auscultation mediate, iii. 138. r. 270. Avarice, ungovernable, iv. 88. Azote necessary to animal nutriment, i. 37. B. Backer's pills, v. 247. Baker's itch, v. 400. Balbuties, i. 376. Baldness, v. 452, 453. Balfour, his hypothesis of sol-lunar in- fluence, ii. 61. Ballismus, iv. 314. Balsamum carpathicum, v. 304. hungaricum, v. 304. Bambalia, i. 370. Banana, i. 37. Banos de tierra, iii. 199. Barbadoes-leg, ii. 384. Barbiers, iv. 319. Bark, Peruvian, history of, ii. 86. Barrenness, v. 94. of impotency, v. 94. of mis-menstruation, v. 96. of irrespondence, v. 97. ■ of incongruity, v. 98. Bastard-pox, iii. 266. Beating, sense of, in the ears, iv. 169. Bee, economy of, v. 7. larves, intestinal, i. 239. Beet, i. 36. Beetle, larves of, intestinal, i. 236. grubs intestinal, i. 236. Belladonna in cataract, iv. 155. amaurosis, iv. 158. Belly-ache, i. 156. dropsy of, v. 274. Bcnat-allil (Arab.), iii. 27. Beras (leprosy), ii. 384. v. 388. 391. Berat (leprosy), v. 388. 391. Beriberia, beribery, iv. 319. origin of the name, iv. 319. Bex, i. 380. huraida, i. 381. sicca, i. 387. couvulsiva, i. 391. Bezoar ) j 21g Bezoardus, J spurious, i. 220. Bichat, his hypothesis concerning the mind, iv. 29. Bildungstrieb, v. 17. Bile, use of, i. 46. 276. Bilious remittent fevers, ii. 99. 100. 115. Bimariy kodek, (Pers.), v. 76. Birds, singing, vocal avenue, i. 331. imitative, i. 332. Bismuth, ozyde of, in indigestion, i. 146. Black assize, ii. 49. disease, i. 281. leprosy, iii. 275. Black vomit, i. 296.—ii. 117.— water, i. 117. Bladder, prolapse of, v. 102. vermicules discharged from, v, 308. stane in, v. 348. inflammation of, ii. 317, Bladder-bougies, i. 271. Bladdery fever, iii. 45. BI a? sit as, i. 371. Blains, v. 413. Blear-eye, ii. 341. Blebs, water, v. 406. Blenorrhaa, v. 52. simplex, v. 53. luodes, v. 53. chronica, v. 60. Blight, iv. 444. Blood, how affected by inspiration, i. 335, modena hue of, how produced, i. circulation of, ii. 7. scarlet hue, how produced, i. 358 338 339. intrinsic properties of, ii. 21. moving powers of, ii. II. sulphur of, ii. 22. iron of, ii. 22. 25. colouring matter of, ii. 23. red particles of, ii. 24. transmits mental and corporeal taints to subsequent generations, ii. 26. circulation of in fetal life, iii. 311. why supposed to be alive, ii. 26. Bloody flux, ii. 353. Blow-fly, larves of, intestinal, i. 239, Blubber, v. 196. Blue-skin, iii. 311. Blushing, cause of, ii. 8. Blush inflammatory, ii. 227. cutaneous, ii. 231. Boak (common leprosy), v. 388. 390. 393, Boerhaave, his doctrine of fevers, ii. 33. Boil, ii. 219. Boletus laricis, v. 362. Bombus, iv. 169. Bones, contortion of the, v. 220. Bone-earth, calculus, v. 348, 349. Bonus henricus, i. 269. Borborygrous, i. 123. Botium', v. 205. Bottis intestinal, i. 236. Bowels, inflammation of, ii. 302. Brady-spermatismus, v. 91. Brain, inflammation of, ii. 252. nature of ramifications and substi- tutes, iv. 6. of man compared with animals iv. 10. ' generally admitted to be a gland iv. 23. S 3 Branks, ii. 266. Bread-fruit tree, i. 36. Bread-nut, i. 36. Breast-pang, suffocative, i. 430, acute, i. 431. chronic, i. 437. Breeze, or gadfly larves, i. 236, 4V2 GENERAL IiMjEX. Breslaw remittent fever, ii. 131. Bricklayers' itch, v. 419. Bright-spot leprous of the Hebrews, what, v. 388. Broken-wind, i. 408. Bronchiae, i. 335. Bronchial polypus, ii. 275. Bronchitis, ii. 274. Bronchlemmitis, ii. 274. Bronchocele, v. 205. Bronchus, ii. 343. Brosimum alicastrum, i. 36. Broussais, Prof, his doctrine of fevers, n. 42. 296. . Brown, his doctrine of fevers, ii. 39. Brown-study, iv. 113. Bubo, ii. 215. iii. 248. Bubukle, ii. 224. Buccal pouch in monkeys and other ani- mals, i. 38. Bucnemia, ii. 378. sparganosis, ii. 378. tropica, ii. 384. Bulam fever, ii. 112. its relation to the Antigua lever and others, ii. 113, 114. Bilge-water tree, i. 249. Burdock, iii. 397. Bursa fabricii in birds, i. 38. Cabbage-tree, i. 37.249. Cachexies, iii. 112. Caddy-fly larves, intestinal, i. 239. Cadmia of Gaubius, iv. 312. Caencsthesis, iv. 194. Caieput-tree, i. 88. Calcareous earth, formed or secreted by all animals, i. 198. Calculus renal, v. 341. vesical, v. 348. intestinal, i 220. urinary, v. 339. its various kinds, v. 340. 348. Caligo, iv. 146. 148. Callus, v. 444. Calor mordicans in typhus, ii. 153. Calvities, v. 453. Camphor, its sedative power against the irritation of the bladder by cantharides, v. 306. Cancer, iii. 230. common, iii. 230. whether contagious, iii. 232. ascribed to vermicles, iii. 233. in various parts, iii. 234. chimney-sweeper's, iii. 235. Cannabis sativa, i. 287. Capsicum, in indigestion, i. 148. Carbuncle, ii. 220. iii. 86. escar, ii. 221. berry, ii. 221. Carbuncled face, ii. 225. Carbuncular exanthem, iii. 82. Carcinus, iii. 230. vulgaris, iii. 230. ^rdamine pratensi?. iv- 312, 3SR Cardamine, the sisymbrium of Dioscoii(le?; iv. 368. Cardialgia, i. 117. Cardialgj, i. 117. Cardiogmus, iii. 301. 804. Carditis, ii. 290. Caries, iii. 323. of the spine, iii. 325. Carminatives, i. 124, 125. . . Carnevaletto delle donne, of Baghvi, ir 307. Carpotica, v. 105. Caruncula, caruncle, v. 442. Cams, iv. 384. asphyxia, iv. 385. ecstasis, iv. 399. catalepsia, iv. 403. lethargus, iv. 407. apoplexia, iv. 411. paralysis, iv. 433. Caryophyllata, i. 194. Casmunar, in indigestion, i. 146. Catacausis, iii. 282. ebriosa, iii. 282. Cataclysis, ii. 164. Catalepsia, catalepsy, iv. 400, 40S. Catamenia, origin and progress, v. 30. Cataphora, iv. 408. Cataract, iv. 148. Catarracta, iv. 148. varieties, iv. 150. Catarrh, ii. 343. Catarrhus, ii. 343. intestinorum, i. 190. bronchiorum, ii. 286. communis, ii. 345. epidemicus, ii. 346. caninus, ii. 349. vesica?, v. 308. suffocationis, ii. 286. Catastagmus, i. 346. 349. Catechu, i. 59. Catoehe, what, iv. 406. Catochus, what, iv. 402. 406. how connected with tetanur, iv. 236. Catotica, v. 237. Cattu schiragaam, vermifuge, i. 251. Cauliflower excrescence, v. 104. Cauma, ii. 140. its varieties, ii. 144. Causus, or burning remittent, ii. 128. Cellular substance of organs, v. 177. Cenotica, v. 28. Cephaltea, iv. 334. gravans, iv. S35. intensa, iv. 337. hemicrania, iv. 340. pulsatilis, iv. 341. nauseosa, iv. 842. Cephalitis, ii. 252. meniugica, ii. 257. profunda, ii. 260. Ccratonyx, iv. 149. Ceratonyxis, iv. 154. Ccrchnus, i. 353. Cerebrum and cerebellum, distinct power' of. iv. 19. I uLUNERAL INDEX. 473 Cesarean operation in labour, v. 151. Oevadilla, i. 249. Chaerophyltum sylvestre, i. 269. Chalasis, iii. 219. Chamomile, in indigestion, t. 150. Chancres, iii. 245, 248. Charbon, iii. 212. Charcoal-powder, its use in indigestion, i. 144. Chenopodium anthelminticum, i. 248. vulvaria, iii. 336. Cherry-laurel, i. 287. Chervil, i. 269. Chest, dropsy of, v. 268. Chicken-pox, iii. 43. Child-bed fever, ii. 171. Chilblain, ii. 246. Chiggoe, Chiggre, v. 437." Chivalry, iv. 95. Chlorine, iv. 270. Chlorosis, v. 71. atonica, v. 75. entonica, v. 7*5. Chocolate, butter of, i. 269. Choke-damp, iv. 386. XoAas, i. 200. XoXij, i. 200. Cholera, i. 200. biliosa, i. 200. flatulenta, i. 203. spastnodica, i. 204. epidemic, i. 205. Ciiololithus, i. 299. quiescens, i. 301. means, i. 302. Chordee, v. 56. Chorea, iv. 306. Chronic rheumatism, ii. 39*7. Chyle, its nature, i. 40. how produced, i. 138. Chylifaction, process of, i. 40. Chyme, i. 138. Cbymifaction, process of, i. 40. Cicuta virosa, i. 175. Cinchona, history of, ii. 86. Cinchonine, ii. 89. Cinetica, iv. 206. Cingulum, v. 410. Circulation of the blood, il. 7. Circumligatura, ii. 216. Clap, v. 53. CLASS I. Proem i. i. 35. Order i. i. 49. Ord. ii. i. 274. II. Proem i. i. 329. Ord. I. i. 345. Ord. h. i. 379. HI. Proem hi. ii. 5. Ord. i. ii. 28. ii. ii. 177. in. iii. 5. iv. iii. 112. iv. Proem iv. iv. 6. Ord. i. iv. 41. ii. iv. 133. in. iv. 205. iv. iv. 324. V. Proem v. v. 5. Vm.,. V.