\£/fy~  ^C^a^          $h 
 
TEXT BOOK
Comer  of  WLtttuvtBt
ON THE
THEORY AND PRACTICE OF PHYSIC.
FART SECOND.
By JAMES JACKSON, M. D.
FOR THE USE OF THE MEDICAL STUDENTS
OF HARVARD UNIVERSITY.

        BOSTON:        ^^i^AR^
WELLS AND LILLY—COURT-STREET.
1827. 
IS27 
INTRODUCTION.
                                  )
As the first part of this text book  relates to the
general theory of medicine, this  second  part may
be considered as  relating to  the practice.   This
distinction is made, however,  rather in  reference!
to the  title of the professorship I hold, and to the
duties belonging to it, than to the exact  character
of the two parts of the work.   The  second part
is represented as  relating to  practice, because it
will describe particular diseases, and the  treatment
adapted  to each ; yet  it will admit and require
many theoretical discussions.
   It will not be attempted in this work,  nor in the
lectures founded on it, to describe all the diseases,
to which the human body is subject.  The space
of time  allotted to  the lectures will not permit
this to be done.  The most important diseases and
those actually met with  in our  climate, must en-
gage  our  principal  attention.  Considerations  of
expediency must determine the share of attention
to be bestowed on any one subject.
   As  has been intimated in  the first part of this
text book, Dr. Good's Physiological System of Not 
4
TEXT  BOOK.
 sology  will be  followed, in the  consideration of
 particular diseases.  There would undoubtedly be
 more consistency in arranging diseases with refer-
 ence to the arrangement of  the functions adopted
 in the first part of this work.   But this is a con-
 sistency not very important  in a practical point of
 view, and all new arrangements are to be avoided,
 which will not produce some positive and consider-
 able benefit  It may be sufficient to have  pointed
 out guch a division of the functions, as is most  na-
 tural and  renders them most intelligible to  the
 student.  In most diseases  functions of different
 kinds are  found to be disordered at the same time.
 It must suffice us at  present, to have  diseases ar-
 ranged  in a methodical manner  under the princi-
 pal functions, however distinguished.
   I  have  adopted  Dr.  Good's system, not   be-
 cause it is the most  recent,  but because  it is suffi-
 ciently comprehensive and is executed with great
 skill j because much  rare  learning has  been use-
 fully employed in the formation of it; and because
 the plan, on which it is formed, appears  to be the
 best ever yet adopted in  works of this kind.  And
 though  it  be a minor advantage, the  tasteful and
 classical selection and formation of names, employ-
 ed by this distinguished scholar, are to be  regarded
 as no small recommendation of the system, in which
 they are introduced.
  But while this system of Nosology  is  followed,
objections will be made freely, though respectfully, 
INTRODUCTION.               5
 to many opinions of the author, both in regard to
 the  arrangement of the system and to the diseases
 embraced in it.  To his third class especially,  and
 to' much which relates to the sanguineous and vas-
 cular functions, great objections must be made.
   The following are some of the most important of
 these objections.   First, he has not regarded those
 diseases, which arise from morbid actions of the ex-
 treme vessels,  whether formative or excretory, as
 diseases of the  sanguineous function, unless they are
 accompanied by a general disturbance in the actions
 of the system,  commonly called fever.  Second, he
 has arranged under various classes, perhaps in every
 one, diseases which consist  in inflammation. Third,
 he has placed  idiopathic fever  in  his third class,
 taking it for granted, that it is properly a disease
 of the sanguineous function; while its  phenomena
 might equally  claim for it  admission  into other
 classes.  The truth is, all  the functions  are disor-
 dered in this disease, and  it is not yet  settled in
 which of  the functions the disease has its origin.
  In following  this nosological system, no reference
 will  be  had to  " the  Study of Medicine," by the
 same author.   That work  may be regarded as the
 author's own commentary on the diseases enume-
 rated in his system and in some  measure on that
 system itself.   My lectures will be  essentially the
 same, as to their matter, as they were  before Dr.
Good's valuable works  were published; although
it  will be  my  endeavour  to gather from  those 
 6                TEXT BOOK.

 works, as from others, whatever can be advanta-
 geously introduced into them.  In short they will,
 as heretofore,  consist of the knowledge I have
 gained and the opinions I have formed, from the in-
 structions of others, as well as from my own expe-
 rience and reflections.   Many transcripts from the
 writings of others might, no doubt, be read to my
 hearers with advantage; but one, who would teach
 usefully, must communicate that knowledge, which
 he has made his own.
   It is not intended that this  part of my text book
 should be  so  full, in  relation to the subjects  of
 which it treats, as the first part.   So much will
 be stated as  will aid the  student materially in fol-
 lowing  the course of the  lectures, and  facilitate
 very much the labour of taking notes.
   The table  of Classification of Diseases will here
 be  copied from  the  first volume of Good's Study
 of  Medicine, and then  the  text book will refer  to
 the characters of the  various classes and orders
 and to such genera and species as 1 deem it neces-
 sary to  treat  of  in  the lectures.  Surgical dis-
 eases and those  which fall within the province  of
 midwifery, will n6t be  noticed  here, because  they
 are subjects of consideration in other courses de-
livered in this school. 
&a*lc
OF CLASSIFICATION.




       By Db. GOOD.
CLASS I. CCELIACA.
DISEASES OF THE DIGESTIVE			FUNCTION.
ORD. I.	ENTERICA.	SPEC. 2.	P. CHRONICUS.
AFFECTING THE ALIMENTARY			Chronic Ptya-
CANAL.		3.	lism. INERS.
GEN. I.	ODONTIA.		Drivelling:
		GEN. III.	DYSPHAGIA.
Misdentition.			
SPEC. 1.	O. DENTITIONIS.		Dysphagy.
2.	Teething. DOLOROSA.	SPEC. 1.	D. CONSTRICTA.
	Tooth-ache.		Constrictive
3. 4.	STUPORIS. Tooth-edge. DEFORMIS.	2.	Dysphagy. ATONICA. Atonic Dyspha-
	Deformity of the Teeth.	3.	gy. GLOBOSA.
5.	EDENTULA. Toothlessness.	4.	Nervous Quinsy. UVULOSA.
6.	INCRUSTANS.		Uvular Dyspha-
	Tartar of the Teeth.	5.	gy. LINGUOSA.
7.	EXGRESCENS.		Lingual Dys-
	Excrescent		phagy.
	Gums.		
		GEN. IV.	DIPSOSIS.
GEN. II.	PTYALISMUS.		
		Mori	
	Ptyalism.	SPEC. 1.	D. AVENS.
SPEC. 1.	P. ACUTUS.		Immoderate
	Salivation.		Thirst.
 
TABLE OF CLASSIFICATION.    [cl. i.-or. i.

                  GEN. VII.   COPROSTASIS.

                          Costiveness.

                  SPEC. 1.

                        2.
SPEC. 2.  D. EXPERS.
             Thirstlessness
GEN. V.  LIMOSIS
Morbid Appetite.
SPEC. 1.  L. AVENS.
             Voracity
2.

3.


4.



5.

6.
GEN. VI.



SPEC. 1.

      2.


      3.

      4.

      5.
   EXPERS.
   Long Fasting.
   PICA.
   Depraved Appe
     tite.
   CARDIALGIA.
   Heart-burn. Wa-
     ter-brash. Car-
     dialgy.
   FLATUS.
   Flatulency.
   EMESIS.
   Sickness.    Vo
     miting.
   DYSPEPSIA.
   Indigestion.


 COLICA.

 Colic.

C. ILEUS.
   Iieac Passion.
  RHACHIALGIA
   Colic of Poitou
   Painter's Colic.
   CI B ARIA.
   Surfeit.
   FLATULENTA.
   Wind-Colic.
   CONSTIPATA.
   Constipated  Co-
     lic.
   CONSTRICTA
   Constrictive  Co
     lie.
C. CONSTIPATA.
   Constipation.
  OBSTIPATA.
   Obstipation.
 JEN. VIII.  DIARRHOZA.

         Looseness.

SPEC. I.  D.FUSA.
             Feculent Loose-
               ness.
      2.    RILIOSA.
             Bilious   Loose-
               ness.
      3.    MUCOSA.
             Mucous   Loose*-
               ness.
      4.    CHYLOSA.
             Chylous  Loose-
               ness.
      5.    LIENTERIA.
             Lienteru.
      6.    SEROSA.
             Serous Looseness.
      7.    TUBULARIS.
             Tubulat Loose-
               ness.
      8.    GYPSATA.
             Gypseous Loose-
               ness.

 JEN. IX.  CHOLERA.

          CJiokra.

SPEC. 1.  C.BILIOSA.
             Bilious  Cholera.
      2.    FLATULENTA.
             Wind Cholera.
      3.    SPASMODICA.
             Spasmodic Cho-
               lera. 
cl. i.-or. i.J    TABLE OF CLASSIFICATION.
9
GEN. X.  ENTEROLITHUS.

   Intestinal Concretions.

SPEC.].  E. BEZOARDUS.
             Bezoar.
      2.     CALCULUS.
             Intestinal Calcu-
               lus.
      :}.     SCYBALUM.
             Scybalum.

GEN. XI.  HELMINTHIA.

          Worms.

SPEC. 1.  H. ALVI.
             Alvine Worms.
      2.     PODICIS.
             Anal Worms.
      3.     ERRATICA.
             Erratic Worms.

GEN. XII.  PROCTICA.

         Proctica.

SPEC. 1.  P. SIMPLEX.
             Simple Proctica.
      2.     SPASMODICA.
             Spasmodic Stric-
               ture  of  the
               Rectum.
      :'..     CALLOSA.
             Callous Stricture
               of the Rectum.
      4.     TENESMUS.
             Tenesmus.
      .",.     MARISCA.
             Piles.
      6.     EXANIA.
             Prolapse  of the
               Fundament.

ORD. II.   SPLANCHNICA.

   AFFECTING THE COLLATlTlOUS
     VISCERA.
GEN. I.  ICTERUS.

      Yellow Jaundice.

SPEC. 1.  I. CHOLCEUS.
            Biliary Jaundice.
      2.    CHOLOL1THI-
             CUS.
             Gall-stone Jaun-
              dice.
      3.    SPASMODICUS.
            Spasmodic Jaun-
              dice.
      4.    HEPATICUS.
            Hepatic Jaundice.
      5.    INFANTUM.
            Jaundice of In-
              fants.

GEN. II.  MEL.ENA.

         Melena.

SPEC. 1.  M. CHOLCEA.
            Black, or Green
              Jaundice.
      2.    CRUENTA.
            Black Vomit.

GEN. III.  CHOLOLITHUS.

         Gatt-stone.

SPEC. 1.  C.QUIESCENS.
             Quiescent  Gall-
              stone.
      2.    MEANS.
            Passing of Gall-
              stones.

GEN. IV.   PARABYSMA.

    Visceral Turgescence.

SPEC. I.  P. HEPATICUM.
            Turgescence   of
              the Liver. 
10
TABLE  OF CLASSIFICATION.   [cl. i.-or. ii.
SPEC. 2.  P. SPLENICUM.
            Turgescence of
              the Spleen.
      3.    PANCREATI-
             CUM.
            Turgescence of
              the Pancreas.
      4.    MESENTERI-
             CUM.
            Turgescence of
              the /Mesentery.
SPEC. 5.  P. INTESTINALE.
            Turgescence of
              the Intestines.
      6.    OMF.NTALE.
            Turgescence of
              the  Omentum.
      7.    COMPLICA-
             TUM.
            Turgescence com-
              pounded of va-
              rious organs.
CLASS II.  PNEUMATICA.
DISEASES OF  THE  RESPIRATORY FUNCTION.
ORD. I.   PHONICA.

    AFFECTING THE VOCAL AVE-
      NUES.


GEN. I.   CORYZA.   '

   Running at the Nose.

SPEC. 1.  C. ENTONICA.
            Entonic  Coryza.
      2.    ATONICA.
            Atonic Coryza.


GEN. II.   POLYPUS.

         Polypus.

SPEC. 1.  P. ELASTICUS.
            Compressible Po-
              lypus.
      2.    CORIACEUS.
            Cartilaginous
              Polypus.
GEN. III.  RHONCHUS.

   Rattling in the Throat.

SPEC. 1.  R. STERTOR.
            Snoring.
      2.    CERCHNOS.
            Wheezing.

GEN. IV.  APHONIA.

        Dumbness.

SPEC. 1.  A. ELINGUIUM.
            Elingual Dumb-
              ness.
      2.    ATONICA.
            AtonicDumbness.
      3.    SURDORUM.
            Deaf Dumbness.

GEN. V.  DYSPHONIA.

     Dissonant Voice.

SPEC. 1.  D. SUSURRANS.
            Whispering Vo ice. 
l. ii.-or. ii.]    TABLE  OF CLASSIFICATION.
11
SPEC. 2.  D. PUBERUM.
             Voice of Puberty.
      3.    IMMODULATA.
             Immelodious
              Voice.

GEN. VI.  PSELLISMUS.

     Dissonant Speech.

SPEC. 1.  P. BAMBALIA.
             Stammering.
      2.    BL^ESITAS.
             Misenunciation.

ORD. II.  PNEUMONICA.

AFFECTING THE LUNGS,  THEIR
  MEMBRANES, OR MOTIVE POWER

GEN. I.   BEX.

          Cough.

SPEC. 1.  B. HUMIDA.
             Common or hu-
              mid Cough.
      2.    SICCA.
             Dry Cough.
      3.    CONVULSIVA.
             Hooping- Cough
SPEC. 2.  D. EXACERBANS
            Exacerbating
              Anhelation.
GEN. II.  LARYNGYSMUS.

   Laryngic Suffocation.

SPEC. 1.  L. STRIDULUS.
            Stridulous  con-
              striction of the
              Larynx.

GEN. III.  DYSPNCEA.

        Anhelation.

<VEC. 1.  D. CHRONICA.
            Shwt-hreath.
GEN. IV.  ASTHMA.

         Asthma.

SPEC. 1.  A. SICCUM.
            Dry or Nervous
              Asthma.
      2.    HUMIDUM.
            Humid or com-
              mon Asthma.


GEN. V.  EPHIALTES.

         Incubus.

SPEC. 1.  E. VIGILANT1UM.
            Day-Mare.
      2.    NOCTURNUS.
            Night-Mare.


GEN. VI.  STERNALGIA.

   Suffocative Breast-pang.

SPEC. 1.  S. AMBULANTIUM
            Acute Breast-
              pang.
      2.    CHRONICA.
            Chronic-Breast-
              pang.


GEN. VII.  PLEURALGIA.


     Pain in the Side.

SPEC. 1.  P. ACUTA.-
            Stitch.
      2.   CHRONICA.
             Chronic pain ii<
               the Side 
12
TABLE OF CLASSIFICATION.     [cl. nt.-im. :.
CLASS III.   H.EMATICA.
     DISEASES OF THE SANGUINEOUS  FUNCTION


ORD. I.  PYRECTICA.
          FEVERS.

GEN. I.  EPHEMERA.

       Diary Fever.

SPEC 1. E. MITIS.
            Mild  Diary-Fe-
              ver.
      2.    ACUTA.
            Acute Diary-Fe-
              ver.
      3.    SUDATORIA.
            Sweating Fever.

GEN. II.   ANETUS.

 Intermitting Fever.  Ague.
SPEC. 2.  E. MALIGNUS.
            Malignant  Re-
              mittent.*
      3.    HECT1CA.
            Hectic Fever.
SPEC. J.  A. QUOTIDIANUS
             Quotidian Ague
      2.    TERT1ANUS.
             Tertian Ague.
      3.    QUARTANUS.
             Quartan Ague.
      4.    ERRATICUS.
             Irregular Ague.
      5.    COMPLICATUS
             Complicated
              Ague.

GEN. III.  EPANETUS.

      Remittent Fever.

SPEC. 1.  E. MITIS.
             Mild Remittent.
GEN. IV.  ENECIA.

      Continued Fever.

SPEC. 1.  E. CAUMA.
             Inflammatory Fe-
              ver.
      2.    TYPHUS.
             Typhous Fever.
      3.    SYNOCHUS.
             Synochal Fever.

ORD. II.   PHLOGOTICA

       INFLAMMATIONS.

GEN. I.  APOSTEMA.

         Aposteme.

SPEC. I.  A. COMMUNE.
             Common   Apos-

      2.    PSOATICUM.
             Psoas Abscess.
      3.    HEPAT1CUM.
             Abscess of the
              Liver.
  * « Autumnal Remittent. C Yel-
low  Fever,  y Burning Remittent.
i Asthenic Remittent. 
cl. iii.-or. ii.]    TABLE OF CLASSIFICATION.
13
SPEC. 4.	A. EMPYEMA.
	Lodgement of
	Matter in the
	Chest.
5.	VOMICA.
	Vomica.
GEN. II.	PHLEGMONE.
	Phlegmon.
SPEC. 1.	P. COMMUNIS.
	Common Phleg-
	mon.
2.	PARULIS.
	Gum-boil.
■>	PAROTIDEA.
	Parotid Phleg-
	mon.
4.	MAMMiE.
	Abscess of the
	Breast.
.">.	BUBO.
	Bubo.
0.	PHIMOTICA.
	Phimotic Phleg-
	mon.
GEN. III.	PHYMA.
	Tuber.
SPEC.l.	P. HORDEOLUM. Sty. FURUNCULUS.
2.	
	Boil.
3.	SYCOSIS.
	Ficous Phyma.
4.	ANTHRAX.
	Carbuncle.
GEN. IV.	IONTHUS.
	Whelk.
SPEC. 1.	I. VARUS.
	Stone-pock.
SPEC. 2.  LCORYMBYFER.
             Carbuncled Face.
              Rosy Drop.

GEN. V.  PHLYS1S.

         Phlysis.

SPEC. 1.  P. PARONYCHIA.
             Whitlow.

GEN. VI.  ERYTHEMA.

    Inflammatory Blush.

  'EC 1.  E. 03DEMATOSUM
             Edematous Ery-
              thema.
      2.    ERYSIPELA-
              TOSUM.
             Erysipelatous
              Erythema.
      3.    GANGRiENO
              SUM.
             Gangrenous
              Erythema.
      4.    VESICULARE.
             Vesicular Ery-
              thema.
      f>.    ANATOMICUM.
             Erythema from
              Dissection.
      6.    PERNIO.
             Chilblain.
      7.    INTERTRIGO.
             Fret.

 tEN. VII.  EMPRESMA.

   Visceral Inflammation.

 PEC. 1.  E. CEPHALITIS.
             Inflammation   of
              the Brain.*
   a, Brain Fever.  C Acute Drop=
of the Heart. 
14

SPEC. 2. E. OTITIS.
             Ear-ache.
      3.    PAROTITIS.
             Mumps.
      4.    PARISTHMI-
               TIS.
             Quinsy.
      .1.    LARYNGITIS.
             Inflammation  of
               the Larynx.
      ii.    BRONCHLEM-
                MITIS.
             Croup.
      7.    PNEUMONITIS
             Peripneumony.
      8.    PLEURITIS.
             Pleurisy.
      !).    CARDITIS.
             Inflammation  of
               the heart.
      10.    PERITONITIS
             Inflammation  of
               the  Perilonx
               um.
      11.    GASTRITIS.
             Inflammation  of
               the Stomach
      12.    ENTERITIS.
             Inflammation  of
               the Bowels.
      13.    HEPATITIS.
             Inflammation  of
               the Liver.
      14.    SPLENITIS
             Inflammation  of
               the Spleen
      15.   NEPHRITIS
             Inflammation  of
               the Kidneys
      16.   CYSTITIS.
             Inflammation  of
               the Bladder.
      17.   HYSTERITIS.
             Inflammation of
               the Womb.
      J8.   ORCHITIS.
             Inflammation of
               the Testicles.
TABLE OF CLASSIFICATION,   [ex. iii.-or. n.

                 GEN. VIII.  OPHTHALMIA.

                          Ophthalmy.

                 SPEC. 1. O. TARAXIS.
                              Lachrymose Oph-
                                thalmy.
                       2. IRID1S.
                              Inflammation of
                                the Iris.
                       3.    PURULENTA.
                              Purulent Oph-
                                thalmy.
                       4.    GLUTINOSA.
                              Glutinous Oph-
                                thalmy.
                       5.    STAPHYLOMA.
                              Protuberant Eye.
                       G.    ECTROP1UM.
                              Everted Eye-lid.
                       7.    ENTROPIUM.
                              Inverted Eye-lid.


                 GEN. IX.  CATARRHUS.
          Catarrh.

SPEC. 1. C. COMMUNIS.
             Cold in the Head
               or Chest.
      2.   EPIDEM1CUS.
             Influenza.
GEN. X.  DYSENTERIA.
         Dysentery.

SPEC. 1. D. ACUTA.
             Acute Dysentery.
      2.    CHRONICA.
             Chronic  Dysen-
               tenj. 
cl. iii.-or. iv.]  TABLE OF CLASSIFICATION.
GEN. XI.  BUCNEMIA.

        Tumid Leg.

SPEC. 1. B. SPARGANOSIS.
            Puerperal Tumid
              Leg.
      2. TROPICA.
             Tumid Leg  of
              hot Climates.

GEN. XII.  ARTHROSIA.

   Articular Inflammation.

SPEC. 1. A. ACUTA.
             Acute Rheuma-
              tism.
      2.   CHRONICA.
             Chronic Rheu-
              matism.
      3.   PODAGRA.
             Gout.
      4.   HYDARTHRUS
             White-swelling.
SPEC. 2.  E. APHTHA.
             Thrush.
      3.    VACCINIA.
             Cow-pox.
      4.    VARICELLA.
             Water-pox.
      5.    PEMPHIGUS.
             Vesicidar or
              Bladdery Fever.
      G.    ERISIPELAS.
             St. Anthony's
              Fire.
GEN. III.  EMPYESIS.

    Pustulous Exanthe///.

SPEC. 1.  E. VARIOLA.
             Small-pox.


GEN. IV.  ANTHRACIA.

   Carbuncular Exanthem.
D.  III.   EXANTHEMA-gpEC1  A. i»ESTIS.
                                    Plague.
                              2.   RUP.ULA.
                                    Yaws.
              TICA

 ERUPTIVE FEVERS.  EXANTHEMS.

GEN. I.  ENANTHESIS.

      Rash Exanthem.

SPEC. 1.  E. ROSALIA.
             Scarlet-Fever.
      2.    RUBEOLA.
             Measles.
      3.    URTICARIA.
             Nettle-rash.

GEN. II.   EMPHLYS1S.

    Ichorous Exanthem.

SPEC. 1.  E. MILIARIA.
             Miliary Fever
ORD. IV.  DYSTHETICA.
cachexies.
GEN. I.  PLETHORA.
         Plethora.

SPEC. 1.  P. ENTONICA.
            Sanguine Ple-
              thora.
      2.    ATONICA.
            Serous Plethora 
16

GEN.
TABLE  OF CLASSIFICATION.    [cl. ui.-or. iV.
II.  HiEMORRHAGIA.

  Hemorrhage.
SPEC. 1. H. ENTONICA.
            Entonic Hemorr-
              hage.
2.
ATONICA.
 Atonic  Hemorr-
   hage.
GEN
III.  MARASMUS.

   Emaciation.
SPEC. 1. M. ATROPHIA.
            Atrophy.
      2.    ANHjEMIA.
            Exsanguinity.
      3.    CLIMACTERI-
              CUS.
            Decay of Nature.
      4.    TABES.
            Decline.
      5.    PHTHISIS.
            Consumption.
GEN. IV.  MELANOSIS.
        Melanose.

SPEC. 1. M. TUBERCULA-
              R1S.
            Tubercxdar Me
              lanose.
GEN. V.  STRUMA.

        Scrophula.

SPEC. 1. S. VULGARIS.
            King's Evil.
GEN. VI.  CARCINUS.

          Cancer.

SPEC. 1.  C. VULGARIS.
             Common Cancer.

GEN. VII.  LUES.

     Venereal Disease.

SPEC. 1.  L. SYPHILIS.
             Pox.
      2.    SYPHILODES.
             Bastard Pox.

GEN. VIII.  ELEPHANTIA-
                SIS.

      Elephant-Skin.

SPEC. 1.  E. ARABICA.
            Arabian Elephan-
              tiasis.  Black
              Leprosy.
      2.    ITALICA.
             Italian Elephan-
              tiaszs
      3.   ASTURIENS1S.
             Asturian Ele-
              phantiasis.

GEN. IX.  CATACAUSIS

         Catacausis.

SPEC. 1.  C. EBRIOSA.
             Inebriate Cata-
              causis.

GEN. X.  PORPHYRA.

j          Scurvy.

|SPEC. 1.  P. SIMPLEX.
            Peterrhial Scum/. 
cl. 111.-0R. iv.]   TABLE OF CLASSIFICATION.     17
SPEC. 2.  P. HEMORRHA-
              GICA.
            Land-scurvy.
      3.    NAUTICA.
            Sea-scurvy.
GEN. XI.  EXANGIA.

        Exangia.

SPEC. 1.  E. ANEURISMA.
            Aneurism.
      2.    VARIX.
            Varix.
      3.    CYANIA.
            Blue-skin.


GEN. XII. GANGRiENA.

        Gangrene.

SPEC. 1.  G. SPHACELUS.
            Mortification.
SPEC. 2. G. USTILAGINEA.
            Mildew-mortifi-
              cation.
      3.    NECROSIS.
            Dry Gangrene.
      4.    CARIES.
            Caries.

GEN. XIII.  ULCUS.

          Ulcer.

SPEC. 1. U. INCARNANS.
            Simple healing
              Ulcer.
      2.    VITIOSUM.
            Depraved Ulcer.
      3.    SINUOSUM.
            Sinuous Ulcer.
      4.    TUBERCULO-
              SUM.
            Warty, excres-
              cent Ulcer.
      5.    CARIOSUM.
            Canous Ulcer.
CLASS IV.  NEUROTICA.
        DISEASES  OF THE


ORD. I.  PHRENICA.

  AFFECTING THE INTELLECT.

GEN. I.  ECPHRONIA.

  Insanity.   Craziness.

SPEC. 1.  E. MELANCHO-
                LIA.
            Melancholy.
      2.   MANIA.
            Madness.
                   3
NERVOUS FUNCTION.

GEN. II.  EMPATHEMA.

   Ungovernable Passion.

SPEC. 1. E. ENTONICUM.
             Empassioned
              Excitement.
       2.    ATONICUM.
             Empassioned
              Depression.
       3.    INANE.
             Hair-brained
              Passion. 
18
TABLE OF CLASSIFICATION.   [cl. iv.-or. h.
GEN. III.  ALUSIA.

 Illusion.   Hallucination.

SPEC. 1.  A.ELATIO.
            Sentimentalism.
              Mental  Extra-
              vagance.
      2.    HYPOCHON-
              DRIAS.
            Hypochondrism.
              Low Spirits.


GEN. IV.  APHELXIA.

         Revery.

SPEC. 1.  A. SOCORS.
            Absence of Mind
      2.    INTENTA.
            Abstraction of
              Mind.
      3.    OTIOSA.
            Brown-Study.


GEN. V.  PARONIRIA.

     Sleep-disturbance.

SPEC. 1.  P. AMBULANS.
            Sleep-walking.
      2.    LOQUENS.
            Sleep-talking.
      3.    SALAX.
            Night Pollution.


GEN. VI.  MORIA.

         Fatuity.

SPEC. 1.  M. IMBECILLIS.
            Imbecility.
      2.    D11MENS.
            Irrationality.
ORD. II.  iESTHETICA.

  AFFECTING THE SENSATION.

GEN. I.  PAROPSIS.

       Morbid-Sight.
SPEC. 1.  P. LUCIFUGA.
            Night-Sight.
      2.    NOCTIFUGA.
            Day-Sight.
      3.    LONGINQUA.
            Long-Sight.
      4.    PROPINQUA.
            Short-Sight.
      5.    LATERALIS.
            Skew-Sight.
      6.    ILLUSORIA.
            False-Sight.
      7.    CALIGO.
            Opake Cornea.
      8.    GLAUCOSIS.
            Humoral Opacity.
      9.    CATARRACTA.
            Cataract.
     10.    SYNIZESIS.
            Closed Pupil.
     11.    AMAUROSIS.
            Drop Serene.
     12.    STRABISMUS.
            Squinting.
GEN. II.  PARACUSIS.

     Morbid Hearing.

SPEC. 1. P.ACRIS.
             Acrid Hearing.
      2.   OBTUSA.
             Hardness of
              Hearing.
      3.   PERVERSA.
            Perverse Hearing.
      4.   DUPLICATA.
             Double Hearing. 
cl. iv.-or. n.]     TABLE OF CLASSIFICATION.     19
SPEC. 5. P. ILLUSORIA.
             Imaginary
               Sounds.
      6.    SURDITAS.
             Deafness.


GEN. III.  PAROSMIS.

      Morbid Smell.

SPEC. 1. P.ACRIS.
             Acrid Smell.
      2.    OBTUSA.
             Obtuse Smell.
      3.    EXPERS.
             Want of Smell.


GEN. IV.  PARAGEUSIS.

      Morbid  Taste.

SPEC. 1. P. ACRIS.
             Acrid Taste.
      2.    OBTUSA.
             Obtuse Taste.
      3.    EXPERS.
              Want of Taste.


GEN. V. PARAPSIS.

      Morbid Touch.

SPEC. 1. P.ACRIS.
             Acrid  Sense of
               Touch or gene-
               ral Feeling.
      2.    EXPERS.
             Insensibility  of
               Touch or gene-
               ral Feeling.
      3.    ILLUSORIA.
             Illusory Sense of
               Touch or gene-
               ral Feeling.
GEN. VI.  NEURALGIA.

        Nerve-ache.

SPEC. 1. N. FACIEI.
             Nerve-ache of the
               Face.
      2.    PEDIS.
             Nerve-ache of the
               Foot.
      3.    MAMMAE.
             Nerve-ache of the
               Breast.


ORD. III.  CINETICA.

   AFFECTING THE MUSCLES.


GEN. I.   ENTASIA.

    Constrictive Spasm.

SPEC. 1. E. PRIAPISMUS.
             Priapism.
      2.    LOX1A.
             Wry Neck.
      3.    RHACHYBIA.
             Muscular Distor-
               tion of the
               Spine.
      4.    ARTICULARIS.
             Muscular Stiff-
              joint.
      5.    SYSTREMMA.
             Cramp.
      6.    TRISMUS.
             Locked-jaw.
      7.    TETANUS.
             Tetanus.
      8.    LYSSA.
             Rabies.  Canine
               Madness.
      9.    ACROTISMUS.
             Suppressed
               Pulse. 
20     TABLE OF CLASSIFICATION.

GEN. II.   CLONUS.

      Clonic Spasm.
[cl. IV.-or. iv.
SPEC. 2.  A. PERTjESA.
             Chronic Wakeful-
              ness.
SPEC. 1.  C. SINGULTUS.
             Hiccough.
      2.    STERNUTA-
                TIO.
             Sneezing.
      3.    PALPITATIO.
             Palpitation.
      4.    NICTITATIO.
             Twinkling of the
              Eye-lids.
      5.    SUBSULTUS.
             Twitching of the
              Tendons.
      6,    PANDICULA-
                TIO.
              Stretching.

GEN. III.  SYNCLONUS.

     Synclonic Spasm.

SPEC. 1.  S. TREMOR.
             Trembling.
2.

3-

4.

5.
CHOREA
 St. Vitus''s Dance
BALLISMUS.
 Shaking Palsy.
RAPHANIA.
 Raphania.
BERIBERIA.
 Barbiers.
ORD. IV.  SYSTATICA.

AFFECTING SEVERAL OR ALL THE
  SENSORIAL  POWERS  SIMULTA-
  NEOUSLY.

GEN. I.  AGRYPNIA.

       Sleeplessness.

SPEC. 1.  A. EXCITATA.
            Irritative  Wake-
GEN. II.  DYSPHORIA.

       Restlessness.

SPEC. 1.  D. SIMPLEX.
            Fidgets.
      2.    ANXIETAS,
            Anxiety.

GEN. III.  ANTIPATHIA.

       Antipathy.

SPEC. 1.  A. SENSILIS.
            SensileAntipathy.
      2.    INSENSILIS.
            Insensile Antipa-
              thy.

GEN. IV.  CEPHALjEA.

        Head-ache.

SPEC. 1.  C. GRAVANS.
            Stupid Head-
              ache.
      2.    INTENSA.
            Chronic Head-
              ache.
      3.    HEMICRANIA.
            Megrim.
      4.    PULSATILIS.
            Throbbing Head-
              ache.
      5.    NAUSEOSA.
            Sick-head-ache.

GEN. V.  DINUS.

        Dizziness.

SPEC. 1.  D. VERTIGO.
            Vertigo. 
cl. iv.-or. iv.]    TABLE OF

GEN. VI.  SYNCOPE.

         Syncope.

SPEC. 1.  S. SIMPLEX.
            Swooning.
      2.    RECURRENS.
            Fainting-fit.

GEN. VII.  SYSPASIA.

     Comatose Spasm.

SPEC. 1.  S. CONVULSIO.
            Convulsion.
      2.    HYSTERIA.
            Hysterics.
      3.    EPILEPSIA.
            Epilepsy.
 CLASSIFICATION.      21

GEN. VIII.  CARUS.

         Torpor.

SPEC. 1.  C. ASPHYXIA.
            Asphyxy.  Sus-
              pended Anima-
              tion.
      2.    ECSTASIS.
            Ecstacy.
      3.    CATALEPSIA.
            Catalepsy.
      4.    LETHARGUS.
            Lethargy.
      5.    APOPLEXIA.
            Apoplexy.
      6.    PARALYSIS.
            Palsy.
CLASS V.   GENETICA.
        DISEASES OF  THE


ORD. I.  CENOTICA.

    AFFECTING THE FLUIDS.

GEN. I.  PARAMENIA.

     Mis-menstruation.

SPEC.l. P. OBSTRUCTIO-
              NS.
            Obstructed Men-
              struation.
      2.    DIFFICILIS.
            Laborious Men-
              struation.
      3.    SUPERFLUA.
            Excessive  Men-
              struation.
SEXUAL FUNCTION.


SPEC. 4. P. ERRORIS.
            Vicarious Men-
              struation.
      5.    CESSATIONS.
            Irregular  cessa-
              tion of the
              Menses.
GEN. II.  LEUCORRHffiA.
         Whites.

SPEC. 1. L. COMMUNIS.
            Common  Whites.
      2.    NABOTHI.
            Labour-show. 
22      TABLE OF CLASSIFICATION.     [cl. v.-or. n.
 SPEC. 3. L. SENESCEN-
               TIUM.
             Whites of ad-
               vanced Life.

 GEN. III.  BLENORRHCEA.

        Gonorrhoea.

 SPEC. 1. B. SIMPLEX.
             Simple urethral
               Running.
       2.    LUODES.
             Clap.
       3.    CHRONICA.
             Gleet.

 GEN. IV.  SPERMORRHffiA

       Seminal Flux.

 SPEC. 1. S. ENTONICA.
             Entonic Seminal
               Flux.
       2.    ATONICA.
             Atonic Seminal
               Flux.

 GEN. V. GALACTIA.

       Mislactation.

SPEC. 1. G. PREMATURA.
             Premature Milk-
               Flow.
      2.    DEFECTIVA.
             Deficient Milk-
               Flow.
      3.    DEPRAVATA.
             Depraved Milk-
               Flow.
       4.    ERRATICA.
             Erratic Milk-
               Flow.
      5.    VIRORUM.
             Milk-Flow in
               Males.
ORD. II.  ORGASTICA.

    AFFECTING THE ORGASM.

GEN. I.  CHLOROSIS.

      Green-Sickness.

SPEC. 1.  C. ENTONICA.
            Entonic Green-
              Sickness.
      2.    ATONICA.
            Atonic  Green-
              Sickness.

GEN. II.   PRffiOTIA.

     Genital Precocity.

SPEC. 1.  P. MASCULINA.
            Male Precocity.
      2.    FEMININA.
            FemalePrecocity.
GEN. III.
LAGNESIS.

Lust.
SPEC. 1. L. SALACITAS.
             Salacity.
      2.   FUROR.
             Lascivious Mad-
              ness.

GEN. IV.  AGENESIA.

      Male Sterility.

SPEC. 1. A. IMPOTENS.
             Male  Impotency.
      2.   DYSPERMIA.
             Seminal Mis-
              emission.
      3.   1NCONGRUA.
             Copulativeln con-
              gruity. 
cl. v.-or. in.]    TABLE OF CLASSIFICATION.
23
GEN. V.  APHORIA.


   Female Sterility.   Bar-
     renness.