—60 CLASS V. Order i. v. 28. n. v. 71. in. v. 105. VI. Proem vi. v. 177. Ord. i..v. 194. u. v. 237. Hi. v. 356. Clavns, v. 444. Climacteric disease, iii. 149. teething, i. 58. Climacteric, Greek, what, iii, 14$. Cloaca in birds, i. 38. Clonic Spasm, iv. 282. Clonus, iv. 282. pathology of, iv. 283. singultus, iv. 235. sternutatio, iv. 287. palpitatio, iv. 289. nictitatio, iv. 298. subsultus, iv. 300. pandiculatio, iv. 301. Clulterbuck, his doctrine of fevfif, ii. 4& Cobalt in consumption, iii. 194. Coffee, its use in asthma, i. 419. its use in sick head-ache, iv. 346. Colchicum autumnale, how far a specific in gout, ii. 421. useful in dropsy* v. 251. Cold, general feeling of, what, iv. 189. in the head, ii. 345. CtELIACA, i. 49. Colic, i. 156. of Poitou, Devonshire, or Painter's, i. 162. COlica, i. 156. cibaria, i. 169. constipata, i. 173. constricta, i. 179. flatulenta, i. 176. ileus, i. 157. rhachialgia, i. 162. Collatitious organs of digestion, i. 39, Colon, valve of, i. 38. Colonitis, ii. 359. Coltsfoot in scrophula, iii. 228. Coma vigil, iv. 409. Comatose spasm, see Spasm. Combustibility of the body, iii. 282. Conception, false, v. 173. Concoction, ancient doctrine of, ii. 31. Concretion, intestinal, i. 217. Congestion, marks of, in typhus, ii. 156. Conjunctivitis, ii. 328. Constipation, i. 182. Consumption, iii. 162. varieties, Hi. 163. how far affected by agues, iii. 210. Contagion, what, ii. 44. impure atmosphere necessary to its spread, ii. 56. laws of, ii. 66. and miasm, identity of, ii. 349. Contortion of the bones, v. 220. Contractility, muscular, iv. 205. Convulsio, convulsion, iv. 362. varieties of, iv. 362 174 GENERAL INDEX. Convulsio, puerperal, iv. 363. v. 112. Copaiva, balsam of, i. 197. Coprostasis, i. 181. constipa, i. 182. obstipata, i. 185. Corns, v. 444. Cornea opake, iv. 146. Corectomia, iv. 155. Corotomia, iv. 155. Corodialysis, iv. 155. Corpora lutea, what, v. 11. Corpulency, v. 195. Coryza, i. 345. ii. 343. entonica, i. 346. atonica, i. 348. how related to catarrh, ii. 343. Costiveness, i. 181. Couching the eye, iv. 153. Cough, i. 380. of old age, i. 382. hooping, or convulsive, i. 391. Country-sickness, iv. 86. Cowhage, i. 247. Cow-pox, iii. 36. its varieties, iii. 37. whether produced by grease in the horse's heel, iii. 42. Crab-louse, v. 435. Crack-brained wit, iv. 96. Cramp, iv. 227. Crampus, iv. 227. Craziness, iv. 42. Credulity, iv. 128. Crepitus, i. 123. Cretinism, v. 221. 228. its relation with rickets, v. 221. Crimping of cod-fish, iv. 25. Crinones, v. 440. Crises, febrile, doctrine of, ii. 58. of Hippocrates, ii. 59. referred to the heavenly bodies, ii. 61. ' Cross-birth, v. 141. Crotophiumj iv. 278. Crotophus, iv. 278. Croton Tiglium as a hydragogue, v. 245. Croup, ii. 274. acute, ii. 275. chronic, ii. 279. Cruritis, ii. 381. Crusta lactea, v. 420, 421, Cubebs, v. 67. Cucumber suppositories, i. 270. Cullen, his doctrine of fever, ii. 36. Cutaneous vermination, v. 433. Cyania, iii. 311. Cycas circinalis, i. 37. Cynanche, see Paristhmitis. Cyrtosis, iv. 214. v. 220. rhachia, v. 221. cretinismus, v. 228. Cystic oxyde, or calculns of the bladder. v. 340. 348. 350. J Cystitis, ii. 317. Cynanche, ii. 267. ceiiuiaris, ii. 270.. D. Dal fll (Arab.) ii. 384. iii. 273.. Dance of St. Vitus, or St. Guy, iv. 306. Dandelion, i. 287. v. 304. Dandriff, v. 385. Daus saleb (Arab.) v. 452. Darkling, intestinal, i. 240. Dartus, darsis, v. 408. Darwin, E. his doctrine of fevers, ii. 41. Day-mare, i. 428. sight, iv. 137. Deaf-dumbness, i. 360. speech maintained and how, i. 361. Deafness, iv. 170. Deber (Plague), iii. 98. Decay of nature; iii. 149. Decline, iii. 155. Defluxion, ii. 283. 327. Delirium femx, ii. 257. mite, ii. 257. tremens, iv. 103. Delivery, premature, its advantages at times, v. 153. origin of the practice, v. 153. Demulcents, their nature and how they act, i. 389. Denigration, morbid, iii. 212. Dentition, economy of, i. 51. Dentrifices, i. 68. Depot laiteux, ii. 379. Depression in cataract, iv. 153. Derbyshire-neck, v. 205. Despair, iv. 90. Despondency, iv. 90. Destitution of urine, v. 297. Devonshire colic, i. 162. Diabetes, v. 311. aquosus, v. 311. insipidus, v. 311. mellitus, v. 311. different hypotheses to account for its symptoms, v. 315. sugar secreted by various organs as well in a state of health as of sickness, v. 323. Diarrhaa, i. 186. fusa, i. 187. biliosa, i. 188. mucosa, i. 190. chylosa, i. 191. lienteria, i. 193, serosa, i. 193. tubularis, i. 195. gypsata, i. 198. urinary, v. 311. Diary fever, ii. 62. Diathesis phlogistica, ii. 179. Dictamnus albus, i. 248. Digitalis, how far useful in phthisis, ii;. in dropsy, v. 250. Digestion, process of, i. 40. hypothesis concerning, i. 42, Digestive Function, i. 35, Organs, i. 35. GENERAL INDEX. founts, iv. 347. Diplopia, iv. 144. Dipsacus, v. 311. Dipsosis, i. 99. avens, i. 101. expers, i. 102. Dirt-eaters of West indies, i. 114. Distemper of dogs, ii. 349. Distrix, v. 451. Division of the symphysis of the ossa pubis in impracticable labour, v. 148. Dizziness, iv. 347. Dodders, v. 433. Dog-tick, v. 438. Dolichos pruriens, i. 247. Doronicum Pardaliauches, i. 191. Dotage, iv. 130. Draeuncnlus, v. 438. Drivelling, i. 89. Drop serene, iv. 156. Dropsy, v. 238. . cellular, v. 242. dynamic and adynamic, v. 241. of the head, ii. 259. v. 258. spine, v. 266. chest, v. 268. belly, v. 274. ovary, v. 279. fallopian tube, v. 282. womb, v. 282. scrotum, v. 284. head (acute), ii. 253. 259. urinal, v. 311. Drowning, death from, iv. 386. Dry gangrene, iii. 321. scall, v. 398. Dulsedo sputorura, i. 86. Dumas, his hypothesis concerning the mind, iv. 29. Dumbness, i. 354. elingual, i. 355. Dunt, in lambs, i. 308. Dysenteria, ii. 353. acuta, ii. 357. hepatica, ii. 359. chronica, ii. 374. how far connected with fever, ii. 356. of contagion, ii. 354. simplex, ii. 358. pyrectica, ii. 362. Dysenteric fever, ii. 362. Dysentery, ii. 353. Dysopia, iv. 140. Dyspepsia, i. 135. , phthisis, i. 137. Dysphagia, i. 89. atonica, i. 94. constricta, i. 90. globosa, i. 95. uvulosa, i 96. linguosa, i. 97. Dysphagy, i. 89. Dysphonia, i. 364. susurrans, i. 364. puberum, i. 367. immodulata, i. 368. Dysphoria, iv. 329. Dysphoria, simplex, iv. 329. anxietas, iv. 331. Dyspncea,.i. 400. chronica, i. 402. exacerbans, i. 406. Dys-spcrmia, v. 89. varieties, v. 89* Dys-spermatismus, v. 89. Dtsthetica, iii. 112. Dysuria, v. 296. 305. E. Ear-ache; ii. 263. Earthbone calculus of the bladder, v. 340." Ecchymoma lymphatica, ii. 379. Eccritica, v. 177. 194. Eccyesis, v. 162. ovaria, v. 164. tubalis, v. 167. abdominalis, v. 167. Ecphlysis, v. 405. pompholyx, v. 406. herpes, v. 408. rhypia, v. 413. eczema, v. 414. Ecphronia, iv. 42. melancholia, iv. 56. mania, iv. 65. Ecphyma, v. 401. caruncula, v. 442. verruca, v. 443. clavus, v. 444. . callus, v. 444. Ecpyesis, v. 416. impetigo, v. 417. _, porrigo, v. 420. ecthyma, v. 427. scabies, v. 428. Ecstasis, ecstacy, iv. 399. Ecthyma, v. 427. Ectropiura. ii. 340. Eczema, v. 414. Edematous inflammation, ii. 229. Effluvium, human, ii. 44. marsh, ii. 44. Elasticity, muscular, iv. 207. Elatio, iv. 94. Elephantia, iii. 271. Elephantiasis, iii. 271. Arabica, iii. 275. Italica, iii. 279. Asturiensis, iii. 281. Elephant-leg, ii. 384. how differs from elephan- tiasis of the Greeks, ii. 384. Elephant-skin, iii. 271. Elephas, iii. 272. Elf-sidenne, i. 425. Ellis, his hypothesis of respiration, i. 339- ii. 12. Emaciation, iii. 133. Emansio mensium, v. 29. Emesis, i. 127. Empassioned excitement, iv. 94. depression, iv. 99-. Empathema, iv. 7&. 176 GENERAL INDEX. Empathema, entonkuni, iv. 80. lxtitise,philautise, superbis, gloriae famis, iracundiae, zelo- typiae, iv. 80. atonicum, iv. 86. varieties, iv. 86. inane, iv. 92. Emphlysis, iii. 28. miliaria, iii. 29. aphtha, iii. 33. vaccinia, iii. 36. varicella, iii. 43. pemphigus, iii. 45. erysipelas, iii. 49. Emphyma,\. 201. sarcoma, v. 202. encystis, v. 210. exostosis, v. 212. Emphysema, t. 287. cellulare, ▼. 889. abdominis, v. 291. uteri, v. 294. Empresma, ii. 249. cephalitis, ii. 252. otitis, ii. 263. parotitis, ii. 266. paristhmitis, ii. 267. laryngitis, ii. 272% bronchleramitis, ii. 274. pneumonitis, ii. 281. pleuritis, ii. 287. carditis, ii. 290. peritonitis, ii. 292. gastritis, ii. 296. enteritis, ii. 302. hepatitis, ii. 307. splenitis, ii. 314. nephritis, ii. 315. cystitis, ii. 317. faysteritis, ii. 318. orchitis, ii. 320. pancreatis, ii. 301. Emprosthotonos, iv. 236. Empyesis, iii. 54. variola, iii. 55. Emrods, i. 265. Enanthesis, iii. 8. rosalia, iii. 8. rubeola, iii. 21. urticaria, iii. 26. Encanthis, v. 442. Encystis, v. 210. Enecia, ii. 139. cauma, ii. 140. typhus, ii. 146. synochus, ii. 168, English melancholy, iv. 104. mercury, i. 269. Entasia, iv. 210. priapismus, iv. 211. loxia, iv. 212. rhachybia, iv. 213. articularis, iv. 226. systremma, iv. 227. trismus, iv. 229. tetanus, iv. 236. lyssa, iv. 244, acrotismus, iv. 278. Enterica, i. 49. Enteritis, ii. 302. adhsesiva, ii. 302. erythematica, ii. 305. Enterolithus, i. 217. bezoardus, i. 218. calculus, i. 220. scybalum, i. 223. Entropium, ii. 342. Enuresis, v. 333. Epanetus, ii. 96. mitis, ii. 97. malignus, ii. 99. hectica, ii. 135. causus, ii. 128. asthenicus, ii. 130 flavus, ii. 105. Ephelis, v. 461. Ephemera, ii. 62. mitis, ii. 63. acuta, ii. 65. sudatoria, ii. 66. Ephialtes, i. 425. vigilantium, i. 428, nocturnus, i. 429. Ephidrosis, v. 360. profusa, v. 361. cruenta, v. 362. partialis, v. 363. discolor, v. 363. olens, v. 364. arenosa, v. 365. EpiaD, iii. 107. Epichrosis, v. 457. leucasmus, v. 457. spilus, v. 458. lenticula, v. 460. ephelis, v. 461. aurigo, v 462. precilia, v. 463. alphosis, v. 466. Epigenesis, theory of, v. 13. Epilepsia, epilepsy, iv. 373, varieties of, iv. 373. Epinyctis, iv. 407. Epiphora, ii. 324. Epistaxis (nasal hemorrhage), iii. 122.129, Ergot, iii. 319.