SPEC. L  A. IMPOTENS.
             Barrenness of
               Impotency.
      2.    PARAMENICA.
             Barrenness of
               Mis-menstrua-
               tion.
      3.    IMPERCITA.
             Barrenness of
               Irrespondence
      4.    INCONGRUA.
             Barrenness of
               Incongruity.


GEN. VI.  jEDOPTOSIS.
     Genital Prolapse.

SPEC. 1. A. UTERI.
             Falling down of
               the Womb.
      2.    VAGINAE.
             Prolapse of the
               Vagina.
      3.    VESICAE.
             Prolapse of the
               Bladder.
      4.    COMPLICATA.
             Complicated Ge-
               nital Prolapse.
      5.    POLYPOSA.
             Genital Excres-
               cence.
ORD. III.  CARPOTICA.
AFFECTING THE IMPREGNATION. I
|GEN. I.  PARACYESIS.

    Morbid Pregnancy.

  PEC. I.  P. IRRITATIVA.
             Constitutional
               derangement
               of Pregnancy.
       2.    UTERINA.
             Local derange-
               ment of Preg-
               nancy.
       3.    ABORTUS.
             Abortion.

  EN. II.  PARODYNIA.

      Morbid Labour.
SPEC. 1.  P. ATONICA.
             Atonic Labour.
      2.    IMPLASTICA.
             UnpliantLabour.
      3.    SYMPATHETI-
               CA.
             Complicated La-
               bour,
      4.    PERVERSA.
             Preternatural
               Presentation.
      5.    AMORPHICA.
             Impracticable
               Labour.
      6.    PLURALIS.
             Multipli'cate La-
               bour.
      7.    SECUNDARIA.
             Sequential La-
               bour.

GEN. III.   ECCYESIS.

  Extra-uterine Fetation.

SPEC. 1.  E. OVARIA.
             Ovarian Exfeta-
               tion. 
24      TABLE OF CLASSIFICATION.   [cl. v.-or. m.

                         GEN. IV.  PSEUDOCYESIS.

                            Spurious Pregnancy.
SPEC. 2.  E. TUBALIS.
            Tubal Exfeta-
              tion.
      3.    ABDOM1NA-
              LIS.
            Abdominal Exfe
              tation.
SPEC. 1. P. MOLARIS.
            Mole.
      2.   INANIS.
            False Conception.
CLASS VI.   ECCRITICA.
DISEASES OF THE EXCERNENT FUNCTION.
ORD. I.  MESOTICA.


  AFFECTING THE PARENCHYMA.


GEN. L  POLYSARCHIA.

       Corpulency.


SPEC. 1.  P. ADIPOSA.
            Obesity.



GEN. II.  EMPHYMA.


         Tumour.

SPEC. 1.  E. SARCOMA.
            Sarcomatous
              Tumour.
      2.   ENCYSTIS.
            Encysted Tu-
              mour.
      3.   EXOSTOSIS.
            Bony Tumour.
GEN. III.  PAROSTIA.

     Mis-ossification.

SPEC. 1. P. FRAGILIS.
            Fragility of the
              Bones.
      2.    FLEXILIS.
            Flexility of the
              Bones.

GEN. IV.  CYRTOSIS.

 Contortion of the Bones.

SPEC. 1. C. RHACHIA.
            Rickets.
      2.    CRETINISMUS.
            Cretinism.

GEN. V.  OSTHEXIA.

        Osthexy.

SPEC. 1. O. INFARCIENS.
            Parenchymatous
              Osthexy. 
cl. vi.-or. h.]     TABLE OF CLASSIFICATION.
25
SPEC. 2. O.IMPLEXA.     .SPEC. 2. E. ABDOMINIS.
             Vascular Osthexy.             Tympany.
ORD. II.  CATOTICA.

 AFFECTING INTERNAL SURFACES.

GEN. I.  HYDROPS.

          Dropsy.

SPEC. 1. H. CELLULARIS.
             Cellular Dropsy
      2.    CAPITIS.
             Dropsy of the
               Head.
      3.    SPIN.E.
             Dropsy of the
               Spine.
      4.    THORACIS.
             Dropsy of the
               Chest.
      5.    ABDOMINIS.
             Dropsy of the
               Belly.
       6.    OVARII.
             Dropsy of the
               Ovaries.
       7.    TUBAL1S.
             Dropsy of the
               Fallopian
               Tubes.
       8.    UTERI.
             Dropsy of the
                Womb.
       9.    SCROTI.
             Dropsy of the
               Scrotum.

 GEN. II.  EMPHYSEMA.

  Inflation.   Wind-Dropsy.

 SPEC. 1.  E. CELLULARE.
              Cellular Infla-
               tion.
GEN. HI.  PARURIA.

      Mis-micturition.

  >EC. 1. P. INOPS.
            Destitution of
               TjT%7tCt
      2.   RETENTIONS.
            Stoppage of
               Urine.
      3.   STILLATITIA.
            Strangury.
      4.   MELLITA,
            Saccharine Urine.
               Diabetes.
      5.   INCONTINENS.
             Incontinence of
               Urine.
      6.    INCOCTA.
             Unassimilated
               Urine.
      7.    ERRATICA.
             Erratic Urine.

  EN. IV.  LITHIA.

      Urinary  Calculus.

 SPEC. 1. L. RENALIS.
             Renal Calculus.
      2.    VESICALS.
             Stone in the
               Bladder.

 ORD. HI.  ACROT1CA.

   AFFECTING THE EXTERNAL SUR-
     FACE.

 GEN. I.  EPHIDROSIS.

       Morbid Sweat.

 SPEC. 1.  E. PROFUSA.
              Profuse Sweat. 
26      TABLE  OF CLASSIFICATION.   [cl. vi.-or. hi.

                          GEN.V.  ECPHLYS1S.

                                   Blains.
SPEC. 2.  E. CRUENTA.
            Bloody Sweat.
      3.    PARTIALIS.
            Partial Sweat.
      4.    DISCOLOR.
            Coloured Sweat
      5.    OLENS.
            Scented Sweat.
      6.    ARENOSA.
            Sandy Sweat.
GEN. II.  EXANTHES1S.

     Cutaneous Blush.

SPEC. 1.  E. ROSEOLA.
            Rose-Rash.


GEN. III.  EXORMIA.

     Papulous Skin.

SPEC.l.  E. STROPHULUS.
             Gum-Rash.
      2.    LICHEN.
            Lichenous-Rash
      3.    PRURIGO.
            Pruriginous-
              Rash.
      4.    MILIUM.
            Millet-Rash.


GEN. IV.  LEPIDOSIS.

        Scale-Skin.

SPEC.l.  L. PITYRIASIS.
             Dandriff.
      2.   LEPRIASS.
             Leprosy.
      3.   PSORIASIS.
             Dry-Scall.
      4.   ICTHYIASS.
             Fish-Skin.
SPEC. 1.  E. POMPHOLYX.
             Water-blebs.
      2.    HERPES*
             Tetter.
      3.    RHYPIA.
             Sordid Blain.
      4.    ECZEMA.
             Heat Eruption.


GEN. VI.  ECPYESIS.

      Humid Scall.

    Z. 1.  E. IMPETIGO.
             Running  Scall.
      2.    PORRIGO.t
             Scabby Scall.
      3.    ECTHYMA.
             Papulous Scall.
      4.    SCABIES.
             Itch.

GEN. VII.  MALIS.
!
  Cutaneous Vermination.

SPEC.l.  M. PEDICULI.
             Lousiness.
2.

3.

4.

5.

6.
PUL1CIS.
 Flea-bites.
ACARI.
 Tick-Bite.
FILARLE.
 Guinea Worm.
CESTRI.
 Gad-fly Bite.
GORDII.
 Hair Worm.
* y Shingles. 3 Ring-worm.
t Q Scalled-head. 
cl. ti.-or. in.]   TABLE OF CLASSIFICATION.    27
GEN. VII	I. ECPHYMA.	SPEC	6.	T. ATHRIX. Baldness.
Cutaneous Excrescence.			7.	AREA. Areated Hair.
			8.	DECOLOR.
SPEC. 1.	E. CARUNCULA. Caruncle.			Miscoloured Hair.
2.	VERRUCA. Wart.		9.	SENSIT1VA. Sensitive Hair.
3.	CLAVUS.			
4.	Corn. CALLUS. Callus.	GEN.	X.	EPICHROS1S.
			Macular-Skin.	
GEN. IX.	TRICHOSIS.	SPEC	. 1.	E. LEUCASMUS. Veal-Skin.
Morbid Hair.			2.	SPILUS.
				Mole.
SPEC. 1.	T. SETOSA. Bristly Hair.		3.	LENTICULA. Freckles.
2.	PLICA. Matted Hair.		4.	EPHELIS. Sun-burn.
3.	HIRSUTIES. Extraneous Hair.		5.	AURIGO. Orange-Skin.
4.	DSTRIX. Forky Hair.		6.	PCECILIA. Pye-balled-Skin
5.	POLIOSIS. Grey Hairs.		7.	ALPHOSIS. Albino-Skin.
 
 
TEXT   BOOK.
                 FIRST  CLASS.

                CCEL.IACA.

      DISEASES OF THE DIGESTIVE FUNCTIONS.

  I.  The digestive functions  comprehend masti-
cation, deglutition, chymification and  chylification.
Subservient to these are the secretory functions of
the mucous membrane and mucous glands of the
alimentary canal, and those of  the liver and pan-
creas ; probably also some function of the spleen;
and the muscular action of the stomach and intes-
tines.  Connected with them are the appetite for
food and drink,  and the function of absorption by
the lacteals, and that of excretion by the large in-
testines.   A difficulty in either of these functions
is productive of disorder in the digestive functions
more or less extensively.
  II. How far the diseases of  the digestive func-
tions are original in the  organs performing them
has been in some measure  considered.  The most
grave diseases, to which  those organs are liable,
are certainly referrible to disease in the vascular
system, as the  primary  morbid  affection.   And 
30
CffiLIACA.
[CL. I.-OR. I.
 probably many of the less  grave diseases of  the
 same organs may be referred to the same origin.
   III.  The first class is divided  into two orders,
 Enterica  and Splanchnica.   Order I. Enteric a.—
 *' Disquiet or diseased action in some part of  the
 passage for the  reception  and detrition of  the
 food."  Genus  I. Odontia.—" Pain  or  derange-
 ment of the  teeth  or their sockets."   Species 1.
 O. Dentitionis. " Irritation from cutting the teeth."
 The diseases, which arise in infancy  and occasion-
 ally at  other  periods, may be noticed  under this
 species.
   IV. The process of dentition,  which  properly
 belongs to the formative functions,  is not necessa-
 rily  productive of disease.   But  there  is scarcely
 any  natural process, which  gives occasion  to dis-
 ease in  so  many individuals  as this; sometimes in
 advanced life, but oftener in infancy.   The dispo-
 sition to  disease  from this  cause, is not equally
 great in all individuals.  The diseases  produced
 by it occur more frequently in summer and autumn,
 than at other seasons ; they  are influenced by diet
 and  regimen; and they are  manifested  in the de-
 rangement of various functions.
  V. The morbid affections  most frequently pro-
 duced  by dentition are  pain, an  eruption in the
 mouth terminating in  little circular  ulcers, (ulcus-
cula  oris,) cough, vomiting, diarrhoea, cholera  in-
fantum, febrile  affections, eruptions on the skin
and especially on the  face and behind  the ears, 
cl. i.-or. i.]    DIGESTIVE FUNCTION.
31
 stupor and convulsions.  Some of these affections
 are perhaps produced or aggravated  through the
 medium  of indigestion, which  is  very often  the
 primary morbid effect of dentition.
   VI.  Indigestion will occasion vomiting and diarr-
 hoea.   The irritation  from dentition  may  alone
 cause inflammation in the mucous membrane of the
 stomach and small  intestines, constituting the  dis-
 ease known among us by the name of Cholera In-
fantum.   But this will be promoted by indigestion
 and by vicissitudes of weather,  if the influence of
 these be not necessary to  its production.   That
 improper food has an  influence, is shown by the
 effect of  weaning at an improper age or season.
   VII. The principal  indications  are to relieve
 the parts over the protruding teeth by incision; to
 remove any burden or offending matters from  the
 alimentary  canal; to relieve any extensive irrita-
 tion by a mild  but extensive counter-irritation,  or
 by narcotics ;  perhaps, sometimes, to diminish  the
 force of vascular action, or to remove local deter-
 minations of blood, by  leeches;  and to remove
 particular local affections, as those of the mouth
 and skin, by  local remedies.  To these may be
 added an  attention to diet  and regimen, with a
 view both to  cure  present  evils and  to prevent
 their recurrence.
   VIII.  Genus  II.   Ptyalismus.   " Involuntary
 flow of saliva from  the mouth."   Without regard-
 ing the species of  this genus, it may be remarked, 
32
CffiLIACA.
[CL. I.-OR. I.
that it is produced by irritation  and inflammation
of the parts within the  mouth;  by affections of
the stomach, and perhaps of other abdominal vis-
cera ;  and by debility.
  IX.  Genus III.   Dysphagia.  " Pain or difficul-
ty of swallowing, without inflammation, and mostly
without  impeded respiration."  This  arises from
stricture and from tumours, and then requires sur-
gical assistance for  the most part; also from affec-
tions of  the stomach  and other causes producing
spasm in the oesophagus, when it is to  be  obviated
by  removing its  cause,  or  by opiates; and  from
affections of the larynx.
   X.  Genus IV.  Dipsosis.   " The  desire  for
drinking excessive or impaired."  The desire for
drink  varies much  from habit and from  constitu-
tional  differences.   This desire is increased in most
instances of  fever,  and  in the  constitutional  affec-
tions  attendant  on inflammation or  other  local
irritations;  especially when the alimentary canal
is the  seat of these affections.  Also  in  diabetes.
It sometimes appears  to be  an idiopathic affection ;
but probably it appears so  only where the original
affection is  peculiarly obscure.  The entire absence
of thirst is  an extremely rare occurrence.
   XI. Genus  V.  Limosis.   "The  appetite for
food  impaired, excessive, or depraved."   Species
 1.  L. Avens.  " Insatiable  craving for food.   Ca-
 nine  appetite."  This  is commonly  a symptom ;
 and when it appears to be  an idiopathic disease, it 
cl. i.-or. i.]      DIGESTIVE FUNCTION.         33
is probable that it is owing to some hidden prima-
ry affection.   The  causes  of this symptom  are,
first, organic  affections of the stomach, or of  oth-
er organs concerned in the  functions  of  assimila-
tion, where these affections arc  such as not lo de-
stroy the  appetite; second, habits  of gluttony;
third, previous exhaustion; fourth, possibly some
peculiar state of the nervous system.  The indi-
cation is to obviate or remove the proximate cause ;
and  the  methods  must vary accordingly.   In the
first  case this indication cannot commonly, if ever,
be fulfilled.   In the  second self-restraint,  labour
and  occupation, with perhaps occasional nauseating
medicines, may  be prescribed.  In the third, the
appetite may be indulged, at  first moderately, but
afterwards to a considerable extent, not only  with
safety,  but with advantage.   In the fourth, nearly
the  same methods as in  the  second  case  must be
resorted to, aided however  by tonic medicines.
   XII.  Species 2.   L. Expers.   " Loss or want of
appetite, without  any other apparent affection of
the  stomach."  The loss of  appetite occurs as a
symptom in almost all acute and  in  many chronic
diseases.  It  may also no doubt occur under great
exhaustion from fatigue and fasting; in consequence
of  a whimsical  abstinence  from food;  or from
grief, anxiety, and other depressing passions.  It  is
sometimes obstinate;  but may be relieved by re-
moving  the acrimonious  secretions which are col-
lected in the  alimentary canal,  by stimulants and
                    5 
34               CCELIACA.            [cl. i-o*. i.

tonics, by stimulating the  skin in different modes,
and by exercise, at first gentle, but  regularly in-
creased,  with amusement  and cheerful occupation
of the mind.
  XIII.  Species 3.   L. Pica.  4. L.  Cardialgia.
5.  L. Flatus, and (5. L. Emesis, are almost always
if not always symptomatic; and may be considered
under the next species, of which  particularly they
often constitute  very distressing symptoms.  Spe-
cies  7. L.  Dyspepsia.   "The  appetite  fastidious
and the food digested  with difficulty."  This  also
is a secondary, or symptomatic affection in many
instances, and most especially in  chronic  diseases.
But  it is  also sometimes strictly primary.   Its prox-
imate cause is the want of vital  power in the diges-
tive organs,  with more  or less of disorder in the se-
cretions of the stomach, or organs allied to it. Dys-
pepsy may be occasioned by various remote causes;
but these may be comprehended  under first, such
as have exhausted the power of  the  digestive or-
gans; and second, such as have prevented its  pro-
duction,  or development.   The symptoms of  dys-
pepsy  are   much  varied by  different  modes of
management.   It  may  be constantly aggravated
and its symptoms rendered distressing by the  con-
tinued  influence of its  remote causes.
  XIV.  The  principal symptoms which  occur in
dyspepsy, are foulness of the tongue and  bad taste
in the mouth; impaired, voracious,  or capricious
appetite; sense of oppression experienced  in the 
ol.i.-or. i.]      DIGESTIVE FUNCTION.         35

breast,  epigastrium  or  hypochondria;   nausea,
eructations, and vomiting;  heart-burn; flatus and
pain in  bowels; constipation and  diarrhoea,  olten
alternating;  emaciation;  pulse  feeble;  dryness,
and coldness of the skin; vertigo  and head ache;
many vicarious pains;  and diminution of strength
in body and mind.  All  these  symptoms are  not
to be found in  every case; which may be explain-
ed by  reference to the  duration  and violence of
the disease, to the extent of the primary affection
in the digestive organs,  to  the  diet  and regimen
adopted, and to the peculiarities of constitution in
different subjects.  In  those  who have  used sti-
muli freely, habitually foul secretions prevail, with
their consequences; and this  even under  a regu-
lated diet.  In those, whose powers have not been
well  developed, there is  a great sense of  weak-
ness and  faintness, when empty, with violent dis-
tress often on taking food, but  without  foul  se-
cretions.   In persons  of  sedentary habits, this dis-
 ease is  often  preceded  by habitual  constipation.
 Sometimes inflammation of a  low kind  is superin-
duced in the stomach.
   XV. In the treatment  of this disease we have,
 first,  to  remove  offensive matters  from the  ali-
 mentary canal by vomiting, or purging,  or both;
 second, to regulate  the diet  as  to quantity and
 quality; third, to promote regular alvine  dischar-
 ges;  fourth, to remove any inflammatory or orga-
 nic changes, which may  have  been induced; fifth, 
 86                COELIACA.            [cl. i.-or. t.
 to promote the more vigorous performance of the
 organic  functions and  especially those  of the di-
 gestive functions, by medicinal tonics, by stimulants
 applied  to the  skin,  by  muscular exercise  in a
 pure air, and by amusement of the mind.  When
 dyspepsy is secondary, the same treatment is to be
 combined, as far as circumstances permit, with that
 which is  appropriate to the primary disease.
   XVI.  Genus VI.  Colica.  " Griping pain in the
 bowels, chiefly about the navel, with vomiting and
 costivcncss."   Of  this genus Dr.  Good  has  six
 species, which he says  constitute a natural family,
 or tribe.   But in truth their resemblance  to  each
 other arises only from having one common feature
 and  not from having  a common  origin.  Griping
 pain in the bowels  is a symptom  attending various
 morbid affections of the alimentary canal.  It  most
 commonly, if not always, arises from a difficulty in
 carrying forward by the peristaltic motion the con-
 tents of the intestines; and  this difficulty  may  be
 traced to various causes,  of which  the  following
 are the most frequent, viz. the quantity of those
 contents; their quality, as being crude or peculiar-
 ly acrimonious;  a  loss of  power,  or  paralysis  of
 some part of the intestinal  canal; an inflammation
 of some  of the textures of that canal,  especially
 when affecting a complete ring in any part;  vas-
 cular congestion  in  the coats  of the  canal;  me-
 chanical  obstacles, such as calculi within the canal,
 intussusception,  hernia, or  stricture of the intes-
tines; and two or more of these combined. 
et.i-on.i.]       DIGESTIVE FUNCTION.       37

  XVII. In the treatment of colic the great object
is, in all cases, to promote tl.c effectual evacuation
of the intestinal contents.   To this  end the cause
of difficulty  must  be ascertained,  and remedies
should be employed to alter the state of the canal
itself, or to excite it to perform its functions more
vigorously, or both,  as the  case  may require.   If
the colic be habitual, or frequently repeated,  the
cause  will almost always  be found in some organic
affection of  the abdominal viscera ;  and the inter-
vals of the attacks must  be occupied in  the remo-
val of such  affection,  if that  be  possible, and in
guarding against  the exciting causes,  which  may
occasion  the fits of the disease.
  XVIU. Genus  VII.   Coprostasis.  "Obstinate
retention of the fa?ces  in the intestines."  Costive-
ness may be regarded  as occasional or habitual.   It
may  be  the  primary difficulty, giving  rise to va-
rious  secondary  affections;  or it may itself be
symptomatic.   It is when habitunl that coslivcncss
requires the most serious attention.  It may origi-
nate in improper diet,so that the large intestines are
not duly stimulated; or in a failure of those intes-
tines  to  obey  the  proper stimulus ;  or in some
mechanical obstacle to  their efforts ;  or in a defi-
ciency in the secretions which are in health mixed
with the feces.   The remedies in every case must
be adapted  to the cause.
  XIX.  Genus  VIII.   Diarrhcza.  "The alvine
evacuations crude, loose  and  too frequent; with 
 38               CC2LIACA.            [cl. i.-or. i

 little or no griping or tenesmus."   The  fecal mat-
 ter, when discharged from  the small  intestines, is
 liquid.  If from any cause  this be hurried through
 the large intestines,  diarrhoea will be  produced.
 This may  happen, first, when  the materials dis-
 charged  by the small intestines are proper, or, se-
 cond, when otherwise ;  and the discharges will be
 varied accordingly.  But in the first case the cause
 of disease must exist in  the large intestines; in the
 last, it must exist, in  part  at least, in  the upper
 part of the alimentary  canal.  It may exist in the
 stomach, small intestines,  or liver; and probably
 also in 1 he pancreas.
   XX. Diarrhoea may be produced by some  mate-
 rial  received  into  the  stomach ; commonly by a
 material  which is  indigestible ;  but sometimes by
 one  which  the healthy stomach can digest,  but
 which a feeble or unsound   one  has not digested.
 The disease may also be  produced by copious or
 morbid secretions  poured  into the intestines.   It
 may be produced by any cause which  renders the
 intestinal  canal  unusually  irritable, although  no
 unusual stimulus be applied.  In diarrhoea the in-
 testines often fail to evacuate with sufficient free-
dom their fecal or other contents.
  XXI. In the treatment of diarrhoea, we have to
follow one  or  more of the following indications,
according to the cause,  which produces  it.  First,
to evacuate offensive materials from the alimenta-
ry canal;  second,  to  remove  any inflammation 
cl. i.-or. i.]      DIGESTIVE  FUNCTION.        39

which may exist; third, to lessen any undue irri-
tability; fourth, to guard against the introduction
of new causes of irritation  into  the  canal ; fifth,
to check any excessive secretions, which may have
become habitual; sixth, to  restore the  tone, or
vigour of  organs  which  have been debilitated.
   XXII. Genus IX.   Cholera.  " Anxiety,gripings,
spasms in  the  legs and arms; with vomiting and
purging;  or flatulent  eructations  and dejections."
The presence of spasms in  the extremities is  not,
in our climate certainly, regarded as  essential to
this disease; nor should we  denominate  a disease
cholera, in which flatus only should be discharged
from  the alimentary canal.   Yet this may no doubt
happen where the real proximate  cause is  the
same in kind, though more  severe, or extending
over a larger surface  than in common cholera.
   XXIII.  Cholera, like most  of the  diseases of
the abdominal viscera, belongs to hot climates and
to the hot season of the year.  Its most  common
remote causes, are exposure to  great  heat and to
vicissitudes of  weather, and  acrid substances  re-
ceived into the  stomach.   But  to  these, others
may be added, and among them is some unknown
cause, of  very  peculiar force, operating extensive-
ly and rendering  the  disease  epidemic at  certain
periods and places.  It has commonly been regard-
ed as the  consequence of  some  hepatic  affection.
It may no doubt  arise from such an affection;  but
probably  the  liver is in  most instances  affected 
40                CCELIACA.           [cl. i.-or. i.

secondarily, and a copious  secretion from  this or-
gan is mure frequently  salutary than  otherwise.
The proximate cause  of cholera seems  always to
consist in an  unusual  excitement of the stomach
and duodenum ; in which the  mucous  membrane
of those organs is acted  upon by a  very powerful
stimulus, or  is  itself rendered  very irritable and
pretcrnaturally  sensible  by  inflammation.   This
last appears  to  be the  case  in  the most violent
forms of the disease.   The inflammation is proba-
bly often accompanied by  great congestion in, or
determination of blood to the neighbouring viscera;
and is rather violent  in its character than lasting
in its duration.  In hot  climates the disease often
terminates fatally in from twelve to forty-eight
hours.
   XXIV.  In the treatment  of cholera, regard must
be had  to  the  severity  of the disease.  One or
more  of the following intentions are  to be adopt-
ed, according to the severity and circumstances of
the disease, viz.  first,  to remove  any offensive
matter from  the stomach,  or duodenum;  second,
to lessen the stimulant,  or acrimonious  quality of
matters not  removed;  third, to diminish the ir-
ritability  of  the stomach and  of the system;
fourth,  to  lessen  the determination of blood to
the gastric viscera.
   XXV.  Genus  X.   Enterolilhus.  " Stony  con-
cretions in  the stomach or  intestinal  canal."  The
occurrence of such concretions is undoubted, though 
cl. i.-or. i.]     DIGESTIVE  FUNCTION.        41
happily it is  rare.  It cannot be  ascertained ex-
cept by the discharge of a portion of them.   The
indications must then be sufficiently obvious, though
it may be difficult to fulfil them.
  XXVI. Genus  XI.  Helminthia.  " Worms  or
larves of insects inhabiting the stomach or intes-
tines."   This definition and that of the preceding
genus are  very  liable  to objection;  since  they
each mention something internal, and not the phe-
nomena by which that something may be known
to exist.   It  may also be objected against the last
of them at least, that  though worms  are a cause
of disease, they cannot strictly be  called a disease.
There are not any symptoms, which show unequi-
vocally the existence of  worms  in the  alimentary
canal.   It  is  not uncommon to find  them  in the
alvine discharges from persons, who  have not ex-
hibited any  marks of ill-health.   They are dis-
charged in various diseases,  even in those which
are occasioned by accidental injuries.   The symp-
toms, which are produced by them, consist in those
which  mark irritation in the alimentary canal, or
sympathetic  affections of other parts of the body.
The treatment consists in  the expulsion or in  the
destruction  of them.   The first may often  be
done by any purgatives,  in persons who are  dis-
eased  otherwise; but requires  drastic purgatives
in healthy subjects.  The second  is not easily  ef-
fected, yet is sometimes  done by substances, which 
42              CCELIACA.             [cl. i.-or. ii.
are poisonous to the worms, but not so to the hu-
man subject.
   XXVII. Genus XII.   Proctica.  « Pain or de-
rangement about the anus, without primary inflam-
mation."  The diseases of this genus are extreme-
ly distressing; but, when  primary, call  mostly for
surgical  aid.  They  are  found  as symptoms, or
accompaniments  of  other diseases.   They  arise
from local irritation,  or from  change of structure
in the  rectum; from an imperfect or a laborious
performance of the  functions  of this  bowel; or
from sympathy of the  same with other  parts of
the alimentary canal, with the  urinary organs, or
with the uterus.  The treatment must have refer-
ence to the  cause in each  case respectively.
   XXVIII.   Order II. of the first class, Splanch-
nica.   " Affecting the collatitious viscera."  Genus
I.  Icterus.   " Yellowness of the eyes  and  skin;
white feces; urine saffron-coloured, and communi-
cating  a  saffron  dye ; the  course of the  bile ob-
structed."   The last  circumstance, being an infer-
ence, does not seem  to  belong  to  the description
of the disease.   Some of the symptoms  of icterus,
but not all  of them, can exist without it.   The
obstruction  may be  occasioned  by various causes,
of which some are easily removed by spontaneous
efforts  or medicinal aid,  while others are nearly or
quite  insuperable.  Though some, or all of these
causes  are known to us,  it  is not possible always to 
cl. i.-or. ii.]       DIGESTIVE FUNCTION.
43
distinguish them in the living subject, and hence a
difficulty in the adaptation of remedies.
  XXIX.  Among those causes which  are easily
removed, we  may place viscidity of the bile, gall
stones, spasms in the common duct, and temporary
turgescence of the same, or of the mucous mem-
brane  of the  duodenum at its  mouth.  Among
those  which are nearly or quite  incurable, the
most important is inflammation actually closing the
common duct by adhesion;  the same inflammation
commonly  extending  to the   surrounding parts.
Pressure from the induration of surrounding parts
may perhaps have a place among the same.  Par-
tial obstruction to the  flow  of  bile in  its natural
channels may be produced by  organic  diseases of
the liver.
  XXX. The indications must  be as uncertain as
our knowledge of  the causes of obstruction in this
disease.  As,  however,  the  causes in  the  great
majority of instances are of the  first class, the in-
dications will be furnished by a  consideration of
these.   Hence we are led to use remedies, which
acting powerfully on the stomach and bowels may
by  mechanical  operation or  otherwise, promote
the evacuation of  the common duct; such as may
overcome  spasm  in  the same;  and such as will
remove vascular turgescence.
   XXXI.  Genus  II.  Melazna.  "The colour of
the eyes and  skin yellow-green,  fuliginous, leaden
 or  livid;  the  dejections pale, occasionally dark 
 *4               CCELIACA.            [cl. i.-or. ii.
 coloured; anxiety; depression of spirits."  Of this
 genus Dr. Good has two species, J\l. Cholcea and
 M.  Cruenta.   It  is  however  obvious,  that  the
 symptoms by which  this  affection  is  marked do
 not  belong to  one  or  two  specific  affections, but
 rather to various diseases, and these often extend-
 ing  to different  organs.   The  alimentary canal is
 as often,  if not  oftener, the seat of  these  affec-
 tions, as the  collatitious viscera; so that  this  genus
 might claim  a place in the first order of this class
 as rightfully as in  the second.  Various organic
 diseases,  as  well as occasional  inflammations, or
 other vascular affections of the abdominal  viscera,
 induce melaena ;  and the  organic  affections  occa-
 sion repeated attacks of it, which at length destroy
 life.    These remarks, apply  to both  species of
 melaena ;  but it may be said of  the second species
 that the blood is rarely, if ever, derived from the
 collatitious viscera.
  XXXII. In  the  treatment of  both  species of
 this  disease, the first indication  is to remove the
 offensive materials  lodged in the intestinal canal;
 for which  powerful and  repeated purgatives are
 often required.   Debility sometimes appears  to
 forbid  this practice;  but,  unless when  extreme,
 this  debility need not be regarded.  The  second
 indication is to divert the blood frcm the  abdomi-
nal viscera.  The third must relate to the organic
disease, if  there be  any such.  And  the  last  is to
restore and niaintain the tone of the parts, which 
cl. i.-or. ii.]      DIGESTIVE FUNCTION.        45

have been  diseased.  These  indications, the third
especially,  cannot always be  fulfilled;  and, when
that appears obvious, palliatives  must be resort-
ed to.
   XXXIII. Genus III.   Chololithus.  "Pain about
the region  of the  liver, catenating with  pain at
the pit of the stomach;  the pulse  unchanged;
sickness; dyspepsy; inactivity;  bilious  concretion
in the gall-bladder or bile ducts."   The formation
of calculi from stagnant bile is not, perhaps, a very
rare occurrence.   When lodged  in the common
bile duct they occasion jaundice  as  already shown.
When this is not produced, it is not very  easy to
ascertain the existence of such calculi, unless while
they are passing through the bile ducts in persons,
who have  previously had jaundice from the same
cause.   In  some instances, however,  we  can be
sufficiently satisfied, where the gall-stone occasions
well marked pain  in its passage,  without either
attending or preceding  icterus.   The  Chololithus
quiescens, however, is hardly to be recognized with
confidence, when  affecting one  who has not had
jaundice. In the treatment of the  C. means, the pain
may be relieved by opiates; and  afterwards purga-
tives, or even emetics may be  required to promote
the passage of the stone into  the  intestines.   It is
more important to  obviate the  remote  causes of
the disease in both species; and for this purpose
errors in diet and regimen must  be corrected.
   XXXIV. Genus IV.   Parabysma.  " Knotty or
unequal  intumescence of the abdomen from an 
46
C02LIACA.
[cl. i.-or. h.
indurated enlargement of one or more of the vis-
cera contributory  to  the digestive  function; de-
rangement of the general  health."   Under  this
genus are included various organic diseases; not
only those of several organs, but also those of dif-
ferent kinds.   The abdominal viscera may be en-
larged by inflammation,  hydatids, tubercles and
tubera.   In practice it is not easy to distinguish,
especially at a late stage of disease, some cases  of
enlargement  in  the  kidneys, ovaries and  womb
from those of enlarged mesenteric glands, nor  per-
haps from some other species of parabysma. The
difficulty of diagnosis in  diseases of this genus  is
often increased by the occurrence of dropsy in the
abdomen.  It may be added  that, generally, the
prognosis in these  diseases is  to  be formed from
attending to  the constitutional effects more than
from an exact diagnosis.
  XXXV. Parabysma may be traced  to a variety
of remote causes; such as constitutional predispo-
sition,  food of bad  quality, intemperance  in the
use of spirituous liquors, and marsh-miasmata.   In
some cases, however, it is not easy to assign any re-
mote cause for diseases of this genus.   The indica-
tions of treatment  are to promote the absorption of
the matter deposited, and to restore the tone of the
injured organs.  The chance, however, of success
in fulfilling these indications,  is not such as to jus-
tify the use of  the  most powerful medicines, un-
less where the disease evidently consists in chro-
nic  inflammation, 
47
                SECOND  CLASS.

             PNEUMATICA.

     DISEASES OF THE RESPIRATORY FUNCTION.