—v. 38. Erosion of the skin, ii. 248. Eructatio, eructation, i. 123. Eruptive fevers, iii. 5. Eruptive surfeit, i. 170. Erysipelas, iii. 49. cedematosum, iii. 52. gangrenosum, iii. 52. pestilens, iii. 88. Erysipelatous inflammation, iii. 49. Erythema, ii. 227. cedematosum, ii. 229. erysipelatosum, ii. 231. gangraenosum, ii. 233. vesiculare, ii. 234. anatomicum, ii. 237. pernio, ii. 246. intertrigo, ii. 248. why ulcerative rather than phlegmonous, ii. 229. mercuriale, ii. 328.—iii. 266. GENERAL INDEX. 477 &■ yilitma, volaticum, v. 371. Essera, or Eshera, iii. 26. v. 375. Esophagus, i. 38. Esthiomenus, v. 409. Everted eye-lid, ii. 340. Evolution spontaneous in labour, v. 143. Exangia, iii. 300. aneurisma, iii. 301. varix, iii. 307. cyania, iii. 311. Exania, i. 272. EXANTHEMATICA, iii. 5. Exanthem, iii. 5. rash, iii. 8. ichorous, iii. 28. pustulous, iii. 54. carbuncular, iii. 82. EXANTHESIS, V. 366. roseola, v. 366. Excernent system, physiology of, v. 177. Excitability of Brown, what, ii. 39. Excuecaria Agallochum, i. 148. Excrescence, cutaneous, v. 441. Excrescence, genital, v. 103. Exfetation, v. 162. ovarian, v. 164. tubal, v. 167. m abdominal, v. 167. Exophthalmia, ii. 338. 339. Exophthalmos, ii. 339. Exormia, v. 368. strophulus, v. 369. lichen, v. 371. prurigo, v. 379. milium, v. 383. how distinguished from Ecthy- ma, v. 368. Exostosis, v. 212. Expectorants, i. 384. in what way they act, i. 384. Extra-uterine fetation, v. 162. See Ex- fetation. Eye-lids, twinkling of the, iv. 298. Extraction of cataract, iv. 153. Exsanguinity, iii. 141. F. Fainting, iv. 355. from various odours, iv. 355. Fainting-fit, iv. 357. Falling-sickness, iv. 373. Falling down ol the womb, v. 99. the fundament, i. 272. False inspiration, iv. 97. False conception, v. 173. Fanaticism, iv. 98. Farcimen, iii. 219. Farcy, iii. 219. Fasciola, i. 233. 246.—v. 6. Fasting long, or chronic, i. 108. woman at Tetbury, i. 112. Fat, formed from bile, i. 47. v. 197. Fatuity, iv. 123. imbecility, iv. 125. irrationality, iv. 129. Febrifuges possess some property not yet ascertained, ii. 95. Febris lenta nervosa, ii. 150. petecchialis, ii. 151. punctularis, ii. 151. purpurata, ii. 151. rubra of Heberden, iii. II. Felon, ii. 226. Fern, male, i. 250. Fetation, extra-uterine, v. 162. See Ex- fetation. Fetus has been born alive at four months, v. 118. may live at seven, v. 118. Feu volage, v. 371. Fevers, ii. 28. difficulty of defining ii. 28. genera in the present work, ii. 30. proeguminal cause, what, ii. 30. procatarctic, ii. 30. exciting cause, ii. 30. proximate, ii. 31. remote, ii. 44. chief hypotheses of, ii. 31. by what agents excited or in* fluenced, ii. 48. laws of, ii. 56. quotidian, ii. 73. tertian, ii. 74. quartan, ii. 76. gastric-inflammatory, ii. 128, diary, ii. 62. sweating, ii. 66. intermittent, ii. 69. remittent, ii. 96. yellow, ii. 105. Bulam, ii. 112. paludal, ii. 106. seasoning, ii. 108. jungle, ii. 108. ardent, ii. 128. continued, ii. 139. inflammatory, ii. 140. imputrid continent, ii. 140. continued, ii. 140. hectic, ii. 135. sanguineous continued, ii. 140. malignant, pestilential, ii. 133. hysterical, ii. 150. nervous, ii. 150. putrid, malignant, jail, camp, hos- pital, ii. 151. synochal, ii. 168. puerperal, or child-bed, ii, 170. peritoneal, ii. 171. eruptive, iii. 5. miliary, iii. 29. bladdery, iii. 45. dysenteric, ii. 361. Fibrinous calculus of the bladder, v. 340. Fibre, nervous, iv. 8. 21. irritable, iv. 21. Fibrous substance of organs, v, 177, Ficus, v. 442. Fidgets, iv. 329. Fievre matellotte, ii. 102. Fil (Arab.) iii. 273. Filaria, v. 4S8. Filix mass, i. 250. Fire-bladders, iii. 87, lib GENERAL INDEX. Fish-skin, v.. 402. Fistula lachrymalis, iii. 330. Flavours, how influenced at different times, and under different circumstan- ces, iv. 181. Flatulency, i. 122. Flatus, i. 122. Flea-bite, v. 436. Flesh-fly, larves of, intestinal, i. 239. Flexibility of the bones, v. 217. Flooding, v. 124. 160. Fluids, sexual, diseases affecting the, v. 28. Fluke-worm, i. 233. v. 6. found in the liver, i. 310. Fluttering of the heart, iv. 289. Flux, i. 186. bloody, ii. 353. hepatic, ii. 376. of aqueous urine, v. 311. Food, small quantity often demanded, i. 110. enormous quantity sometimes de- manded, i. 104. which most tender among animals, i. 153. water sufficient food for animals, i. 110. sufficient, i. 110. Fool's parsley, i. 175. Folly, iv. 130. Forgetfulness, iv. 125. singular examples of, iv. 128. Fragile vitreum, v. 215. Fringilitas ossium, v. 215. Fragility of the bones, v. 215. Frambcesia, iii. 107. Frank, Prof., his doctrine concerning fe- ver, ii. 42. Fraxinella, i. 248. Freckles, v. 460. Fret, ii. 248. Frog-tongue, i. 97. Frogs, singular procreation of, v. 9. Frost-bite, iii. 318.—iv. 398. Fundament, falling down of, ) . „_„ prolapse of, J '* »• Fungi, a common cause of surfeit, 1. 175. springing up nightly in gangrenous limbs, i. 231. Fungus haematodes, iii. 329. Furunculus, ii. 219. Furor lascivious, v. 83. Fusible, calculus of the bladder, v. 340. G. Gadfly larves, i. 236. v. 439. Galactia, v. 63. praematura, v. 64. delectiva, v. 66. depravata, v. 67. erratic*, v. 68. virorum, v. 69. Gallantry romantic, iv. 95. Gall-bladder w anting in many animals, i. 276. ^ Le Gallois, his experiments, iv. 25, Gall-stone, i. 298. passing of, i. 302. Ganglion, v. 210. Ganglions of the brain, what, iv. 12. Gangrana, iii, 314. sphacelus, iii. 315. ustilaginea, iii. 319. necrosis, iii. 321. ~ caries, iii. 323. . Gangrenous inflammation, ii. 233. Gaping, iv. 301. Garden-lettuce, ii. 285. Gases, inhalation of, i. 423. Gastric juice, discovery of, i. 42. quantity of, i. 43, quality of, i. 43. other powers, i. 43. 44. Gastritis, ii. 296. adhaesiva, ii. 298. erythematica, ii. 298. Gastro-enteritis of Broussais, ii. 42. 296. Generative function, v. 5. machinery of the, v. 6. process of, v. 13. different hypotheses of, v. 15. • difficulties accompa- nying the subject of generation, v. 18.19. Genetica, v. 28. Geoffroya, i. 250. Geuru urbanum, i. 194. Ginseng, whether an aphrodisiac, v. 88. Glanders in horses, ii. 350.—v. 55. Glaucedo, iv. 147. Glaucoma, iv. 148. Glaucosis, iv. 147. Gleet, v. 60. Glottis, i. 329. air how rendered sonorous in, i. 330. capable of supplying the tongue's place, i. 335. Gluttony, i. 106. Goggle-eye, iv. 161. Goggles, iv. 161. Goitre, v. 205. Gold, preparations of, iii, 262. Gonorrhoea, v. 52. Gordius, intestinal, i. 237. cuticular, v. 440. Gout, ii. 401. origin of term, ii. 401. its varieties, ii. 403. how far refrigerants may be em- ployed, ii. 409. 413. reputed specifics, ii. 421. compresMon and percussion, ii. 423. Grandmcs, iii. 166. Granulation, ii 197. Grass-hopper, wart-eating, v. 443. Gratiola officinalis, v. 252. Gravedo of Celsus, ii. 345. Giuvel, urinary, v. 344. Gray hair, v. 451. Great-pox, iii. 245. Green-sickness, v 71. Grief ungovernable, iv. 89. Grocer's itch. v. 419. GENERAL INDEX. 4?$ Grog-blossoms, ii. 224. Grounsel, its use in sickness of the sto- mach, i. 133. Grutuni, v. 383. Gryllus verrucivorus, its power in destroy- ing warts, v. 443. Guinea-worm, v. 438. Gum, yellow, of New Holland, i. 148. of infants, i. 292. Gum-boil, ii. 212. Gum-rash, v. 369. Gums, excrescent, i. 78. scurvy of, i. 79. Gutta, iv. 149. seu Junctarum dolor, ii. 401. obscura, iv. 149. serena, iv. 149. 156. Gymnastic medicine, ii. 126. iii. 204. H. H^matica, ii. 177. Haemoptysis, iii. 119. 129. Haematemesis, iii. 120. 125. 129. Haematuria, iii. 126. Heemorrhagia, iii. 118. 129. entonica, iii. 119. atonica, iii.-129. Hair-worm, intestinal, i. 237. cutaneous, v. 440. Hair, morbid, v. 445. matted or plaited, v. 448. gray, v. 451. bristly, v. 447. sensitive, v. 456. Hallucination, iv. 94. Hanging, death from, iv. 386. Hardness of hearing, iv. 166. Hare-brained passion, iv. 92. Harvest-bug, v. 438. Head, dropsy of, v. 258. Head ache, iv. 334. stupid, iv. 335. chronic, iv. 337. sick, iv. 342. throbbing, iv. 341. spasmodic, iv. 342. blind, iv. 352. Hearing, how far it exists in different ani- mals, iv. 15. Hearing, morbid, iv. 163. acrid, iv. 164. hardness of, iv. 166. perverse, iv. 164. 