  XXXVI. This class is divided into two orders,
Phonica  and  Pneumonica.   Order  I.   Phonica.
" Affecting the vocal avenues." Not to be noticed
in this work.  Order II.   Pneumonica.   "Affect-
ing the lungs, their membranes, or  motive power."
It may be doubted whether the affections enume-
rated under  this  order,  most of  them  at  least,
would not find a place more properly in a table of
symptoms than in one of diseases.
  XXXVII.  Genus I.   Bex.  " Sonorous and vio-
lent expulsion of air from the lungs."  In this ex-
pulsion, the air may be  made to bear on different
portions of the trachea  and perhaps of the  bron-
chial vessels, according to the  seat  of  irritation.
This is one source of the  variety in  coughs.  But
there are other sources of that variety.  Coughs
differ according as the  motions of the  organs of
respiration are impeded or not; according to the
more or less  free  admission of air to every part
of the lungs;  according  to  the presence  or ab-
sence of  matter to be  moved  by  the act, and to 
 4a             PNEUMATICA.         [cl. ii.-or. ii.
 the quantity and quality of  this matter when pre-
 sent.   The use of the action is very obvious,  when
 there is any material to be removed from the air-
 passages.   Its use is  less  obvious, when there is
 not any such  material.  It appears  in such  cases
 to arise from irritation  occurring in some one of
 the organs concerned in respiration,  or from  some
 sympathy of those organs  with other parts.  Only
 the third species will be particularly noticed.
   XXXVIII. Species 3.   Bex Convulsiva.  "The
 cough convulsive and suffocative; accompanied by
 a shrill, reiterated hoop; and frequently with vomit-
 ing ; contagious."  This appears to be a specific dis-
 ease, occurring about a fortnight after exposure to
 contagion.  It does not  ordinarily affect  the  same
 individual  twice.  In its commencement  it is not
 easily distinguished from a catarrhal cough; though
 in some  cases at least it has even then a peculiar
 character.  The cough is  at first short,  and fre-
 quently  repeated ;  seeming to occur from a  very
 sudden irritation, which  produces an instantaneous
 and irresistible effort.   This character is changed
 after a few days;  and at the end of  about a  fort-
 night the cough is found to  be less frequent, and
 in longer spells  or  kinks;  but is still irresistible.
 These kinks, or paroxysms, often terminate in the
 expectoration of simple mucus ;  of  which the se-
 cretion is augmented by  the irritation of coughing.
 They  also often occasion vomiting,  and  bleeding
from the nose.   The violence of the cough  con- 
cl. h.-or. ii.]    RESPIRATORY FUNCTION.       49

tinues to increase, till the end of the fifth or sixth
week; and  then sometimes the disease  subsides
rapidly in the course of ten days;  while, in some
instances, it continues till the end of three months
from its commencement.
   XXXIX.  This disease does not always material-
ly affect  the general health in vigorous subjects ;
yet at the beginning it usually causes some loss of
appetite  and some febrile symptoms.   But it does
not exclude  other diseases ; and it is liable  to be
increased by  every derangement  of the  health,
which occurs during its  continuance.  Thus it is
especially aggravated by the diseases of dentition
and by catarrhal affections;  and it seldom termi-
nates fatally, except in combination with  these or
other diseases.  It is remarkable  also  that  after
this convulsive cough has  subsided, pulmonary  ca-
tarrh, or other  inflammations  of  the  lungs will
occasion a cough  of the  same  character;  and by
the violence of this the pulmonary  inflammation is
often much  increased.
   XL. In the treatment of Bex convulsiva, we are
principally limited to guarding  against the causes,
which  may  aggravate  the  disease.  It  is  very
doubtful,  at  least,  whether any remedies can be
relied on to  shorten its duration, or to diminish its
violence.  Perhaps a short course  of alteratives
at the commencement of the disease is beneficial.
Care in diet,  that  the  digestive organs  may not
become embarrassed; and exercise in  the open air,
                    7 
50
PNEUMATICA.
[CL. 1I.-OR. II.
that the strength may be maintained, and that the
system may not be  made susceptible  to the influ-
ence of  atmospheric vicissitudes ;—these  consti-
tute the most  important  parts of the  treatment
for healthy subjects.  In those, who are tender or
diseased, the treatment must be adapted to cir-
cumstances.  When inflammation of the lungs oc-
curs in conjunction with this disease, the remedies
for inflammation  must  be  employed  as in other
cases ;—only that they should be resorted to more
promptly and employed more  vigorously,  than if
the same inflammation  existed alone.  In protract-
ed cases of this disease, whether simple or com-
bined with other diseases, experience has shown a
peculiar  advantage in  change  of air.  Medicinal
tonics  are  useful under the  same  circumstances,
but their good effects are less unequivocal  than
those of a  change of air.
   XLI. Genus II.  Laryngismus will be most con-
veniently noticed when  treating of croup.  Genus
III.  Dyspn&a.   "Permanent difficulty  of breath-
ing ; with a sense of weight on the chest."  This
affection is  to be regarded as a symptom.   It shows
itself in various diseases; first, in such as affect the
organs of motion employed in respiration ; second,
in such as prevent the admission of the usual quan-
tity of air into  the  lungs, when the chest is duly
expanded.   Among these  last will be included an
unusual fulness of the  blood-vessels  of  the lungs.
This unusual fulness may be  produced in different 
cL.n.-0R.n.]      RESPIRATORY  FUNCTION.     51

modes; and often occurs when there  are  other
permanent causes of dyspnoea.  In this  case there
will ensue an exacerbation of the usual dyspnoea.
The dyspnoea may thus  become so great as  to de-
troy life ; but ordinarily the exacerbation is tempo-
rary,  and subsides upon the equalization of the cir-
culation.  This equalization may be induced by the
very rest from voluntary motion, which the dyspnoea
imposes.  In some instances the obstruction  to the
admission of air  arises from some effusion of blood,
serous fluid, or other material within the thorax. In
these cases, the  patient is often incapable of the re-
cumbent posture, and cannot  be relieved, until the
matter  effused has been in  some way removed.  In
cases of organic diseases of  the  heart  we some-
times find various immediate  causes of dyspnoea
produced; and  by their co-operation  the distress
becomes nearly  or quite  insupportable ; so that at
length the action of the heart is arrested, and death
ensues.   Lastly, the exacerbations may, no  doubt,
be occasioned by spasm  in some of the muscles of
respiration.
   XLII.  In the investigation of the  causes of dys-
pnoea, as  well as of other symptoms  in thoracic
diseases, much may be  learnt  by attending to  the
effects  of position and motion; also  by percussion
and by auscultation, mediate  or immediate.  In
great dyspnoea  voluntary efforts  are made,  by  the
use of the muscles attached to the upper extremi-
ties,  to enlarge   the  thorax; and this especially,
when there is any compression within that  cavity. 
52
PNEUMATICA.
[cl. ii.-or. »•
 For this purpose  the  erect is  preferable  to the
 recumbent position.   If any organ presses  on the
 trachea or its great branches, the position, which
 relieves that pressure, will  be preferred.   If the
 lungs on one side be rendered useless, or nearly so,
 the  position, which  leaves  those on  the opposite
 side most free, must be assumed.  When there is
 compression  of the air-vessels,  especially if the
 heart be diseased, motion by quickening the circu-
 lation will aggravate the dyspnoea.
   XLIII. The  practice of percussion of the tho-
 rax  is founded on  the  following circumstances.
 When the air is admitted fully into the lungs, the
 thorax resounds on percussion like a hollow  cask,
 with the exception of  certain regions.  When the
 air is not permitted to enter any particular  part of
 the lungs, a blow over that  part will produce a flat
 sound,  The extent, over  which  this flat sound is
 perceived,  will determine the extent to which the
 air-vessels are  compressed  or obstructed ; and if
 the compressing cause  be moveable, such as a fluid
 in one of the cavities  of the  pleura,  this may  be
 discovered by attending to the effects of a change
 of position, as regards  the  parts  affording the flat
 sound.
   XLIV. The use of  the  stethoscope is founded
 on the  following  circumstances.   The motion  of
 the air in the lungs, with  all  the  obstacles to the
regular passage of it, is productive of sounds, which
may be  heard  by placing  the ear on  the  chest, 
cl. 11.-0R. ii.]    RESPIRATORY  FUNCTION.      53

So also are the motions  of the  heart capable of
being  ascertained by the ear.   But  these sounds
in the  thorax may be ascertained most convenient-
ly through a cylinder of  wood, or of other mate-
rial; one end  of the instrument being rested on
the chest, and one end being applied to  the ear.
WThen such an instrument is used the auscultation
is mediate; when the ear is applied to the thorax
the auscultation is immediate.   If the instrument
be applied when the patient is speaking, a tremor
is perceived over  healthy  lungs;  but when the
lungs are diseased, or compressed, the changes are
manifested  by  certain  peculiar changes in  the
sounds transmitted through the  instrument,
   XLV. The treatment of dyspnoea must be deter-
mined  by  the cause  producing it.   Where  this
cannot be  ascertained,  certain remedies  must be
resorted to, as palliatives of the symptom, which
may apply to the various causes of  it.   There is
often  a temporary advantage in lessening the quan-
 tity of blood in the  pulmonary vessels. The  dys-
 pnoea  is often aggravated by a load in the stomach.
 Then vomiting gives relief.  Emetics also relieve
 by their effect  on the circulating  system and by
 removing spasmodic affections.   Opium, after eva-
 cuations, will often be found a most valuable auxi-
 liary.   In chronic  dyspnoea, change  of residence,
 with attention to diet and  regimen,  will, in some
 cases, afford the most lasting relief.
   XLV1.  Genus VI.   Asthma.   "Difficulty of 
54
PNEUMATICA.
[cl. ii.-or. ii.
breathing temporary, recurrent; accompanied by
a wheezing sound, and sense of constriction in the
chest; with cough and expectoration."   Asthma
is considered by Dr. Good, as constituting a disease
altogether different from dyspnoea.   Commonly,
however, dyspnoea is employed as a general name
for difficulty of breathing; and, regarded  in  this
light, asthma is a species of dyspnoea.  The pe-
culiarities of that  kind of dyspnoea,  which  is call-
ed asthma, seem  to be  these, viz.  first,  the dys-
pnoea is attended by a wheezing; second, the pa-
tient has not any difficulty in  enlarging the cavity
of the thorax; on the contrary, he does enlarge it
abundantly in inspiration; third, the enlargement
of the thorax does not afford  the patient comfort
and relief, he still wants air;  fourth, the  patient
has  a difficulty in contracting  the  cavity  of the
thorax, not  however connected with any undue
retention of air in  it; fifth, the dyspnoea  is attend-
ed with a cough, and at an early period is aggra-
vated by it; sixth, the cough at first produces an
expectoration of crude  matter,  i. e. frothy  serum,
or simple, adhesive and transparent  mucus, from
which no relief is  obtained;  but  gradually some
opake mucus is discharged,  and in proportion as
this increases, the patient is relieved; seventh, the
disease is divided into fits or  paroxysms, and these
may terminate  in other modes, as well as by ex-
pectoration;  and these other  modes appear to be
such as lessen the blood in the lungs. 
«.. ii.-or. ii.]     RESPIRATORY  FUNCTION.     55

   XLVII. The remote causes of this kind of dvs-
pncea, like those of dyspnoea generally, are various;
and this is especially true, in respect to the excit-
ing causes of the paroxysm  in  persons  subject to
this affection.   But the most  interesting question
is  what is the  proximate cause.   This seems  to
me to consist in a  fulness of the  blood-vessels of
the mucous membrane of the lungs,  extending in
a greater or less degree to the larger blood-vessels
of the same organs.   This  vascular  fulness may
be attended by some  proper  inflammation of  the
sanie  mucous membrane, limited  perhaps to small
portions of its surface ; but the fulness is then in a
much greater proportion than in  ordinary cases of
inflammation.   It may  be true in addition, and in-
deed, seems to  be  so, that the  muscles become
irritated by the extra  labour they are  called to,
and which they are not allowed to remit, until at
length their actions become spasmodic: or, more
definitely, until their actions become  sudden and
violent, instead  of being slow and firm, as in health;
and ultimately  this  mode of action is readily adopt-
ed by them, when even a slight embarrassment of
the respiration is in any way induced.
   XLVII1. These  considerations lead to an ex-
planation  of the two kinds of asthma so general-
ly noticed, the  humoral  and  the spasmodic.   It
will be  found,  perhaps, that  the readiness, with
which the spasmodic affection occurs,  depends on
the original or  acquired constitution of the patient. 
56
PNEUMATICA.
[cl. n.-OR. ii.
In such as are irritable and  feeble the  spasmodic
affection may be most easily induced, and  will be
the predominant circumstance in the disease.
  XLIX. In the treatment of asthma, there is one
leading intention to be adopted.  This  is to take
off, or  remove the vascular  fulness in the  mucous
membrane of the lungs.  When however the dis-
ease has acquired the spasmodic  character,  a  se-
cond intention must also  be  adopted, viz. to over-
come the spasmodic  effort.  The circumstances to
be regarded  and the  methods  to  be  adopted in
fulfilling the first  intention, are  more or less com-
plicated in different cases.   In some rare instances
this intention may be fulfilled by blood-letting.  It
may be fulfilled in  most cases  with  more  safety,
sometimes as suddenly and  more permanently, by
emetics, alteratives,  counter-irritation,   sedatives,
and tonics.   All these remedies may be  found use-
ful, at different  periods, in the same subject.  The
prevention of a return of the  disease is  at least as
important, as the treatment  under the  paroxysm.
This is to be effected by all  those means,  which
give vigour  without  increasing  irritability, and
which  promote regularity in the organic functions.
In addition, it  is necessary that  the patient avoid
all offensive stimulants; and  that the mind be kept
free from anxiety and from agitation.
   L. Genus VI.  Sternalgia.  " Violent pain about
the sternum, extending towards  the arms: anxiety,
difficulty of breathing and  sense of suffocation." 
cl. ii.-or. ii.]     RESPIRATORY FUNCTION.
57
In addition to these essential symptoms, this dis-
ease is often attended with  palpitation of the
heart,  syncope, and  various  irregularities  of the
pulse.   It seldom  appears  in  persons  under fifty
years of age.   It  occurs  in paroxysms, and espe-
cially  while the  patient is walking.   Then he
finds it absolutely necessary to stop,  and  often
to support himself against  a post or wall, to pre-
vent falling.   The disease  is sometimes  suddenly
fatal.   It usually  continues to recur during life;
at first  only on exercise, and subsiding  entirely on
rest; but at length the patient will seldom enjoy
intervals of entire relief;  the paroxysms  will be
induced by slight causes, and will take place even
during  sleep.   In some  instances, however, the
disease subsides spontaneously, or  from  remedies,
leaving the patient free from it  for  several years
before  death.
   LI.  The proximate cause of sternalgia has not
been ascertained.   This  distressing  affection has
been found connected with  various organic diseases
of the heart and the  neighbouring parts ; but those
diseases seem to act  only as remote causes.   This
is true  at least of the disease when occurring only
in paroxysms, Sternalgia ambulantium of Dr. Good,
The S. chronica may perhaps more justly be refer-
red to  some  organic disease, impeding the free
action of the heart.
   LII. In the treatment of this disease, the only
remedy of universal  application during the par-
                   8 
58
PNEUMATICA.
[cl. ii.-or. ii.
oxysms  is rest; and of this the patient is usually
compelled to avail himself.   But, with a  due re-
gard to* general principles,  we may resort some-
times to bleeding, sometimes to emetics, sometimes
to opiates,   In the  intervals we must guard  the
patient  from violent efforts; but in other respects
attend only  to the  establishment of good  general
health.   The diet should be of the least stimulat-
ing kind.  If there  be  an  increasing  tendency to
the paroxysms, and especially if the symptoms con-
tinue in some measure  during  the  intervals, mer-
curials and  counter-irritation on the chest, and a
permanent  drain by seton  or  issue,  may be em-
ployed  with benefit.  Lastly, tonics are useful in
some instances ; at least, in  cases of much debility,
and  in irritable habits, 
59
                 THIRD CLASS.

              HiEMATICA.

     DISEASES  OF  THE SANGUINEOUS FUNCTION.

  LIU. In this class we find Fsome  of the  most
important and most interesting diseases, which oc-
cur in  the human  body.  Among these  are the
febrile diseases, which seem to constitute a natural
tribe, which are  readily enough distinguished in a
general way,  but respecting which, pathologists
have never agreed as to a definition  of their cha*
racter, nor as  to  an  explanation of their nature.
It is principally with a  view to  the  accommoda-
tion of this tribe of diseases, that Dr. Good has
created this class.  It is to be lamented that even
with his extensive learning and nice discrimination)
he  has not been more successful  in overcoming
the difficulties connected with this subject.
  LIV. It will not be  profitable  to  engage fully
in critical animadversions upon errors on a subject,
on  which nothing better is to be found; but some
difficulties must be stated  to prevent misconcep-
tions.  What is  meant by the sanguineous func-
tion?  This  must  be  clearly understood,  and it
must appear that we are  capable of understand- 
60
HiEMATICA.
[CL. III.-OR. I.
 ing distinctly when it is not duly performed in any
 of its parts, before we  can determine what dis-
 eases are  to be arranged in this class.   It would
 seem that all the  operations,  in which  the blood
 is essentially concerned, belong to  the sanguineous
 function.   We might then include  first, the change
 of chyle into blood; second, the circulation of the
 blood ; third, the  use or appropriation of this fluid,
 or any  part of it,  in the  various  functions of for-
 mation ; fourth, the functions by which it is purg-
 ed of materials no longer fitted  for use, or the
 vascular excretory functions.
   LV.  In accordance  with  this view of the sub-
ject, we might rank in  this class  all diseases  in
 which the functions just enumerated are deranged.
But is it not obvious that, if  this plan were adopt-
 ed, we  should include in  this class   a large part  of
 the diseases now distributed  through  the other
classes  of the same system ?  Is it  contended, that
 in diseases included under  other  classes,  though
the sanguineous function  may be  in  fault,  this is
not obvious ; and that a disease of the sanguineous
function is not properly  a symptom in those dis-
eases?  May it not be replied, that the same is true
in respect  to many diseases,  actually  included  in
this class ?  In  truth the  sanguineous function be-
longs  to every  part of  the  body, and  this is the
foundation of the  difficulty in this case.
  LVI. It might indeed  be  urged, that there are
Certain  functions, which belong to the sanguiferous 
cl. iii.-or. i.]    SANGUINEOUS  FUNCTION.
61
system, where it acts independently of other or-
gans.  This  is  true  in  respect to the first and
second of the operations enumerated § LIV. ; but
the diseases included in this  class,  by Dr. Good,
are not confined to those operations, or functions.
Some additional objections must follow immediate-
ly in considering the first order  of this class.
   LVJI.  The third class is divided  into  four or-
ders, viz.  Pyrectica, Phlogotica,  Exanthematica,
and Dysthetica ; in English, fevers, inflammations,
eruptive fevers, and  cachexies.  It is obvious at
once, that, in this arrangement, the plan adopted in
the two  first classes, and  in  some  of the subse-
quent  ones,  is  abandoned.    The  orders in this
class have not any reference  to different organs,
nor to  different functions.  This seems  to betray
the consciousness of the author, that  he had left
the ground, on which he had before stood.  There
would, however, be less objection to this arrange-
ment, if  the  distinctions of the orders and their
characters were perfectly well marked.
   LVIII. Order I.  Pyrectica.  "Heat and num-
ber of the pulse preternaturally augmented: usu-
ally preceded by rigor and  followed by perspira-
tion : during  the rigor,  pains  fixed or wandering:
lassitude : debility of mind and voluntary muscles."
It would be  difficult to give  a  better  description
of fevers in  the same  number of words; but in
truth no  short  description of  fever  is  of  much
practical value ; for the  disease appears  under so 
62
H.EMATICA.
[cl. iii.-or. i.
many and such various characters,  that  it can be
known only by studying its history.  Dr. Good has
made four genera in this order, and has very pro-
perly distinguished them  by their types.
  LIX. Genus  I.   Ephemera.   " One  series of
increase and decrease; with a tendency to exacer-
bation and remission, for the  most  part appearing
twice in twenty-four  hours."*  This is the defini-
nition given in  the " Study of Medicine."  That
which is  given  in  the " Physiological System of
Nosology," is  to be preferred; and is in  the fol-
lowing  words.   "Attack  of  fever sudden; par-
oxysm single,  and terminating in about twenty-four
hours."   The circumstances to be regarded in a
description of fever are very numerous;  they  are
presented under various  combinations;  and  it is
difficult to make any  one  general remark  on the
subject, without adding some  exception or qualifi-
cation.   Patients exhibiting  very different symp-
toms are  acknowledged to have this disease by all
practitioners.    No one has yet succeeded in trac-
ing all  the phenomena  of this disease from any
one  original change in the  state, or functions of the
body.  It will be attempted to pourtray the most
constant and  apparently most important  phenome-
na of fever;  classing them  under general heads,
as far as  may be, in order to  assist the  memory;

  * It would seem that this is  an error, being the same definition after-
wards given to Enecia, the fourth genus of this order. Yet it appears in
the last and  improved edition of the Study of Medicine. 
cl. iii.-or. i.]     SANGUINEOUS FUNCTION.     63

and to point out some of the most common varie-
ties in the combinations of these phenomena.   It
should be added that, while the term fever is ap-
plied loosely, even by medical men,  to  any affec*
tion, in  which there  is heat and acceleration of
pulse, there is one disease, to which no other name
has ever been generally appropriated.   This is
the disease  which is now to be  described, begin-
ning with that  which is the simplest in its type.
   LX. An Ephemera is a fever of one paroxysm.
This paroxysm consists of several distinct stages
in the most  regular cases.   If a good acquaintance
be  formed with the disease  as  thus  presented, it
will furnish  a prototype, to which reference  may
be  advantageously made in the  description of  the
other genera of this  order.   The stages  may be
denominated the access, the cold stage, the hot stage,
and the crisis,
   LXI.  The access consists in an affection of  the
whole system.   It begins with an undefined sense
of uneasiness, and is succeeded in various degrees,
and with some diversity as to order, by the  foU
lowing symptoms, viz.  pain  in the head, loins,  and
limbs; diminished sensibility, and indisposition to
exercise  the powers of the mind, particularly  the
memory  and the  attention; a coat on the  tongue;
bad taste, or dryness in the mouth,  with thirst;
loss of appetite and even disgust for food, espe-
cially for animal food ;  sense of fulness  or uneasi-
ness, or both, about the scrobiculus cordis; nausea, 
64
HjEMATICA.
[cl. III.-OR. I.
sometimes  with vomiting; sense of distention in
the bowels, but without  that of action;  no alvine
dejection, or  only a  scanty one, at the  usual pe-
riod ;  urine diminished and without sediment  after
standing;  skin  cool, and inactive; contraction of
the superficial veins; pulse gradually accelerated,
but diminished in volume ; diminution of the se-
cretions ; muscular strength depressed, and an in-
disposition  to exert it; watchfulness at  the  usual
period of  sleep, or disturbed sleep, or  coma; deli-
rium on waking, and occasionally at other times,
but not preventing  the  proper use of reason for
short  periods, when  roused to it.   The symptoms
of this stage may be said generally to be growing
worse, as long as they continue ; though  this is not
true at every moment, nor as to every particular.
   LXII. The symptoms which have been enume-
rated, do not all of them occur  at  once, nor  all in
every case.  The most violent of them very  rare-
ly occur before the symptoms  of the hot stage
have supervened.   They are, however, enumerat-
ed in connexion with the  others  for reasons to be
stated hereafter.    They present themselves as
marks of  disease in  the whole  system,  and with-
out any such one local  affection, as that they can
be referred to that, as their obvious source.  The
suddenness of their  invasion, the rapidity of  their
course, and the duration of  the access, as a dis-
tinct stage, are very various. 
cl. iii.-or. i.]     SANGUINEOUS  FUNCTION.     65

  LXIII. The access  is succeeded by  the  cold
stage; or more properly  the symptoms of the
access continuing, those of  the cold stage are add-
ed to them.  The symptoms  of this stage  are a
sense of coldness, chilliness, shivering, shuddering
and shaking; a  contraction of the skin  and the
appearance  called  goose-flesh,  or a  smoothness
like that of marble ; an actual reduction of  ten>
perature, though not always  corresponding with
the sensations of the patient;  and an increase of
the  pains  and  other  symptoms  of  the access.
This stage seldom  exceeds two or three hours in
duration.
   LXIV. The hot  stage follows, and  is in some
measure opposed to that which precedes it.   The
more grave symptoms, described  as belonging to
the first stage, may now come on, or if they have
before occurred, they increase.  But the peculiar
symptom of the third stage is heat,  which is va-
rious in its degree,  in  the  suddenness of its  inva-
sion, and in its stedfastness.   With this is common-
ly found a change in the pulse, and in the  aspect
of the skin.  In this stage, likewise,  the increase
of delirium is sometimes  accompanied by violent
muscular exertions; but, except  under  delirium,
the  debility of the  animal system is increased.
Vomiting often occurs in this stage.  The dura-
tion of  this stage  is  ordinarily from two to four
hours;  but k is sometimes much prolonged.
                    9 
66
HiEMATICA.
[cl. iii.-or. i.
  LXV. The fourth  and last stage of a perfect
paroxysm, or ephemera, is the crisis.  This  con-
sists, first,  in the  subsidence  of the  symptoms,
which belong to the access; second, in  the renew-
al of the usual  functions and display of the usual
powers  of the body,  though not  without  some
marks of exhaustion;  and third, in the  occurrence
of some unusual evacuations,  arising perhaps out
of the new circumstances,  in which  the body has
been placed by the disease.   The order, in which
the phenomena of the disease  subside, and  those
of health re-appear, is various.
  LXVI.  There are  two other modes, in which
the hot stage of an ephemera may terminate; but,
though  in these the fever ceases, the paroxysm is
not perfect.  These  modes are hemorrhage and
inflammation.  Both of these often occur in fever,
ancl the fever does not terminate,  but continues
with  them;  but   sometimes they  terminate the
fever, as well when it is of other genera, as when
it is an ephemera.   When either inflammation or
hemorrhage exist without terminating  fever, they
may be regarded as local affections combined with
the fever.  It may be  noted in this connexion, that
congestion in  the  blood-vessels of some  one or
more organs, is another local  affection often com-
bined with fever.  The general symptoms of con-
gestion  are a suppression more  or less entire of
the functions of the part affected, coldness, and a
defect  of  vascular actions.  Either of  these local 
cl. iii.-or. i.]    SANGUINEOUS FUNCTION.      67

affections  will modify the  symptoms and  progress
of fever.   Lastly, with or without these local af-
fections, though  oftenest  with  them, fever often
terminates fatally.
   LXVII. The  symptoms of the access have been
described  as  occurring  separately and  at first,
though they continue, so far as possible,  through-
out the two subsequent  stages of  the paroxysm.
All, which ever occur in the  access alone, being
those which most  distinguish idiopathic fever, are
placed together to make the character of the dis-
ease  appear more distinctly;  although  some of
these symptoms most commonly appear at a later
period.   It is now to  be noted, that the  access
does not  always  occur  distinctly by itself,  but
sometimes in  common  with the cold stage.   It
may likewise happen, that the cold stage is want-
ing.   Then the  hot  stage follows  immediately
upon the access, and may even come on  at  the
same time.  Likewise the hot stage  may  not ap-
 pear distinctly marked; but the  crisis may imme-
 diately follow the cold stage.
   LXVIII. It  is next  to  be noted, that  of the
 symptoms enumerated, as belonging to fever, there
 is not one, nor is there any particular assemblage
 of them, which can always be found in  this dis-
 ease.  Further,  among those  which do occur,
 there is a great difference in respect to their  rela-
 tive force, or violence.   Thus the system is affect-
 ed very unequally, and hence presents a very dif- 
68
H^EMATICA.
[cl. iii.-or. I.
 fcrent aspect  in  different  cases.  There is not,
 however, sufficient uniformity in these differences
 to furnish a foundation for the distinction of diffe-
 rent  species of fevers.   The distinctions pointed
 out by Dr.  Good,  under the  name of species, as
 well  as some others, may, however, be attended to
 with  profit.
   LXIX. Genus II.  Anetus.   "Paroxysm  inter-
 mitting,  and returning  during the course of  the
 disease : the intermissions  generally perfect, and
 regular."  Possibly  the following  definition may
 be  preferable,  A fever of two or more distinct
paroxysms ; with a period of intermission between
 every  two successive paroxysms.   The disease is
 essentially the  same as an ephemera, often repeat-
 ed.   The paroxysms are not, indeed, all  of  them
 perfect.   The  symptoms of different stages pre-
 dominate in different instances.  The  paroxysms
 are seldom perfect, at first, but gradually become
 more  so.   The disease sometimes terminates sud-
 denly after a perfect  paroxysm.  More frequent-
ly, after many repetitions, the  paroxysms  again
become less regular and less perfect; and at length
 the patient is left  free from the disease, though
the vigour of the body is much impaired.  While
declining, the disease is often brought on with new
violence by accidental derangements of the health;
and even for a  long time after it has  subsided, it
may be  renewed in the same way.
  LXX.  As the period  from  the  termination pf 
cl. iii.-or. i.]    SANGUINEOUS  FUNCTION.      69

one paroxysm to the  commencement of the next,
is called the intermission,  so the  period from the
commencement  of one paroxysm to that of the
next, is called the interval.  The  interval in diffe-
rent intermittents, is  from one day to three,  and
even longer.   The interval commonly has a  re-
spect to the diurnal period, though not always.   It
commonly observes the same  period as long as it
continues; but this does not always happen; and
especially when the disease has been arrested and
returns again, it often changes as  to the length of
its interval.   When the disease  recurs daily, it is
said to be of the quotidian  type;  when once in
two days, of the tertian type, &c.  The distinction
of the species of Anetus, is founded  on the type ;
and very  properly.
   LXXI. In regard to all the  different species of
intermittent fevers, it may be noticed, that  the in-
terval does not always observe the  diurnal period
with   accuracy.   The  tertian,  for  instance,  may
have  an  interval  of forty-six  or fifty hours,  in-
stead  of  one  of forty-eight  hours.   In the  one
case, it is called an anticipating tertian, and in the
other, a retarding tertian.  There are  also inter-
mittents, which are quite  irregular as to their in-
tervals.
   LXXII. The quotidian commences in the morn-
ing, and its paroxysm occupies more than half the
twenty-four hours.   The tertian commences at
noon,  and occupies less than  twelve hours.  The 
70              H7EMATICA.          [cl. iii.-or. i.

quartan commences in the afternoon, and occupies
less than  nine  hours.  But these characteristics
are not constant.   Generally the disease is more
obstinate,  the longer its interval.
  LXXIII. In  some  cases,  in  which there  is a
daily paroxysm of fever,  the disease is called a
double tertian.  This happens, where two succeed-
ing paroxysms differ from each other, in any well-
marked manner, while the alternate paroxysms re-
semble each other.   In  a similar manner, double
and triple  quartans are said to take place.
  LXXIV. In respect to the character of inter-
mittent fevers, there is the  same diversity, as in
fevers  of  other types, and such as has been point-
ed out  in  respect  to an  ephemera.   Like other
fevers, they may be accompanied by hemorrhage,
inflammation, or congestion.   They are sometimes
attended by comatose or convulsive affections, pro-
bably in consequence of  congestion in the brain.
They may subside, and leave important  organs in-
durated ;  and this induration takes place, especial-
ly, in the  abdominal  viscera.   In this way death
may be  ultimately  produced.    They  may  also
prove  more  immediately fatal,  when  combined
with other diseases.   But they seldom prove fatal
when simple,  or uncombined.  Their duration is
various, commonly  extending to several months.
  LXXV. Genus  III.   Epanetus.  "Symptoms
strikingly  exacerbating and remitting; but without
intermission;  one   paroxysm  every twenty-four 
cl. iii.-or. i.]    SANGUINEOUS FUNCTION.      71
hours."   Of this genus Dr.  Good  has three spe-
cies, Epanetus Mitis, E. Malignus,  and E. Hectica.
It does not appear necessary to discuss fevers of
this genus  separately.  They would  seem some-
times to  belong  to intermittents in their  general
character, and at others, to continued  fevers.   Af-
ter considering the treatment of the  other  kinds
of fever, these may be  brought into  view.   But
this opportunity  may be taken  to object to  the
opinion, that hectic fever is  ever strictly idiopathic.
It has something of the form, without  the essential
characters  of idiopathic fever.    In almost  all
cases it obviously depends  on a local disease;  and
if in some  few instances  a  local disease  is not dis-
covered, we should be slow to admit  that it does
not exist.
   LXXVI. Genus IV.   Enecia.   "One series of
increase  and decrease; with a tendency  to exacer-
bation and remission for  the most  part  appearing
twice every twenty-four hours."   Continued fever
commences in a  manner more or less formal, like
an ephemera, or the  paroxysm of  an  intermittent.
But after the commencement, the  formal resem-
blance is lost.   The  paroxysm is  not completed,
and the  disease does  not subside,  or does so very
imperfectly, until  it has  finished its whole course.
Its duration is from three days to  as  many weeks,
and even  sometimes double this  space of  time.
From its commencement, the symptoms are  grow-
ing more severe, from day  to day, for many days; 
72
HjEMATICA.
[cl. iii.-or. i.
and when some of them are  mitigated, others in-
crease, or new ones appear.  At length it termi-
nates in a crisis, of which, however, the symptoms
do not commonly  appear at once, but  in more or
less regular  succession, for several days.  It  may
likewise terminate in hemorrhage or in inflamma-
tion.
  LXXVII. Continued fever in  our climate often
comes on slowly  and  insidiously;  and  the symp-
toms, which constitute fever  in the popular sense,
are not  manifested till the  disease has  become
firmly established.  In other words, the symptoms
of the access come on, as it  were, silently and
gradually, and in so doing, they occupy not only
hours, but frequently, days.   Then the cold stage
supervenes,  not often with violence; but it is often
protracted.  It is followed by the hot  stage; but
frequently the  symptoms  of these two are inter-
mixed for many hours, and even for a day or  two.
After once subsiding,  however,  the  symptoms of
the cold  stage  seldom recur, and the  disease  is
marked by the continuance  of  the  symptoms of
the access, accompanied by exacerbations  and re-
missions of those  of the hot stage.  It  is in fevers
of this type, that  it is  especially important to bear
in mind, that the  symptoms of the access essential-
ly constitute the  disease;  and this, whether they
appear previously and  distinctly,  or only come on
in company with those of the other stages. 
cl. iii.-or. i.]     SANGUINEOUS  FUNCTION.      73

  LXXVIII. In our climate,  with the exception
of peculiar epidemics,  enecia ordinarily lasts three
weeks, and not rarely four weeks or more, before
an entire crisis  has  taken place.  In  the  summer
its duration is shorter; but this increases in the au-
tumn; and after the occurrence of frost and during
the winter the  disease is often protracted through
five and  even  six weeks; and then  instead of a
perfect crisis, there sometimes ensues a long con-
tinued state  of weakness, with more or less of
local disease.   At all seasons  it is frequently ac-
companied by  inflammation,  commonly of  a  low
kind ; and not rarely by congestion, or hemorrhage,
with or without inflammation.   It is not very often
fatal, where  the evidence  of one  of these local
affections has not appeared; though this evidence
is not always of the  most strongly  marked cha-
racter.
  LXXIX. Continued  fever  is said at first to in-
crease from day to day, then to remain stationary
for a season,  and then  gradually to decline.   This
regularity, however, is not very often to  be ob-
served, especially if all the  symptoms  be  taken
into  account.   But the severe pains,  the heat and
the thirst increase  for  several days; then, while
these abate,  symptoms quite  as  formidable, such
as stupor, or watchfulness and delirium supervene,
accompanied by increased muscular weakness and
by an entire  failure in the functions of the alimen-
tary canal, with a very feeble performance of all
                   10 
74              H^MATICA.           [cl. iii.-or. i.
the organic functions.   Under these circumstances,
the severity of the disease is measured by that of
any local affection accompanying it, by the severity
of the symptoms above specified, by the expression
of the  countenance, by  the  position the patient
may assume, by the state of the skin,  tongue and
mouth, by that of the abdomen and of the evacua-
tions, and by that of the  pulse  and  respiration.
The danger  is generally greater in the autumn,
than in the summer, but diminishes after the pe-
riod of hard frost.
   LXXX. The disease  has many varieties, which
are also found in fevers of  other types, but which
are not so distinct as properly to constitute species.
These varieties are dependent on  the dispropor-
tion of the different elements  of the  paroxysm;
on the unequal affection of the system,  in conse-
quence of which different subordinate systems are
more especially deranged; and  on the  positive
local affections of particular organs.   Among these
varieties may be  noticed the  cauma,  typhus and
synochus, recognized by Dr. Good, and  many of
his predecessors,  as  species.   Among  them  may
also be enumerated the gastric, the ataxic or ma-
lignant,  and the adynamic or putrid fevers;  like-
wise, those which are grounded on  the prevalent
characters  of particular epidemics, such  as the
yellow and petechial, or spotted fevers.
   LXXXI. It may now be remarked in respect
to remittent fever,  epanetus,  that in a large pro- 
cl. ih.-or. i.]    SANGUINEOUS FUNCTION.     75
portion of instances it is produced in company with
intermittents, and appears properly to be a modi-
fication of anetus.   This opinion seems  to be sup
ported by the treatment, which it then requires.
The want of a perfect  intermission is perhaps to
be  attributed to  the combination  of some  local
affection with the  constitutional  disease.  But as
continued fever has commonly some  remissions, so
far at least as regards the  appropriate symptoms
of the hot stage, it sometimes happens, that these
remissions are strongly  marked ;  and then the fe-
ver may be  called  remittent,  though  it has the
essential characters of the continued  fever.   This
is found true, so far as the  effect  of treatment is a
test, when such remittents occur  in company with
continued fever.
   LXXXII.  Fever, like other acute diseases, often
becomes epidemic.   It may be so over a larger, or
smaller region of  the earth.   An epidemic  fever
is commonly limited to one season of the year, and
during that season it will have a prevailing charac-
ter, more or less  strongly  and distinctly marked.
Subsiding  on the  change of  season,  it  will some-
times recur the following year, or even for three
successive years, at the same season, with nearly
the same prevailing character.
   LXXXIII. In respect to  epidemic fevers, and
 especially those  which are  most  remarkable, it
 has been thought that, as  they possess peculiar
characters, so they constitute distinct species. This 
76
HEMATIC A.
[cl. iii.-or. I.
 opinion, rendered venerable  by the authorities by
 which it is supported,  does not seem to rest on a
 very solid foundation.   It will  appear that, while
 there are certain characters, which are generally
 found in the cases of an epidemic, there are always
 some and often many cases, in which these charac-
 ters are wanting.   It is, however, urged, that there
 is something common to all the  cases, though this
 is almost hidden;  or  something which  may  be
 seen, but cannot be described.  It is at least doubt-
 ful, whether  this something be  not  common to
 fever generally, rather than peculiar  in any parti-
 cular epidemic.  An examination of  the two most
 remarkable epidemics  of our own country, as well
 as of some others, will  give an opportunity to illus-
 trate the opinions here advanced.
  LXXXIV.  In regard not only to  epidemic  fe-
 vers,  but to other epidemic diseases  also,  it has
 been  said,  that they are  capable of converting
 other diseases to  themselves.  This is figurative
 language; but  the fact,  intended to be stated, has
 often been observed, although  the  truth  has no
doubt been exaggerated in many instances.   It
 would seem that, when powerful causes occasion a
general disposition to an epidemic disease,  many
different occasional causes will induce this disease.
Among such  causes  are many common diseases,
such as catarrh, which,  by deranging  the health,
may, like any other temporary derangement, ope-
rate as exciting causes of the epidemic  disease, 
cl. iii.-or. i.]     SANGUINEOUS FUNCTION.      77