167. double, iv. 168. illusory, iv. 169. varieties of, iv. 169. Heart, organization of, ii. 6. how far it may leap for joy, ii. 7. fluttering of, iv. 289. throbbing of, iv. 289. Heart-burn, i. 117. ache ungovernable, iv. 89. Heat, general feeling of, how produced, iv. 188r eruption, v. 414. Hectic fever, ii. 135. Hectica, ii. 135. Hedge-hysscp, V. 252. Helcoma, ii. 324. Helix hortensis, v. 6. Hellebore, how far a specific in gout, ii. black, as a hydragogue, v. 246. Helmtnthia, i. 227. alvi, i. 232. crratica, i. 237. podicis, i. 235. Hemeralopia, iv. 135. Hemicrania, iv. 340. Hemiplegia, iv. 436. Hemorrhage, iii. 118. entonic or active, iii. 119. varieties of entonic, iii. 119. atonic, iii. 129. varieties, iii. 129. Hemorrhoids, i. 265. Hemp-seeds, in jaundice, i. 287. Hen-blindness, iv. 138. Hepatic flux, ii. 376. Hepatitis, ii. 307. acuta, ii. 307. chronica, ii. 313. Herb bennet, i. 194. Hermaphrodites, v. 6. Hernia humoralis, ii. 320. carnosa, v. 204. Herpes, v. 408. Hesitation in speech, i. 370. Hiccough, iv. 285. Hidroa, y. 414. Hieronosus, iv. 363. Hirsuties, .v. 450. Hirudo viridis, v. 6. Hirudo sanguisuga, intestinal, i. 238. Hives, ii. 276. iii. 43. Hoffmann, his doctrine of fevers, ii. 34. Holy fire, ii. 236. iii. 86. Home-sickness, iv. 86. Honey-dew, what, i. 229. Hooping-cough, i. 391. Hoppers, i. 239.' H-Tdeolum, ii. 218. Horns, never grow after castration, v. 12. Horn-pock, iii. 78. Horse-hair-worm, intestinal, i. 237. Hor>e-leech, intestinal, i. 238. Hour-glass contraction of the womb, v. 160. Human Understanding, Locke's Essay on, examined and eulogized, iv. 34. analysis of, iv. 35. Humoral opacity of the eye, iv. 147. Hunger sensation of, how accounted for, , i. 99. Hyboma, iv. 215. Hyhosis, iv. 214. Hydarthrus, ii. 424. Hydatids, iii. 165. Hyderus (diabetes), v. 311. 321, Hydra, v 6. Hydragogues, v. 236. Hydrargyria, i. 84. ii. 328. Hydrocephalus, ii. 260. v. 258. Hydrocele, v. 284. 286. Hydrocele muliebris, v. 286. Hydrocephalus, ii. 259. v. 258, Hydrocyanic acid, iii. 208. Hydrometra, v. 282, isu bE>ERAL 1NDE> Hydrophthalmia, ii. 338. Hydrophobia, iv. 244. without rabies, iv. 244. Hydrops, v. 238. ceiiuiaris, v. 242. capitis, v. 258. spins, v. 266. thoracis, v. 268. abdominis, v. 274. ovarii, v. 279. tubalis, v. 282. uteri, v., 282. scroti, v. 284. matella, v. 328. Hydrothorax, v. 268. Hyoid bone, i. 329. Hyperacusis, iv. 164. Hypercousis, Iv. 164. Hypochondrias, iv. 99. its varieties, iv. 101. Hypochondrism, iv. 99. Hyperhydrosis, v. 361. Hypertrophic )iiim3Q5, Hypertrophy, J Hypochondrism, its varieties, iv. 101. Hypochyma, iv. 149. Hypochisis, iv. 149. Hysteria, iv. 369. foeruinina, iv. S70. masculina, iv. 370. Hysteroptosis, v. 98. 103. Hysterics, iv. 369. Hysteritis, ii. 318. simplex, ii. 318. puerperarum, ii. 319. Hystriacis, v. 447. I. & J. Jaundice, yellow, i. 275. spasmodic, i. 282. hepatic, i. 290. gall-stone, i. 282. of infants, i. 292. black, i. 293, 294. green, i. 293, 294. Iceland liver-wort, iii. 201. Icterus, i. 275. cholaeus, i. 278. chololithicus, i. 282. spasmodicus, i. 282. hepaticus, i. 290. infantum, i. 292. ichthyiasis, Ichthyosis, v. 402. Ideas, what, iv. 35. of sensation, iv. 36. reflexion, iv. 36. objective and subjective, iv. 36. complex, iv. 36. association of, iv. 38. Idiotism, iv. 131. Ignis sacer of Celsus, ii. 236. iii. 86. Jealousy, ungovernable, iv. 85. Jimmerat (Arab.) iii. 97. Ileac passion, i. 157. Ileus, i. 157. Illusion, iv. 94. Imbecility, mental, iv, 124. Impetigines of Frank, v. 359, Impetigo, iii. 112. Imposteme in the head, ii. 263. Impotency, male, v. 86. barrenness of, v. 92. Impregnation, Diseases affecting the, v. 105. physiology of, v. 10o. among various classes of animals, v. 6. Inability to beget offspring, v. 86. * species, v. 86. to conceive offspring, v. 94. Incarnation, ii. 197. Incongruity, copulative, v. 91. Inconstancy, iv. 128. Incontinence of urine, v. 504. Incubus, i. 425. Indian-pink, i. 251. Indigestion, i. 135. Inflammation, general, of Fordyce, ii. 140. visceral, ii. 249. of the brain, ii. 252. throat, ii. 268. kidneys, ii. 315. larynx, ii. 272. lungs, ii. 281. pleura, ii. 287. pancreas, ii. 301. peritonaeum, ii. 292. heart, ii. 290. stomach, ii. 296. bowels, ii. 302. liver, ii. 307. spleen, ii. 314. bladder, ii. 317. womb, ii. 318. testicles, ii. 320. eyes, ii. 321. iris, ii. 326. articular, ii. 388. Inflammations, ii. 177. pathology of, ii. 177. proximate cause of, ii. 179. remote causes of, ii. 184. healthy, ii. 185. unhealthy, ii. 185. adhesive, ii. 186. ulcerative, ii. 186. always tend to the surface, ii. 189. resolution of, what, ii. 190. suppurative, ii. 185, 186. process of ii. 186. Inflammatory fever, ii. 140. its varieties, ii. 144. blush, ii. 227. Inflation, v. 287. cellular, v. 289. tympanic, v. 291. of the womb, v. 294. Influenza, ii. 346. its order of recurrence, ii. 352, Inoculation for cow-pox, iii. 38. small-pox, iii. 78. plague, iii, 93, Inquietudo, iv. 329- GENERA* INDEX. m Insanity, iv. 42. pathology of, iv. 44. proximate cause, iv. 50. whether more common to Eng- land than other countries, iv. 54. whether an increasing malndy, Insensibility of touch, iv. 190. ..... complicated with in- sensibility of other senses, iv. 190. Inspiration, false, iv. 97. Instinct, what, ii. 27. Intellect, diseases affectinc the, iv. 41. ' Intellectual principle, iv. 26. Intermarriages between near relations, wisdom ot restraints divine and human upon, v. 26. Interment before death, danger ef, iv. 4( Intermittent Fever, ii. 69. quotidian, ii. 73. tertian, ii. 74. irregular, ii. 77. complicated, ii. 78. treatment of, ii. 82. quartan, ii. 76. Intestines, organ of, i. 38. Introsusception, i. 158. Invermination, i. 227. Inverted eyelid, ii. 342. Iodine, ii. 428. iii. 227. v. 38. Ionthus, ii. 222. varus, ii. 223. corymbifer, ii. 224. Joy, ungovernable, iv. 81. Iriditis, ii. 326. Iris, inflammation of, ii. 326. (herpes), v. 411. Iritis, ii. 326. Irk, medini (Guinea-worm), v. 438. Iron-caattry, iii. 329. Irrationality, iv. 129. Iscbias, ii. 395. Ischuria, r. 302. Itch, v. 428, 429. baker's, v. 400. bricklayer's, v. 419. complicated, v. 429. grocer's, v. 419. pocky, v. 429. rank, v. 428. watery, v. 428. mangy, v. 429. Itch-tick, v. 437. Judam (Arab.), ii. 384. iii. 272. Juzam (Arab.), ii. 384. iii. 272. K. Kibe, ii. 246. Kidneys, inflammation of, ii. 315. Kin-cough, or kind-cougb, i. 391. King's evil, iii. 220. Kinic acid, ii. 89. Knife-eaters, i. 115. EOIAU, i. 49. Kouba or kuba (Arab.), v. 389. Krummbolzohl, vermifuge, i. 246, Vor,. V — 61 L. Labour, morbid, v. 126. atonic, v. 127. unpliant, v. 130. varieties of, v. 130. complicated, v. 135. perverse, v. 141. varieties of, v. 142. impracticable, v. 146. muciparous, v. 154. premature, v. 118. sequential, v. 157. show, v. 50. Laceration ol vagina, v. 131. Lacerta aquatica, intestinal, i. 839. Lachrymose opfathalmy, ii. 323. Lacteals, organ of, i. 40. v. 181. Lagnesis, v. 80. furor, v. 83. salacitas, v. 80. Lallatio, i. 375. Lambdacismus, i. 375. Land-scurvy, iii. 287. Lappa, iii. 297. Laryngic suffocation, i. 398. Laryngitis, ii. 272. Laryngismus, i. 398. stridulus, i. 398. Larynx, i. 329. of birds, i. 331. stridulous constriction of, i. 398. Lascivious madness, v 83. La Trappe, austerities of, iv. 60. Laughing, how produced, i. 337. Lauro-cerasus, see Prunus, Prussic acid. Lawrence, his hypothesis concerning life and a living principle, iv. 31. Lax, i. 186. Eead, subacetate of in hemorrhages, iii. 132. Lectiminga, v. 252. Leech, intestinal, i. 238. Leg, tumid puerperal, ii. 378. of West Indies, ii. 384. Legitimacy of children, v. 107. Leipopsychia, iv. 353. Leipothymia, iv. 353. Leipyria, iii. 159. Lenticula, v. 460. Lentigo, v. 460. Lentor of the blood, what, ii. SS. Leontodon taraxacum, i. 287. v. S04. Leontiasis, iii. 274. Lepidosis, v. 384. pityriasis, v. 385. lepriasis, v. 337. psoriasis, v. 398. ichthyiasis, v. 402. Lepriasis, v. 387. Leprosy, v. 387. Asturian, iii. 281. black, iii. 275. d nil-white, v. 390, 391 dusky, v. 391. 393. nigrescent, v. 392, S9S. bright-white, v. 391. 393. I Lerema, iv.130. ■k>2 UENF.RAL INDEX. Lethargus, )j 407- Lethargy, J varieties of, iv. 408. Leucasmus, v. 458. Leuce, v. 391. Leucorrhaa, v. 46. communis, v. 47. nabothi, v. 50. senescentium, v. 51. Libellula or dragon-fly, singular position of sexuil organs, v. 9. Lichen (in botany) caninus, iv. 2C6. terrestris cinereus, iv. 266. in pathology, v. 371. Lientery, i. 193. Life, various hypotheses concerning, iv. 28. weariness of, iv. 104. Lign-aloes in indigestion, i. 148. Lightning, death from, iv. 397. Limosis, i. 103. avens, i. 103. cardialgia, i. 117. dyspepsia, i. 135. emesis, i. 127. expers, i. 108. flatus, i. 122. pica, i. 113. Lippitude, ii. 341. Lippitudo, ii. 341. Lisping, i. 377. Lithia, v. 339. renalis, v. 341. vesicalis, v. 348. Lithiasis, v. 339. Lithic calculus, v. 340. Lithontriptics, v. 355. Stephens's, v. 355. Lithopaedion, v. 170. Lithotomy, v. 357. Lithus, v. 339. Liver, organ of, i. 89. how affected by summer heat, ii. 100. use of, i. 276. found in most animals of every rank, i. 276. turgesccnce of, i. 305. inflammation of, ii. 307. Living principle, various hypotheses con- cerning, iv. 27. Loathing, i. 129. Lobelia syphilitica, iii. 261. Lochial discharge profuse, v. 153. 161. Locked jaw, iv. 229. varieties, iv. 231. Locke, tribute to his Essay on Human Understanding, iv. 34. Loemus, plague, iii. 65. Lodgment of matter in the chest, ii. 205. Long-sight, iv. 140. Looseness, i. 186. Lopezia Mexicaua, or lopez-root, i. 194. Lordosis, iv. 214. Love, ungovernable, iv. 86. Love-sickness, iv. 86. Lousiness, v. 434. Loria, iv. 212. Lowness of spirits, iv. 99. its varieties, iv. 101. Ludibria fauni, i. 429.. Lues, iii. 245. syphilis, iii. 245. history of, iii. 245. Ostiacks said to be insusceptive ol, iii. 252. syphilodes, iii. 266. Lullaby speech, i. 375. Lumbago, ii. 390. 395. Lumbricus cucurbitinus, i. 241. Luna fixata, iv. 312. Lungs, structure of, i. 335. Lupus, iii. 331. Lust, v. 80. Luscitas, iv. 136. Lyssa, iv. 244. canina, iv. 253. felina, iv. 251. M. Macular-skin, v. 457. Madness, iv. 65. varieties, iv. 65. lascivious, v. 83. Madwort, iv. 270. Magendie, his hypothesis concerning the living principle, iv. 30. of the absorbent system, v. 185. his azotic regimen of, in calcu- lus, v. 354. Maggots, intestinal, i. 239. Magnesia, its use in indigestion, i. 143. Malabar nut, i. 141. Malaria of the Campagna, ii. 96. Mai de la Rosa, iii. 9. 281. de Siam, ii. 108. del Sole, iii. 279. Maliasmus, v. 433. Malis, v. 433. pediculi, v. 434, 435. puiicis, v. 436. acari, v. 437. filiariae, v. 438. gordii, v. 440. oestri, v. 439. Malleatio, iv. 309. Malum pilare, v. 445. Mama-pian, iii. 110. Manducation, i. 40. Mange, v. 429. Mania, iv. 65. varieties, iv. 65. the illusion often unconnected with the cause of the disease, iv. 69. most easily cured when produced by accidental causes, iv. 70. heat and cold in the cure applied at the same time, iv. 74. attendance on religions services, how far advisable, iv. 75. moral treatment of, iv. 75. Manie sans delire, iv. 92. Manipulation, iv. 223. Marasmus, iii. 133. jatrophia, iii. 185, 136. anbaemia, iii. 141 • GENERAL INDEX. 183 Marasmus, climactericus, iii. 149. tabes, iii. 155. phthisis, iii. 162. Marcus, his doctrine of fever, ii. 43. Mare's milk as a vermifuge, i. 252. Marsh effluvium, ii. 44. principles, ii. 45. laws of, ii. 56. Masques a louchette, iv. 161. Materialism, hypotheses in support of, iv. 29. Matter, lodgment of in the chest, ii. 205. of the world, its essence not known, iv. 27. whether extension be a distinct property, iv. 28. whether solidity, iv. 28. Maw-worm, i. 235. Meal-bark, i. 37. Measles, iii. 9. black, iii. 25. Medicine, gymnastic, iii. 204. pneumatic, iii. 206. Megrim, iv. 340. Melaena, i. 293. Melana, i. 293. choloea, i. 294. cruenta, i. 296. Melaleuca Leucodendron, i. 88. Melampod um, v. 246. Melanaema, iv. 385. Melancholia, iv. 56. its varieties, iv. 56. Melancholy, iv. 42. 56. how distinguished pathogno- mically from mania, iv. 43. why mistaken at times for hypochondrism, iv. 57. exciting causes, iv. 59. tendency to violence and abusive language accounted for, iv. 62. Melanose, )••. en Melanosis, S zu' Melas, v. 391. Melasma, v. 428. Melliceris, v. 210. Membranes of Bichat, i. 39.—v. 177. fibrous, ib. mucus, ib. serous, ib. Memory, retention of, how differs from quickness, iv. 126. failure of, iv. 126. Menorrhagia, v. 41. Menstruation obstructed, v. 29. by retention, v. 29. by suppression, v. S3. laborious, v. 34. superfluous, v. 41. vicarious, v. 43. irregular cessation of, v. 4A. Mental extravagance, iv. 94. Mephytic suffocation, iv. 394. Merganser, i. 332. Mergus, i. 332. Mesotica, r. 194. Metamorphopsia, iv. 144. Mecutash, v. JJ95. Miasm, febrile, what, ii. 44. laws of, ii. 56. powers of in typhus, ii. 147. identity with contagion, ii. IOS. Mildew mortification, iii. 319. Miliary fever, iii. 29. Milium, v. 383. Milk, artificial, iii. 201. Milks, analysis of in different animals, iii.* 201. Milk-teeth, i. 54. Milk-flow, premature, v. 64. deficient, v. 66. depraved, v. 67. erratic, v. 68. in males, v. 69. Millepes, i. 286. Millet-rash, v. 383. Mind, its nature but little known, iv. 26. whether in its essence material or. immaterial, iv. 27. real character deducible from natu- ral and revealed evidence, but its essence not known, iv. 28. by what means it maintains an in- tercourse with the surrounding world, iv. 33. various hypotheses examined, iv. S3. the difficulty felt by Locke, iv. 34. its faculties to itself what organs are to the body, iv. 38. feelings of, iv. 39. subject to diseases as well as the body, iv. 39. 45. Misanthropy, iv. 104. Miscarriage, v. 118. Miscee, Indian dentrifice, i. 78. Misemission, seminal, v. 89. Misenunciation, i. 371. Mislactation, v. 63. Mismenstruation, v. 28. barrenness of, v. 96. Mismiclurition, v. 296. See Paruria. Misossification, v. 214. fragile, v. 215. flexile, v. 217. Mogilalia, i. 377. Mole, uterine, v. 171. cutaneous, v. 458. Mollescence of the brain, iv. 418. Mollifies ossium, v. 217. cerebri, iv. 418. 443.—v. 261. Monorchids, whether natural, v. 10. Morbilli, iii. 9, Morbus niger, i. 293. comitialis, iv. 373. pilaris, v. 440. puerorum, v. 76. sacer, iv. 363. Moria, iv. 123. imbecillis, iv. 124. demens, iv. 129. Mordekie, Mordechie (Arab.) i. 20t> Morpio, v. Mort de chien (cholera), i. 206, 484 GENERAL INDEX. Mortification, iii. 315. Moss, Iceland, i. 391. Mouth-watering, i. 86. Mulberry calculus of the bladder, v. 340. S48. Mulberry-eye-lid, ii. 332. Mumps, ii. 266. Mungo radix, iv. 264. Musca, larves of, intestinal, i. 239. carnaria, i. 239. vomitoria, i. 239. Muscae volitantes, iv. 239. Muscles, diseases affecting the, iv. 205. fibres of, iv. 6. in mass, iv. 205. voluntary and involuntary, iv. 208. See muscular fibres. Muscular fibres, what and how produced, iv. 6. contraction, laws of, iv. 206. See Muscles. Mushrooms, what kinds poisonous, i. 175. Musk in rabies, iv. 267. artificial, how prepared, i. 394. Myopia, iv. 141. Myosis, iv. 155. Mydriasis, iv. 157. Myrrh in hectic fever, ii. 138. N. Nausea, i. 129. Neck-lace, anodyne of children, i. 56. Necrosis, iii. 321. ustilaginea, iii. 319. Nega, v. 395. Negroes, pye-balled or spotted, v. 464, 465. Nephritis, ii. 315. Nerve-ache, iv. 193. of the face, iv. 195. foot, iv. 201. breast, iv. 202. Nerves, number and general character, iv. 8. whether solid chords or hollow cylinders, iv. 18. Nervous function, its extent and impor- tance, iv. 5. fluid, iv. 23. both sensific and motory, it. 24, • " nature of its essence, iv. 360. deafness, iv. 166. Netek (Hebrew) Scall, v. 395. Nettle-lichen, v. 372. 377. rash, iii. 26. Neuralgia, iv. 193. faciei, iv. 195. mistaken for tooth- ache, i. 70. pedis, iv. 201. mamma;, iv. 202. Neurilemma, iv. 19. N<5urostynia, iv. 237 Neurotica, iv. 4) Nictitatio, iv. 298. Night-mare, i. 429. Night-pollution, iv. 120. Night-sight, iv. 135. Nirles, v. 410. Nisus formativus, what, v. IT, Node, iii. 250—v. 212. Noli me tangere, iii. 331. Numbness, iv. 190. Nutmeg, hypnotic quality of, i. 12&. Nux vomica, i. 121. 149. in intermittents, ii. 92. palsy, iv. 451. Nyctalopia, iv. 135. 137. Nymphomania furibunda, v. 84, 85. Nystagmus, iv. 162. O. Obesity, v. 195. general, v. 195. splanchnic, v. 198. Oblivion, iv. 125. Obstipation, i. 185. Ocular spectres, iv. 142. Odontia, i. 50. dentitionis, i. 61. dolorosa, i. 60. stuporis, i. 71. deformis, i. 73. edentula, i. 74. incrustans, i. 77. excrescens, i. 78. (Estrus, (larves of, or) bots, intestinal, i. 236. cuticular, v. 439. Oil, train, in chronic rheumatism, ii. 399. Oleum de cantharidibus, i. 62. templinum, i. 246. jecoris aselli, ii. 399. Olives, singular mode of rearing, i. 41. Omentum, organ of, i. 47. Oneirodynia, iv. 115. Ononis spicata, as a diuretic, v. SOS. Onyx, ii. 324—iv. 149. Opacity humoral, iv. 147, Ophiasis, v. 454. Ophiorrhiza Mungos, iv. 264. Ophthalmia, ii. 321. taraxis, ii. 323. iridis, ii. 326. purulenta, ii. 328. glutinosa, ii. 336. metastatica, ii. 33S. epidemica, ii. 329. gonorrhoica, ii. 333. catarrhalis, ii. 333. intermittens, ii. 334. ectropinm, ii. 340. Ophthalmo-blenorrhoea, ii. 330. Ophthalmoptosis, ii. 338. Ophthalmy, ii. 321. lachrymose, ii. 323. purulent, ii. 328. of infants, ii. 334. Egyptian, ii. .T3f> GENERAL INDEX. 