   LXXXV. The causes of fever  have been inves-
tigated by the  learned  and wise for many  ages,
but  without satisfactory results.  Of the remote
causes, those which are called exciting,  or occa-
sional  causes, are ascertained with some degree of
certainty.  Any sudden derangement of the proper
functions, such  as at  other times would  be easily
and shortly remedied by the natural efforts of  the
system, may act as  an exciting cause of fever and
of other acute diseases, in one, who is already pre-
disposed.   But the predisposition to this particu-
lar disease is necessary, and  this must have some
cause for its  production.   To  discover this cause
is  the  difficulty.
   LXXXVI. In regard to intermittent fever, it  has
long been admitted  that its predisposing cause is
an emanation from the earth,  called  marsh-mias-
mata.  The evidence  that some emanation  from
the earth, and from grounds more or less similar in
character to marshes, do produce intermittent  fe-
ver,  is abundant.   That intermittents sometimes
arise, where noisuch source is obvious, is also  true;
but it is to be noted, that the disease may appear-
long after exposure to its predisposing cause ; and
this may help us to explain some apparent anoma-
lies.   Meanwhile nothing is known of the material
thus emanating from  marshy grounds, except this
property of producing disease.  It is  known also,
that  this material does not act at any considerable 
78
H^MATICA.
[cl. UI.-OR. I.
distance from its source,  either in a vertical, or a
horizontal direction.
  LXXXVII.  In  regard to  continued fever, the
following  facts are  sufficiently ascertained.  The
disease sometimes  prevails successively among the
inmates of the same house, for  many weeks, and
even months in succession,  without affecting any
occasional visitors to the sick;  and this  happens
in clean houses, and where  no obvious nuisance is
near.   In other  cases  it prevails within a very
limited district of  a city or  village, without being
communicated  to visitors, who remain in  such dis-
trict only a few hours.   In other instances  its range
is more  extensive,  the  disease  showing  itself  in
every part of  a village or town,  or  over a much
wider region of country.  In  such cases,  it is not
easy, nor  perhaps  possible, to  ascertain  whether
the disease  is  communicated  from one  person  to
another.   Yet these  facts, taken together, and
compared  with  what  is  known  respecting the
causes of intermittents, create a  probability, that
some emanation may take place from the soil, ca-
pable of producing continued fever.   Yet, if this
be admitted, it must be  allowed, that the material
thus emanating is not  known, the qualities of the
soil from which it arises are  not known,  and the
only advantage from the observation, is to lead  us
to avoid the places, in which  fever prevails.
   LXXXVIII. The opinion,  that continued fever
is generally, or even ever,  produced  in  the  way 
cl. iil-or. i.]    SANGUINEOUS FUNCTION.      79
 just pointed out, has not been commonly received.
 Yet that it is  often produced by some  cause, dif-
fused through  the atmosphere, has been believed by
 many  pathologists.   Whence  a cause often  so
 limited as  to the extent of its influence, can be de-
 rived to the atmosphere, except from  the earth,
 it is not perhaps very easy to imagine.  The water
 used for drinking may  possibly  convey to the sto-
 mach the material, which is productive of the dis-
 ease.  In this case  the atmosphere may  remain
 pure.   But this  supposition  is not  supported  by
 any particular evidence,  and is  opposed by  some
 facts.   Some  material,  capable of producing fever,
 appears to be generated on board ships  at sea.
 Hence  those  on board are  sometimes  affected at
 sea; in other  cases, persons engaged in discharging
 the cargoes of ships in  port, become affected with
 fever,
   LXXXIX.  But other causes have been suppos-
 ed to have some influence,  and even the principal
 influence,  in  producing fever.   Several of  these
 causes have been thought to be of animal origin.
 These  are first, some vitiation of the atmosphere,
 where  a number of persons in health are confined
 in the  same  apartment; second,  some  vitiation
 where  a number of persons affected with disease,
 exclusive of fever, are confined in the same apart-
 ment ;  third,  some material generated in the  body
 of  one  sick  with fever;  fourth,  some  material
 generated  in  dead animal matter,  under  the pro- 
80
H.EMATICA.
[cl. iii.-or. I.
cess of putrefaction.   In regard to these causes,
there is much contradictory evidence.   Under my
own observation, and within the circle of my own
knowledge, none of these causes have  ever pro-
duced fever,  unless the third;  and that has not
often, nor ever  with certainty appeared to have
this effect.
  XC. The remote causes of ephemera  have never
been distinctly considered ; unless  by  those,  who
regard as an  ephemera the symptomatic affection
following a debauch.  The  ephemera is a fever
of uncommon type ; and observations respecting
it, have not  been  made distinctly.   As, however,
it has sometimes  appeared in epidemics, in com-
mon with continued fevers,  it is highly probable,
that it has the same remote causes.  The remote
causes of remittent fever, need not to be separate-
ly considered.
  XCI. The question respecting  the proximate
cause of fever, is attended with the same doubt,
and has been answered as variously,  as that re-
specting its predisposing cause.  On what does the
remote cause act ? on the whole system, or  any
particular part ? If on one part, or on one subor-
dinate  system, which is it?  What is the nature of
the change it produces? How  does this change
lead to the sensible phenomena, by which the dis-
ease is manifested? These are the  principal ques-
tions presented by a consideration  of  the subject.
How far they have been  answered, will appear 
cl. iii.-or. i.]    SANGUINEOUS  FUNCTION.      81
by a brief statement and discussion of the princi-
pal opinions, which have been maintained on the
subject.
  XCII. It may first be remarked, that one opinion
has been very  generally adopted,  viz;  that the
actions of the system in fever, or some part of
them, consist in  spontaneous  efforts to remove, or
overcome the  primary injury inflicted  on the sys-
tem, and to restore health.   As the disease con-
sists in  a  succession  of unusual  operations  and
changes, and as  the last  of  these, in favourable
cases, is immediately followed by a state  of health,
though not of strength, the opinion, that this last
operation removes, or  overcomes  the injury, and
thereby  produces  health, is rendered  plausible.
But the preceding operations, each in its  turn,
seem necessary to the production of that last one;
and therefore  they are  all necessary to  the pro-
duction of health, if that last one is so.   But whe-
ther the general  opinion is  well-founded,  may
admit of much doubt.
  XCIII. These things being premised, it may be
stated, first, that the proximate cause  has  been
supposed to consist in some change in the  quality
or quantity of some of  the fluids of the body, and
that the subsequent phenomena result from efforts
to correct  this  evil.  This opinion, after having
been almost universally  received for  many ages,
scarcely finds  any advocates  at the present day.
It is inconsistent with the  physiological doctrine
                   11 
82
HjEMATICA.
[cl. iii.-or. i.
 that all changes in the animal fluids are secondary,
 and are  produced  by changes in the  functions of
 the solids.   No  positive evidence is  adduced in
 support  of  this humoral doctrine.   Yet  it has
 not been  disproved  by  positive evidence.  The
 science of chemistry  is  not yet able  to detect all
 the changes, which occur in animal and vegetable
 fluids.
   XCIV. Second, the proximate cause has been
 supposed to consist  in  some modification  of the
functions.  It has been supposed that  the remote
 cause, acting on  the  capillaries  and  extreme ar-
 terial  vessels,  induces   a contraction, or  spasm
 in them, and that this  may be  regarded  as the
 proximate cause of fever.  The supporters of this
 doctrine endeavour to show, that the effects of this
 cause  must  be  those changes in the  circulating
 system, by which the leading phenomena of fever
 are produced, and by which the  termination of it
 is effected.   This theory makes the contraction of
 the evcreme vessels essential to the production of
 fever in every instance;  it admits not  of  any ex-
 ception.   But much evidence  may be  adduced to
 show, that in many cases  of fever, such contraction
 does not take place  in those  organs in which the
 matter can be ascertained;  and that the  subse-
 quent changes do not uniformly proceed with the
 regularity,  which  the theory requires; and that
 the disease does not terminate, when  the  contrac-
 tion, where it can be ascertained, has been over-
 come. 
bl. iii.-or. i.]    SANGUINEOUS  FUNCTION.     83

  XCV.  Third,  it  has been  supposed,  that  the
proximate cause consists in a diminution of the vi-
tal power, or energy.   This opinion, in its simplest
form, has been supported by one  pathologist; by
another,  it  has  been supposed  that  this diminu-
tion of power causes the contraction of the ex-
treme vessels, and the consequences above describ-
ed ; and by another,  it seems to have been  sup-
posed, that  the  diminution of the vital  power is
accompanied by some modification of it.  A general
and fundamental difficulty in admitting the doctrine
of  diminution in vital  power is, that  the continu-
ance  of the disease  tends  to  increase that cause,
that  the remedies  employed  in many cases have
the same tendency,  and yet  the  disease subsides
 after a  certain  time under  these circumstances.
 To the  doctrine of  a modification  of  the  vital
 power or powers, there seems to be less objection.
 But though this doctrine be true, it is so indefinite
 as not to help us in  the explanation of the symp-
 toms ; and still less  can it assist us  in  the treat-
 ment.
    XCVI. Fourth, it  has been  supposed that the
 proximate  cause consists  in inflammation, and that
 the  constitutional  affection is not idiopathic, but
 symptomatic.   Those, who  maintain this opinion,
 differ in respect to the parts inflamed; some point-
 ing to one  organ, others  to  another, while others
 believe that the local  affection  exists  in  various
 organs.   In favour of this opinion, is adduced the
 evidence of dissections  of those,  who  have died 
84              H.&MATICA.           [cl. iii.-or. i.
 of fever.   But it is  urged against it, that these
 dissections have not been made  in cases of simple
 fever ; that it is  allowed, that fever is often  at-
 tended by inflammation ; that it is often fatal when
 so attended ; but  that in many cases  no  traces of
 inflammation have  been discovered  after death;
 and that these cases are positive proof against the
 doctrine.
   XCVII. On the whole,  as no change, certainly
 no uniform change, is found to exist primarily in the
 fluids;  as no particular functions are found to  be
 uniformly deranged primarily;  as there is nothing
 in the  disease,  which  has  a tendency to restore
 any particular functions; as no organic changes are
 discovered  by  dissection,  uniformly in  any  one
 organ, nor, in all cases, in any organ whatever; as
 all the  functions appear to be  deranged, which
 must arise, either  from some change  in the stimuli
 applied to all the organs,  or  to some particular
 organ, the rest being affected by sympathy;  or must
 arise from some change in  the structure, or some
 change  in the vital powers of  all the organs;  the
 most probable opinion appears to be, that some
 change  or modification of the  vital powers, does
 constitute the proximate cause.  That is, the im-
 mediate effect of the remote  causes  is to induce
 some,change in the vital properties, this occasions
 the subsequent phenomena;  the return to health
is  marked  by a-recovery  of  the vital  powers,
not in degree or quantity, but  in kind or  quality, 
cl. IH.-OR. i.]    SANGUINEOUS FUNCTION.
85
 It must, however, be  acknowledged, that if this
 doctrine be true, it does not admit of any impor-
 tant inferences.   Likewise, in common with other
 hypotheses on this subject, the one  here proposed
 furnishes no explanation of the  remarkable diffe-
 rence among fevers, as to type.
   XCVIII. To  the remarks made on this subject,
 it may be  proper to  add, that, in seeking for the
 proximate  cause of the  disease  under  considera-
 tion, too much attention has been given to  the cold
 and rigors, the heat and  vascular excitement, and
 the sweat or other evacuations which follow. How-
 ever true it be,  that  these circumstances  are the
 most essential to fever in the popular sense of the
 word, they by no means constitute the most pecu-
 liar part of the disease under consideration. These
 symptoms are common to various affections of the
 system, and occur even in consequence of the in-
 stitution of new or unusual processes in  the ani-
 mal  economy, although  such processes are of a
 natural  and healthy kind,  The  essential  charac-
 teristics of idiopathic fever are found in the symp-?
 toms of the access.
   XCIX.   There are  some  general principles,
 which guide us  in forming a prognosis in fever,
 The prognosis is most favourable, when the diffe-r
rent stages occur in due  time  and  proportion;
when the  system  is  equally affected; and when
the disease is unaccompanied by congestion, inflam-
mation,  or hemorrhage.  Under the  opposite cir-j 
86               H^MATICA.          [cl. iii.-or. I.
cumstances the prognosis is unfavourable ; likewise,
when the powers  of the  system fail very much,
or are  exercised  with  great irregularity ;  when
great evacuations  occur,  without obvious relief;
and  when  the secretions  or excretions  undergo
rapid decomposition.  In proportion as the mutual
influence of the mind and  body ceases to be exer-
cised, the prognosis is unfavourable.
  C.  In the treatment of fever the  continued ex-
posure to the remote causes  should be avoided, if
possible ; as these sometimes counteract  the ten-
dency to recovery.  But  the proximate  cause is
not so far known to us, as  to furnish any indication.
Experience is  our only guide.  From this we learn
to adopt certain general  intentions.  The  treat-
ment must vary according to the  type.  In  the
first  attack of the  disease  the  type cannot  be
known  with certainty; yet an  opinion  may  be
formed from the usual  character of the  diseases
of the climate and season.  But  the same modes
of treatment  are  applicable on  the  first attack,
whatever the  type ; though not  equally necessary
in all.
  CI. The first question,  in  regard to the treat-
ment of fever, is,  whether it  should be active,  or
whether the disease should be watched, and spe-
cial  evils only obviated.   Experience seems  to
decide in favour of the  former  method in all the
early part of the disease ; but, in proportion as this
has advanced, active treatment must be avoided. 
cl. iii.-or. i.]     SANGUINEOUS  FUNCTION,     87

  CII.  Various remedies are  found successful, in
arresting  fever, when  employed early, and espe-
cially in the first  paroxysm; and these  remedies,
when they do not arrest the  disease,  often dimi-
nish its violence and shorten  its duration.  These
are  remedies capable  of  making a  strong and
somewhat  sudden  impression on  some part of the
system; as on  the  stomach,  or on the  skin.   If
the fever  be simple, or uncombined and regular,
an emetic,  given in the first paroxysm, will produce
the effects above  described.   It is  not,  however,
indifferent, what  emetic medicine is usual.  The
good effects  more certainly ensue, if free purging
follow the vomiting.  These evacuations are often
attended or followed by a crisis, more or less per-
fect; and, as one  of the symptoms of this crisis, a
sweating commonly occurs.  While this lasts, and,
indeed, while the changes which appertain to the
crisis are  taking place,  the  patient should be kept
at rest, and excluded from all vicissitudes of tem-
perature,  and restrained from taking food.  If the
vomiting be not successfully produced and the pa-
tient not  relieved, the  same remedy may be re-
peated on the second, or third day.
  CII I. If the fever be not arrested by the reme-
dies mentioned,  the subsequent treatment must
depend on the  type.   If it be an intermittent, the
question will arise whether  the  returns of the
paroxysms can  be prevented,  and whether this is
iafe.   To these questions,  experience  answers in 
88             H^MATICA.          [cl. iii.-or. i.

the affirmative.   When a paroxysm terminates by
a regular and perfect crisis, the relief is often per-
manent;  it  is likewise more  easy by  medicinal
agents to prevent the return of the paroxysms in
such a case.   It is then a first  object to promote
a perfect crisis, and afterwards  to employ the re-
medies to prevent the recurrence of the paroxysm.
   CIV. In order to promote a perfect crisis, first,
if  there  be any  accompanying inflammation, or
congestion, or any remarkable hardness of  pulse
with  great  heat;  blood-letting, general  or  local,
purging and counter-irritation, are to be employed,
one or all.  Second, if  there be any  irritation ex-
isting in the alimentary canal, this must be remov-
ed.  Third,  if there  be  a disproportion in the
force, or  duration  of any one  stage of the par-
oxysm, this must  be  counteracted  by the appro-
priate remedies.  If this disproportion exist in the
predominance of  the  symptoms of  the access
alone, or  conjoined with those of the cold stage,
external stimulants, such as can be applied most
extensively, must be employed;  likewise internal
stimulants of such kind, as are most transient and
at the same  time  most immediate in their opera-
tion ;  to which may be  added  opium, which ope-
rates  in some manner,  not  perhaps  satisfactorily
explained.   If there be  a predominance of the
symptoms of the hot stage, external and internal
stimulants should be withdrawn  and withheld, aS
far as possible, and cold ablutions and cold drinks 
 cl. iii.-or. i.]     SANGUINEOUS FUNCTION.     89

 employed;  and in  the  same  case, the medicines
 called refrigerants, maybe administered with some
 benefit.
  CV.  It is, however,  to  be remembered,  that
 when the  symptoms of  the  cold  and hot stages
 occur with a good share of force, a perfect crisis
 is apt to follow.  It is only when there is found in
 the paroxysms  of an intermittent the dispropor-
 tion, which has been  described,  that  the force of
 symptoms should be reduced by  any direct  means.
 When,  other things  having  been attended to as
 much as possible, the paroxysms  are not found to
 terminate in the most  perfect  manner, so as to
 leave an entire intermission, we have, fourth, to
 employ  the  more direct  remedies, with which ex-
 perience has made us acquainted for  promoting a
 crisis.   These remedies are the medicines called
 alteratives.   Of these, the  most powerful are  the
 preparations of antimony  and mercury.   These
 may be  exhibited both during the paroxysm, and
 in the intermission, but most in the former.
  CVI.  A crisis which  is  perfect, or nearly  so,
 having occurred, whether spontaneously, or by the
 aid of remedies,  the next  intention should be, to
 prevent the return of the paroxysm.  The reme-
 dies employed for this purpose,  are found to suc-
ceed, sometimes, when the crisis has not been per-
fect, but oftener, when it  has.  Of these remedies,
the  most noted is the bark of the Cinchona.   This
 may be  employed in its crude  state, or  certain
                   12 
90
HjEMATICA.
[cl. iii.-or. i.
preparations of  it may be substituted. •  This  re-
medy must be given  during  the intermission, and
in full doses.  If successful, either wholly or par-
tially, it  must be repeated after the two or three
next febrile periods ;  and, at intervals, for several
weeks, in order  to secure the patient from relapse.
   CVII. There  are  other remedies, which have
also been found  effectual, though generally less so
than  the cinchona,  in arresting the  paroxysm.
These are  various  vegetable   tonics  and  astrin-
gents; opium; and several  metallic articles.—Of
these last, a preparation of arsenic is the most effec-
tual ;  this being scarcely, if at  all,  inferior  to cin-
chona.
   C VIII. In continued fever, if the disease  be not
arrested at  its  commencement,  by  the treatment
proposed for the first paroxysm, the  methods  to
be pursued  must differ from those  recommended
in an intermittent.  In continued fever, the  active
treatment may be adopted with advantage  at an
early period, but not  at a  late  one.  As the dis-
ease goes on with various degrees of rapidity, the
periods called early and late, are not absolutely
the same in all cases.  The judgment must  be
made up on this  subject, in  each case,  from the
prevailing character  of the fevers,  of the   place
and season in which it occurs, and from  the rapi-
dity of its  increase.   In fevers  commonly  preva-
lent among us in the autumn, the active treatment
may be employed in  the first week, but not very
freely afterwards. 
cl. iii.-or. i.]    SANGUINEOUS  FUNCTION.      91

  CIX. The active treatment in continued fever
is to be pursued on the principles already suggest-
ed for the treatment of a  first  paroxysm, § CII.,
and for promoting a perfect paroxysm in an inter-
mittent, § CIV.   But the remedies, which prevent
the recurrence of a paroxysm in intermittents, are
not applicable to continued fever.
   CX.  When the period for the active  treatment
has passed by, in continued fever, the management
of the  patient is still  very important; as  the dis-
ease may be rendered more  safe,  though it may
not be  shortened by art.   Under such circumstan-
ces, the alimentary canal must be kept clear  from
irritation.   The temperature of the patient  must
be carefully watched and  regulated, with a  view
to his comfort.   All causes preventing quiet sleep,
must be warded off.   The mind  should be  kept
tranquil, and the body at rest, in a well ventilated
and clean apartment.
   CXI. In respect to diet, the general  principles
 already inculcated, under the head of  Therapeu-
 tics,  (Part I.  of this work,  §§ CCLXXXII—
 CCLXXXIV.,) should be followed.  The  appli-
 cation of  these  principles, will  of course lead to
 very different results  in intermittent and continued
 fevers.  In the first, when the crisis of a paroxysm
 is imperfect, the patient will often  be wanting in
 appetite,  and  incapable of digesting food, during
 the intermission.  But when it is not so, nutritious
 food should be allowed him; for in all cases of 
92
H.EMATICA.
[ex. iii.-or. I.
 fever, it is important to maintain the vigour of the
 patient.   In giving  food during the  intermission,
 regard should be  had to the usual  seasons for
 meals; but this must be so far modified, as not to
 give food so near the  period of the expected par-
 oxysm, as that it shall not be digested before that
 period.  Cordials may also  be taken  during the
 intermission, so far as  the state of the patient may
 require; but they  should  be given  at such times,
 as  that they shall not  be  exercising their full in-
 fluence, during the paroxysm, or certainly not dur-
 ing the hot stage.
   CXII. In  continued fever, neither the appetite,
 nor the  powers  of  digestion will  allow the  same
 use of food, as  in  intermittents.   So far as the
 appetite will permit, farinaceous and mucilaginous
 substances in a liquid  form, and  vegetable  acids
 should be given; but  the  former should be given
 rather at the periods of remission, while the lat-
 ter may  be used  more safely during the exacerba-
 tions.  Meanwhile, during the  whole  time, and in
 intermittents, during  the  paroxysms,  the thirst
 should be gratified,  as  far  as  possible.  For this
 purpose, cold water is  ordinarily the most grateful
 and the most useful beverage. This, however, can-
 not be given  with safety, while the patient is cold,
nor when the perspiration of the crisis exists. Then
 the temperature of the  water must be  at least
 tepid,  and that article  may be made more grate?
ful and more  salutary by some  light aromatic. 
 cl. iii.-or. i.]     SANGUINEOUS FUNCTION.      93

   CX11I. The most embarrassing questions, in  re-
 spect to diet, arise at the period of convalescence,
 in continued  fever.  When  the  appetite first  re-
 turns, it sometimes increases rapidly, but its gratifi-
 cation is  often followed by  indigestion, and this
 occasions a  relapse  into disease.  The appetite,
 when truly spontaneous, may be indulged as to the
 quality of the diet, in most  instances, but not as
 to  quantity.    The  appetite  may  be indulged
 more readily, when the disease has gone through
 its whole course,  than when  it has been arrested
 by treatment.
  CXIV. During  convalescence, and  previous  to
 this, when the vital  powers of the system appear
 to flag very much, cordials may be given  to  the
 patient, so far as  they are grateful to him.   Life
 seems  to depend  on the  proper management of
 them, in some cases.   There is a question, whether
 tonics may not be  used in the  same cases.  This
 question  may generally be  answered in the nega-
 tive.
  CXV.  The treatment of ephemera and of epa^
 netus, has not  been  particularly  considered, but
 may be inferred from what has  preceded.  The
 ephemera cannot be distinguished until it has ceasr
 ed.  It must  be treated as fevers of  other types,
 at their  commencement.  The  remittent is to  be
 regarded as  a modification of an  intermittent  or
continued fever, and  treated accordingly.
  CXVI.  In the course of fever, there sometimes
occur sudden  changes, and these are often of an ura> 
94
HiEMATlCA.
[cl. iii.-or. ii.
favourable kind. They consist in the severe attack
of a new paroxysm, in the formation of inflammation,
or in hemorrhage.  According  to  the cause, must
be the treatment.  The  prevailing  character of
the epidemic, when one exists,  is  to  be  regarded
carefully,  but is not to be  made the  sole guide in
the treatment.
  CXVII. Order  II.   Phlogotica.  "Fixed heat
and pain, or soreness; increased secretion; lesion
of a  particular part,  or organ; mostly  accompa-
nied with  fever."  Dr. Good means to include the
inflammations, which  are  most important,  in this
order.  But he limits it, as Cullen  does the Phleg-
masiae, although not  within the same boundaries.
He does not include  in it  various slight  inflamma-
tions.  The consequent evil is, that diseases  be-
longing to the same natural family,  are  found dis-
tributed through different classes and orders. This
is one of  the evils arising  from  describing diseases,
sometimes by the internal  morbid changes, and at
,other times by their  symptoms, or external phe-
nomena.
  CXVIII.  Some general information on the most
essential processes of inflammation has been com-
municated under the  head of  general  pathology.
But the symptoms were not stated, nor were  the
constitutional  affections described.  When inflam-
mation is  on the skin, or parts subject to examina-
tion,  the part is red,  with very few exceptions, is
usually hot, painful  and swollen.  The  sensibility 
 cl. iii.-or. ii.]    SANGUINEOUS FUNCTION.     95

 of the part is increased, so far as concerns pain, at
 least; for the specific sensibility of a part is dimi-
 nished by inflammation.  The irritability  also is
 increased.
   CXIX. Internal  parts are  affected by  inflam-
 mation in the same manner, generally speaking, as
 external  parts.   The situation of  internal parts
 does not permit us to see the  redness, and often
 prevents our  ascertaining  the heat  and  swelling.
 But the pain exists, and is usually a leading symp-
 tom in making us acquainted with the inflamma-
 tion.   Pain, however, is not a sufficient evidence of
 inflammation.    The  increase of sensibility, and
 where the parts  possess irritability,  the  increase
 of that, are  additional evidences of this  disease.
 The distress, or pain, attending  the distention of
 the parts,  adds to  the evidence.   The increased
 secretion, or some  kind of liquid effusion  in the
 part, or its vicinity, is a later symptom;  but one
 of great importance  in  showing the  existence of
 inflammation.   This  alone may be regarded  as
 evidence  of inflammation,  when the  symptom is
 distinctly  marked.
  CXX.  The lesion  of the   part, taken  in the
 most general sense, is also a very important symp-
 tom.   Of this, we judge by the examination of the
 part, when so situated  as  to  permit it.   But  in
 other cases we judge by the failure, or imperfec-
 tion, or difficulty of its  functions. The variety of cir-
cumstances to be taken into view, under this head, 
96
ILEMATICA.
[cl. iii.-or. 11.
modified by the degree of difficulty,  or change, is
so great, that they can scarcely be enumerated.
   CXXI. Lastly,  the constitutional  affection,  or
"fever," aids  us exceedingly  in ascertaining  the
existence of inflammation, in the internal parts of
the body.   This constitutional  affection  is not,
however, to be  taken as the  measure of  the in-
flammation ; as regards either  its severity,  or ex-
tent, or importance.   The constitutional  affection
is  to be  regarded as  sympathetic, and  it varies
according to several  circumstances.  The  princi-
pal of  these, are the constitution ;  the part affect-
ed, taking into view, both the  organ  and the tex-
ture ;  the extent of  the inflammation, its severity,
and its species : also,  the  rapidity of its course ;
and, lastly, its stage.
   CXX1I.  In acute inflammation there is a marked
difference in the constitutional affection,  as  being
active,  or passive ; although these are often  mixed,
one part  of the system exhibiting active,  while
another part exhibits passive sympathy.  The for-
mer has been called  " general  inflammation," the
latter " symptoms of morbid irritation ;" they have
also been called inflammatory fever,  and typhoid
fever.   In  chronic inflammation  the  distinction is
less strongly marked, and the  two kinds of sym-
pathy, are almost always mixed.
   CXXIII.  The principal symptoms of active con-
stitutional sympathy in acute inflammation are the
following, viz. a hard  pulse, commonly attended by 
cl. iii.-or. n.]     SANGUINEOUS  FUNCTION.     97

strength and fulness and by increased  frequency ;
heat and dryness of the  skin, often preceded by
chills ; thirst, and diminution of appetite for food ;
a white, thin coat on the  tongue, closely adhering
to that  organ;  pains in various parts of the  body ;
diminution  of  muscular strength; rapid respira-
tion ; high-coloured urine ; watchfulness, and some-
times delirium  and  convulsions.  These symptoms
are dependent  on changes in the  circulation,  and,
perhaps, other causes, which  sometimes  produce
death, independently of the local disease.
   CXX1V.  The principal  symptoms  of passive
constitutional sympathy in acute inflammation are
the following, viz.  a great sense of weakness, and
a depression of strength; pulse small  and very
frequent;  tongue  coated variously,  but  shortly
getting dark  and  foul;  parched  and clammy
mouth; skin cool and moist, or dry and of unequal
temperature in  different parts; disgust for food,
and often  nausea and vomiting;  watchfulness,  or
coma;  delirium, convulsions,  or other spasmodic
 affections;  and these, when severe, terminating in
 death.
   CXXV.  In regard to  both affections, as  they
 are produced by the local  disease, the  symptoms
 change with that, and are terminated with it gene-
 rally.   They diminish, when the inflammation has
 terminated in  suppuration, or other effusion.  But
 sometimes the disorder, which is at first sympathe-
 tic, is productive of so much derangement  in im*
                    13 
98
HjEMATICA.
[cl. iii.-or. n.
 portant functions, that the  general health  is not
 easily restored, when  the local  disease  has sub-
 sided.
   CXXVI. The  constitutional affection  does not
 always  assume the decided character implied in
 the description.   It  often  partakes  of  the two
 characters, in  various  proportions.   Frequently,
 the active sympathy appears at first, and gradually
 changes  to the passive ; but sometimes the re-
 verse  of  this  takes place.    In  both  cases,  the
 symptoms are  often  mixed with  those  of  local
 sympathy between the  part affected, and  some
 particular organ.
   CXXVII.  The constitutional affection, attending
 chronic inflammation is  less violent, than either of
 those before described.   The principal symptoms
 are emaciation and debility; to which are  often
 added failure  in the digestive functions, irregulari-
 ty in  the  excretions,  the urine especially, being
 scanty and high-coloured,  and depositing a lateri-
 tious sediment; imperfect sleep; accelerated pulse;
 and often hectic fever.   This fever is  marked by
 paroxysms, once or twice in  twenty-four hours;
 but these are  not regular for many days in succes-
 sion.  These paroxysms have their cold, hot, and
 sweating stages, the vascular  system being as much
affected, as in  idiopathic  fever;  but it is not at-
 tended by  the affection of the  animal system, nor
 by  the   appearance of  universal disease,  which
occur in idiopathic fever.  By the constitutional 
cl. iu.-or. ii.]     SANGUINEOUS  FUNCTION.     99

affection,  in  cases  of  chronic inflammation,  the
powers of life appear to become gradually ex-
hausted, and death is  produced, when the  local
disease is  not such as immediately to interrupt any
of the functions essential to life.
   CXXVIII. In treating of inflammation  former-
ly, (first part of this Text Book, § CXXIX.,) the
irregularities of the various processes were defer-
red for future discussion.  These irregularities, or
deviations, from the common  course,  may be ob-
served  in the  adhesive,  suppurative, ulcerative,
and restorative processes.   The adhesive process
does not appear to belong  to  the  mucous  mem-
brane.  It does, however,  occur there, so far as
the effusion of fibrine marks its character, although
an actual  adhesion is  a most rare consequence.
This effusion of fibrine on the mucous membrane
sometimes happens in inflammation of a sudden
and rather violent character,  in healthy subjects.
But it happens, perhaps,  more  frequently,  when
the vessels of the part, with  the  whole  system,
have  beome much enfeebled, when  the proper
mucous secretion has,  therefore, failed, and  the
membrane is left unnaturally denuded.  The con-
sequence  of this state  of things,  is either a watery
secretion,  or an effusion of fibrine ; apparently as
a defence to the part.
   CXXIX.  Another and very important irregula-
rity in the adhesive process, is the  imperfect per-
formance  of it, when its seat  is a circumscribed 
100
HjEMATICA.
[cl. iii.-or. ii.
cavity.  This happens  in  a hurried  and violent
inflammation ; in persons of impaired constitutions;
and  generally where  there is  great  irritability,
without vigour.   In  this case,  there  is not esta-
blished any  limit  to  the diffusion of  pus; and by
this diffusion the inflammation is extended.
  CXXX. The  suppurative process  may be defi-
cient, or excessive, and is liable to  many other ir-
regularities.   The  deviations  are  analogous to
those of the secretions.  From  a suppurating sur-
face there may be poured  out  blood alone,  or any
one or more of the  proximate elements of blood,
mixed with  pus.   Sometimes,  in scrophulous ab-
scesses especially, the matter discharged appears
to consist  of a coagulated  matter, mixed  with  a
serous fluid, slightly  opake.  Likewise  pus of  a
specific kind is produced in certain cases; the dif-
ference from common pus, not being  recognized
by the senses, nor  by chemical tests;  but by the
effect on a living body.
  CXXXI.  In the ulcerative process there are fre-
quent deviations from that, which is designed only
to give a passage to  pus.   This process occurs on
the  skin and on  the  mucous  membrane, extending
from without, inward and  on one, or  every side
from its circumference.  This happens  in certain
specific inflammations,  produced  by morbid poi-
sons, or otherwise ;  or where  any obstacle  exists
to the  restorative process; also, occasionally,  in
cases of deficient vital  power, in parts acciden- 
cl. iii.-or. ii.]    SANGUINEOUS FUNCTION.    101

tally  injured.  In all  cases  suppuration goes on
upon  the part ulcerated.  In healthy inflammation,
ulceration is  preceded   by adhesion ; but in  some
cases of disease, this does  not happen,  and then
arteries or veins may be laid open, and  a conse-
quent hemorrhage ensue.
   CXXXII.  In the restorative process we see fail-
ures from  weakness of the  parts,  or of the con-
stitution, especially in the lower extremities.  Even
in healthy  and vigorous subjects, if this process be
often  interrupted  and  delayed, it fails to take
place, and the suppuration  process is continued.
This  last process may  then be carried on with
little  inconvenience,  for  the  most  part;  but,
upon  local  or constitutional  irritation, there will
often be a  sudden  extension  of inflammation,  or
of the  formative  process  at least,  in  the sur-
rounding parts ;  and then,  sometimes, adhesion or
ulceration  will ensue   but more  commonly, the
new inflammation  will  shortly subside,  upon the
removal or subsidence of the offending cause, leav-
ing the ulcer as  it was.  There  is also  an irregu-
larity in the  restorative process,  when one part of
an ulcer is disposed to heal and  another is not.  In
this case, even a temporary  cicatrization will take
place over an unsound part.   Lastly, in opposition
to the restorative process, mortification sometimes
occurs in an  inflamed part.   This  happens where
the inflammation is very active and violent in heal-
thy subjects; also, upon very slight inflammation, 
102
HiEMATlCA.
[cl. iii.-or. it.
and  almost  at its  commencement,  in debilitated
subjects.
  CXXXIII.  A distinction is always recognized be-
tween acute and chronic  inflammation.   This is a
distinction practically useful;  but it is not suscep-
tible of exact definition.   The gradation is  such,
that it is impossible to draw an exact line between
the two.  When a part goes  through all the pro-
cesses very slowly,  the inflammation is called chro-
nic.   But still  more,  if the  adhesive process, or
the ulcerative having occurred, the fulness of ves-
sels, the pain or soreness, the interruption of func-
tions, or any of  the common characteristics of the
disease  continue, the inflammation is called chronic.
  CXXXIV. The  remote  causes  of inflammation
are various; first, such as injure  the  structure of
parts, either mechanically, or chemically.   Under
this head, may be included foreign or dead matter
lodged  within the  substance of  any living  part.
Second, such  as disturb the  functions of  a part;
particularly such as occasion a sudden interruption
of the vascular  excretory functions.   Third, such
as act by some peculiar  stimulus, having  proper-
ties, not cognizable by chemistry.  These are of
vegetable and  animal origin.  Of the last, some
are natural secretions in particular animals, thence
called  venomous;  others  are  secreted only  by
diseased parts,  whence  they are  called  morbid
poisons.
  CXXXV. In the treatment of inflammation,  re- 
cl. iii.-or. ii.]    SANGUINEOUS FUNCTION.     103
 gard must be had to various circumstances.   The
 kind of inflammation, its seat, its  stage, and the
 constitution of the patient  must be  especially re-
 garded.   It is usually desirable to arrest the dis-
 ease, and to make it terminate in resolution; or to
 diminish its violence and extent.   But  sometimes
 it is to be allowed to  go through its regular  pro-
 cesses, these are to  be guarded and facilitated, and
 the  strength supported  so far as  may be possible.
   CXXXVI.  The remedies for  the  promotion of
 resolution, whether wholly or partially, are evacua-
 tions, counter-irritation and alteratives,  with rest,
 and  abstinence from food  and from  stimulants.
 But these remedies  belong  to active inflammations,
 or common acute inflammation, and to cases where
 there  is strength to  bear them.  Sedatives, both
 local and general, are advantageous in some cases.
 It is, when inflammation is  marked by irritability,
 without strength, that general sedatives  are useful.
 Local sedatives are  useful in superficial inflamma-
 tions.  When there has been constitutional weak-
 ness, preceding the  inflammation,  and  in certain
 other cases, tonics and certain  stimulants will pro-
 mote resolution.
  CXXXVII.  If mortification has  occurred,  or is
 threatened, it is to  be  averted, or  its  extension
 prevented by  the  remedies  appropriate  to active
inflammation, where  there  is strength;  by tonics,
where there  is weakness.   Nearly the  same ob-
servations apply to cases of excessive suppuration, 
104
PLEMATICA.
[cl. ih.-or. ii.
or secretion.   In sluggish inflammations, stimulants
are sometimes beneficial.  In  inflammation of the
mucous membrane, especially  when  the secretion is
purulent, a peculiar stimulant,  Balsam of Copaiba,
and some similar articles have been found useful.
  CXXXVII I. The diseases of the first five gene-
ra in the  order Phlogotica, fall more under the care
of the surgeon, than that of the physician.  These
genera  are  denominated  Apostema,  Phlegmone,
Phyma, Ionthus and Phlysis.   It is true, that some
of these  diseases are connected with  constitutional
derangements, but not of a  specific  kind.  So far
as the general health is deranged, the treatment
must  be directed to the particular difficulties.
  CXXXIX.  Genus  VI.  Erythema.  " Red, gla-
brous, tumid  fulness of the  integuments;  disap-
pearing on pressure; pain  burning; inflammation
ulcerative ; terminating in cuticular scales, or vesi-
cles ;  occasionally  in  gangrene."   The inflamma-
tion here described is of the  kind commonly call-
ed erysipelatous.  It affects the cutis, or the cel-
lular  membrane, immediately subjacent to it.   It
does not  spread equally from a centre, but by con-
tinuous sympathy on  one side.  When  it  affects
the cellular membrane, the  adhesive  process does
not take  place;  nor does suppuration often  occur,
though it does occasionally.   The  effusion is com-
monly serous.   The  parts affected suffer from
soreness, rather than pain, though not without this.
When suppuration does occur, the pus is diffused 
cl. iii.-or. ii.]    SANGUINEOUS  FUNCTION.    105

extensively from  want  of  the  adhesive process;
and  thence  ulceration  also becomes  extensive.
Gangrene sometimes occurs.  The extent, to which
the disease spreads,  depends partly on the cause
producing it, and  partly on the  state of  the con-
stitution.
   CXL. Dr. Good makes  seven  species under this
genus, viz.  Erythema  cedematosum, erysipelato-
sum, gangrenosum, vesiculare, anatomicum,  pernio
and intertrigo.   Of these, the  three  first  species
have been sufficiently adverted  to for our purpose.
The fourth, E. vesiculare, is produced occasionally
by the use of mercurials,  employed either inter-
nally or externally, in persons of a peculiar consti-
tution, or at a time when the  constitution  is  in a
peculiar state.   The  fifth, E. anatomicum, is pro-
duced  by the matter of a dead body applied to a
scratch in the  skin.   The  inflammation spreads
with great rapidity, and occasions  extensive  de-
struction in  the  parts affected.  E.  pernio is the
disease familiarly known under the  name of chil-
blain;  and E.  intertrigo, the  fret or excoriation
very common in children, and sometimes occurring
in adults.
   CXLI. Erythema, with  the exception  of the
two last species, is commonly attended by a consti-
tutional affection.   This is sometimes  of the active
kind;  but  more frequently it is  the  passive sym-
pathy.  When it is of the first kind, and strongly
marked, there is an advantage  in blood-letting; as
                   14 
 106            tLEMATICA.         [cl. iii.-or. h.