435 Ophthaimy, epidemic, ii. 329. glutinous, ii. 336. Opisthonia, iv. 236. Opisthotonus, iv. 236. Orange-skin, v. 462. Orban, his practice of using acids in con- sumption, iii. 197. Orchitis, ii. 320. Organic molecules, what, v. 16. Orgasm, diseases* afffxting the, v. 71. Orgastica, v. 71. Ormskirk medicine, iv. 269. Ornithrohynchus paradoxus, or platypus, Orthopncea, i. 401. Oscitancy, iv. 301, Osmondia regalis, i. 250. Osteopoedion, v. 170. Osthexia, Osthexy, v, 231. infarciens, v. 232. implexa, v. 233. varieties, v. 233. Otaheite, vowel-softness of many pasages in this and other savage tongues, i. 376. Otitis, ii. 263. Otorrhea, ii. 264. Ova, human, v. 14. Ovaria, human, v, 14. P. Painter's colic, i. 162. Palpitatio, iv. 289. cordis, iv. 289. arteriosa, iv. 292. complicata, iv. 295. Palpitation, iv. 289. in the epigastric region, iv. 294. Palsy, iv. 433. varieties, iv. 436. shaking, iv. 314. Pandicnlatio, Pandiculation, iv. 301. Papula, v. 368. Papulous skin, v. 368. Parabysma, i. 304. hepaticum, i. 305. complicatum, i 324. intestinalt, i- 321. mesentericum, i. 318. omentale, i. 323. pancreaticum, i. 317. splenicum, i. 314. Paracentesis in drop»y of the chest, of early origin, v. 272. Paracusis, iv. 163. acris, iv. 164. obtusa, iv. 166. perversa, iv. 167. duplicata, iv. 168. illusoria, iv. 169. varieties, iv. 169. surditas, iv. 170. Paracyesis, v. 110. irritativa, v. 111. uterina, v. 116. nbortus. v. 118, Parageusis, iv. 179. acuta, iv. 182. obtusa, iv. 183. expers, iv. 184. Paralysis, iv. 433. varieties of, iv. 436. whether likely to be benefited by tertian ague, iv. 454. Paramenia, v. 28. obstructionis, v. 29. difficilis, v. 34. superflua, v. 41. erroris, v. 43. cessationis, v. 44. Paraphimosis, ii. 216. Paraplegia, iv. 440. Parapets, iv. 186. acris. iv, 185. expers, iv. 190. illusoria, iv. 192. Parasynanche, ii. 267. Parenchyma of orgens, v. 177. Parenchyma, diseases affecting the, v. 194. Paristhmitis, ii. 267. varieties, ii. 269. Parodynia, v. 126. atonica, v. 127. implastica, v. 130. sympathetica, v. 135. perversa, v. 141. amorphica, v. 146. pluralis, v. 154. secundaria, v. 157. Paroniria, iv. 115. ambulans, iv. 116. loquens, iv. 119. salax, iv. 120. Paronychia, ii. 226. Paropsis, iv, 134. luciiuga, iv. 135. noctifuga, iv. 137. longinqua, if. 140. propinqua, iv. 141, lateralis, iv. 142. illusoria, iv. 142, caligo, iv. 146. glaucosis, iv. 147. catarracta, iv. 148. synizesis, iv. 154.. amaurosis, iv. 156. strabismus, iv. 161. Parosmis, iv. 173. acris, iv. 173. obtusa, iv. 177. exp--rs, iv. 178. Parostia, v. Ssl4. fragilis, v. 215. flexilis, v. 217. Parotitis, ii. 266. Paruria, v. 296. inops, v. 297. relentionis, v. 300, still at itia, v. 305. mellita, v. 310. incontinens, v. 333, incocta, v. 336. orratica^v. 33T, 4Sb' GENERAL INDEX. Passio bovina, v. Passion ungovernable, iv. 78. Passions of the mind, as liable to disease, as its intellectual faculties, iv. 78. Pearl-ash, in indigestion, i. 146. Pearl-eye, iv. 148. Pectoriloquism, iii. 186. Pediculus, v. 434. ^elagra, )iH. 279# Pellagra, J Pemphigus, v. 406. Percussion of the chest, ii. 205—iii. 184.— v. 270. Peripneumonia, ii. 288. Peripneumony, ii. 281. varieties, ii. 281. Peritoneal fever, ii. 171. Peritoneum, inflammation of, ii. 292. Peritonitis, ii. 292. propria, ii. 293. omcntalis, ii. 295. mesenteric a, ii. 295. Pernio, ii. 246. Pestis, iii. 84. its resemblance to small-pox ex- amined, iii. 65. varieties, iii. 84. Phacia, v. 460. Phalaena pinguinalis, larves of, intestinal, i.239. Phalangosis, ii. 342. Phasianus, mot-mot, i. 331. Pheasant, mot-mot, i. 331. Philautise, iv. 82. Phimosis, ii. 216. Phimotic phlegmon, ii. 216. Phlebitis, ii. 187—iii. 310. Phlegmasia?, ii. 177. Phlegmatia dolens, ii. 379. Phlegmone, Phlegmon, ii. 210. parutis, ii. 212. communis, ii. 211. parotidea, ii. 213. mamma?, ii. 214. bubo, ii. 215. phimotica, ii. 216. Phlogistica, ii. 177. Phlogotica, ii. 177. Phlyctasnae, ii. 236. Phlyzacium, v. 415. Phlysis, ii. 225. Phonic a, i. 345. Phosphorus in typhus, ii. 166. gout, ii. 416. Phrenica, iv. 41. Phrensy, ii. 257. Phryganea grandis, larves of, intestinal, i. Phthiriasis, v. 433. Phthisis, iii. 162. varieties, iii. 163. dyspeptic, iii. 164. Phthisurie, v. 320. Ph'hoe, iii. 165. Pliyma, ii. 217. hordeolum, ii. 218. furunculus, ii. 219. svcosis. ii. 219. Phyma, anthrax, ii. 220. Physalis Alkekengi, or winter-cherry, r- 306. Physometra, v. 294. Pian, iii. 107. Pilare m:ilum, v. 445. Piles, i. 265. Pin of the eye, iv. 146. 154. Pityriasis, v. 385. Placenta, retention of, v. 158. Pladarotis, ii. 332. Plague, iii. 84. varieties, iii. 84. of Athens, iii. 86. of London, iii 89. of Morocco, iii. 91. of British army in Egypt, iii. 94. how far related to the small-pox, iii. 65. inoculation for, iii. 93. exposure to, diminishes its power, iii. 101. influenced by state of the atmos- phere, iii. 102, 103. Platalea Leucorodia (spoon-bill), i. 331. Plethora, iii. 113. entonica or sanguine, iii. 115. atonica or serous, iii. 116. ad molem, iii. 114. ad spatium, iii. 114. Pleuralgia, i. 438. acuta, i. 439. chronica, i. 440. Pleurisy, ii. 287. spurious, ii. 396. Pleuritis, ii. 287. vera, ii. 288. mediastina, ii 289. diaphragmatica, ii. 289. Pleurodyne, i. 438. Pleuro-peripneumonia, ii. 288. Pleurost hot onus, iv. 236. Plica, v. 448. Pneumathorax, v. 289. Pneumatic medicine, iii. 206. Pneumatica, 1.345. Pneumatosis, v. 289. Pneumatothorax, v. 289. Pneumonica, i. 379. Pneumonitis, ii. 281. vera, ii. 282. maligna, ii. 285. notha, ii. 286. Podagra, ii. 401. its varieties, ii. 403. Pcecilia, v. 463. Poison of viper as an antilyssic, iv. 277, Poliosis, v. 451. Polyglottus, mocking-bird, i. 332. Polypus, i. 349. elasticus, i. 350. coriaceus, i. 350. bronchial, ii. 279. uteri, v. 103. vaginae, v. 103. Polysarcia, v. 195. adiposa, v. 195. Pompholyx, Pomphus, y. 406- GENERAL INDEX. 487 Pontine marshes, insalubrity of, ii. 296. Porphyra, iii. 284. simplex, iii. 285. haemorrhagia, iii. 287. nautica, iii. 293. Porphyrisma, iii. 9. Porrigo, v. 420. Portland powder, ii. 418. Pose, ii. 345. Power, nervous, iv. 24. sensific and motific, iv. 24. motific, or irritative of a lower description than sensific, iv. 25. Pox, iii. 245. bastard, iii. 266. Precocity, genital, v. 77. Pregnancy, morbid, v. 110. from constitutional derangement, v. 111. from local derange- ment, v. 116. from miscarriage, v. 118. proper period of, v. 110. spurious, v. 170. utmost extent al- lowed, v. 108. Premature delivery, its advantages at times, v. 153. Presbytia, Presbyopia, iv. 141. Priapism, iv. 211. Pricking, general feeling of, iv. 188. Prickly-heat, v. 372. 375. Pride ungovernable, iv. 83. Procidentia ani, i. 272. uteri, v. 99. Proctica, i. 253. simplex, i. 253. spasmodica, i. 254. callosa, i. 260. exania, i. 272. marisca, i. 265. tenesmus, i. 264. Praotia,v. 77. fceminina, v. 78. masculina, v. 77. Prolapse, genital, v. 98. of the bladder, v. 102. parturient, v. 131. vagina, v. 101. womb, v. 99. Protuberant eye, ii. 337. Primus, Lauro-cerasus, i. 287. in fevers, u. 92. Prurigo, v. 379. Pruritus, iv. 185. 187. Prussic acid, i. 366. 397. iii. 208. _ its effects on the stomach, l 132. how best relieved, i. 132. Psellismus, i. 369. bambalia, i. 370. blaesitas, i. 372. Pseudocsthesia, iv. 192. Pseudocyesis, v. 170. molans. v. 171. Pseudocyesis, inanis, v. 173. Psoas abscess, ii. 202. Psora, v. 389. 398. Psoriasis, v. 398. Psorophthalmia, ii. 336. Pterygium, ii. 326. iv. 146. Ptosis, ii. 342. Ptosiridis, ii. 338. Ptosisiridis, ii- 338. Ptyalism, i. 81. Ptyalismus, i. 81. acutus, i. 82. chronicus, i. 88. iners, i. 89. Pubis symphysis ossa, division of, in im- practicable labour, v. 149. Puerperal fever, ii. 170. epidemic, ii. 173. contagious, ii. 173, mania, iv. 65. convulsions, iv. 363. Pulex (Daphnia), v. 7. (Monoculus), v. 7. Pulex, v. 436. Pulsatilla nigricans, iv. 147. 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. 20. of Solano, ii. 20. of Bordeu, ii. 20. Pulselessness, iv. 278. Pulvis antilyssus, iv. 266. Cobbii, iv. 268. Pupil, closed, iv. 154. double, iv. 155. five-fold, iv. 155. Purpura, iii. 9. 29. Pursiuess, i. 405. Purulent ophthalmy, ii. 326. Pus, a secretion, ii. 195, 196. Hewson's view, ii. 196. Hunter's, ii. 196. use of, ii. 198. 200. how distinguished from mucus, iii. 183 Push,'ii. 211. Pye-balled skin, v. 463. Pyrectica, ii. 28. Q- Quartan ague, ii. 76. double, trebl jje, 1 icate, |l ' 78. 79. duplicate, triplicate, j Quas, Russian, iii. 298. Quinsey, ii. 267. varieties, ii. 268. nervous, i. 95. Quinine, ii. 89. Quinic acid, ii. 89. R. Rabid blood, as an antilyssic, iv. 27* >. 4»8 GENERAL INDEX. Raines, iv. 244. canine, iv. 253. feline, iv. 251. Rainbow worm, v. 411. Ramollissement de Cerveau, ii. 257. iv. 418. v. 261. Ranc£, Abbe de, melancholy of, iv. 80. Ranula, i. 98. Raphania, iv. 317. Raptus nervorum, iv. 227. Rash exanthem, iii. 8. rose, v. 366. gum, v. 369. uchenous, v. 371. pallid, v. 370 pruriginoiiN, v. 379. millet, v. 383. rainbow, v. 411. tooth, v. 369. wild-fire, v. 369. Rer.lination. iv. 153. Rattling in the throat, i. 352. Rectum, stricture of, spt^nodic, i. 254. callous, i. 260. Red-gum, v. 369. Relaxatio uteri, v. 99. Remittent fever, ii. 97. mild, ii. 97. malignant, ii. 99. autumnal, ii. 99. yellow, ii. 105. burning, ii. 128. asthenic, ii. 130. of Breslaw, ii. 131. Renal calculus, v. 341. Respiration, effect of, on the blood, i. 337. how produced, i. 336. Ellis's hypothesis, i. 339. quantity of air expired and inspired in, i. 338. 342. Rest-harrow as a diuretic, v. 303. Restlessness, iv. 329. Retching, i. 129. Retention of the menses, v. 29. secundines, v. 158. Revery, iv. 108. of mind, iv. 109. abstraction of mind, iv. 108. 111. brown-study, iv. 108. 113. Rhachialgia, i. 162. Rhachia, v. 221. Rhachitis, v. 221. origin of the name, v. 221. Rachybia, iv. 213, 214. Rhatany root, v. 42. 50. Rheuma, how used formerly, ii. 401. iv 149. Rheumatism, acute, ii. 390. whether co-exists with gout, ii. 389. 8 ' articular, ii. 390. lumbar, ii. 395. of the hip-joint, ii. 396. pleura, ii. 396. chronic, ii. 397. Rhonchus, i. 352. stertor i. 353. rprchnns. i. 353. Rhus vernix, i. 396. iv. 451. tnxicodendrum, iv. 452. Rhypia, v. 413. Richerand, bis hypothesis concerning a living principle, iv. SO. Rickets, v. 221. Ringing in the ears, iv. 169. Kiug-worm, v. 409. 411. scall, v. 420. 423. Rosalia, iii. 8. Rose-rash, v. 366. Rose-wood, i. 126. Roseola, v. 366. Rosy-drop, ii. 224. Rot in sheep, cause of, i. 243. Rotacismu.i, i. 375. Rougeole, iii. 10. Rubeola, iii. 9. 21. Rubia tinctorum, v. 37. Rutmla, iii. 107. Rubus chamaemorus, iii. 297. Rumbling of the bowels, i. 123. Rumination, instances of in man, i. 127. Running at the nose, i. 345. Rupia, v. 413. Rye, spurred, v. 38. S. Sahafata (Arab.), scall, v. 399. Sala.itas, > Salacity, ) Saliva, analysis of, i. 81. Salivation, i. 82. Salmon, fecundity of, v. 8. Sambucus ebulus, v. 246. nigri, v. 246. Sancti viti chorea, iv. 306. Sand, urinary, v. 341. white, v. 341. red, v. 342. Sanguiferous system, machinery of, ii. 5. moving powers of, ii. fluids of, ii. 22. Santonica, i. 248. Saphat (Hebr.) scall, v. 394. 399. Sarcocele, v. 204. Satyriasis furens, v. 84. Scabies, v. 428, 429. Scabiosa Indica, i. 244. Scale-skin, v. 384. Scall, dry, v. 398. humid, v. 418. scabby, v. 420. milky, v- 420, 421. honey-comb, v. 420. 422. Scalled head, v. 420, 421. Scandix cerefolium, i. 269. Scarabaeus, (beetle-grubs) intestinal, i. 239. Scarlatina, iii. 8. Scarlet-fever, iii. 8. with sore throat, iii. 10. 13. Scelotyrbe, iv. 307, 308. 314. Scented odours issuing from the bodies of animals, v. 365. Sciatica, ii. 390. 396. GENERAL l.NDEA. 4*H Sclerotitis, ii. 323. Scotodinus, iv. 350. Scotoma, iv. 350. Scott's acid bath, in jaundice, i. 288. lues, iii. 262. Scrophula, iii. 219, 220. Scurvy, iii. 284. land, iii. 287. petecchial, iii. 285. sea, iii. 293. dynamic, iii. 288. Scybalum, i. 223. Sea-bear, i. 37. calf, i. 37. sickness, how produced, i. 133. worms, feed harmlessly on copper- bottomed ships, i. 173. Seasoning fever of hot climates, ii. 108. Secale cornutum, or spurred rye, i. 175. Secernent system, diseases of, v. 177. physiology of, v. 177. Secretions, furnished by different animals, and often the same animal in different parts, v. 191. sugar "j sulphur j urine bile, J honey wax silk phosphorescent light air electricity furnished by plants equally diversified, performed by an electric agency of the nerves, v. 325. Sccundines, retention of, v. 158. Self-conceit, ungovernable, iv. 82. Seminal fluid, how secreted, v. 10. powerful influence of, on the animal economy, v. 12. flux, v. 61. entonic, v. 62. atonic, v. 62. misemission, v. 89. Senega, v. 247. Seneka-root, i. 421. Sensation, diseases affecting the, iv. 133. Sensation and motion, principle of, iv. 17. whether a common power, or from distinct sources, iv. 19. Senses, external, in different animals, iv. 13. whether any animal possesses more than five, iv. 16. Sensific and motific fibres, iv. 24. 209. Sensorial powers, diseases affect- ing jointly, iv. 324. Sentimentalism, iv. 94. Serpigo, v. Seta equina, intestinal, i. 237. Vol. V.—fi? >v. 192. Seville Orange tree, iv. 312. Sex and features how accounted for, v. 14. 16. Sexual fluids, diseases affecting, v. 28. Shaat (Hebr.) v. 394. Shaking palsy, iv. 314. Shampooing, iv. 223. Shark, procreation of, v. r>. Shechin, v. 395. Shingles, v. 408. 41Q.' Short-breath, i. 402. Sibbens, or Sivens, iii. 269. Sick-head-ache, iv. 342. Sickness of the stomach, i. 127. Sighing, how produced, i. 337. Sight, in different animals, iv. 15. Sight, morbid, iv. 134. night, iv. 135. day, iv. 137. long, iv. 140. of age, iv. 141. short, iv. 141. skew, iv. 142. false, iv. 142. Silliness, iv. 130. Silver, nitrate of, in epilepsy, iv. 382. power of producing a dark colour on the skin, iv. 382. Singing-birds, vocal avenue of, i. 332. nightingale, i. 332. thrush, i. 332. tuneful manakin, i. 332. mocking-bird, i. 332. Singultus, iv. 285. Sisymbrium, iv. 368. Skin, papulous, v. 368. macular, v. 457. orange, v. 462. Slaughter-houses, exhalation of, in con- sumption, iii. 207. Slavering, i. 89. Sleeplessness, iv. 325. Sleep-disturbance, iv. 115. sleep-walking, iv. 116. sleep-talking, iv. 119. night-pollution, iv. 120 Small-pox, iii. 54. varieties, iii. 74. Smell, morbid, iv. 173. acrid, iv. 173. sex, age, and other qualities dis. coverable by it, iv. 175. obtuse, iv. 177. want of, iv. 178. illusory, whence, iv. 350. how far it exists in different ani- mals, iv. 14. Snaffles, ii. 349. Snail, procreation of, v. 6. Sneezing, iv. 287. Snivelling, i. 347. Snoring, i. 353. Snuff-takinar, why injurious, i. 141 Snuffles, ii. "349. Snuffling, i. 347. Soap, i. 287. Soins, iii. 298. 190 i.ENERAL INDEX. Sol-lunar influence, Balfour's hypothesis of, ii. 61. Solid parts of organs, of what composed, v. 177. Solvents biliary, i. 304. Somnambulism, iv. 116. Sore-throat, ii. 267. ulcerated or malignant, ii. 269. Soreness, general feeling of, iv. 185, Sounds, vocal, i. 375. guttural, i. 378. nasal, i. 375. - lingual, i. 375. dental, i. 375. labial, i. 375. 377. imaginary in the ears, iv. 169, Sparganosis, ii. 379. Spasm, doctrine of, as applicable to fevers, iii. 35. Spasm, constrictive, iv. 210. its species, iv. 210. clonic, iv. 284. its species, iv. 285. synclonic, iv. 304. its species, iv. 304.359. Spawn, or hard roe, what, v. 8. Spectres, ocular, iv. 142. Speech, how produced, i. 330. inability of, i. 354, dissonant, i. S69. may be produced without a tongue, i. 355. Speechlessness, i. 354. Sperm, or soft roe, what, v. 8. Spermorrhcea, v. 61. Spider discharged from the anus, i. 239. Spigelia, i. 244. 251. Spignel, v. 38. Spilosis, v. 459. Spilus, v. 459. Spina bifida, v. 266. Spina ventosa, what, iii. 325.—v. 217. . Spinal marrow, its chord double, iv. 20. 210. Spine, dropsy of, v. 266. curvature of, iv. 441. disease or injury of a cause of para- plegia, iv. 440. mollifaction or softening of, iv. 443. muscular distortion of, iv. 213. Spirit of animation, of Darwin, ii. 41. Spitting of blood, iii. 124.129. Sflanchnica, i. 274. Spleen, office not known, i. 47. not found below the class of fishes, i. 47. turgescence of, i. 314. Splenalgia, ii. 315. Splenitis, ii. 314. Spoon-bill, i. 331. Spurred-rye, i. 175. v. 38. Spurzheim, his hypothesis upon the nature of the mind, iv. 30. Squalus, procreation of, v. 8. Squinsy, ii. 267. ^ouintiug, iv. 161. Squinting, varieties, iv. lt>2. St, Anthony's fire, iii. 49. varieties, iii. 5t>. St. Guy, dance de, iv. 306. St. Vitus's dance, iv. 306. Stahl, his doctrine of fevers, ii. 34. Stammering, i. 370. Staphyloma, ii. 337. varieties, ii. 337. Stays, tight, their mischievous effects, i- 440. Steatome, v. 210. Sterility, mate, v. 8. female, v. 94. Sternalgia, i. 430. ambulantium, i. 431. chronica, i. 437. Sternutatio, iv. 287. Stertor, i. 353. Stethoscope, ii. 205. iii. 186. v. 270. Stiff-joint, muscular, iv. 226. its varieties, iv. 226. Stitch, i. 439. Stomach, organ of, i. 38. omnivorous power of, i. 36. self-digesting power of, i. 44. seat of universal sympathy, i. 48. inflammation of, ii. 296. Stone in the bladder, v. 348. Stone-pock, ii. 223. Stoppage of urine, v. 302. Strabismus, iv. 161. Straining, i. 284. Stramonium, iv. 267. Strangury, v. 305. spasmodic, v. 305. scalding, v. 306. callous, v. 306. vermiculous, v. 308. polypous, v. 310. mucous, v. 308. Stricture of the rectum, spasmodic, i. 254. callous, i. 260. Strophulus, v. 369. Struma, iii. 219. vulgaris, iii. 220. Studium inane, iv. 113. Stultitia, iv. 129. Stupidity, iv. 124. Sturgeon, mode of procreation, v. 9. Stuttering, i. 370. Sty, ii. 218. Stymatosis, iii. 126. Subsultus, iv. 300. Sudor anglicus, ii. 66. Suffocatio stridula, ii. 275. Suffocation from asphyxy, iv. 386. hanging or drowning, iv. 388. mephytic, iv. 394. electrical, iv. 397. from severe cold, iv. 398. Suffusio, iv. 149. 156. scintillans, iv. 143. reticularis, iv. 143. Sugar in saccharine urine, the proportion. v. 313. Sulphur fumigation, v. 431. UENERAL INDEX. 191 Summer-rash, v. 372. 375. Sun-burn, v. 461. Super-annuation, iv. 130. Superfetation, v. 106. 