 the system then becomes better qualified to bear
 the necessary subsequent treatment. But more fre-
 quently vomiting and purging are beneficial.  After
 these evacuations tonics, and especially cinchona, in
 large doses, may  often  be employed  with advan-
 tage.   To the part affected, when the temperature
 is much elevated, the remedies are local sedatives,
 and especially evaporating lotions; when the tem-
 perature is reduced,  warm and more stimulant ap-
 plications.  For E. pernio and intertrigo stimulant
 applications are  most effectual; while constitutional
 remedies are seldom required.
   CXLII. Genus VII.   Empresma.   " Deranged
 function of an internal organ,  membranous or pa-
 renchymatous ;  with  local pain; fever mostly a
 cauma; inflammation  mostly adhesive."  To as-
 certain the existence of inflammation of an  inter-
 nal organ, is sometimes extremely  easy ; but in
 other cases it is most  difficult  to discriminate be-
 tween such an  inflammation and other diseases.
 The difficulty is not  removed  by the  definition
 given above ; nor, perhaps,  could  it  be  by any
 generic definition.  The  fever is " mostly a cau-
 ma ;" or, in  our own language, the  constitutional
 affection is mostly of  the  active kind.  This may
 be  true in respect to  internal inflammations, if all
 the cases  be brought into  view.   But it is not true
 in a large proportion of the severe cases, which
 call for medical  treatment,  and require nice dis-
 crimination.  The " inflammation is  mostly adhe-
sive."   This cannot be ascertained respecting an 
CL. III.-OR. II.]
SANGUINEOUS FUNCTION.
107
internal inflammation at the period, when it is im-
portant to discriminate the disease.   And this also
is not true in respect to a  large proportion of the
most severe and important cases.  We have then
left, as symptoms of this genus, the derangement
of function  and local pain.  But these symptoms
often occur, where there  is not any inflammation.
If the definition of the order  be also taken into
consideration, we shall not find the characteristics,
by which we may decide the question, whether an
internal  part be, or be not inflamed, in the  cases
of difficult  diagnosis.   This, in truth, cannot  be
done by brief definitions.   It can be done only by
attending to the whole  history of the several dis-
eases, respectively, included  under this genus, and
of such as resemble them  in their characters.
  CXLIII.  Species 1.  E. Cephalitis.  " Pain  in
the head ; aversion to  light;  face  more  or less
flushed; cauma."   These  symptoms are not con-
stant ;  and  there  is a  difficulty,  especially at an
early  period, in detecting  inflammation  of the
brain.   This is owing, very much, to the intimate
connexion between the functions of that organ and
those  of other  parts.    Besides, oftentimes the
early symptoms are of a  less striking  character
than might be anticipated.  It  is highly important
to ascertain  the order of symptoms  in doubtful
cases.   Pain in the head  occurs in  a  vast  many
diseases; and in cephalitis it  is sometimes very
slight, and seems sometimes to be absent. 
108
H.EMATICA.
[cl. iii.-or. h.
  CXLIV.  The  symptoms,  which are  found in
cephalitis, may commonly be referred to two dis-
tinct stages of  the  disease; but these  two  stages
bear no certain proportion  to  each other  either
as to duration, or as to severity.  In the first stage
the  sensibility is  exalted;  there  is  commonly
some pain or distress in the head, and often  ver^
tigo  or confusion of mind; sometimes delirium of a
furious character.  The pain is sometimes  aggra-
vated  by  some  particular  position  or motion.
Other  parts sympathize, the alimentary canal es-
pecially ; hence nausea, retching, vomiting and cos-
tiyeness ; the pulse are quickened;  and then ensue
other marks of constitutional sympathy, sometimes
of  the active, but  often of  the  passive   kind.
Meanwhile, the patient is not always  disqualified
for muscular efforts and even for some of the com-
mon active  business  of life.  In  the second stage
the effects of  pressure  on the  brain appear, viz,
stupor; paralysis; convulsions;  slow  pulse, be-
coming quick  again  when  the  strength is greatly
exhausted;  smooth, cool, inactive  skin ; followed
by symptoms of exhaustion and death ; or  termi-
nating  suddenly, perhaps, with convulsions.   It is
not rare for this disease to supervene upon others,
and then it is often unnoticed, until  the symptoms
of the second  stage  appear.  Its frequent  combi-
nation  with fever has been noticed.  The pheno-
mena observed after death do not bear a certain
relation to the symptoms  in  this  disease.  This is. 
ol. iii.-or. n.]    SANGUINEOUS FUNCTION.    109

to be explained by a consideration of the greater,
or less rapidity in the organic changes.
   CXLV.  It is almost essential to the  successful
treatment of this disease to commence the treat-
ment early.  Then the usual methods may pn>
duce resolution.  If effusion of any kind has taken
place, the disease is very seldom removed.  When
the disease presents itself under an active form,
the most copious depletion, both general and local,
is requisite.  Then counter-irritation and  alteraT
tives should be employed.  In  all cases the hair
should be removed at once, and if there be exter-
nal heat, cold applications should be made to the
head.  Rest and  the  abstraction of all stimulants
are essential.   When the  disease occurs in a fee-
ble subject and is also attended by passive sympa-
thy, general depletion  must be omitted, or  used
very sparingly; but alteratives and other reme-
dies may be  employed to the fullest extent.  A
spontaneous  recovery  is so rare, in this disease,
that active treatment is justifiable, even at a late
period.  The  distress  at a  late period may  be
mitigated by opiates.
   CXLVI. Species 2.  E. Otitis.   " Severe  pain
in the ear; tenderness upon pressure; deafness or
confusion of  sounds."   Inflammation affects every
part  of the  ear;  and, as the symptoms depend
more on its extent and violence, than on the part
affected, that part is not always easily ascertained,
There  is, however,  sufficient ground for distin- 
 110            HAEMATIC A.           [cl. iii.-or. ii.

guishing two varieties, the external  and internal.
When the disease is  severe, in either case, the
constitution  is affected by sympathy.   In some in-
stances, though rarely, the disease extends to the
brain.   It is a more frequent occurrence for the
inflammation to extend to the portio  dura of the
auditory nerve;  and then  there is  produced that
particular paralytic affection, which  Mr. C. Bell
has described.   The  remedies are those common
to other inflammations.
  CXLVII.  Species  3.   E. Parotitis.  " Painful
unsuppurative tumour of the parotid glands,  often
extending to the maxillary; conspicuous  external-
ly ; frequently accompanied  with  swelling of the
testes in males,  and  of  the  breasts in females."
It may be  doubted  whether this disease  ought
properly to  be introduced into this genus.  It is a
disease of a specific character, produced  by a spe-
cific contagion, and, like  small-pox, very rarely oc-
curs twice in the same subject;  or rather  in the
same gland.   For the disease, having affected one
of the parotids,  the other is  not thereby exempt-
ed from it at a  future day;  at least,  not always.
The tumour commences  immediately below the
articulation of the lower jaw-bone,  and raises up,
or outward,  the  inferior  part of the external ear.
It spreads downward  and forward, increasing for
four days, but most rapidly the  two first.  It sub-
sides in the  course of  the four following days, and
sometimes more  rapidly.   The  subsequent swell- 
 cl. iii.-or. ii.]    SANGUINEOUS FUNCTION.     111

 ing of the testes is not a frequent occurrence, and
 that of the breasts a very rare one.   The consti-
 tutional  affection is usually,  though  not  always,
 slight.  Medicinal  remedies are  seldom wanted.
 The swelling of  the testes, as well as that of the
 parotid glands, subsides  without suppuration ; but
 it is  remarkable that a wasting of  the former
 glands sometimes ensues.
  CXLVIII. Species 4. E. Paristhmitis.  " Red-
 ness and swelling of the fauces; with painful and
 impeded deglution."  There is a great  variety in
 the affections necessarily included  in this species;
 for  the inflammation affects the whole of the fau-
 ces, or a part only ; it is quite limited to the sur-
 face, or goes deep into the  substance ;  it is mild,
 or severe; it affects the constitution very various-
 ly, and not in proportion to its  local violence; and
 it sometimes terminates in an abscess, but common-
 ly not. The disease is also complicated in its symp-
 toms from extending to  the pendulous palate and
 parts above it,  so as to occasion, in some cases, a
 most  inconvenient  and distressing obstruction  in
 the nasal passages.   But, in addition to  these va-
 rieties of common inflammation in the fauces, Dr.
 Good has given as varieties of this species P. Ma-
ligna, P. Pharyngea, and P. (Esophagi; the first a
disease marked  by a  peculiar  inflammation, the
others by a difference in the seat of the disease;
the first of these  requiring different remedies from
the common inflammation;  the others not  admit- 
112
II^MATICA.
[cl. iii.-or. ii.
ting the topical remedies employed in that inflam-
mation of the fauces.
  CXLIX. First variety.  E. Paristhmitis tonsil-
laris.   " Swelling of the mucous membrane of the
fauces, and especially of the tonsils; redness florid;
fever a cauma."  This differs from  the catarrhal
affection of the fauces.   It seldom  extends over
the  whole  of  the fauces  at  once,  but  com-
mencing in or about one  tonsil, extends  in  a day
or two,  to the other, involving in its  course the
pendulous  palate,  and  sometimes  the  posterior
fauces.  Commonly it does not remain in one spot
more  than four days, and terminates in resolution.
It often occasions an cedematous  swelling in the
uvula, in  consequence  of  its pendulous situation
and the looseness of its texture ; and, occasionally,
this part becomes permanently elongated, and then
gives  rise  to frequent irritation in the parts below,
causing cough and retching.  But sometimes this
inflammation  terminates in suppuration, and then
the swelling is large and hard from the  beginning,
deglutition becomes nearly or quite impossible for
a time, and the  duration of  the  disease is much
longer than in other cases.  Some individuals are
very subject to the disease in this form.  The re-
medies  are evacuations,  and refrigerants  to the
parts, in the  form  of gargles.  But if there is a
tendency  to suppuration,  and the disease is not
arrested before the  third day,  it must  pursue its
own course. 
 cl. iii.-or. ii.]    SANGUINEOUS FUNCTION.     113

   CL.  Second variety.   E. P. maligna.   " Red-
 ness crimson ; with ulcerations covered with mu-
 cous and spreading sloughs, of an ash  or whitish
 hue; fever a typhus.  Frequently epidemic; ge-
 nerally contagious.   Found  also  as a symptom in
 rosalia or scarlet fever."  This inflammation is of
 the  erythematous character.  It commences on
 the surface and sometimes it is so superficial in its
 whole course, that the parts do not  appear to be
 at all swollen.  Yet the soreness is very great, and
 the constitutional affection of a more formal kind
 than  in the first variety.  But  more  commonly
 there are patches of  lymph thrown  out,  forming
 the sloughs described, and the parts under these
 appear to lose vitality in the bad cases.   Then, in
 casting off the sloughs, the  circumjacent parts of-
 ten swell very much.   This sloughing  is attended
 with prostration of strength, as if the system  suf-
fered from a great  poison,  or laboured  much in
 separating the dead  from the  living parts.  The
 danger is  to be estimated by the colour  of  the
sloughs, and by the degree of fcetor in the  breath;
 the dark sloughs and very  offensive  smell being
bad symptoms.   In severe cases the  respiration is
affected by accumulation  of matter  and swelling
in the fauces; and occasionally the  inflammation
extends to the epiglottis and even to the  larynx.
The constitutional affection is not always  such as
corresponds in character  with  typhus; but often
                  15 
114
FLfcMATICA.
[cl. iii.-or. n.
more like  synochus;  at  first  active, afterwards
passive  sympathy.
  CLI. In the treatment of this variety of the dis-
ease, when  the  constitutional  affection  is of the
active  kind,  benefit  is sometimes derived  from
bleeding, and often from other remedies, tending
to lessen  the  violent  vascular  action.   By  this
treatment the  inflammation  is limited  in extent
and violence.  But most commonly the  tendency
to weakness in vascular action and the early  pros-
tration forbid general blood-letting, though leeches
may even then be used.  In most cases there is
benefit and almost always  safety in vomiting at an
early period.  The  contents of the  stomach are
often found  to be offensive ; but independent of
the evacuation of these, the  vomiting tends, as in
many other cases, to  diminish the  inflammation,
and at  the same time to counteract  the  constitu-
tional affection.   This is even  more  useful when
this affection is of the passive,  than when of the
active kind.   Moderate purging  is also  useful in
the commencement  of the disease ; and  it  is ne-
cessary afterwards to prevent any accumulation in
the alimentary canal.
  CLII.  When the  inflammation assumes a bad
character, and the symptoms of morbid  irritation
are strong, tonics and stimulants are often highly
useful;  especially cinchona.  Through the whole
disease local applications are very beneficial. Cold
lotions to the neck, and stimulating and  astringent 
cl. HI.-OR. ii.]     SANGUINEOUS  FUNCTION.    115

gargles,  are  the  best local  remedies.   In very
young subjects the astringent washes  must be ap-
plied by the  syringe.
  CLIII. Third variety. E. P. pharyngea. " Red-
ness florid, and especially at the lower part of the
fauces; deglutition extremely painful  and  difficult :
fever a cauma."  Fourth variety.  E. P. oesopha-
gi.   " The impediment,  to  deglutition  felt below
the pharynx, with a circumscribed pain, and rejec-
tion  of food when it reaches the seat of  obstruc-
tion."   Neither of these varieties require any par-
ticular comment; except that in some  individuals
the latter is habitual and  terminates in  suppura-
tion.
  CLIV. Species 5.  E. Laryngitis.  " Pain about
the larynx; epiglottis swollen  and erect; breath-
ing shrill and  suffocative;  great  anxiety; degluti-
tion  impeded;  fever a  cauma."  The  essential
symptoms are  the  difficulty of respiration  and of
deglutition; usually accompanied by hoarseness of
voice.  The proximate  cause  is an  inflammation
in the upper part of the larynx,  sometimes affect-
ing  the upper, or anterior face of the epiglottis,
and  always  the pharynx,  especially  the  part  im-
mediately behind  the larynx.  The  inflammation
is attended  by a  puffy swelling of the mucous
membrane of  the parts mentioned.  It  occasions
death by suffocation.  The treatment  is that  of
inflammation generally, where resolution  is possi-
ble,  and should be practised without delay.  Mer* 
116
HiEMATICA.
[cl. iii.-or. ii-
 curials are especially useful.  In a  bad state of
 the disease bronchotomy should be performed.
   CLV. Species 6.  E. Bronchlemitis.  " Breath-
 ing permanently laborious  and suffocative ;  short,
 dry cough ; expectoration  concrete  and  membra-
 nous ; fever a cauma."   Of  this species Dr. Good
 has two varieties, acute and chronic ; of which the
 first only answers to the disease commonly  known
 among us  by the name  of croup.  This disease
 follows inflammatory affections of the  fauces and
 catarrh, or commences  suddenly without any pre-
 cursor.  Its most  distinctive symptoms  are  a pe-
 culiar sound  in  respiration,  and a ringing  cough.
 The respiration does indeed become  suffocative
 and very distressing; but  this is  in an advanced
 stage.  In the  early stage the patient often ap-
 pears void of  distress and in good spirits.   This
 disease belongs  to children, occurring rarely be-
 fore the third year, and still  more rarely after the
 eleventh.  Its proximate  cause is a peculiar in-
 flammation in the  mucous membrane of the wind-
 pipe, often extending to the bronchia, and causing
 the formation of a false  membrane.   It is the af-
fection  of  the larynx, which is most  important,
though the disease is commonly spoken of as be-
ing especially  in the trachea.  The false  mem-
brane is  not always found on examination  after
death.  It  is said  to be  expectorated  sometimes
with relief; but  this is most rare.  The disease is
almost always fatal, when left to its own course ; 
 cl.ui.-or.ii.]    SANGUINEOUS FUNCTION.    117

 nor are remedies of much avail, unless employed
 within  the first  two  days.  The  object  of  the
 treatment  is resolution of the inflammation.  This
 is effected by emetics, by alteratives and by bleed-
 ing.   The last is  the most  certain remedy,  and
 should be resorted to at  once, if  the  disease has
 passed to the second day.
   CLVI. There do occur, very rarely, cases of a
 chronic kind which may be called croup, or bronch-
 lemitis.   That is, the sound in respiration is of the
 same  kind, and  the  distress is sometimes great.
 But the course of the disease is so different, that
 it must  be  an affection different from  the acute
 croup.  It appears to me to  belong to the  period
 of dentition only, and probably is  a sympathetic
 affection of the spasmodic kind.   It is temporari-
 ly relieved by vomiting.   It should be added, that
 some  children  are  very  liable to  croup, or to
 croupy breathing.  In such the disease easily yields
 for the  most part;  but will sometimes prove fatal
 after  frequent recurrences.
   CLVII.  Children are also  liable to a  species of
 asthma, which often attacks them near  midnight.
 It is usually relieved  by  vomiting,  either  sponta-
 neous, or from medicine;  and then they common-
 ly throw off undigested food.   This, most proba-
 bly, is the disease called by Dr. Good Laryngismus
stridulus.
  CLVIII.  Species  7.   E.  Pneumonitis.   "In-
 flammation of the lungs; obtuse pain in the chest; 
118
H^EMATICA.
[cl. iii.-or. u.
constant difficulty of respiration,  alleviated  by an
erect position ;  tumid, purple face, or lips ; cough,
generally moist, often bloody ;  pulse usually soft."
The inflammation in this disease has its seat in the
cellular membrane of the lungs;  though it  often,
and  even commonly extends both  to the  serous
and  mucous  membrane.   The  symptoms  must
vary according  to the extent and violence of the
inflammation.   It happens,  not xery rarely, that
pain is not  complained  of; especially at an early
period.   There is  some  sense of oppression and
difficulty of  breathing,  and cough; these  local
symptoms are  attended  by constitutional sympa-
thy, which is  various  in amount.   When these
symptoms come on  suddenly, they mark the acute
form of the disease ; but the disease also appears
in the subacute and even in the chronic form.  In
estimating the  weight of  the  malady reference is
to be had to  the degree of difficulty in respiration,
to the embarrassment produced  by coughing, and
to the constitutional affection.   This last, however,
is not to be estimated  merely by the state of the
pulse, but by the whole amount of constitutional
disease.  In  the  progress of the disease the ap-
pearance  of  the matter  expectorated,  and  the
ease  or  difficulty  of expectoration aid  much in
forming an opinion of the extent  and  character of
the inflammation.
   CLIX. In  acute  pneumonitis the inflammation
occurs almost  invariably in the inferior portion of 
cl. iii.-or. ii.]     SANGUINEOUS  FUNCTION.    119
the lungs; or is most severe in that portion, when
not confined to it.  Also,  it occurs  much oftener
on the right side  than on  the  left.   Hence  arises
some affection of the liver, and  most frequently
this is such as to  cause  a  great secretion of bile
from perhaps the fifth to the tenth day, and  a con-
sequent diarrhoza.  This  diarrhoea  affords  great
relief in most  instances.   The same  relief  is not
obtained from a diarrhoea, at a late  period, in pro-
tracted  cases.  Hemorrhage,  whether from  the
lungs or from the nose,  affords some relief; and,
when copious, sometimes terminates the disease at
once.
   CLX.  In most  cases, and especially those  of fa-
vourable termination, expectoration occurs, and the
disease is  said to terminate  by it.   The  matter
expectorated is commonly derived  from the mu-
cous membrane.  The more  fully this membrane
participates in the disease, the  more  favourable the
issue. It furnishes a watery fluid or pure mucus at
first; or,  if much affected,  there is some  blood
combined with the  mucus.   The  matter expecto-
rated gradually acquires the purulent character;
a true suppuration of the  mucous membrane tak-
ing place.  In proportion to the perfection of this
process the  induration  of the lungs is  removed,
and expectoration is rendered more easy.
   CLXI.  In some instances the suppuration  occurs
in the  cellular  membrane, or substance  of  the
lungs; but this is rare.   When this happens,  as 
120
H^MATICA.
[cl. III.-OR. II.
in other abscesses in the  cellular  membrane, the
suppuration is sometimes in one large cavity, some-
times in  many little  cavities, communicating with
each other more or less freely.  The matter form-
ed  in the first of these cases is often very large ;
but the parts  may even then recover, and health
be restored.
  CLX1I.  Pneumonitis sometimes terminates  in
mortification.  More frequently the induration con-
tinues, the  symptoms of active inflammation sub-
siding; and then a slow suppuration may ultimate-
ly ensue  ; or the patient remains liable continually
to fresh accessions of the  inflammatory processes.
This course rarely takes place  in  a healthy  state
of the system.
  CLXIII.  In the treatment of pneumonitis resolu-
tion is to be attempted  at an early period.   This
attempt is seldom  successful  in its full extent, but
very commonly is so  to a certain degree,  and the
danger of the  disease is thereby much diminished.
Even at a  period  comparatively late, after the
seventh day, the inflammation may be  moderated
in violence, and rendered more favourable in cha-
racter, in severe cases, by the milder remedies em-
ployed to produce resolution.   At  a late period, if
the constitution appears to sink under the disease,
the actions of the  system must be  maintained by
cordial stimulants.   Various  substances are often
employed with benefit under  the name of expecto-
rants.  Some of these are such  as diminish the 
BL.in.-OR.il.]    SANGUINEOUS  FUNCTION.     121

inflammation in the cellular membrane, others such
as stimulate the mucous membrane.
   CLXIV.  Pneumonitis  is  always attended with
danger and often terminates life, at all ages.   But
it  is  sometimes  peculiarly fatal, and especially
when it is extensively epidemic.   It is  then called
malignant, and  sometimes is otherwise distinguish-
ed.  The disease, when bearing this  character, is
usually sudden in its invasion, and the constitutional
affection is strongly marked from the commence-
ment ; it consists in  active  sympathy at first, but
is  shortly  followed by some symptoms of  passive
sympathy; and these soon predominate.  There is
likewise an extension of the  inflammation to the
abdominal viscera in many instances; the liver is
often  affected; and hence  the  disease  has  been
called bilious.   There is not  one  uniform course
in  the parts inflamed; but, in general, the process-
es of inflammation are marked by  violence and
succeed each other with great rapidity ; and there
is  a great tendency to an  extension of the disease
from  its original bounds.    When pneumonitis  of
this character  is epidemic,  there  is  found with it
pleuritis and carditis.  In  this  variety of disease
resolution is  to be attempted by the  most  copious
depletion at an early period.  If this be not effect-
ed then, it can  seldom be done afterwards;  and,
when it is not,  evacuations  appear to exhaust the
powers of life without affording any  relief.
                   16 
122
H/EMATICA.
[cl. iii.-or. h.
  CLXV.  Another variety of this disease  has
been described under the name of peripneumonia
notha.   This designation has been  applied to some
different affections;  sometimes to the variety last
described, sometimes to cases of influenza.   But
the disease  described  by  Sydenham under  this
name, and which occurs more or  less frequently
every year in our climate, appears to be a catarr-
hal  affection of the  lungs, in the first instance.   As
such it is not regarded as important; but  present-
ly, inflammation, or  vascular congestion, at least,
spreads to the  cellular  membrane, and dyspnoea,
embarrassing cough, with difficult,  though copious,
expectoration ensue.  These  symptoms  are  not
accompanied by hardness nor  by  great  accelera-
tion of the pulse, the skin is often  cool and moist;
there  is a tendency  to coma, and the patient sinks
unexpectedly into great muscular debility.   In the
aged and intemperate the disease is very often fatal.
  CLXVI. In  this  variety  blood-letting can  sel-
dom be employed with advantage,  or even with
safety.   Other evacuations are  more safe,  but
must be proportioned to the  powers of the patient.
Vomiting is often useful; and if the liver, or other
abdominal  viscera sympathize  strongly with  the
lungs, free  purging may be employed.  Altera-
tives and vesication  are more universally safe,  and
when  the powers  are sinking  very low,  cordials
must  be used  freely.   Death  sometimes occurs
suddenly in this disease, when  the patient  seems
to be convalescent. 
cl.iii.-or.Ii.]     SANGUINEOUS  FUNCTION.    123

  CLXVII. Species 8.   E.  Pleuriiis.    " Acute
pain in  the chest, increased  during inspiration ;
difficulty of lying on one side ; pulse hard ;  short,
dry, distressing cough."  In severe  cases of pneu-
monitis  the inflammation almost always extends to
the pleura ; and in severe  pleuritis the inflamma-
tion commonly  extends to  the  lungs.   But, even
when severe, the  inflammation  is,  in both  cases,
sometimes confined to the parts first affected.  In-
flammation of the  pleura  to  a small  extent and
not severe probably occurs often without any very
well  marked   symptoms.   Adhesions  are  found
after  death in  more  instances, than the  frequen-
cy of the disease would lead us to anticipate.   In
severe cases, there is  usually a copious effusion
both  of lymph and serum,  and adhesion common-
ly terminates the disease.  But in some cases sup-
puration ensues, and constitutes the most legitimate
empyema.   In simple pleurisy  there is cough ;  but
no expectoration, or an expectoration of  only sim-
ple mucus with  more or  less of  watery fluid.
The  inflammation also  terminates in mortification
in some  rare  cases.  The   treatment  has for  its
object the discussion, or the diminution of the in-
flammation.    The  means, though of  the most
grave character and highest importance,  need not
be here specified.
   CLXV1II.  Species  9.   E.   Carditis.   " Pain in
the region of the heart, often pungent;  anxiety;
palpitation; irregular pulse."   Inflammation of the 
124
HiEMATICA.
[cl. iii.-or. ii.
 pleura and lungs, especially when on the left side,
 not very rarely extends to the  pericardium.   But
 inflammation also originates in  the  heart;  and
 though it may affect  all the textures  of that or-
 gan, yet its common seat is  the serous  membrane.
 Here, as elsewhere,  the inflammation  may be va-
 rious in  extent, in severity  and  in rapidity ; but
 even in its mildest form, it most  frequently has a
 fatal  termination.   In severe cases  this occurs
 quickly, but in mild cases it is often  much  pro-
 tracted.
   CLXIX.  Pain in the heart is  not a very com-
 mon symptom  in Carditis;  at least, not such pain
 as to cause  much complaint.  On  the  other hand
 vicarious  pains are  very common, and these may
 be in the trunk,  especially in the abdomen, or in
 the  extremities.   The anxiety, felt particularly at
 the  heart, or about the preecordia, and  manifested
 in the whole aspect and figure, is a more  constant
 symptom, perhaps, than pain in the heart.  Pal-
 pitation is sometimes  felt over a  great extent of
 surface, and is usually accompanied by orthopncea;
 but neither  of these  symptoms are manifested  at
 the commencement of the disease,  except in severe
cases.  Faintness  and  fainting often take  place.
Cough,  as in pleurisy, without expectoration,  or
 with an expectoration of natural,  transparent  and
adhesive mucus,  occurs  in  this  disease.  Nausea
and  vomiting very  frequently  attend  it.  The
pulse is often more regular than would  be antici- 
 cl. iii.-or. ii.]     SANGUINEOUS FUNCTION.    125

 pated,  and,  though  commonly much accelerated,
 is not always so.
   CLXX. Carditis  terminates in  adhesion,  in the
 effusion of serous fluid, and in suppuration ;  or life
 is destroyed by the sympathetic  irritation and ir-
 regular circulation, before either of these effects
 are  fully produced.  In  the two first modes of
 termination the functions of  the   organ are more
 or less constantly disordered, or at least become so,
 whenever  the  circulation is quickened;  but  life
 may be much prolonged.   In the third mode the
 case proves  rapidly fatal.  In the  acute  form of
 the disease art  is of little avail,  unless the most
 copious depletion and other remedies  for produc-
 ing resolution are employed at the very beginning
 of it.   In the subacute and  chronic forms  some-
 thing beneficial  may be effected by local depletion,
 counter-irritation and alteratives,  together with a
 mild diet.
  CLXXI.   Species  10.   E.  Peritonitis.   "Pain
 and  tenderness  of  the  abdomen,  especially  on
 pressure or in an  erect posture ;   with  little affec-
 tion  of  the subjacent viscera, or abdominal walls."
 This definition applies  principally to the  variety
which Dr. Good afterwards gives us, under  the
name of Peritonitis propria.   He has two  other
varieties,  P.  omentalis  and  P.   mesenterica.   In
 truth inflammation may occur  in  any point of  the
peritoneum, and is found  in  every part, whether
investing the viscera, or  lining the  walls  of  the 
126
HjEMATICA.
[cl. iii.-or. ii.
abdominal  cavity.    In whatever  part  of  the
peritoneum it occurs,  it almost  always produces
contiguous sympathy in the part  in  contact, espe-
cially when acute ; and thus its  extension is pre-
vented in a  healthy state of the system.   It sel-
dom extends to the other textures connected with
the  peritoneum.   When the  inflammation is se-
vere  and rapid, the adhesion fails,  and then the
disease  is propagated  over the  whole  cavity by
the matter effused.  In such cases there is found
after death a purulent serum with flakes of coagu-
lable lymph floating  in it.   Where adhesion is
perfect,  it is not  very  rare to find pus; and some-
times there  is an  effort  at  least  to bring this
through  the  parieties  by ulceration.
   CLXXII.  It is important to distinguish this dis-
ease from other  painful affections of the abdomen.
This is not always easy; but it has happened  from
want of  care and from ignorance of the disease,
that experienced practitioners have  failed  remark-
ably in making this distinction.   It is by observing
the effects of pressure, of posture and of respira-
tion that the distinction is to be made.
   CLXXIII. Severe peritonitis is  almost  inevita-
bly fatal, when not met by the  most active treat-
ment in  the  beginning.  This  consists in  copious
general and local bleeding, fomentations and  simi-
lar applications, vesication, cathartics and altera-
tives.    When the inflammation is subacute,  or
chronic,  it gives  rise to  a  great  varietv of symp- 
cl. iii.-or. n.]     SANGUINEOUS  FUNCTION.    127

toms;  which consist  in  uneasy sensations of the
parts, difficulty  and disorder in the functions of the
viscera in the  neighbourhood, and  many sympa-
thetic  affections both  local and general.   Ascites
is one  of the effects of a low peritonitis,  however
induced, and often when limited to a small surface.
The formation of tubercles  on  the peritoneum
is also  attended by a thickening of that membrane
and  a  serous effusion, both of  which are  truly
processes of inflammation.
  CLXXIV.  Species  II.   E. Gastritis.  "Burn-
ing pain at the  pit of the  stomach, increased by
swallowing; rejection  of every thing; hiccough;
emaciation; oppression  and  dejection of  mind;
fever a synochus."  The inflammation here refer-
red to  belongs  to the mucous membrane.  The
remark continually occurs in reading the definitions
of diseases, which consist in  inflammation of any
organ,  that the  symptoms vary exceedingly accord-
ing to  the extent, severity and other characters of
the inflammation.   Hence the symptoms enume-
rated in the definition may indeed show the exist-
ence of the inflammation, to which  it refers; but
also, the inflammation may exist  without all and
perhaps without any  of the  symptoms so  enume-
rated,  but with  a different set of symptoms. These
remarks apply  most especially to  inflammation of
the mucous membrane of the alimentary  canal.
  CLXXV. Inflammation of  the mucous mem-
branes  does not, ordinarily, extend  to other  tex- 
128              ILEMATICA.         [cl. iii.-or. ii.

tures; and  it does  not exhibit  after  death  the
strong marks, which are ancticipated in cases of  a
violent character during life.  It sometimes does
extend to other textures, and then ulceration and
still  oftencr  thickening of  the  parts  are found
after death.  In such cases adhesion to adjoining
organs is usually found also.  When the inflamma-
tion  is confined to  the mucous membrane,  ulcera-
tion  of that  membrane sometimes  ensues.   All
these appearances occur in and about the stomach.
The symptoms in all these  cases are such, as more
or less distinctly mark the nature of  the disease.
  CLXXVI. The symptoms  of gastritis, like those
of other inflammations, consist  in pain and heat of
the part, with increased sensibility and irritability;
and in the disturbance of the functions of the or-
gan.   Now  the common symptoms  may vary, as
in other  inflammations, according  to the  natural
sensibility and irritability of the constitution, to the
extent of the disease,  its severity, 6ic.   The  dis-
turbance of the functions of the organ will depend,
caeteris  paribus, on the  strength of  the  constitu-
tion  generally,  and on that of the diseased organ
particularly.
  CLXXVII. Gastritis may be  produced by the
common causes of visceral  inflammation,  and by
the local  action of agents injurious to its texture,
operating either mechanically or chemically.  In
the treatment of it some regard must be had to its
remote cause.   If this consist in any substance 
cl. iii.-or. ii.]     SANGUINEOUS  FUNCTION.    129
present in the stomach, or if any substance aggra-
vating the disease be there present, such substance
must  be removed  or rendered  innocuous.   As
far as possible  the  stomach should be left  free
from  any substance, which  can  irritate it, even
temporarily.   Mean while, with due reference to
these considerations, the  common remedies of  in-
flammation should be employed.  If the disease
be acute and recent, general  bleeding  is useful;
but otherwise  this remedy must be omitted  or
employed  sparingly.   Opium  is often useful  in
mitigating  the  suffering  until remedies  of more
permanent effect can be  brought into,  operation.
Local bleeding, vesication, and, as soon as may be,
purging are very important  remedies.  It is, how-
ever, to be  kept in mind  that if  disorganization
can be prevented and the violence of constitution-
al irritation controuled, the inflammation as in other
mucous membranes may be  allowed with safety to
go through its regular course.  The same remark
holds good in  regard to the  whole  alimentary
canal.
  CLXXVIII.  Species  12.  E. Enteritis.  "Grip-
ing pain  in the  belly ; tenderness  and  vomiting:
fever a synochus."   The general remarks on the
variety of  symptoms in gastritis apply as strongly
to enteritis.  Particularly in this last  the  extent
and seat of the disease  influence the  symptoms :
and no doubt these must be influenced by the cir-
cumstance of the relative situation of the diseased
                   17 
130
FLEMATICA.
[cl. iii.-or. II.
part to the form of the canal; as, whether it em-
braces a  ring of the canal  or extends in the longi-
tudinal direction.   The observations made on dis-
eases of  the first  order of the first class, and those
on gastritis, render further  observations  on  this
species unnecessary.
  CLXXIX. Species  13.   E. Hepatitis.   "Ten-
sion, soreness, and pain in the region of the liver;
pain about the right shoulder, felt especially when
lying on  the left side ; short, dry cough."  Acute
hepatitis, especially if the  peritoneal  coat  be af-
fected, is very distinctly marked  by its symptoms.
But chronic inflammation of the liver is not easily
detected  in  many  instances, unless  there  be dis-
covered  enlargement and tenderness  on pressure
over and just  below the seat of  this  organ.   De-
rangement of the functions of the liver is  so  rea-
dily produced  by diseases of the other  digestive
organs, that it is  not an evidence, when alone, of
disease in that organ.
   CLXXX. The  treatment  in  hepatitis must  be
conducted on the same principles, which guide us
in the inflammation of other organs.   In  our cli-
mate  suppuration rarely occurs  in  the liver,  but
induration is not  uncommon.  The  great object is
to produce resolution.  It has been thought that
mercurials were peculiarly efficacious in all diseases
of  this organ, and among others in cases of inflam-
mation in it.  This  opinion  is in  great part to be
attributed to  prejudices  formed, when it was not 
cl. iii.-or. ii.]    SANGUINEOUS  FUNCTION.     131

known how useful  mercurials were in inflamma-
tions of other parts of the body.   On  the other
hand, they are often relied on  too  exclusively in
chronic hepatitis.   In  this a  careful regulation of
diet and regimen is  most important; and  benefit
is often derived from  the  mineral acids, both ex~
ternally applied and internally, and  from tonics of
various kinds.
   CLXXXI. Species  14.  E. Splenitis.   " Heat,
fulness, and tenderness in the  splenic region; with
pain upon pressure."   In ascertaining inflammation
of the spleen we have not the advantage of being
guided  by the state of  its functions,  since those
are not known.   But practically  this is  of less
consequence than  might be  anticipated;  for all
the abdominal viscera are so connected,  that a
disease in  one of them  often deranges the func-
tions of all, and the part first affected cannot al-
ways be ascertained.  This  is  especially  true  in
respect to the stomach,  duodenum, liver, pancreas
and spleen.  Acute splenitis is not  common in our
climate;  nor is a well marked  chronic inflamma-
tion of the spleen  of frequent  occurrence among
us.  The most common  instances are  in  persons
coming from districts, in which  intermittent fever
prevails.   In the treatment there is nothing pecur
liar.
   CLXXXII. Species 15.  E.  JVephritis.   "Pain
in the renal region;  frequent micturition; vomit-
ing; numbness of the thigh on  the affected side ; 
132
HvEMATICA.
[CL. III.-OR. H.
 retraction of the testicle."   Well marked nephri-
 tis is a very rare disease with  us.   It  is a  very
 distressing and dangerous one, when left to its own
 course ;  but it yields to the treatment adapted to
 diseases of this genus, if commenced at  a  period
 sufficiently early.   Demulcents  and a  free  use of
 liquids are  found  beneficial; but  acrid diuretics
 not so.
   CLXXXII1. Species  16.   E. Cystitis.  "Pain
 and swelling of the  hypogastric  region; painful,
 or obstructed discharge of urine ; tenesmus."  This
 is a more frequent  disease than the last, both from
 acrid  substances which  reach  the  bladder and
 from cold.   It occurs in females from a sudden
 stoppage of the catamenia ;  and in that case it
 is often  accompanied by inflammation  in the ad-
joining parts ; sometimes by pleurisy; by sympa-
 thetic vomiting; and by symptoms of  morbid irri-
 tation.   In  all cases  cystitis produces strangury,
and sometimes a retention of urine.   The  secre-
tion is generally much diminished.   Tenesmus is
sometimes an attendant.   The treatment does not
vary from that of  other inflammations, except in
the free  use  of demulcents internally, with warm,
mild injections into  the rectum, and sometimes the
use of the catheter.
   CLXXXIV. Species 17. E. Hysteritis. "Pain,
swelling  and  tenderness in the hypogastric region ;
heat,  pain, and tenderness in  the os uteri; vomit-
ing ; pulse rapid."   Inflammation of the uterus, as 
CL. III.-OR. II.]
SANGUINEOUS FUNCTION.
133
also that of the bladder in females,  is frequently
overlooked, especially at  its commencement,  not
so much from any obscurity in the disease, as from
the want of a full account of the symptoms.   It
often produces sympathetic affections of the blad-
der and  rectum.   It  not  uncommonly terminates
in the adhesive stage, leaving the organ enlarged;
but if the mucous membrane of the uterus  be in-
flamed, it may be affected  by a suppurative pro-
cess.   Sometimes  menorrhagia  is  produced  by
hysteritis ;  and this disease, as well  as inflamma-
tion of the ovaries, when chronic, occasions habi-
tual  menorrhagia.
   CLXXXV.  Species  18.   E. Orchitis.   "Pain
and swelling of the testicles; nausea and vomiting;
depression of spirits; pulse quick, and somewhat
low."  Inflammation of the testicles is readily de-
tected by the local symptoms.  It  is sometimes
attended by active, but oftener by passive consti-
tutional sympathy ; and, as happens in the female
in affections of the genital  organs, it is likewise
attended by particular  sympathy of the stomach
and of the brain.   This  disease is  produced by
the common causes of inflammation; by irritation
propagated from the urethra, probably by the vas
deferens; and by some sympathy with the parotid
glands in cases of mumps.   It is not  uncommonly
followed by hydrocele,  especially when produced
by a blow on the part; and then the inflammation
is evidently in the tunica vaginalis testis.  It is 
134
HiEMATICA.
[CL. III.-OR. II.
sometimes followed by permanent  enlargement of
the testis,  and more rarely by a  wasting of this
organ.   To the usual means for producing resolu-
tion there may be added in this case some local
remedies, not applicable  generally to the  other
species  of empresma.  These remedies are such
as appear  to act  as  sedatives to the  vascular
system at the first,  and afterwards such as  are
deemed stimulant.
  CLXXXVI. Genus VIII.  Ophthalmia.   " Pain
and redness of the eye and its appendages; intole-
rance of light; flow of tears or other discharge."
From the variety of textures belonging to  the eye,
and from the different  species of  inflammation to
which, in common with other parts it is liable, its
inflammations present themselves  under numerous
forms.  Hence the  treatment  of  its  diseases has
often been made  a distinct and sole object of pro-
fessional pursuit; and this  not without advantage.
At the same  time it is  only by studying carefully
the  general  principles, or laws of inflammation,
that we  can  learn  to  understand the  numerous
phenomena presented in the  various cases of oph-
thalmia.  And again, the  interest  attached to the
minutest diseases of the eye  leads  to observations,
which throw light  on  inflammatory  processes in
other organs. The subject is too  extensive to be
taken up in its details in  this course; but this is
compensated in some measure by the  frequent re? 
at. iii.-or. ii.]     SANGUINEOUS FUNCTION.    135

ference to it in the  illustration of the diseases of
other parts.
   CLXXXVII.  Inflammation of the eye is impor-
tant, in proportion as it tends to  limit or  prevent
the natural motions of any part  of the ball, or its
appendages; or to produce  opacity in any mem-
brane  or humour, destined for the  transmission of
light;  or to induce organic or vital injury to the
retina.  In proportion  as  any of these  evils are
threatened, does it become an object to effect a
resolution of the inflammation; and, accordingly,
in some cases  the remedies for this purpose are to
be employed to the  extent and with the prompti-
tude called for in the  inflammation of organs es-
sential to life.  In other cases, great as is the evil
which may be produced by the  disease, this may
be averted by mild local remedies.  The eye sym-
pathizes strongly with  the stomach and some other
organs.  Hence disorders elsewhere may produce,
or maintain ophthalmia; and hence too,  this dis-
ease  may  be  relieved  by acting  powerfully  on
other  organs,  as by vomiting.
   CLXXXVIII.   Genus IX.   Catarrhus.   "In-
flammation of the mucous membrane of the fau-
ces, often extending  to  the bronchia,  and  frontal
sinuses; infarction of the nostrils;  sneezing; and,
for the most part, a  mucous  expectoration, or dis-
charge from the nose."  In this disease there may
be inflammation in the  mucous  membrane of the
nose, fauces, or lungs, and this  inflammation may 
136
HiEMATICA.
[CL. III.-OR. II.
commence in any one of these parts and  extend
to the  others.   It  is  thought that  the mucous
glands are the  proper  seat of the inflammation;
or, at least, the source of the  matter discharged.
The disease is various in its violence, in the rapi-
dity  of its course, and in the extent which it occu-
pies  at  one  time.   Hence  a great variety  in the
symptoms it presents at its  attack, and afterwards.
If violent and extensive, a  constitutional affection
may be  induced, and sometimes this is severe.  If
the nose,  and especially the nostrils, be first at-
tacked,  the disease  may commence with sneezing,
a greater or less sense  of fulness in the nose,  and
a feeling of  heaviness in the head.   At first there
will be  no  discharge, or it will  be very watery.
Subsequently the mucus will assume the opacity
of pus,  will  lose some  of the  adhesiveness which
belongs  to it, and will flow  in increased quantity.
  CLXXXIX.  The process is  similar, in  every
part of the  vocal  and respiratory passages;  but
the inconvenience experienced, and  the  mode of
removing the matter which is  formed, varies with
the  part affected.  The disease  assumes impor-
tance when the lungs are  extensively affected, or
when the inflammation spreads  to  the celiular
membrane, as has been noticed under the head of
E. pneumonitis. This is true, especially, with very
young subjects,  and with old ones.  The dyspnoea,
the difficulty  of expectoration, or labour in cough-
ing, the livid flushing of the face, and the stupor, 
„l. iii.-or. ii.]     SANGUINEOUS FUNCTION.     137
are  the  symptoms  to  be  particularly  regarded.
W hen these are severe, and especially if they are
attended by coldness,  or by unequal  heat of the
skin, with   moisture, the case  is full of danger.
This disease is the  one  peculiarly  known under
the  name of a cold,  although this  name is  occa-
sionally applied to  other affections.   It  has been
so named from an  opinion  that it  always arises
from exposure to cold,  or  some analagous cause;
but  this opinion is contradicted by experience.
  CXC.  Catarrh does not,  ordinarily, call for ac-
tive  treatment; but it may be shortened and miti-
gated by abstinence, by evacuations,  and  by altera-
tives, with opium.  In severe cases blood-letting,
vesication and the treatment employed  in other
cases of  active inflammation must be  resorted to.
But  in young  and tender subjects it is  most impor-
tant  to watch that it may not introduce other
diseases.   The croup, for instance,  is often  pre-
ceded by catarrh.   It  is also often  important to
prescribe the mode of prevention for persons very
liable to  this  disease.   This may consist  in avoid-
ing the remote causes,  or in rendering  the  body
insensible to their influence.  The last method is
the best  in almost all cases.
  CXCI. Dr. Good  distinguishes catarrhus  epide-
micus as a distinct species from catarrhus communis,
and  confines the former  name to the disease well
known as  infiuenza.   This  disease is  epidemic,
whenever it occurs; and is justly distinguished as
                   18 
138
HiEMATICA.
[CL. III.-OR. II-
a  different disease from  common  catarrh.  But
every epidemic catarrh is not influenza.  Common
catarrh is often epidemic  for a  few weeks at  a
time in autumn, winter and spring;  and it is often
severe when  epidemic,  especially  among young
children.  The influenza is the  most remarkable
for the wide extent of its prevalence among  the
nations.  It  consists  in a constitutional affection,
or fever  not dependent on a  local  affection,  but
accompanied by inflammation of the mucous mem-
brane of some part; and this part  commonly, but
not always, the lungs, fauces or nose.
   CXCII. The influenza  is sometimes  limited to
adults, or to those  above the age of puberty, but
not often.  It attacks several in the same family,
and many families  at the same moment.  It passes
over extensive  regions in various  directions,  but
occasionally leaves some spots untouched  at  first,
yet visits them afterwards.  It  occurs  at  all sea-
sons; sometimes two years in succession; sometimes
with intervals  of many years.   Though violent at
first, the constitutional affection  subsides shortly;
often in two days.   But the  local  affection occa-
sionally spreads to the cellular  membrane of the
lungs, or to the pleura, and then there is  a secon-
dary affection  of the constitution, which is sympa-
thetic.   Rest  and  moderate evacuations are com-
monly sufficient; but in severe  cases blood-letting
and the other  remedies for resolution are employ-
ed with  benefit. 
cl. iii.-or. n.]    SANGUINEOUS FUNCTION.     139

  CXCIII. Genus X.   Dysenteria.  "Inflamma-
tion of the mucous membrane of the larger intes-
tines ; griping and tenesmus; frequent  and often
bloody dejections; the feces irregularly discharg-
ed."  Inflammation of the  mucous membrane of
the large intestines is  undoubtedly the  proximate
cause of dysentery ; as is shown both by the symp-
toms and by examinations  after death.  But here,
as in  some other cases, the proximate  cause  is
placed by Dr. Good, among the  symptoms, which
distinguish the disease.   The  inflammation  may
differ in extent, violence, and character; and there
is a corresponding difference in the symptoms and
course of  the disease.  Sometimes it is slight and
mild, sometimes severe and malignant.   It occurs
at all seasons, but most frequently in the  autumn.
Then it is often  epidemic, and more severe and
fatal than at other seasons.
   CXCIV.  Dysentery often appears in  the same
situations, in which fever  occurs, and  may proba-
bly be referred  to the same  miasmata.   It has
been attributed to the water employed in diet, in
particular spots, and  perhaps  sometimes with jus-
tice.   Cold is among  the  exciting  causes  at least.
It is thought to be contagious,  but perhaps not on
sufficiently good  evidence.  It is  remarkable that
there  is sometimes a sudden conversion, as it has
been called, of this disease into rheumatism, and
the opposite.  Dysentery  exists  in  combination
with fever,  as  other inflammatory diseases do, 
 1W            H.EMATICA.           [cl. iii.-or. it.
 The danger is  increased  very much by the com-
 bination.  In simple dysentery the danger is to be
 estimated in part by the pain in the abdomen and
 the difficulty of producing  fecal  discharges; but
 much more by  the  violence  of sympathetic affec-
 tion in the general system and in the stomach.
  CXCV. In the  treatment  of dysentery  regard
 must be had to the violence of the disease ; but
 there are certain indications, one  or all of which
 must  be regarded in every case ;  the  methods of
fulfilling them being adapted to the circumstances.
These indications are,  first,  to remove and with-
hold all causes  of  irritation  from  the alimentary
canal.   Second, to lessen the sensibility and irrita-
bility of  the  diseased  parts.  Third,  to remove
 the inflammation.   Fourth,  to maintain the vital
actions, when disposed  to sink.  And fifth,  to re-
store the tone of the digestive organs in the latter
stage  of the disease.  In some mild cases it is suf-
ficient to fulfil the  first indication ; but  most  fre-
quently the second  must afterwards'be  complied
with,  that the diseased organs may be left at rest.
In other cases,  when the  inflammation  is severe,
this must  be diminished before the  efforts  neces-
sary for alvine  evacuations can be endured with
safety.  In such cases  it is often necessary to at-
tend to the second  and  third  indications  at the
same  time.  When the disease has continued long
and the digestive powers are  much impaired, while
the necessity for nourishment is urgent, it is requi? 
 ci. iii.-or. ii.]    SANGUINEOUS FUNCTION.     141

 site  to fulfil the fourth and fifth indications.   The
 fourth alone must be regarded, when  there is a
 sudden sinking and evacuations  cannot be support-
 ed, and this sometimes at an early,  though not at
 the  earliest period of the  disease.   The same in-
 dications  are to  be respected  in chronic,  as in
 acute dysentery;  though in  the methods of fulfil-
 ling them  there  should be  a difference.   When
 dysentery  is  combined with fever, general  princi-
 ples, heretofore stated, must be referred to.
   CXCVI. Genus XI.  Bucnemia.  " Tense, dif-
 fuse, inflammatory swelling of a lower extremity ;
 usually  commencing at the inguinal glands, and ex-
 tending in  the course of the lymphatics."  Under
 this  genus  are comprehended two species, B. Spar-
ganosis and B. Tropica.   The first  of these  falls
 very naturally among the diseases, discussed in the
lectures on midwifery.   The second never  origi-
nates among us;  and the  consideration of it in
this course may give way  to  diseases which  will
frequently demand your attention in practice.
   CXCVII.  Genus XII.   Arthrosia.   "Inflam-
mation  mostly  confined  to the  joints;  severely
painful; occasionally extending to the surrounding
muscles."  Of  this  genus  Dr. Good makes  four
species, A. Acuta,  A. Chronica, A. Podagra and A.
Hydarthrus.  In  the two  first  species   the  term
arthrosia  is  used  as equivalent to  rheumatism,
while in the two last it is  employed in  its strict
generic  sense.  In regard  to the  distinction of 
142
HjEMATICA.
[cl. iii.-or. ii.
rheumatism into acute and chronic it may be said
that like a similar distinction of inflammation ge-
nerally, it is practically convenient; yet it  is a dis-
tinction not susceptible of precise definition, nature
not allowing any such  clear marks, as to justify us
in making two species in this way.  On  the other
hand, among the cases called  rheumatism  there is
so great a variety, that if we make any distinction
of species  we  might  perhaps found it  on  other
circumstances than  the  duration  of the  disease.
The  third  and  fourth species of  this  genus  are
much more distinctly marked than the two first.
   CXCVIII.  Species  1.  A. Acuta.  "Pain, in-
flammation  and  fulness, usually about the larger
joints and surrounding muscles; often wandering;
urine depositing  a lateritious sediment;  fever  a
cauma."  Acute  rheumatism is  evidently an in-
flammation ; but  one of a peculiar kind.   There
is, in its essential nature, a difference from that of
other inflammations; but what this  is we do not
know.  Its external  characters are  usually  suffi-
ciently  clear; but they are  not  always so, espe-
cially  at its  commencement. Its most  common
seat is in the large joints and in the course of the
vertebras.   But it also attacks the  small joints, the
muscles, the various textures  of the eye, and other
parts.  Its first attack may be on  the  eye ;  then
it cannot be known until it  shifts  its seat  to the
joints.   In  whatever part it  commences, it usually
affects  in  succession various  parts of   the  body, 
cl. iii.-or. ii.]     SANGUINEOUS  FUNCTION.    143

commonly leaving one or  more parts  and appear-
ing in others.   The  same  parts  may be  affected
twice or  oftener  during  the  continuance  of the
disease.   The  inflammation does not tend to sup-
puration.
   CXC1X. The local affections in  acute rheuma-
tism are rarely preceded by a constitutional affec-
tion ; usually this follows in a few days, and is one
of the best examples of general inflammation.  The
urgent  symptoms usually  abate  within three  or
four weeks;  but  they recur once and again; and
firm convalescence does not take place, in the ma-
jority of  instances, in a less  time  than  three
months, unless  the disease be relieved by art.
   CC. In some instances  a derangement  of the
digestive functions appears to  be associated  with
this disease from  the commencement; and in all
cases such a derangement  is apt to occur in the
course of the disease, unless  sedulously guarded
against.   The proper rheumatic affection is aggra-
vated by every  such derangement.  The  most
alarming occurrence in this disease is  an affection
of the chest; for not only the muscles of the chest,
but  most  grave  diseases of the lungs and heart
take place.   The rheumatic inflammation of the
heart is commonly seated in its serous membrane;
on this membrane the adhesive process is produc-
ed, and  the matter effused is  not absorbed with
the same readiness as about the joints.  Delirium
is rare.   A spontaneous diarrhoea or diaphoresis 
144            H^EMATICA.          [cl. iii.-or. ii.

will sometimes  terminate  acute rheumatism ;  but
these often occur in it without a removal, and even
without an alleviation of the disease.   Most com-
monly the recovery is slow and gradual, being in-
terrupted by many relapses, or recurrences of the
disease.  The constitution may never recover its
original vigour;  but death is very seldom the im-
mediate consequence of acute rheumatism, unless
the heart be affected.
  CCI. The acute  rheumatism may be arrested
by art at an early period;  and even at a late pe-
riod it may be  somewhat abridged in its duration
and much mitigated.   But in all stages, though the
appearances of disease  are removed, the disposi-
tion to it remains for some time ;  generally longer
or shorter, according  to the previous  duration- of
the malady;  and the  treatment must then be  di-
rected to  the removal of this  disposition and to
guard against causes, which would call it into ac-
tion.
  CCII.  At an  early  period, resolution of  the
rheumatic inflammation  is  to be effected upon  the
same  principles, on which other inflammatory  dis-
eases  are  treated.  Blood-letting is not advanta-
geously employed, except  in vigorous  subjects  and
at a very early period of  the disease; for,  if  the
disease be not  fully removed by  it,  or by other
means shortly after it has been used, the disposi-
tion to new attacks is rather increased.  Purging
is a much safer evacuation,  and may be repeated 
cl. iii.-or. n.]    SANGUINEOUS  FUNCTION.    145

more or less freely, as long as the disease continues.
At first, and  at  any period when the stomach is
disordered, purgatives  may be very  beneficially
combined with emetics.  At an early period dras-
tic purgatives may be used once and  again, even
for several days in  succession;  but not when they
produce much exhaustion.   At a later period gen-
tle purgatives should be used.
   CCIII. Alteratives, either in combination with
emetics and cathartics, or after them, are  valuable
remedies in Arthrosia of both  the two first spe-
cies"; but, in  the first, antimonials and ipecacuanha
are preferable to mercurials.   In  this species  an-
timonials should be used to as large an extent as
the system can bear, and in combination with small
doses of opium;  and at an early  period of this
species, a limited use of mercurials, in conjunction
with antimony is  beneficial; but  a full salivation
should be cautiously avoided.   Counter-irritation
and  narcotics are  also  beneficial  under certain
limitations.   The disposition to a  recurrence may
be overcome by the use of tonics, and by  guarding
against exciting causes.
   CCIV. Besides the disease, which has been now
described,  rheumatism  occurs in a form,  which
may properly be called acute,  yet without a dis-
position to change its seat, usually without  swelling,
and without any or with very slight constitutional
disease.  This may be called  local acute  rheuma-
tism.   It is known by pain, which is  much aggra-
                   19 
146
H/EMAT1CA.
[cl. iu.-or. ii.
vated by motion in the  part, or is felt  only  on
motion.  It comes  on very suddenly in many in-
stances, and sometimes during an unusual exposure
to cold or moisture.   Its most  frequent seats are
the neck, shoulders, loins and hips.  Its  severity
and duration are very various.  It  often yields to
local stimulants; but  sometimes  these  must be of
a powerful kind; and occasionally it requires pur-
gatives.  These may  be  of a stimulant character.
  CCV. Species 2.  A. Chronica.   " Pain, weak-
ness and rigidity of the larger joints and surround-
ing muscles ;  increased  by  motion; relieved  by
warmth;  limbs spontaneously  or  easily  growing
cold;  fever and swelling slight, often impercepti-
ble/'   The disease, which has been described as
acute rheumatism,  sometimes  continues  under a
chronic form.   In some  cases one  or  more parts
continue swollen, lame, or  painful; in  others the
disease is not thus fixed in its  seat,  but often  re-
news its attacks on  one or more parts,  varying in
severity and in duration.  In both  cases the dis-
ease is  usually denominated chronic; although in
the last it is the disposition to the  disease, which
becomes chronic; while  the  several  attacks may
be said to be acute.
   CCVI.  There is  another form  of chronic rheu-
matism, which comes  on  more gradually and some-
times becomes fixed in one or more parts, varying
in severity at  different  times.  This  sometimes
commences in the local acute form  of the disease; 
cl. iii.-or. ii.]     SANGUINEOUS FUNCTION.    147

the local attacks becoming more frequent and pro-
longed, until at length  the  parts are  never quite
free from lameness.  The disease  in this case is
aggravated by whatever disturbs or deranges the
organic functions.   Swelling is  not  a common at-
tendant on chronic rheumatism ; at  least not in
any great amount.   On the other hand, the limbs
affected sometimes become  emaciated.   But the
swelling which does occur is often permanent, and,
though small, it occasions a distortion and rigidity
of the joints.
  CCVII. Chronic rheumatism  may exist in a se-
vere degree, without any well-marked constitution-
al affection.   But  it is  often associated,  at least,
with dyspepsy, and sometimes with other diseases ;
and  occasionally emaciation,  debility, accelerated
pulse and even  hectic  paroxysms  attend this as
they do other chronic  inflammations.   Both acute
and chronic rheumatism are sometimes connected
with cutaneous diseases; thus bearing some analo-
gy to diseases produced by morbid  poisons.   And,
combined with the symptoms of secondary syphi-
lis, there are sometimes not  only pains, but articular
swellings, which could  not  easily be  distinguished
from rheumatic  swellings in some  instances,  or
from white swellings in others.
  CCVIII.   Rheumatism, but  especially  in  its
chronic form,  may be ranked among the hereditary
diseases.    The  disposition  to it   exists  in the
constitution.   But  as in all  similar cases, this may 
148
HiEMATICA.
[CL. III.-OR. M.
 be restrained or brought  into action by habits of
 living, or by accidental causes.   In some instances,
 however, the disease is evidently  excited by acci-
 dent in subjects apparently not predisposed; yet
 the disposition  is  then  formed  and  continues for
 many subsequent years.   Cold,  moisture, and in-
 temperance are the  principal remote causes.
   CCIX.  In  regard  to the proximate cause there
 are cases of chronic rheumatism, in which it  would
 be difficult to decide  even to what subordinate
 system this appertains;  whether  to  the vascular,
 the nervous, or some other system.  But in well
 marked  cases  of  acute  rheumatism this  cause
 seems clearly to consist in some morbid action of
 the vascular system; and,  tracing  the chronic
 rheumatism from the acute, we  are justified in
 supposing that the proximate cause, of  that  also,
 exists  in the same system.   How far  the  same
 opinion can be admitted in regard  to  that form of
 chronic rheumatism,  which neither  originates in
 the acute disease, nor resembles it, may be a mat-
 ter of more doubt.  The morbid action  in  the
 vessels appears to  partake of the simplest charac-
 ters of inflammation; yet it  is an inflammation
 different in kind from others.
   CCX.  In the  treatment of Arthrosia chronica, it
 is  important, first, to attend to the general health.
 If this be deranged,  whether previous,  or  subse-
 quent to the rheumatism, it must,  as far as  possi-
ble, be amended.  For the  proper rheumatic afr 
 cl. iii.-or. ii.]    SANGUINEOUS FUNCTION.     149

 fection, the remedies are to be found  among eva-
 cuants, alteratives,  stimulants, narcotic sedatives
 and tonics.   Local bleeding  is sometimes benefi-
 cial ; and purgatives, especially  those  which are
 stimulant,  may generally be  used with benefit, so
 long as they do not produce  exhaustion.  Emetics
 are sometimes, but more rarely useful.
   CCXI.  Species 3.    A. Podagra.   " Pain,  in-
 flammation, and fulness,  chiefly about the  smaller
 joints:  returning  after intervals; often preceded
 by, or alternating with, unusual  affections of the
 stomach, or other internal parts ; unsuppurative."
 There  is not  any one  mark,  by which  gout or
 rheumatism may always be distinguished;  though
 there are many, by which they may be ordinarily.
 Gout, like rheumatism,  is a painful affection of the
joints, accompanied by swelling and redness; and
 the pain is  aggravated by motion.  But,  usually,
gout is confined to the small joints, at least until it
has  frequently  returned; while rheumatism  is
 more confined to the large joints, especially  at its
commencement.  In both there is a constitutional
 affection; but in gout this  precedes the local dis-
ease, and is  principally a gastric affection, with de-
pression of spirits; though the local  affection  is
sometimes followed  by  general inflammation.  In
acute rheumatism the local disease almost always
precedes the constitutional affection; but  this af-
fection  becomes  more  severe  than in gout, and
continues for a  longer time.  Gout,  like rheuma? 
150
HiEMATlCA.
[cl. III.-OR. II.
tism, shifts suddenly;  but does  not  affect many
joints at once, as acute rheumatism often does.
  CCXII.  A. Podagra sometimes occurs only once
in the same individual.  But in most of its subjects
the attack is renewed frequently, from twice in a
year to once in three or four years.   In some sub-
jects it  produces so much injury to the joints, after
frequent paroxysms, as to cause  permanent lame-
ness, and this in the vertebras, as well as in the
limbs.   More commonly the patient is free from
articular  inflammation, and sometimes  from  all
other disorders, during the  intervals of the par-
oxysms.   Gout is sometimes irregular in its course
and  affects the  more noble organs, occasioning
in them great disorder of various kinds, and some-
times causing sudden death.
  CCXIII.  Gout is  more  frequently hereditary
than rheumatism, and may be traced, like a family
likeness, through  many generations.  But it also
occurs in those whose ancestors were free from it.
In these cases it is commonly attributed to habits
of luxury and idleness.  It is said to occur in those
who drink wine freely ; but  not  in  those who in-
dulge in ardent spirits, unless these  be mixed with
a vegetable acid.  But it  certainly appears in not
a few, who have never indulged in luxury, nor idle-
ness.   Its subjects are most  commonly persons of
rather a large  frame, with  large  heads and full,
round breasts, and  a  florid  complexion.   Its par-
oxysms are sometimes habitual, and occur without 
cl. iii.-or. ii.]    SANGUINEOUS FUNCTION.    151

any obvious exciting cause ;  but it is often induced
by the same exciting causes, which produce  other
acute diseases.   Its proximate cause has not been
discovered.
   CCXIV.  This disease will not yield to any uni-
form mode  of  treatment.  The paroxysms have
been relieved by various methods; but the health
has been  said  to  be otherwise injured,  in many
cases, by some of the  methods employed.   The
principles of treatment  adapted to common inflam-
mation  may be  followed to a certain  extent, in
some cases; but it  must be  done  cautiously,  and
particularly in those, who have had frequeunt re-
turns of  the disease.   Evacuations  from the  ali-
mentary canal, especially purging, may usually be
employed with benefit.  If the evacuants be com-
bined with articles, which are sedative to the vascu-
lar system, they are both more safe and more useful.
In cases not admitting active treatment, it is pro-
per only to regulate what is amiss in  the alimen-
tary  canal,  to enjoin rest under the paroxysm, and
adapt the diet to the digestive powers.
   CCXV.  As  the disease so commonly  recurs
and  generally exhausts the system more and more,
it becomes  important  to guard against these evils
during  the intervals of health.  To this end all
those habits, which aided in inducing the disease,
must be altered;  and methods must be adopted to
increase the vigour and lessen the irritability of
the  system.  In general, temperance and  active 
152
H^MATICA.
[cl. iii.-or. n.
exercise must be  prescribed ;  but with a due re-
gard to the circumstances of each case.
 ' CCXVI. Species 4.  A. Hydarthrus.   This  is
one of the diseases, which custom has  assigned to
surgery.   The  consideration of it  will therefore
be omitted.   I  shall,  however, introduce  here a
fifth species of  Arthrosia, which appears to have
escaped the notice of Dr. Good.   This is the dis-
ease described  by Dr. Haygarth  under the name
of Nodosity of  the joints, and  I have given  it a
corresponding name, deriving  the term from the
greek.
  CCXVII. Species 5.  A. JYodosia.  An enlarge-
ment about the joints, most common in the fingers
and toes;  hard; without discoloration of the skin;
attended by pain; continuing through life; appear-
ing to consist in a morbid growth of  the ends of
the bones, periosteum, ligaments and joints.   This
disease occurs  almost exclusively in women,  and
chiefly at the  period of life  when menstruation
ceases. It commences without violence, but for the
most part progresses  constantly, without lessening
the duration of life.   Distortion is produced in the
joints affected,  and ultimately  their  use is lost.
The skin is not affected.   Although bearing some
resemblance to  gout and rheumatism, Nodosia may
be  readily  distinguished  from  them  both.   Dr.
Haygarth found  leeches  and  bathing with dry-
pumping the  most effectual remedies  for this dis-
ease. 
cl. iii.-or. m.]    SANGUINEOUS FUNCTION.     153

  CCXVIII.  Order III.   Exanthematica.  " Cu-
taneous  eruptions, essentially accompanied  by fe-
ver."  The language used in regard  to cutaneous
diseases  is founded on very natural opinions, but
not on philosophical principles;  and this language
misleads the mind.  A disease on the skin is attri-
buted to some material cause existing  within the
body ; and it is supposed that this  cause " break-
ing forth on  the  surface,"  or being  pushed  out,
constitutes the material part of the cutaneous dis-
ease.   It is  obvious,  however, that a  disease on
an internal membrane, might be, with  equal  jus-
tice,  regarded  in a similar light.   In all  these
cases there is a change in the  organic functions of
the part affected, and in all there is often formed
some material, which either in a liquid, or  solid
form  is  thrown off from  the part.  In  each case
the immediate agents are the blood-vessels of the
part,  and in each  the remote cause of the disease
is often applied to some distant part,  and its local
effects are preceded by some constitutional distur-
bance.   But  in neither case is there reason to sup-
pose  that the material  thrown off  is generated in
any other part than that, on which  it is exhibited.
Hence the expression " cutaneous disease"  is pre-
ferable to that of " cutaneous eruption."
  CCXIX. The great variety in the characters of
cutaneous inflammations would be unknown to us,
if the skin were as much hidden from view as the
internal membranes are.   It is probable, however,
                   20 
154
HJEMATICA.
[CL. III.-OR. III.
that this variety is greater than that of inflamma-
tions  in  any other  organs.   In  distinguishing
these inflammations one of the  most striking cir-
cumstances  is that  in  some  cases  the  system  at
large appears interested in forming them ; or  un-
dergoes what is  called a fever before  their  ap-
pearance ; while in other cases the disease is  form-
ed without the intervention of any, or of  any such
disease  of the whole  system.   In cases  of both
descriptions the inflammation might be called  " a
disease  of the sanguineous  function ;"  but not in
the sense which Dr. Good has  meant  to affix to
this phrase.    Those only of the first description
are intended by him to be included in this third or-
der, under the name of  exanthematica,  or " erup-
tive fevers."  The other cutaneous diseases may,
for the  most  part,  be found in the third  order
" Acrotica" of his sixth class  " Eccritica."
  CCXX. Genus I.   Enanthesis.   " Eruption  of
red,  level,  or  nearly  level patches;  variously
figured;  irregularly  diffused;  often  confluent;
terminating  by  cuticular exfoliations."   Of this
genus Dr. Good  has given  three  species,  which
are well marked, distinct diseases, viz. E. Rosalia,
E. Rubeola, and E. Urticaria.
   CCXXI.  Species 1.  E. Rosalia.  " Rash,  a
scarlet  flush,  appearing  about the second day on
the face, neck, or fauces; spreading progressively
over the body; and  terminating about the seventh
day ; fever a  typhus."   There are two  well mark- 
cl. iii.-or. m.]    SANGUINEOUS FUNCTION.    155
ed varieties of this  disease,  E. Ros. simplex and
E. Ros. paristhmitica.   In the first there is a rash
only, though often affecting the mouth and fauces
as well as the skin ;  in the second there  is an in-
flammation of a grave character in the fauces.  In
the first the constitutional affection  is  commonly
mild, sometimes nearly wanting.   It  is not, how-
ever,  uniformly of  the  typhoid  character.   The
eruption consists in  minute  red  spots.   The seat
of the inflammation  is that part of the skin most
immediately under the  cuticle.   It  does not ap-
pear that any effusion takes  place ;  but as the in-
flammation declines  the cuticle  is thrown  off in
branny scales.   The eruption  almost  always sub-
sides on the fifth  day from  its  first appearance,
and in one or two days afterwards no vestiges of it
remain.  The fever subsides before, or with the
eruption in most cases.
   CCXXII. The second variety, scarlet fever, with
sore throat, usually commences with soreness in the
fauces and difficulty  in swallowing.  This is some-
times preceded, and almost  always  accompanied
by fever, or constitutional affection.  The  erup-
tion does not appear on  any  certain  day, nor does
it appear to influence  the  progress of the disease
in  any remarkable  degree.  On  the  other hand
very much depends on the state of  the  throat.
The inflammation of the throat in this species is
usually attended by  swelling  and almost always by
sloughs on the tonsils, or other parts of the fauces. 
 156            H^EMATICA.         [cl. iii.-or. hi.