156. Suppression of the menses, v. 33. Suppurative inflammation, ii. 186. Surditas, iv. 170. Surfaces, internal, diseases af- fecting, v. 237. Surface, external, diseases affect- ing the, v. 358. Surleit, i. 169. eruptive, i. 170. Suspended animation, iv. 385. Susurrus, iv. 169. Sioeat, morbid, v. 360. profuse, v. 361. bloody, v. 362. partial, v. 363. coloured, v. 363. scented, v. 364. sandy, v. 365. :s\van, dumb, i. 331. musical, i. 331. Sweating-fever, ii. 66. whether Englishmen only subject to it, ii. 69. Sweet-spittle, i. 83. 86. Swimming of the head, iv. 352. Swine-pox, iii. 43. Swooning, iv. 354. varieties, iv. 355. Sycosis, ii. 219. Sympathies and antipathies, how formed in the mind, iv. 38. Symphysis pubis, division of, v. 148. Synanche, ii. 267. Synclonus, iv. 304. tremor, iv. 304. chorea, iv. 306. ballismus, iv. 314. raphania, iv. 317. beriberia, iv. 319. Syncope, iv. 353. simplex, iv. 354. varieties, iY. 355. recurrens, iv. 357. Synechia, iv. 155. Synizesis, iv. 154. Synocha, ii. 140. Synochal fever, ii. 139. Synochus, ii. 139. its varieties, ii. 140. Syphilis, iii. 245. Syphiloid diseases, iii. 266. Syrigmus, iv. 169. Syringe, i. 93. Syspasia, iv. 359. convulsio, iv. 362. hysteria, iv. 369. epilepsia, iv. 373. Ststatica, iv. 324. Systremma, iv. 227. Tabes, iii. 155. varieties, iii. 156. Tabes dorsalis, iii. 158. Tabor or Talbor, his early use'of the bark ; in agues, ii. 89. ! Taedium vita?, iv. 104. Taenia solium, i. 233. vulgaris, i. 233. generation of, v. 9. Tarantismus, iv. 307. 314. Tar, fumigation with, iii. 205. water, useful in indigestion, i. 144. Taraxacum, i. 287. v. 304. Taraxis, ii. 332. Taste, how far exists in different animals, iv. 14. 179. Taste, morbid, iv. 179. acute, iv. 182. obtuse, iv. 183. want of, iv. 184. illusory, whence, iv. 350. Teats in the mare, inguinal, v. 10. Teeth, tartar of, i. 77. transplantation of, i. 75. whether an extraneous body, i. 64. moveable, i. 53. whether injured by sugar, i. 66. pretended, reproduced by jugglers. L 59. carious, i. 60. ** deformity of, i. 73. Teething, i. 51. permanent, i. 57. in adults, i. 57. in old age, i. 58. Tela mucosa, v. 177. Tenderness, general external feeling of, how produced, iv. 185. Tenebrio, intestinal, i. 240. Teneritudo, iv. 185. Tenesmus, i. 264. Teresa, Saint, iv. 98. Tertian ague, ii. 74. double, triple, duplicate, , Testes, diminish in the winter in many ani- mals, v. 10. where seated in the cock, v. 10. Testudo, v. 210. Tetanus, iv. 236. anticus, iv. 236. 238. dorsalis, iv. 236. lateralis, iv. 236, 237. erectus, iv. 236. 239. Tetter, v. 408. Therioma, v. 409, Thirst, morbid, i. 99. immoderate, i. 101. sensation of, how accounted for, i. 99. Thirstlessness, i. 102. Throbbing of the arteries, iv. 294. heart, iv. 289. Thrush, iii. 33. its varieties, iii. 33. Thymiosis, iii. 107. Tic, meaning of the term, ;v. 22P. douloureux, iv. 195", Tick bite, v. 437. J- 7H. ■i"J2 UENERAL INDEX. Tiglium seeds as a hydragogue, v. 215. Tinea, v. 420, 421. Tissu muquex, v. 177. Titubatio, iv. 329. Toads, suckling in cancer, iii. 242. Tonicity, iv. 208. Tongue, lolling, i. 97. speech not necessarily dependent npon it, i. 355. Tonquin powder, iv. 268. Tooth, derangement of, i. 50, wise, i. 57. ache, i. 60. edge, i. 72. rash, v. 369. Toothlessness, i. 74. Torpor, iv. 384. Touch, morbid, iv. 185. acute sense of, iv. 185. insensibility of, iv. 190. illusory, iv. 192. Tracheitis, ii. 274. Trance, iv. 403. Transudation in dead animal matter, v. 184. Trembling, iv. 364. Tremor, iv. 304. Trichechus Dudong, i. 37. Trichiasis, ii. 342. Trichoma, v. 445. Trichocephalus, i. 232. Trichosis, v. 445. setosa, v. 447. plica, v. 448. hirsuties, v. 450. distrix, v. 450. poliosis, v. 451. athrix, v. 452. area, v. 454. decolor, v. 455. Tripudatio, iv. 314. Trismus (entasia) iv. 229. varieties, iv. 231. maxillaris, iv. 195. dolorificus, iv. 195. Triton palustris, intestinal, i. 239. Tsorat of the Jews, what, v. 388. 394.398. Tubba, iii. 109. Tuber, ii. 217.—iii. 165. Tubercles, what, iii. 165. Tumid-leg, puerperal, ii. 378. of West Indies, ii. 384. Tumour, v. 201. sarcomatous, v. 202. fleshy, v. 202. adipose, v. 202. pancreatic, v. 202. cellulose, v. 202. cystose, v. 202. scirrhous, v. 202. mammary, v. 203. tuberculous, v. 203. medullary, v. 203. encysted, v. 210. steatomatous, v. 210. atheromatous, v. 210. honeyed, v. 210. "ansrlionic, v. 210, Tumour, horny, v. 210. bony, v. 212. osteous, v. 212. periosteous, v. 212. pendulous, v. 213. exotic, v. 213. Turgescence visceral, i. 305. Tussis, i. 380. Twinkling of the eye-lids, iv. 298. Twinning, congruous, v. 155. incongruous, v. 155. Twins, v. 155. Twilchings of the tendons, iv. 300. Tympanites, v. 291. Tympany, v. 291. whether ever an idiopathic af- fection, v. 292. Typhomania, ii. 152. 257. Typhus, how far approximates yellow fe- ver, ii. 53. described, ii. 146. causes, ii. 146. how becomes contagious, ii. 147. extent and intensity of contagion, ii. 147, 148. mild, ii. 150. malignant or putrid, ii. 151. specific properties of its miasm, ii. 155. septic power, distinct from its debilitating, ii. 155. copious bleeding, how far advisa- ble, ii. 157. U. & Y. Vaccinia, iii. 36. its varieties, iii. 37. Vagina, prolapse of, v. 101. Vapours, iv. 101. Varicella, iii. 43. Variola, iii. 54. how far related to plague, iii. 65. Varioloid eruptions, iii. 81. Varix, iii. 307. Varus, ii. 189. Vas efferens, v. 183. inferens, v. 183. Veal-skiD, v. 457. Vegetation promoted by animal dejections, i. 42. Veins and arteries, ii. 6. extensive line of swelling after bleeding, iii. 308. Vena Medinensis, v. 439. Venereal disease, iii. 243. Ventriloquism, what, i. 333. Vermifuges, i. 243. Vermis Medinensis, v. 439. Vermination, cutaneous, v. 433. Vertigo, iv. 348. origin of, iv. 348. varieties, iv. 352. Verruca, iv. 443. Vesiculae seminales, v. 10, 11. differ in different animals, v. 11, Vesicular inflammation, ii. 234. fever, iii. 45. GENERAL INDEX. 493 v esicular fever, its varieties, iii. 46. Viper, poison of, as an antilyssic, iv. Vis insita, iv. 21. nervea, iv. 21. a tergo, hypothesis of, ii. 13. Viscus quernus, iv. 368. Vitiligo, v. 457. Vitus's (St.) dance, iv. 307. Ulcer, iii. 326. depraved, iii. 327. callous, iii. 327. fungous, iii. 327. cancerous, iii. 327. sinuous, iii. 330. carious, iii. 332. Ulcus, iii. 326. incarnans, iii. 327. vitiosum, iii. 327. sinuosum, iii. 330. tuberculosum, iii. 331. cariosum, iii. 332. Vocal avenue, i. 329. Voice, how produced, i. 330. dissonant, i. 364. imitative, seat of, i. 334. whispering, i. 364. of puberty, i. 367. rough, ■) harsh, I nasal> . I i. 368. squeaking, f whizzing, I guttural, J palatine, or through the nose, i. 363. immelodious, i. 368. Vomica, ii. 208. occult, ii. 209. open, ii. 209. Vomiting and purging, i. 200. Vomiting of blood, iii. 125.129. how produced, i. 127, Vomito prieto, ii. 108. Vomituritio, i. 129. Vomitus, i. 129. Voracity, i. 103. Upas tiente, iv. 364. Uric calculus, v. 340.345. Urinal dropsy, v. 311. 333. Urinary calculus, v. 340. sand, v. 341. gravel, v. 344. Urine, earths, salts, and other principles of, v. 339. bloody, iii. 126. 129. destitution of, v. 297. stoppage of, v. 300. saccharine, v. 310. honeyed, v. 310. incontinence of, v. 333. unassimilated, v. 336. erratic, v. 337. Uroplania, v. 337. Urticaria, iii. 26. TJteri procidentia, v. 99. prolapsus, v. 99. relaxatio, v. 99. Uterine hemorrhage, iii. 126. 130. W. Wakefulness, iv. 325. irritative, iv. 325. chronic, iv. 327. Walrus, i. 37. Wart, v. 443. Water in the head, v. 258. Water-blebs, v. 406. Water-flux, v. 311. Water-brash, i. 117. Water-pox, iii. 43. Water-hemlock, i. 175. Weariness of life, iv. 104. Web of the eye, iv. 146. Weeping, how produced, i. 337. Wen, v. 210. adipose, v. 210. honeyed, v. 210. horny, v. 210. Wheal-worm, v. 438. Wheezing, i. 353. Whelk, ii. 222. White-gum, v. 369. White-swelling, ii. 424. Whites, v. 46. WhiHow, ii. 226. Whizzing in the ears, iv. 169. Wild carrot, as a diuretic, vr303. Wind-cholera, i. 203. cholic, i. 170. dropsy, v. 287. Winking, iv. 288. Winter-cherry, v. 306. Wit, how it may exist without judgment, and hence in insanity, iii. 97. crack-brained, iv. 96. Witlessness, iv. 129. Womb, inflammation of, ii. 318. falling down of, v. 99. retroverted, v. 100. extirpation of, v. 100. Worm-grass, i. 251. Worm, goose-foot, i. 248. Wormword, i. 149. Worms, intestinal, their ability to resist di- gestion, i. 45. various species, i. 227. long round, i. 232. thread, i. 2H2, 233. tape, i. 233. broad tape, i. 233. thread, i. 235. maw, i. 235. erratic, i. 237, hepatic, i. 310. vesical, v. 308. Worm-seed, i. 248. Wry-neck, iv. 212. X. Xanthic oxyde of the bladder, v. 340. Xerophthalmia, ii, 324. 494 GENERAL INDEX. V. Yam, i. 36. Yava skin, ii. 385. Yawning, iv. 301. Yaws, iii. 107. Yellow fever, how far approaches typhus, ii. 53. description of, ii. 105. Yellow-jaundice, i. 275. gum of infants, i. 292. Z. Zaruthan, iii. 239. Zona, v. 410. ignea, v. 410. Zoster, v. 408. 410. THE END. t A. JL o i NATIONAL LIBRARY NLI1 D3277^3fl if NLM032779384