 These sloughs form on the surface and  gradually
 get deeper.   At first  they are of a light  colour;
 but they grow more dark  subsequently.   In  pro-
 portion as they are more  extensive, more deep
 and more dark coloured, the disease is dangerous.
 The absorbent glands  of the neck are usually en-
 larged and tender, and sometimes they suppurate.
 In some instances the  local  disease extends to the
 nasal passages and even to the ears.
   CCXXIII.  The convalescence from this disease
 is slow, and is often interrupted by other diseases.
 The  British writers  mention dropsical  affections
 as very common, and as occurring  particularly
 upon exposure to cold, even as late as three weeks
 after the  rash has subsided.   With us rheumatism
 more frequently supervenes, and this usually with-
 in a  week  after the  eruption  has  disappeared.
 This  may affect  any part of the body, but is most
 common in the wrists  and hands,  ancles and feet.
 It is  marked by tenderness  of  the  parts, some
 swelling and  occasionally redness, with great pain
 on motion.  It differs  from  rheumatism  occurring
 in other cases by subsiding  spontaneously in most
 instances within  a week.  Scarlet fever is conta-
gious, and one variety  may be produced by expo-
 sure to  the other.   Its severity, and the  mortality
 occasioned by it, are very various at different pe-
riods.  The eruption does  not  occur twice in the
same  individual,  with perhaps  a few  exceptions.
But it is not very rare  to see the sore throat, such 
cl. 111.-0R. in.]    SANGUINEOUS FUNCTION.    157

as has been described, occur twice and even often-
er, in the same person; and  this even from expo-
sure to the disease in its more perfect form.
   CCXXIV. The  violence  of the cutaneous dis-
ease and of the fever attending it may be reliev-
ed, especially at an early period.   But the inflam-
mation is of a specific kind ; and its duration cannot,
probably, be diminished by any treatment.   The
affection of  the throat, when severe, requires the
treatment pointed out for Empresma Paristhmitis
maligna.  Mercurials  and digitalis, sometimes pre-
ceded  by blood-letting, are  found most useful in
the dropsical affection which has been mentioned.
Gentle purging, and local tepid bathing are gene-
rally sufficient in the  treatment of the  rheumatic
affection.
   CCXXV.  Species  2.  E. Rubeola.   " Rash  in
crimson, stigmatized dots, grouped in irregular cir-
cles or crescents; appearing about the fourth day,
and terminating about the seventh,   preceded by
catarrh; fever a cauma."  This disease  resembles
scarlet fever in many points; yet differs so decid-
edly from it, that we are surprised that  they were
long confounded under the same  name.  The in-
flammation is in both of a specific character  and
very superficial,  but  differs  in the  form of the
spots and somewhat in colour.  The  eruption may
be seen, first, on the fauces,  then  on  the face and
neck, and afterwards on the trunk and extremities.
Meanwhile  the inflammation  spreads  from  the 
158
H^MATICA.
[CL. III.-OR. HI.
fauces to the lungs, though not  in the same mea-
sured course ; nor does it probably there retain its
specific  character.  All the textures  of  the lungs
become  inflamed in bad cases, though the mucous
membrane  only partakes  of  the disease at first.
The constitutional affection often  increases   in se-
verity after the  eruption, in consequence of the
pulmonic inflammation.  The danger of the dis-
ease depends  mainly on  this  inflammation.   The
measles, like scarlet fever, varies much in severity
and danger to life  in different countries  and  sea-
sons.
  CCXXVI. This  disease  appears in a  spurious
form.   Rubeola sine catarrho  of  Willan, R. Incocta
of Dr. Good.   This does not  give its subjects an
exemption from the true disease; for the true dis-
ease, with a few  exceptions does not occur twice
in the same subject.  The spots  in  measles often
assume  a slightly  livid  or dark hue at the period
of decline, and this when  the convalescence is fa-
vourable.   But in some cases the eruption has an
unusually dark appearance even at  an  early pe-
riod, or  at the time when  it  should  be subsiding,
and the system suffers under passive sympathy.
This variety called the black  measles, (R. Nigra
of Good,) is uncommon among us; and is said to be
attended with  great  danger.  It may  be  added
that a sudden  and premature subsidence of the
eruption, accompanied  by great   internal  distress,
particularly at the chest, and immediately threat- 
cl. iii.-or. in.]    SANGUINEOUS FUNCTION.     159

enmg life, is  one of  the evils  much dreaded  in
this disease.  But with us this is an accident very
rarely observed.
   CCXXVII.  In measles active  treatment is not
always  requisite.  It  becomes so Avhen the consti-
tutional affection is violent, but still more when the
disease  of the lungs  is severe.  When  the  lungs
are affected the treatment must have reference  to
them, and this without much regard to the period
of the cutaneous disease.  It is, however, impor-
tant to  distinguish  the rapidity and labour of re-
spiration,  attending an accelerated circulation on
the first days  of  the disease, from the  embarrass-
ment in the respiration, caused by inflammation  of
the  lungs.  In the rubeola nigra,  if  the  system
yield greatly,  cordials and tonics are requisite; and
the same  may perhaps be called for in some rare
instances  of the sudden  subsidence  of the  cuta-
neous eruption.
   CCXXVIII. Species 3.  E.  Urticaria.  "Rash
in florid,  itching, nettle-sting  wheals; appearing
about the second day; irregularly fading and re-
viving, or wandering  from part to  part;  fever a
mild remittent."   Unlike the other two species of
this genus, this disease is not contagious, and may
affect the same  subject  repeatedly.  It is  often
produced   by  offensive materials  taken into the
stomach.   It  may  be mitigated by a cooling ca-
thartic and a cool regimen.   Or, when any offen- 
160
H^EMATICA.
[CL. III.-OR. III.
sive material has been swallowed, this may be re-
moved by an emetic.
  CCXXIX.  Genus  II.  Emphlysis.  "Eruption
of vesicular  pimples, filled progressively with an
acrid and colourless, or nearly colourless fluid; ter-
minating: in scurf or  laminated scabs."   The two
first species, E. Miliaria, E. Aphtha, and the fifth,
E. Pemphigus, will not be noticed.   Species 3.  E.
Vaccinia.  "Vesicles few, or a single one; confin-
ed to the part affected ;  circular, semi-transparent,
pearl-coloured; depressed in the middle, surround-
ed with  a red areola."   Of this species  Dr. Good
gives four varieties, two  of  the casual and two of
the inoculated disease, one  of each kind being spu-
rious.  This is a contagious disease,  never propa-
gated except  by inoculation.   It  is, so far as  is
ascertained, derived either  from  the cow or the
human subject.   It does not occur twice, in a per-
fect form,  in the same subject.  The  small pox
does not occur in those who have undergone this
disease.  There  are some  exceptions;  but they
are not frequent; and when  the small  pox does
occur after the vaccine  disease, it  is usually in a
mild and safe form.
  CCXXX. Vaccinia exhibits,  in  the part inocu-
lated, the  following characters,  with some little
variations in  the rapidity of its course.   There is
first a  pimple, then a vesicle and then a scab, each
of which is  precisely circular, with  a  depression
more or less distinct in the  centre.   The pimple 
cl. iii.-or. m.]   SANGUINEOUS FUNCTION.     161
begins to form in about forty-eight hours from the
time of inoculation.   This is red,  projecting and
hard, or firm.  It gradually  enlarges,  and an effu-
sion of serous fluid taking place on its surface, un-
der the cuticle, a  vesicle is  formed  on the  fifth
day.  The vesicle increases  and entirely takes the
place of the pimple in the two following days;  so
that on the seventh day there is  seen  a  vesicle,
more thick, or more prominent  on  the  skin than
the pimple had  been, as well as spread  over a
larger surface.   On the eighth or ninth  day a red
areola, or an inflamed ring is formed around the
vesicle, and this continues to  enlarge, at least, one
day more.   About the  ninth day the  disease may
be  considered  at  its height.  At this time the
vesicle is much distended, with a deep indentation
at the centre, where the  cuticle seems to be at-
tached ;  the margin overlaps its base ;  and there
is a peculiar appearance, as if cords radiating from
the centre, passed  to its circumference, and par-
tially prevented the distention of the cuticle.  Its
contents are transparent and appear to be confined
in distinct cells, so that several  punctures are re-
quired to discharge them.  The fluid, if discharg-
ed, very soon concretes; and the orifice, by which
it is discharged, is thus closed.  The  vesicle then
fills again in a short time with a fluid of the same
character as before.  On the tenth, or  eleventh
day at farthest, the scab begins  to form,  by the
drying or concretion of the vesicle.   This com-
                   21 
162              HiEMATICA.         [cl. iii.-or. nr.

mences at the centre, and gradually extends to the
circumference, not being perfectly formed  before
the twelfth, nor often  before the  fourteenth day.
It falls off spontaneously from the eighteenth to
the twenty-second day.  When  first  formed  it is
of the full size of the vesicle, but it shrinks a little
before its separation.  It leaves  a slight cicatrix,
quite superficial,  in which are seen several  minute
depressions.   In many  persons these  disappear
after a few years.  The scab is  a little  various in
colour; about  as various, in this  respect, as maho-
gany-
  CCXXXI.  This disease is  often, though not al-
ways, attended by a constitutional  affection.   Ge-
nerally at the end of seven  or eight days  there
is some soreness and  swelling  in  the  absorbent
glands nearest  the vesicle, commonly  in the axilla;
and on the following some  pain in  the  head or
stiffness of the  neck with other slight  febrile symp-
toms, supervene.   This affection is very slight in
infants, and generally is more  severe as the sub-
ject  approaches the adult age.  It  does not re-
quire any medical treatment.  The  only care re-
quisite is to guard the inoculated part from  acci-
dents, and to see that  it goes through the several
processes, so as to  secure  the patient from small
pox.
  CCXXXII.  Vaccinia Degener, or spurious cow-
pock, is only an imperfect cow-pock,  arising either
from the bad quality of the virus employed, from
some bad state of the  constitution in the patient, 
ol. iii.-or. in.]    SANGUINEOUS FUNCTION.     163

or from some  accidental  interruption of it.   It is
not one uniform disease, admitting  a precise  de-
scription.  Generally it is marked by one or more
of the  following  characteristics.   The disease is
too rapid in its progress ; the cuticle forming the
vesicle  is thin and readily breaks  or bursts;  the
fluid  is  turbid,  often  yellow or  straw-coloured,
sometimes approaching pus ;  the vesicle does not
preserve its perfect circular form ;  the depression
at the centre and  the  tumid  edges of the  vesicle
are wanting; and the  scab is flaky and soft, and
often separates prematurely.
   CCXXXII1. To produce the true disease the vi-
rus should be taken from a perfect  vesicle, before
the areola is formed,  and should  be used within
twenty-four hours.  If not inserted immediately,
it should be conveyed  on the  point of an  instru-
ment, on which it will  not  have any chemical ac-
tion.   It should be  inserted in  a healthy subject,
and particularly in one not affected with any cuta-
neous disease.   To test the  influence of the dis-
ease  on  the system,  a new  inoculation may  be
made at  the end  of four days  from the first.  If
the first inoculation have  its  proper influence, the
two will  have advanced to the same stage  of the
disease  at the  end of seven  or eight days, the
vesicles differing  only  in size.   The influence of
vaccination may also be tested by  a second inocu-
lation with the  vaccine virus  at the end of  several
months, or years.  If the first has  been successful.^ 
164
HAEMATIC A.
[CL. III.-OR. III.
 the second will at most produce  an imperfect dis-
 ease, and this will arise and terminate more rapid-
 ly than the first.
   CCXXXIV.  Species 4.  E. Varicella.  »Vesi-
 cles scattered over the body;  glabrous; transpa-
 rent ;  pea-sized;  in  successive  crops,  with red
 margins; pellicle thin; about the  third day from
 their appearance  bursting at the  tip and concret-
 ing  into small puckered scabs,  rarely leaving a ci-
 catrix."   This mild disease is produced by its spe-
 cific  contagion,  without  personal   contact;  and
 occurs only once  in the same  subject, with very
 few exceptions.  It is  too  mild a disease to call for
 remedies in most  cases, and never requires power-
 ful ones.   It is  most important to mark the diffe-
 rences between it and small pox.
   CCXXXV. Species 6.   E. Erysipelas.   " Vesi-
 cation diffuse ;  irregularly  circumscribed ;  appear-
 ing on a  particular part of the body, chiefly the
 face, about the  third day; with  tumefaction  and
 erythematic  blush;  fever  usually  accompanied
 with sleepiness, often with  delirium."  Dr. Good
 insists, very properly,  on the distinction between
 erysipelas  and  erythema,  though they are often
 confounded.  Erythema is a local disease, produc-
 ed  by various causes,  often connected with  the
 state of the  constitution at the  time, and  has a
 tendency to vesication.   Erysipelas,  like rubeola,
 variola and varicella, commences  with fever.   It
is an erythematous affection,  producing vesication 
«. 111.-0R. in.]     SANGUINEOUS  FUNCTION.    165

as an essential part of the disease; sometimes con-
tagious, though not  commonly so.  It is also true
that erysipelas sometimes prevails more than usual,
without our  being able  to  trace it to contagion.
The same person may be affected  with  this dis-
ease more than once.  Sometimes  the inflamma-
tion is not limited to one region, but occurs succes-
sively  in various parts of the body.  On this ground
Dr. Good makes two varieties, the local and erra-
tic erysipelas.
  CCXXXVI. In the treatment the principal  re-
liance  is to be  placed on some  evaporating lotion
to the part affected and cinchona internally.   But
the system must be prepared for the  cinchona by
evacuating the alimentary canal.  Likewise, blood-
letting is sometimes useful as a part of the prepa-
ratory treatment.   Rest and  a free state of the
bowels must  be enjoined through the whole treat-
ment.  When there is great sinking, wine and cor-
dials must be administered.
  CCXXXVII. Genus III.   Empyesis. "Eruption
of phlegmonous  pimples ; gradually filling with a
purulent fluid ; and terminating in thick scabs, fre-
quently leaving pits  or scales."  Of this  genus
there is only one species, E. Variola.   " Pustules
appearing from the third to the fifth day; suppu-
rating  from the eighth to the tenth; fever a cau-
ma ; contagious."  The  small pox  seldom occurs
in the  same subject more than  once, and especial-
ly not with  severity.   This disease is communi- 
166
MMATICA.
[CL. III.-OR . HI-
cated by matter in an insensible form, without per-
sonal contact, or by inoculation  with  the virus in a
sensible form.  In the last case a distinct local dis-
ease is produced  in the first instance,  and  this is
followed by a constitutional affection,  as  in  the
vaccine disease ; but, different from that, the con-
stitutional affection is followed  by many pustules.
In the first  case without any known local affection,
the constitutional  disease and pustules follow the
exposure  to the contagious matter.  The disease
does not follow the exposure so soon  as it does the
inoculation ;  but is more  severe, and  much  more
frequently fatal.    The  local  affections, whether
primary or  secondary, exhibit  the following cha-
racters ; first that  of pimples, then vesicles attend-
ed each by  a small areola, then pustules  and then
scabs.   In bad cases  when the scabs  fall  off, some
of them leave permanent cicatrices  with  depres-
sions, constituting  pits, particularly  on  the face.
This happens from the formation of sloughs  at
the bottom  of the pustules and a  rapid cicatriza-
tion under them.   Besides the constitutional affec-
tion at the  commencement of  the disease,  there
is one, occasioned  by sympathy, at the height of
the local disease ; which has been called the secon-
dary fever.   This is often fatal.
  CCXXXVIII. There are some varieties noticed
in this  disease, each capable, though not equally
capable, of  producing the others.  Among  these
some persons have been disposed to place vaccinia, 
cl. iii.-or. iv.]    SANGUINEOUS FUNCTION.     167

This, however, always reproduces itself alone and
is  never produced by variolous virus of any  kind.
The  disease called varioloid  is a  variety of the
variola; the eruption being more or less imperfect
in its characters, and more rapid, than the perfect
disease, in its course.
   CCXXXIX.  In  the  treatment of small  pox  it is
most important to remember that the disease con-
sists in a cutaneous inflammation of a  severe cha-
racter.  This is an inflammation, which cannot be
removed by resolution ; but it is one which may
be increased, or diminished  by the mode  of ma-
naging its subject.   To diminish this inflammation
the patient should be at  rest, should be kept cool
and on a light diet, and should be evacuated accord-
ing  to  the  violence  of  the  disease.   When the
inflammation assumes the erythematic character,
as it sometimes does, cinchona should be employed
freely,  proper  evacuations  from  the alimentary
canal having been premised.   WThen  the powers
of the system flag and appear insufficient to carry
on the successive  processes of the  diseases, a dis-
creet use  of cordials is found beneficial.
   CCXL. Passing by the plague and yaws, with
which happily we  have little  to  do,  we proceed
now to  Order  IV.  Dysthetica.   "Morbid  state
of the blood, or blood-vessels; alone,  or connect-
ed with a morbid state of the fluids, producing a
diseased habit."  There is certainly a convenience
in the term cachexy,  or  depraved habit,  as de- 
168
HiEMATICA.
[cl. iii.-or. iv.
scriptive of a state of  the  system,  which is often
exhibited under disease ; and of which the cause
is not always at once obvious.   But the ideas con-
veyed by the term are  not sufficiently definite for
scientific purposes; and the morbid affections pro-
ducing the  state,  usually or always  local,  are so
various, that they do  not easily admit of being
ranked in any one class, or order.  They  consist,
in many instances, of organic changes; and these
are often the consequences of inflammation.  The
subsequent disorder in the functions, however, are
not always the  direct  effects  of  inflammation.
Accordingly, the  same effects are  produced  by
organic changes in the  same parts, without inflam-
mation.   The  consequences  of  organic changes
are disordered functions, propagated from the part
affected,  to other parts, according to its relations
to  them.  But sometimes the disordered functions
are occasioned by other causes ; no organic  change
existing.  The  distinction of diseases so similar in
their  phenomena, yet so dissimilar in their causes,
is attended with  great  difficulty.  This difficulty
it should be the business of the Nosologist to over-
come.  Instead of doing so, he has  been  apt to
make a convenience of a class  or order of cachex-
ies, in which to include  diseases not  easily  arrang-
ed elsewhere.  Dr. Good has  narrowed the limits
of this order by  his definition.  Yet he has, per-
haps, been somewhat  arbitrary  in  determining
what diseases to admit  into it. 
cl. iii.-or. iv.]    SANGUINEOUS FUNCTION.    169

  CCXLI. The  principal characters of cachexy
may be traced to a failure, or change, in the func-
tions of formation.   First, there is a failure in nu-
trition, whence the form  and colour are altered,
the texture of parts exposed  to the  eye seems
changed, and  the general vigour is impaired.   Se-
cond, there is a like failure in secretion, so that
the secreted fluids are lessened  in quantity, or al-
tered in quality.   Third, there is some  new for-
mation, or operation performed by  the  extreme
vessels, such  as tumours, effusion of serous or other
fluids.   Now, these  changes and  failures  in the
functions of formation may  be  traced  to a failure
in the functions of  assimilation, or to a  direct sym-
pathetic affection from organic or  other changes
in various organs.   Where  the source of difficulty
is known, the disease will be characterized by the
nosologist, and will be placed  in his system, with
reference to that.   But  where this  source  is not
known, he will be glad to have a class of obscure
diseases, among which to place the case he has to
provide for.   If all  this were explicitly acknow-
ledged it might be less important;  but the  evil is
that such a class is  introduced  with all the  form
of  scientific definition;  and  diseases are  brought
together, which have, at least, as  close an affinity
to those of other parts of the  nosological system,
as to each other.   Why, for instance, are organic
diseases of the liver, and other organs, arising from
the presence of tubercles, placed in other classes
                    22 
 170            HjEMATICA.          [cl. iii.-or. iv.

 or orders, while  similar organic diseases  of the
 lungs are arranged in the  order under  considera-
 tion ?  Similar questions  may be multiplied  very
 much.
   CCXLII.   Genus  I.   Plethora.  "Complexion
 florid ; veins distended; undue sense of heat and
 fulness;  oppression of the head, chest, or other
 internal organ."  Of this genus there are two spe-
 cies.  Species  1. P. Entonica.   " Pulse full, strong,
 rebounding;  muscular fibres firm and  vigorous."
 Species  2.   P.  Atonica.   " Pulse  full, frequent,
 feeble;  vital  actions  languid; skin smooth and
 soft; figure plump, but inexpressive."   The states
 of the system here  described, those of the two
 species being more or less mixed in some cases, are
 very generally recognized by medical practitioners.
 There may be some  hesitation in admitting them
 on  the  list of diseases.   But this  will be found
 perhaps, to be  a question about words rather  than
 things.  A more important question  may be made,
 whether these  states arise without some local dis-
 ease.  Probably  they  do;  but they seldom  con-
 tinue long, without producing local disease.  Like-
 wise,  the appearance  of plethora  frequently ac-
companies inflammatory diseases in  persons,  who
 had not  previously exhibited the marks of  that
 disease.
  CCXLIII.  In  the  treatment, some  evacuation
 may be requisite in both species,  but most  in the
first, for  immediate  relief.   Likewise  any local 
cl. iii.-or. iv.]   SANGUINEOUS  FUNCTION.    171

affection, whether a cause or  consequence of the
plethora, must be removed.  Then the permanent
relief must  be obtained  by attention  to diet and
regimen.
   CCXLIV. Genus II.  Hcemorrhagia.   " Flux of
blood,  without  external  violence."    A flow  of
blood following a  division of an  artery or vein is
readily  understood.  Such  a  flow is arrested  by
natural  causes, except when it  takes place from a
very large vessel. But, without violence, blood may
be discharged from the vessels of any organ.  In that
case the blood may  be retained within or about the
organ, becoming diffused throughout a circumscrib-
ed cavity, or rupturing  the organ and forming a
bed for itself: or, if it  be near any outlet, it may
there find a passage from the body.  In the for-
mer case  the  blood effused  must  press upon the
organ and perhaps  the surrounding parts, and may
there be productive of various evils.  If these be
not such as  to destroy life,  the blood will be ab-
sorbed after a time, and  health  will  be restored.
In the  latter  case, which is  by much  the  most
common, the  only  necessary consequences will be
those of loss  of blood  from  any cause; and this
will be  a benefit or an injury according to the state
of the part, or of the constitution.
   CCXLV.  The  first  inquiry in regard  to this
subject  is, by what orifices the blood escapes from
the vessels.  These orifices maybe preternatural,
or natural.  It seems generally  to be taken for 
172             HjEMATICA.        [cl. iil-or. iv.

granted, that they are preternatural.   There are
two ways,  in which these may be formed ; by in-
ternal  violence  and by ulceration.  There is  no
doubt  that they are formed  in both ways.   They
are formed by  internal  violence, viz.  by  the im-
pulse of the circulating  blood upon the coats  of
feeble  vessels.   This may sometimes happen, but
it may   well be  doubted  whether it is a frequent
occurrence, and whether it occurs in vessels  of
any great size,  so  as  to  be   the  cause  of  the he-
morrhagies, which call  for  medical care.  It  is
also true that the  orifices are formed by ulcera-
tion.   But this also is comparatively a rare occur-
rence,  and  only  in  cancerous, or  other very mor-
bid ulcers; or in cases of aneurisms.
  CCXLVI.  The orifices  may  also be natural.
There  are not any natural orifices  in  the  vessels,
which  can be demonstrated,  yet  the existence  of
such can hardly  be doubted.   It has been thought
that there  are,  in the coats of  the arteries and
veins,  especially of the  latter,  inorganic  pores,
which  may be so enlarged as to allow the passage
of blood.  In the  dead body, after a certain time,
we sometimes see blood infiltrated through the
vascular tunics and colouring the surrounding parts.
Some evidence has been  adduced to show that a
hemorrhage may  occur  through  these inorganic
pores;   but this  evidence is shown only in cases  of
vessels   morbidly  and  preternaturally  enlarged.
There is not any reason to suppose that this is the
case ordinarily in cases of hemorrhage,  and some 
cl. iii.-or. iv.]    SANGUINEOUS FUNCTION.    173

positive  testimony  can be  adduced  against this
supposition.
   CCXLVII.  There are  other  orifices  from the
vessels, which have been regarded as organic pores.
These are the orifices of the exhalants, which are
found in every part, and  among the  rest on  the
mucous membrane lining all  natural outlets. These
exhalants are in direct continuation from  the large
vessels.  They are not in  their common state large
enough to permit the red  globules to pass through
them.   But this is owing to a contraction of their
tunics, and these will certainly  admit so  much di-
latation as to allow a  free passage  for the blood.
It is generally acknowledged that blood sometimes
flows in this way ; and this kind of  hemorrhage is
denominated anastomosis,  because the blood flows
through the mouths of the  vessels.   It   has been
doubted whether large hemorrhages take place in
this way.   That they do,  however, may be shown
by the most strongly marked cases.   These cases
will indeed warrant the belief that,  in most instan-
ces of spontaneous  hemorrhage, the  blood is  dis-
charged from  its vessels in the manner last  de-
scribed.
   CCXLVIII. We next inquire under  what cir-
cumstances the exhalants pour  out blood.  This
seems to happen when the  extreme vessels are in
a state very analogous to  that, in which  they are
in inflammation.  It happens in different stages of
inflammation,  or  under circumstances similar  to 
174             HiEMATICA.          [cl. iii.-or. iv.

those,  under which inflammation arises ;  it some-
times relieves inflammation;  it  is sometimes  fol-
lowed  by  inflammation;  it  is  accompanied  and
sometimes preceded  by constitutional excitement,
as inflammation  is; it  may  happen  without  any
affection of the system, as inflammation does ;  and
it  is influenced  by some  of the same remedies,
which  have an influence on inflammation.
   CCXLIX. Dr. Good has two  species in this ge-
nus.  Species 1.  H.  Entonica.  " Accompanied
with increased  vascular action : the blood florid
and tenacious."  Species 2.   " H. Atonica.  " Ac-
companied  with general  laxity  or  debility;  and
weak  vascular  action;  blood attenuate and of a
diluted red."  The distinction  here made is very
o-enerally  insisted on, and  there  is  certainly some
foundation for  it.   But that  all cases will find a
place in one or the other of these species, relying
on the characteristics here mentioned, is not true.
The extreme cases are  well marked,  but there
are intermediate ones of every conceivable grade,
havino- the peculiarities of  these  two  affections
variously  intermixed.   In the cure of hemorrhage
so much regard to this  distinction is necessary as
this, viz.  to  consider  the  general  evidences of
strength,  or weakness of  the constitution, and the
degree of force in the circulation at the time.
   CCL.  In the  treatment  of  hemorrhage  very
different intentions are to be  adopted in  different
cases.   So much  blood may be lost  as  to  cause 
cl. 111.-0R. iv.]    SANGUINEOUS FUNCTION.    175
 great weakness, or to destroy life.  When these
 evils are to be justly feared the intention should
 be  to  arrest the  hemorrhage.  There  may  be
 reason  to fear that inflammation will  ensue upon
 hemorrhage, and  that of such a kind,  or  in such
 an organ, as  to  endanger  life ;  and then the in-
 tention should be  to guard against such  inflam-
 mation.  The  hemorrhage may be often  repeat-
 ed and become habitual, though never great  at
 any one time.   Then  the recurrence is to  be
 prevented.   This habitual  hemorrhage is some-
 times  connected  with  chronic  inflammation  or
 other organic disease of some organ, and then the
 removal of  this original affection must be made
 the object.   Habitual hemorrhage  also continues,
 and perhaps is produced, in consequence of weak-
 ness or relaxation in  the vessels, from  which  the
 blood is discharged.  Then tonics and astringents
 are useful.   Hemorrhage is sometimes  referrible
 to a peculiar constitutional disposition; but this is
 brought into  action  by  various  exciting  causes.
 The constitution cannot be altered, but the excit-
 ing causes may be obviated, or counteracted. Last-
 ly,  hemorrhage may be slight  and unimportant,
 or even beneficial, and then should  not be  inter-
 rupted and may even be  promoted.   It has here-
 tofore been  shown  to you that in fever hemorr-
hage is most frequently salutary ;  at  least, in this
climate.
  CCLI. The hemorrhages from particular parts 
176
FLEMATICA.
[cl. iii.-or. iv.
are introduced  by Dr. Good  as varieties under
each of the two species.   These are Haemorrha-
gia narium, Haemoptysis,  Haematemesis, Haematu-
ria, H. Uterina, H. Proctica.  The most important
of these varieties is Haemoptysis ; and this only will
be particularly  noticed.   Haemoptysis.  The name
implies simply spitting of blood, but it is employed
in nosology to distinguish that spitting of blood, in
which the fluid is derived from the lungs.  Blood
may reach the  mouth from the posterior nares,
from the fauces, and from its own vessels;  proba-
bly, also, from the glands, whose ducts open into
it.  It is not always easy  to determine whether the
blood is  from  one of these sources, or  from the
lungs.  There is not any single criterion, on which
we can rely; but an attention to all the circumstan-
ces will commonly decide  the  question.  In hae-
moptysis the danger is sometimes great; but it is
very rarely urgent,  or immediate.  In  cases  of
aneurism of the aorta, or other large vessel in the
chest, and in an advanced stage of pulmonary con-
sumption this hemorrhage is sometimes followed
by instant  death.  The  immediate  danger  from
hemoptysis is not commonly great; but  the re-
mote danger is  so.  This  does not  arise from the
hemorrhage ; it arises from the  inflammation,  or
organic disease  of the lungs, which often ensues.
   CCLII.  In haemoptysis, therefore, a prognosis
must be formed from all  the attendant circumstan-
ces of  the case taken together, and  the  treatment 
cl. iii.-or. iv.]    SANGUINEOUS FUNCTION.    177
must  be decided on  accordingly.   If there be
present pain,  or a sense of  heat in the chest,
dyspnoea, and  either  active or  passive sympathy
of  the whole system, inflammation in the lungs
and congestion of blood  there must  be inferred.
There is then danger of fixed disease, and this is
to be warded  off by the same remedies which are
useful in inflammation.  Evacuations, counter-irri-
tation, alteratives, sedatives, rest  and abstemious
diet,  duly  adapted  to the  circumstances  of the
case, must  be  employed for present relief.   If the
hemorrhage continue long, and the system suffer
from exhaustion, astringents of the most powerful
character are requisite.   But to remove the pre-
sent difficulty is more easy than to prevent its re-
currence and  the slow progress of organic disease.
This, however,  may often  be  effected,  even  in
cases of bad aspect,  if from the beginning and for
a long period the patient will keep up some small
drain from the  breast externally, will  pass  much
 of  the time  in  regular exercise  in the open air,
 and will adhere undeviatingly to the least stimu-
 lating diet; avoiding at all times great excitement,
 both physical and moral.
    CCLIII. On  the  other  varieties of hemorrhage
 remarks may be  made of the same  general cha-
 racter, mutatis  mutandis,  as  on  that already dis-
 cussed.  The state  of  the  organs,  whence  the
 blood is derived, as evinced by  local symptoms
 and by the  presence or absence of constitutional
                  23 
178
HiEMATICA.        [cl. iii.-or. iv-
 sympathy; and  the state  of the general health
 must  determine the  importance of  the  disease,
 and the treatment to be adopted.
   CCLIV. Genus  III.   Marasmus.   " General
 extenuation of the body  with debility."   A  loss
 of flesh and strength occur in most, though not in
 all diseases.   They occur  in all  the  acute, febrile
 diseases.  Dr. Good means, of course, to exclude
 these  from the  present genus.  They occur also
 very frequently in chronic diseases; whether these
 be from chronic inflammation, organic changes, or
 other causes.   These symptoms occur  peculiarly
 in all the tuberculous  diseases, whatever be their
 seat.  Of these  the tuberculous pulmonary con-
 sumption is the most familiar, but  not the only in-
 stance.  They occur in some diseases, not  of local
 origin, so far as we know ; and they occur in con-
 sequence of the  influence of mineral  poisons ; of
 both which Dr. Good has  given  us  instances  in
 this genus.  When  these  symptoms show them-
 selves, we should always look for a local  origin,
 examining the state of the mind as well  as that of
 the body, keeping in view  the species  enumerated
 in this genus  by our learned  nosologist, but not
 limiting ourselves to these.   These species are the
 following, 1. Marasmus Atrophia, 2. M. Anhcemia,
 3. M.  Climacterus,  4. M.  Tabes, 5. M.  Phthisis.
Only the last of these will be especially noticed in
this course.
  CCLV. Species 5. Marasmus Phthisis. "Cough: 
cl. m.-0R. iv.]   SANGUINEOUS FUNCTION.    179

pain or uneasiness in the  chest, chiefly on decum-
biture :  hectic fever : delusive hope of recovery."
The definition of the genus is to be kept in mind,
while attending to this of the species.  The symp-
toms here  described will sometimes  occur when
there is only an  induration,  or chronic  inflamma-
tion of the  lungs, or tubercles  in them, without
suppuration in either case.   But for the most part
these symptoms  may be regarded as evidence that
suppuration exists in the lungs.   This  may be in
the mucous membrane, in the  cellular membrane,
or  parenchymatous  substance,  or in  tubercles.
Hence we  have three varieties denominated by
Dr. Good, Catarrhalis, Apostematosa, and Tuber-
culosa.  The aspects, under which this disease may
present itself, are various. For not only under each
of its forms may the disease be developed more or
less rapidly ; but also the varieties are  more or less
intermixed in many instances.   Especially, the tu-
berculous variety is developed oftentimes by the
occurrence of inflammation in any of  the textures
of the lungs.  The  dyspeptic phthisis of W. Phi-
lip, and the fistulous phthisis  must  also be noticed.
  CCLVI.  The catarrhal consumption commences
in a common catarrh.  It happens when the affec-
tion of the  mucous  membrane is much protracted
by accidental causes, and then mostly  where the
constitution is originally bad, or has been rendered
so by intemperance.  It  is  also  after a frequent 
180
HjEMATICA.
[cl. iii.-or. iv.
repetition of the catarrhal affection in successive
years, that this disease is induced, in  most instan-
ces.  Oftentimes the  inflammation  extends from
its original seat to the  cellular membrane, whence
induration of the  lungs ensues ; and hence  great
dyspnoea.   The cough is often  harassing and the
expectoration profuse ; but the  pulse  is less acce-
lerated, and the hectic fever less  distinct, than in
the tuberculous variety.
  CCLVII. The second variety,  Phthisis aposte-
matosa, is a  consequence of pneumonitis, as  has
been noticed before.  The quantity of pus form-
ed is sometimes exceedingly large, yet the patient
may even then recover.  If he does  not recover
shortly  after the  discharge  of  the  apostem,  the
pulse becomes quick and small, and  marasmus  and
hectic  paroxysms ensue.  The cough  is tedious, but
expectoration of  pus  takes place  only  once  or
twice in twenty-four hours ;  or, the apostem clos-
ing, the pus gathers  anew until  it  is again opened,
and then follows a new and copious  expectoration.
In bad  cases of this variety there is  often  much
blood expectorated,  and  the breath  is exceedingly
offensive.
  CCLVIII. The third  variety, Phthisis tubercu-
losa, is  the most frequent and the most fatal.   It
depends on the existence of tubercles in the lungs.
These  are bodies of a peculiar character.  They
are originally small  transparent  cysts.  They  un-
dergo various changes; frequently becoming solid 
cl. iii.-or. iv.]   SANGUINEOUS FUNCTION.    181
from  the deposition  of a  caseous  matter;  and
after this change, or without passing  through it,
pus, or a fluid like it, is  formed in them.  Then
they open into the bronchia and their contents are
discharged; but they do not then  close up.   On
the contrary they usually continue  to discharge
pus.  Their  coats also  change  in thickness, and
often  become  opaque.  ^These  tubercles vary in
size, but most commonly they are about as large
as a small  pea.   It often happens,  particularly in
the upper  part of the  lungs, that many of these
tubercles become conglomerated, either from be-^
ing crowded  together, or by the adhesive process
in the intervening cellular  membrane.   In this
case the suppuration extends through  the indu-
rated mass, but  not  in  a  single cavity;  and the
individual tubercles cannot  be  recognized.  Over
the part so  indurated,  and  sometimes over  the
whole lung,  adhesion occurs and obliterates  the
cavity of the  pleura.
   CCLIX. There is  reason to believe that tuber-
cles in the lungs commonly exist a long time, with-
out giving rise to any  peculiar symptoms;  and
perhaps in some instances they do not prevent long
life.  They probably do not cause  any morbid ir-
ritation until  the  process of suppuration commen-
ces, accompanied, perhaps, by some  inflammatory
action in the  surrounding parts.  The early symp-
toms  in tuberculous  consumption are not such as
to excite much attention.  There is a slight, heck* 
182
HiEMATICA.
[cl. iii.-or . iv-
 ing-cough, and a dyspnoea.  After a  time there is
 occasionally a small expectoration of simple mucus,
 particularly in the morning.  There is a very gra-
 dual emaciation, and some alteration in the coun-
 tenance.   This loses its colour and clearness, being
 sometimes flushed, and readily changing from pale
 to red, and the contrary.  The  appetite  falls off
 in some cases, and still more  frequently the diges-
 tion is attended with difficulty. The pulse becomes
 more frequent than in health.
   CCLX.  The progress of the disease is general-
 ly, though not always, slow.  After a time it be-
 comes strongly marked, so as to  be recognized
 very easily.  The cough  is attended with  an ex-
 pectoration of  pus in  the  morning; the dyspnoea
 is more obvious, especially after  muscular  exer-
 tion; the  pulse get  small and frequent;  hectic
 paroxysms occur irregularly; and  the  marasmus
 becomes strongly marked.  At  the same  time
 there is pain in the thorax, oftentimes not severe,
 nor fixed in one spot; and  there  is a difficulty in
 lying down on one, or the  other side, or in assum-
 ing the horizontal position.  Ultimately,  all  the
 symptoms increasing, death is commonly preceded
 by colliquative sweats  and diarrhoea with  edema
 of the lower extremities.   Through the  whole,
 the patient appears to have  a  singular blindness
to the character of his disease, and looks forward
with great  hope and often  with confidence to his
recovery. 
ci.ni.-0R.iv.]    SANGUINEOUS FUNCTION.     383

   CCLXI.   This variety of pulmonary  consump-
tion is often modified by accidents.   In some cases
it commences with  haemoptysis;  or this  occurs
during its course.   If at an advanced period, life
is in some rare cases  terminated by this affection.
Sometimes the  tuberculous  phthisis is developed
prematurely  by a severe catarrh, or even by other
acute disorders, in which the lungs are not parti-
cularly involved.  Or, by  similar causes, its pro-
gress is  hastened, after it  has commenced.  On
the  other  hand,  it is sometimes  suspended  by
pregnancy; though its  progress  afterwards is not
less fatal, and is commonly rapid.   In its  course
amenorrhoea  is produced in females ; and, likewise,
amenorrhoea,  arising from  other  causes, is  among
the accidents  which hasten its progress.
   CCLXII. This disease may occur in subjects of
any age.  In connexion with an enlargement of the
mysenteric glands, and perhaps  tubercles in the
abdomen, it is found in young children; and  it is
also found in   persons,  who have arrived at old
age.   But its  most  common victims  are  from
eighteen to forty years of age.
   CCLXIII.   In the treatment of  the two first va-
rieties much may be done at an early period; but
then the evil  result is  not anticipated, especially
in the  catarrhal  consumption.   In  this variety
alteratives, sedatives and counter-irritation with a
regulated diet and regimen will  commonly effect
a cure, even at  an advanced period; unless  the 
184
HiEMATICA.
[cl. iii.-or. iv.
subject have a very bad constitution,  or establish-
ed habits of intemperance,  or has arrived at old
age.   Balsam of Copaiba is likewise often useful
in the catarrhal phthisis.  In  the second  variety,
a spontaneous cure often  takes place, if the  con-
stitution be unimpaired, although the  apostem be
very large.   The  treatment  in  this  form of  the
disease should be more dietetic than  medicinal, as
in other cases of large suppurations.
  CCLXIV. In the  treatment  of the  tuberculous
consumption remedies do  little  more  than to pal-
liate the  sufferings,  unless employed  at  a very
early period.  Then  a counter-irritation of some
kind on the chest, long continued, with a carefully
regulated diet, and constant, hardy exercise in the
open air will sometimes arrest the disease for a
season,  and even  permanently.  Where  the  pa-
tient cannot endure  exposure in a cold  climate,
there is an advantage in  passing his winters  in a
warm one.  So far as  catarrhal, or  any common
inflammation exists with the tuberculous affection,
the  influence of the former may be taken off by
the common alterative medicines and other appro-
priate  remedies.  But in the  use  of these,  and
especially  of mercurials,  caution is  requisite ; as
they do not relieve and sometimes  aggravate the
tuberculous disease.    Iodine  is among the reme-
dies to  be  tried for this disease ; but will proba-
bly  share the fate  of other powerful  articles,
which have been proposed  from age to age.   The 
cl. iii.-or. iv.]    SANGUINEOUS FUNCTION.    185

treatment for hemoptysis has  been stated.   In a
confirmed state of phthisis opiates and sometimes
tonics will palliate the disease.   It is not probable
that the tubercles are ever removed, though their
development may be prevented.  It  very  rarely
happens that a tubercle, which has suppurated, is
healed afterwards.
   CCLXV. In regard to those cases of pulmonary
consumption, which are  truly secondary, following
and being combined  with well marked diseases of
the stomach, liver  or other organs,  there  is no
doubt that  the  curative  efforts  should relate to
those primary affections.  For this  there are two
reasons, one that the removal of them  may, though
not with certainty, relieve the secondary affection;
—the other, that  they  are more subject to medi-
cinal influence than the  pulmonary disease.
   CCLXVI. The fistulous phthisis is  a rare  varie-
ty, not cognizable, probably, at its commencement;
but is of long  duration  and gradually assumes a
distinct  character.  It is distinguished by a severe
cough, lasting for many years,  often aggravated
by accidental causes; attended  by an expectora-
tion of a small quantity  of pus in the morning
after long and severe coughing.   This expectora-
tion is prevented by the occasional increase of in-
flammation in the  lungs, and is most  perfect and
regular when the patient is in the best health.  The
local disease is  accompanied by so  much debility
and emaciation, as marks its subject as an invalid;
                   24 
186            HjEMATICA.         [cl. 111.-0R. iv.

but, under its aggravations, hectic paroxysms are
induced, and with these life is ultimately terminat-
ed.  An examination  of the lungs shows  an ab-
scess, or ulcerated cavity, with  a fistula  leading
from it  and opening  upon  one of the  bronchial
tubes at  some distance.   The disease does not
admit of an artificial cure ; but  much may be done
to  prolong life  by guarding  against  the  causes,
which would aggravate the disease.
  CCLXVII.  The  tuberculous diseases.do not
appear  to be  sufficiently  noticed in  Dr.  Good's
work, except when occurring in the lungs.   Tu-
bercles are not limited to any organ,  nor to any
one texture.  Passing over  other  parts, it is im-
portant to notice  them, as occurring in  the abdo-
men.   In  this  cavity they are found in the  peri-
toneum  and in the  several organs.   As  in the
lungs, their rise and development is slow ;  though
not equally so in all cases.   They ultimately cause
extensive  adhesions.  Their existence  is marked
by different degrees of  uneasiness and general ill
feeling.   Presently vomiting and perhaps diarrhoea
may follow, with various symptoms of  dyspepsy.
At  length an enlargement of the  abdomen takes
place, with a feeling  of fleshy hardness  to the
touch.   Ultimately great pain and difficulty in the
peristaltic motion  of the intestines; with  consti-
pation or  the  discharge of  fluids only.  The sys-
tem yields under a defect of nourishment and the
constant   irritation  in  the  diseased parts.  The 
cl. iii.-or. iv.]   SANGUINEOUS  FUNCTION.     187
emaciation and debility are as great as in phthisis,
but the pulse are not so much accelerated, nor are
the hectic paroxysms so exquisitely marked.  Drop-
sy is often among the consequences  at a late stage.
Relief can be  obtained only when the disease  is
detected at an  early period.   Then the remedies
are  analogous  to  those recommended  at an ear-
ly period of tuberculous  phthisis.   This disease
may well claim a place in the  genus Marasmus;
but  I  will not  at  present assign  to it a specific
name.
   CCLXVIII.  Genus IV.  Melanosis.   "Secre-
tion of a black material,  more  or  less  inspisated;
staining or studding  the visceral  and other organs."
This singular disease has  been brought into notice
by the pathologists of the present day in Paris.
Although very interesting to the philosophical  in-
quirer, the  consideration  of  it in this course must
yield to subjects of more practical importance.   It
is regarded  by Dr.  Baron as a variety of tubercu-
lous disease.
   CCLXIX.  Genus V.  Struma.   " Indolent, glan-
dular tumours, chiefly in the neck, suppurating slow-
ly,  and imperfectly, and  healing  with difficulty;
upper  lip thickened ;  skin  smooth; countenance
usually  florid."  Only one species is admitted by
Dr. Good in the  latest edition  of  the " Study of
 Medicine."  Species 1.   Struma Vulgaris.  " Tu-
 mours confined to the external  conglobate glands ;
 pea-sized, orchesnut-sized ; appearing in infancy or 
 188            FLEMATICA.          [cl. iii.-or. ir.

 youth;  subsiding  in  mature age; hereditary."
 The learned nosologist  here confines  the  term
 struma to one  only of the affections, which are
 usually called scrophulous; but  to that,  which no
 doubt was the first distinguished, and first designa-
 ted by this name.   Struma is not certainly  limited
 to the ages of infancy and youth.  It has occurred
 under my observation in adults,  though  not  com-
 monly.  It shows  itself in persons of  the same
 character, as to constitution,  as those in which tu-
 berclar phthisis appears.   It  resembles  certainly
 the disease in the mesenteric glands of young chil-
 dren ; and these also have, very  often at least, tu-
 bercles in the lungs.  The  processes of softening,
 or suppuration are slow alike in struma and in the
 pulmonary tubercles; and so in both are the process-
 es of healing.   In the case of struma, the  system
 can usually  endure  the disease long enough  to
 permit the healing; in that of tubercles it cannot.
 Struma having commenced in the  absorbent glands,
 a  disease apparently of the same character in the
joints often ensues; and a similar disease  in the
joints sometimes occurs, where the disease  of the
glands has not preceded.
   CCLXX.  From the facts stated it would seem
that the nature of the disease called struma, and
that of various other affections above enumerated,
are the same.   The nosological  characters  differ,
chiefly because one is an external disease, and the
others mostly internal.  Those others, which might 
cl.ih.-or.iv.]    SANGUINEOUS FUNCTION.     189

not be  called internal,  occur in parts different in
texture from the absorbent glands, and therefore
present different characters.   In all the cases the
constitution suffers in a greater or less degree ; but
most  where  the most  noble organs  are affected,
In all, the local disease  is marked by  the slowness
and weakness of the morbid actions ; and probably
there is also  something specific in those actions.
   CCLXXI.   In the treatment of struma and the
analogous diseases, the indication at an early period
is  to produce  resolution;  or  to arrest the disease,
although the  tumour may not  be  removed; for
the tumour will sometimes remain without change
for many years.  At a later  period, when suppur
ration has  occurred, the indication is to promote
the restorative process.   To  fulfil those indications
various remedies have  been  employed, sometimes
with success, but perhaps oftener without.   Tonics
and gentle stimulants are recommended for both
purposes;  but with  them various mineral articles
of doubtful character, some  recognized as altera-
tives, and some as stimulants, have  been united to
fulfil the first indication.  For  the  last indication
some  of the  narcotics have been thought useful.
For all purposes, perhaps, the  principal  reliancp
may be placed on nutritious, but simple diet, habit-
ual exercise in the open air, bathing, regular hours,
and cheerful  occupation.
  CCLXXII.    Genus  VII.  Lues.   "Ulcers on
the genitals, inguinal buboes,  or  both, after impurp 
 190             ILEMATICA.        [cl. iii.-or. iv.

 coition; succeeded by ulcers  in the throat, copper
 coloured spots on the skin, bone-pains and nodes."
 The sixth genus, carcinus, is omitted, as falling en-
 tirely within the limits of surgery.  The seventh
 genus may be  regarded partly in the same  light;
 yet may also be claimed in part, if not principally,
 as within  the  province of  medicine.   Dr.  Good
 means to include in this genus the various diseases,
 which may be propagated by sexual intercourse
 from  a diseased subject to a  healthy one.  How
 many such there are,  has not been well settled; but
 he makes one species of that, which has been more
 exactly described; and includes under  a second
 species all the others.  These others resemble the
 first partially.   Hence, while he denominates the
 first syphilis, he calls the second syphilodes.  To
 the definition  of the genus some objections may
 be made; since all the symptoms enumerated do
not perhaps belong to all the diseases meant to be
 included in the second species ; and particularly
 the copper coloured  spots on the skin are thought
 not to be common to them.   It is a minor objec-
 tion that these diseases may commence,  and have
 been  thought sometimes to commence actually, on
 other parts besides the genital organs.
  CCLXXIII.   Species  1.   L. Syphilis.   "Ul-
cers on the genitals circular,  ungranulating,  thick-
 ened  at  the edge; those  of  the throat deep  and
 ragged;  symptoms  uniform  in  their  progress;
speedily and uniformly yielding to a course of mer- 
cl. 111.-0R. iv.]    SANGUINEOUS FUNCTION.    191
cury, where it agrees with the constitution;  less
certainly, and with more difficulty yielding without
it."  This definition is copied from the second edi-
tion  of the " Study of Medicine," and differs from
that first given in the Nosology, as to the necessity
of mercury.   The  affections which  occur in  this
disease,  are  distinguished as primary  and secon-
dary.  The  primary are  chancre and  bubo, to
which some add gonorrhoea ; the secondary are ul-
cers in the fauces, sometimes extending to the nose
and  other adjacent parts; copper-coloured, scaly
and  other eruptions on the skin ;  and nodes.   To
these,  may  perhaps be  added some  other affec-
tions, which occasionally follow the prim ry affec-
tions, and are equally obstinate with those gener-
ally  regarded as syphilitic ;  and, among these  oth-
ers,  may be mentioned diseases  of the joints, mark-
ed by pain and swelling; and which have a char-
acter intermediate  between those of rheumatism
and  scrophula.
   CCLXXIV.  It  has been supposed, not without
some reason, that there are different diseases which
are  contagious, and which usually originate in the
genital organs ; and that of these, one or more  may
be overcome by the powers  of the constitution,
while one or  more cannot.  But if  this be  true,
the  attempts to  discriminate  these  different dis-
eases,  though  made  by men of  skill and talents,
have not yet  been successful.  And so far as we
know, there is no form  under  which the disease 
192
ILEMATICA.
[a. ii.-or. iv.
appears, in which spontaneous cures have not ta-
ken place.
  CCLXXV.   While many remedies  have been
found useful in the treatment of syphilis, mercury
in some form was for a long time thought  to be
essential for  its  cure, except only  for gonorrhoea.
This remedy was supposed  to act  as a specific by
many,  and the  mode  in which it operated was a
subject of doubt  and  dispute  among the rational
practitioners.  John  Hunter seemed  to  establish
the doctrine that it operated as an alterative; or
induced new  actions in the diseased part, and thus
superseded the morbid actions;  and that the con-
stitution, being able to overcome the mercurial ac-
tions of the parts, was allowed to exercise its usual
curative powers.  It was observed however,  that
as soon as the mercury  occasioned salivation, and
sometimes sooner, the diseased part manifested an
amendment, and  that under a salivation the  part
would  heal  entirely.   Hence  the  doctrine  of a
mercurial disease  as a substitute for syphilis, could
not be supported.  It was further shown by Mr.
Hunter, that although a present syphilitic affection
could be removed  by the influence of mercury,
the recurrence of the disease in a new order of
parts could not thereby be prevented.  Hence he
inferred that the disposition could not be cured
with the same certainty as the morbid action.
  CCLXXVI.  In the  treatment  of  the disease
without mercury, the cure is commonly more pro- 
cl. iii.-or. iv.]    SANGUINEOUS FUNCTION.     193

tracted than when that remedy is employed.   The
plan of treatment is to place the patient at rest,
to regulate the general health, to employ evacua-
tions when the vascular actions are not very mod-
erate, to withhold all stimulating articles of diet, to
employ tonics when debility and morbid irritability
are manifested, and to attend carefully to keep the
parts affected in a very clean state.
   CCLXXVII.  Species2.  L.Syphilodes.   "The
generic ulcers indeterminate  in their  characters;
symptoms  irregular  in  their  appearance;  usually
yielding spontaneously;  variously  affected by a
course of mercury."  The importance, in a practical
view, of distinguishing  these two species relates to
two points; first, from want of the proper discrimina-
tion, the moral character of the parties concerned
may be made to suffer unjustly ; and second, that we
may know when the use  of mercury  is requisite.
With Mr. Hunter and his disciples, although they
sought to discriminate the phenomena carefully in all
cases, the ultimate criterion in a doubtful case was
the ability of  the constitution to overcome the dis-
ease without mercury.   As the observations of the
present day have shown that this criterion can not be
trusted, increased attention has been given to other
marks of distinction.   As yet, however, this has not
been done with all the success which could be de-
sired.   In proportion as ulcers or eruptions  differ
from those which have been described, we should
be more ready to delay at least the use of mercury
                 25 
 194            ILEMATICA.          [cl. iii.-or. iv.

 If the disease be intractable, we should inquire
 into the general character and the present state of
 the  constitution,  to  see how far that will explain
 the phenomena.  Generally speaking, when ulcers
 heal  in one  part, while  they spread in another,
 we should not be  ready  to call  them syphilitic;
 and especially if primary affections and on the geni-
 tal organs.   Sloughing ulcers should not be treat-
 ed as syphilitic.   Although  in some cases,  the
 state  of the constitution may cause sloughing about
 those which are syphilitic ; yet we should wait for
 the sloughing to terminate, and be decided by  the
 aspect the ulcer may assume.   In all doubtful cases
 the use of mercury should be avoided, at least un-
 til other remedies have been tried.
  CCLXXVIII.  Passing  by  the intermediate  ge-
 nera,  I shall  under  the eleventh  consider organic
diseases of the heart. Genus XI.  Exangia. " En-
 largement, breach, or other morbid perforation of
 a large  blood-vessel, without  external  opening."
Species  1.  E. Aneurisma.  " Pulsating tumour  of
an artery."   Under this species,  as a variety,  we
find E. Aneurisma Cardiogmus.   The propriety of
the arrangement will not be considered.  This  va-
riety according to Dr. Good, "is  characterized by
an obtuse intumescence and constant disquiet of the
praecordia; with  a  sense  of  internal weight, and
pulsation increased on the  smallest motion."  The
heart is liable  to various  organic diseases, which
can be in  some measure distinguished from  each 
[cl. iii.-or. iv.      CuWmC FUNCTION.      195

other during life, but which have for the most part
certain symptoms in common.  Hence they might be
made to constitute a separate genus.   An aneurism
of the aorta at or near its arch, on either side, has
some if not all of the same common symptoms ; so
that this might be  included in the same genus.
  CCLXXIX.  The symptoms attending an organic
disease of the heart vary, as the disease progress-
es.   At first they may  be  slight, occasional, and
not easily distinguished from those disturbances in
the functions of the heart which arise from debi-
lity and other causes.   But after an  indefinite  pe-
riod they become declared  with sufficient distinct-
ness.  The most certain  and notable of these symp-
toms are, a sense  of weight, anxiety, or distress in
the  region of the heart;  palpitation ;  dyspnoea,
slight  when at rest, usually affecting the voice, of-
ten aggravated in  a recumbent position, and  always
by quick motion on rising ground; and  lividity in
 the lips, and often in  the cheeks.  The  most re-
 markable  of the organic  changes in the heart is
 an  enlargement; in which  the parietes may be
 thickened, the  cavities  being  unaltered, or these
 being enlarged  at the same time ; or in which the
 cavities may be enlarged, while  the parietes are
 rather extenuated than thickened.  These changes
 are sometimes  primary, but often secondary;  and
 then they  are  the consequence of some mechani-
 cal obstacle to the free  and  easy play of the heart.
 Such  obstacles  may exist in the valves of the heart, 
196
ILEMATICA.
[cl. iii.-or. iv.
 in the pulmonary artery, in the aorta, in the pari-
 etes  of the heart itself,  in the coronary arteries,
 in an adhesion  of the pericardium, and perhaps
 in less obvious causes, even at a distance from the
 heart.
   CCLXXX.  With  the symptoms before stated
 are commonly joined many others, viz: in the pulse,
 as observed in the wrist, and  other parts of the
 body, various irregularities;  in the digestive func-
 tions embarrassments more or less  severe, which
 often  aggravate  the difficulty in the  functions of
 the  heart; in the excretions,  particularly  in  the
 urine, a diminution and change of quality ; in the
 countenance  edema, as well as  lividity, with an ex-
 pression of anxiety;  in the lower limbs and else-
 where, hydropic effusions ; and lastly various symp-
 toms arising from similar effusions in the great ca-
 yities.  The head also suffers  variously from an
 occasional retardation of  venous blood in it;  and
 sometimes effusion there occasions apoplexy ;  occa-
 sional numbness  and  temporary suspension of  the
 pulse in the limbs, may perhaps be referred to the
 same cause.  In  the lungs also, effusion of blood
 takes place, as shown by hemoptysis during life,
 and ecchymosis after  death.  Although some diffi-
 culty in the functions of the heart and lungs is ma-
 nifest at  all times, yet the degree  of difficulty is
 very  various.  There is  often a sudden aggrava-
 tion of it,  which continues  for many hours, and even
for several days.  This may arise from an inflam- 
[cl. iii.-or. iv.     -ORGM«e FUNCTION.       197

matory affection any where, but  especially  from
such an occurrence within the thorax.  Even in an
incipient stage of organic disease of the heart, or
aorta,  death is often occasioned by the addition of
an inflammation  in the pleura, or lungs. If nothing
like  this occur, and the patient escape those acci-
dents which may cause sudden death, he is at length
worn out by the irritation and disordered functions
produced by the organic disease.
   CCLXXXI.   The remote causes of these dis-
eases are to be found in an original constitutional
tendency to them; in sedentary and studious habits,
and in the anxieties of public life,  especially when
occurring in persons of athletic frame;  in intem-
perance ; and in strong  moral  affections long con-
tinued.  Sometimes  also violent bodily efforts, and
perhaps sudden and temporary excitement of the
mind cause  injuries to the heart, which ultimately
produce extensive organic changes.  The common
effect of all organic diseases of the heart, is a failure
in the maintenance of the mechanical  relations of
the heart to the other parts of the body.   To this
source and to sympathy  may be traced the symp-
toms which are  noticed in those diseases.
   CCLXXXII.   It would certainly be very useful
to distinguish during life, the different organic chan-
ges.   There is a difficulty in doing this, which may
be attributed to several causes ; first,  to the over-
powering influence of those  symptoms, which are
common to all these affections; second,  to the great- 
198
H/EMAT1CA.
[cr.. iii.-or. iv.
er or less extent of the changes when of the same
kind; third, to the more or less rapid development
of these changes; fourth, to the degree of irritability
in the constitution.   We can  however with some
degree of assurance, distinguish the  following af-
fections, viz: hypertrophia of the heart, dilatation
of its cavities, and these  two combined.   In  ma-
king these  distinctions,  much aid may be derived
from the use of the stethoscope.   We  may  also
sometimes  distinguish diseases of  the valves  and
aneurism of the aorta.   Dropsy of the pericardium
is not easily distinguished.
  CCLXXX1II.  In the treatment  of organic dis-
eases of the heart, we can hardly look for perma-
nent relief.  It is probably only when the common
symptoms of these diseases arise from chronic in-
flammation of the pericardium, with perhaps drop-
sy of that bag, that a permanent relief is obtained
from medicine.   But, while medicine fails in giving
permanent relief in these diseases,  there are none
in which  it palliates more  remarkably  the  dis-
tressing symptoms;   and none,  in which  it  seems
more certainly to save the patient for the moment,
from the opening jaws of death.  This it does by
removing the effects of  the original disease  on
other parts of the body.
  CCLXXXIV.  In the treatment, the following
are the indications to be fulfilled, the remedies be-
ing adapted to the varying circumstances of differ-
ent cases, and care being taken not  to sacrifice the 
cl. iii.-or. iv.]      OnnANtC FUNCTION.       199

permanent vigour and strength of the patient, any
further than the immediate hazard of life renders
indispensable.   First, to diminish the strength and
violence of the actions  of the  heart, when these
are too great. Second, by counter-irritation to over-
come or to diminish inflammation in the heart, or in
other parts.   Third, by alteratives and diuretics to
remove hydropic effusions.  Fourth, by diet, regi-
men, and sometimes by sub-tonics to preserve  or
restore the tone of the  digestive organs, so  as to
prevent the  aggravations from indigestion, as well
as  to  preserve  or  restore the  general vigour.
Fifth,  by cordials  to support  the actions of life
when  failing under  exhaustion.—The  remaining
genera of the fourth order, third class, are passed
over, not as uninteresting;  but as belonging rather
to surgery than medicine.   We proceed therefore
to the next class. 
200
                CLASS FOURTH.

             NEUROTICA.

       DISEASES OF  THE NERVOUS  FUNCTION.

  CCLXXXV.  To this function Dr. Good refers
all the functions of  the intellect, of sensation and
of motion, at least of voluntary motion.  The orders
of this class have reference to this sub-division  of
the functions.  We have formerly (Part I. sections
XLVII—LX) stated that in many  cases disorders
of the animal, or nervous functions  are secondary;
but that in some cases they are primary, so far  as
we  can ascertain.
  CCLXXXVI.   Order I.  Phrenica.   «Error,
perversion, or debility  of one or more of the men-
tal  faculties."   That the mind is affected by mor-
bid changes in the body, is past dispute.  That the
corporeal changes may be either in the encephalon,
or in other parts of the body, is also certain.  Fur-
ther, that these changes often arise from some  al-
tered action of the vascular system is certain.  But
whether disorder ever arises in the  mind primarily,
the body  being  sound and  its functions  quite
healthy, it is  very difficult to  say.  Yet this can
not be disputed, that causes operating on the mind
alone, in the first instance, give occasion to diseases 
CL. IV.-OR. I  .]
NERVOUS FUNCTION.
201
of the mind.  The only doubt is, whether in such
cases the body be not already diseased or predis-
posed, and whether these moral affections do not
act as occasional causes and indirectly on the body;
and  thus ultimately affect the mind again through
the body.
   CCLXXXVII.   Genus I.  Ecphronia.   "Dis-
eased perception with little derangement of the
judgment, occasionally shifting into diseased judg-
ment, with little derangement of the perception;
disturbing  the mind generally; diminished sensi-
bility ; irregular remissions."  The two species of
this genus are  melancholia and  mania.   In the
first the  mind is deranged only in relation to one
object, or a few connected objects; in the second, in
relation to all or most objects.  In respect to the
treatment, the following remarks may  be  made.
First, in all cases the moral influence of causes op-
erating on the patient must be considered, and those
causes regulated accordingly.  He should be kept
under control as far as possible by gentle means ;
all irritating  objects and persons should  be  remo-
ved from him; so far  as possible those which are
grateful  should be substituted;  and personal  re-
straint should be carried so far only as may be re-
quisite for the safety of the patient and his atten-
dants.   Meanwhile  regular  employment of body
and occupation of mind should be prescribed, when-
ever practicable.   Second, if the disease of the
mind has followed any known disease of the body,
                  2(j 
                        <

 202             IfcEMATICA.          [cl. iv.-or 3J
 medical treatment may be adopted in reference to
 the physical state thus made known.   Third, if any
 derangement  of body be  found to  co-exist with
 that of the mind, the physical treatment should
 be regulated accordingly.
   CCLXXXVIII.  The further discussion of the
 genera of this order will be omitted.   It will only
 be remarked here that in  his  second edition, Dr.
 Good has  introduced the  disease known  under
 the name of delirium tremens,  as belonging to the
 Genus Alusia.   He  makes  it  A.  Hypochrondrias
 Autalgica,  or  Vapours ;  not saying however that
 every  case of  vapours  is  delirium  tremens.   I
 had before that  edition  was  published  assigned it
 a  different place, in which it will appear.
   CCLXXXIX.   Order II.  ^Esthetica.  " Dul-
 ness, depravation, or abolition of one or more of the
 organs of corporeal sense."   A very  brief consid-
 eration of the diseases of these organs, will show
 that they may  consist in affections very various as to
 their  seat and nature.   Yet, so far as their causes
can be understood, they must be of the same kind
as those  producing disease  in  other  parts.   The
organs of sense may be  affected by  inflammation,
and other  vascular diseases; by  sympathy, and
perhaps by diseases originally nervous.   There is
however one genus of this order, the sixth and
last, which  I shall comment  upon.
   CCXC.   Genus VI.  Neuralgia.   " Acute sen-
sibility and lancinating pain in  the course of one 
f*. iv.-0R.3C/i       NERVOUS  FUNCTION.      203

or more branches of nerves in an organ;  most-
ly with an irregular motion of the adjoining mus-
cles ;  recurrent  in short  paroxysms, with indeter-
minate intervals, or remissions."  This disease oc-
curs in different parts of the body, and hence Dr.
Good makes three species of this genus, intimating
that probably there are many more.   These are
JY. Faciei,  JY. Pedis,  and JY. Mammas.  Neural-
gia is, so far  as can be ascertained, a truly nervous
disease.   It is possible indeed  that there may be
an inflammation,  or some other vascular affection
of the nerve ;,but there is  not any evidence that
this is the case.   Nor indeed is there any evidence
respecting the  nature  of this disease,  which can
guide us in the cure of it.  The great distress which
 belongs to it, and its long continuance, have led  to
many experiments, and we must be confined to an
examination  of the  results of  these.   The reme-
dies which have  been thought useful are found
 in the classes of narcotics, alteratives,  stimulants
 and tonics ;  to which may be added the division of
 the nerve affected.  Each of these classes furnish-
 es remedies which have been said to succeed ; and
 all of them  have sometimes failed.   The explana-
 tion may perhaps be found in the supposition that
 the disease  is not always  the  same; being  some-
 times idiopathic, sometimes sympathetic.
    CCXCI.   Order III.   Cinetica.   "Irregular
 action  of the muscles,  or  muscular fibres;  com-
 monly  denominated spasms."   In  health the ani- 
204
fCE5C\T!CA.
[ca iv.-or. r*l.
 mal muscles contract only from volition ;  the or-
 ganic muscles from their appropriate stimuli; and
 both in accordance with  the  force, and  mode of
 application  of the  causes  applied  respectively.
 But sometimes, perhaps from original affections of
 the muscles themselves, but much more frequently
 from affections of other parts, the muscles act ir-
 regularly.   The original disease  may not be mani-
 fest, or it may be slight, and the effect seems dispro-
 portioned to its cause.    But this seems so, only
 because we are incapable of measuring with pre-
 cision the real  morbid affection, and the mode in
 which  the parts operate on each other.  General-
 ly spasm,  or irregular action of the muscles, may
 be considered as  evidence of increased action  in
 the muscles ; but it is not so always.  For, the ac-
 tion  being the  same, the  contraction will increase
 by diminishing the weight to be moved.  Hence a
 relaxation  of one set of  muscles will  occasion a
 contraction  of  the  antagonists.   This order  con-
 tains three genera, distinguished by the three dif-
ferent  kinds of spasm.
  CCXCII.  Genus I.  Entasia.  " Irregular mus-
 cular action,  producing contraction, rigidity,  or
both."   This  has  been  commonly  called tonic
spasm.  Dr. Good has  arranged under this genus
 nine species, of which a part only will be noticed.
  CCXCIII.  Species 5.   E. Systremma.   "Sud-
den and rigid contraction and convolution of one or
more muscles of the body; mostly of the stomach 
cfc.iv.-OR.m.]      NERVOUS  FUNCTION.      205

or extremities; vehemently painful, but of short
duration."   At least two  varieties of this species
might be made; one cramp of  the limbs, and one
cramp of the stomach.   The  original disposition
to these affections  is probably  much  greater  in
some persons than in others; at least a disposition
to it may be produced by habits of various descrip-
tions.  The most common exciting  causes are un-
usual muscular exertions; cold  ;  irritation  of the
stomach or bowels by acrid or  acid substances, or
by flatus ; and affections of the mind.  When the
stomach is  affected, the  disease is not only dis-
tressing but dangerous.   In  this case  opium and
stimulants  are to be used until  the spasm ceases;
afterwards the alimentary canal  must be evacuated.
The modes of prevention are also to be regarded.
These have reference to the exciting causes.
   CCXCIV.  Species  6.   E.   Trismus.   "Per-
manent and rigid fixation of the muscles  of the
lower jaw."  Species 7.  E.  Tetanus.   " Perma-
nent and rigid  fixation of  many or all the volunta-
ry  muscles; with  incurvation  of the  body and
dyspnoea."   These two diseases might  perhaps  be
regarded   as  varieties  rather than  as  distinct
species.  The  difference is in the parts affect-
ed.  The  organs affected in the two cases are
of  the same kind; the  nature of the affection,
its  causes   and treatment are  the  same.   The
predisposing causes, are not perfectly ascertained; 
206           rfaOBlTICA.           [cl. iv.-or. iiX

but they would seem to be such as debilitate, while
they increase the irritability.   The exciting causes
are exposure to cold and moisture, and to the rays
of the sun in  hot climates ;  wounds ;  and in infants
acrimonious matters in the alimentary canal.   The
proximate  cause  appears to be a sympathetic af-
fection of the muscles;  though some pathologists
have  endeavoured to show that it was  an  inflam-
mation in the nerves, or in the medulla spinalis.
The most successful  treatment consists in a liberal
use of opium.  This is to be  given with reference
to effects only,  in large  doses, at short  intervals.
But if the stomach or  bowels contain  any  offen-
sive matters, these  should  be dislodged.  Also,
purging always renders  the  system more suscepti-
ble of the  effects of opium, and therefore is bene-
ficial.  Perhaps in some rare cases, a similar bene-
fit may be obtained from blood-letting.  Wine and
alcohol, arsenic, and some  other medicines, have
been  used with success in some  instances.  But
most frequently all remedies fail.
   CCCV.    The  eighth  Species   of Entasia,
Lyssa, commonly called  hydrophobia, will be pass-
ed  over without remark.   This is  not done be-
cause the disease is unimportant;  for on the con-
trary it is almost constantly fatal.  But, because no
remedy has yet been proposed,  on which reliance
can be placed; and because,  very happily, I have
never had  a  case of  this distressing  complaint
under my care.  Dr. Good, in his Study of MedU 
tx. iv.-or. wi]      NERVOUS FUNCTION.
207
cine, has given a full and learned summary of what
is known of this disease.
  CCXCV1.  Species 9.   E. Acrotismus.   "Fail-
ure or cessation of the pulse, often  accompanied
with pain in the epigastrium; the perception, and
the  voluntary muscles  remaining  undisturbed."
This affection  is probably symptomatic in all cases;
though in some instances the original disease cannot
be discovered.  It occurs sometimes in one limb, or
in  one artery only, in organic  diseases of the
heart.   In  a single  instance  of such a disease,  I
found after death  that the artery affected was ob-
structed  by an adhesion.   But this is not usually
the  case.   Why  a  disease  of the heart  should
cause a failure of  the  pulse in one  artery and not
in  others, we cannot explain.
   CCXCVII.   Genus II.   Clonus.   "Forcible
agitation of one or more muscles in sudden and ir-
regular snatches."   This affection may arise from
various local  irritations, and we can often see the
connexion between the part irritated, and the part
which is thrown into  motion.  Thus singultus or hic-
cough  is produced by irritation of the stomach, or
intestines;  and is  sometimes  of long  continuance
either from the irritation being continued, or from
habit.   Sternutatio  or sneezing is analogous  to
hiccough, and, like  it,  sometimes continues very
obstinately.  These constitute the two first species
of this genus.
  CCXCVIII. Species 3.  C. Palpitatio.  "Sub- 
208             HjEMATICA.         [cL.*fc-oR.lW

sultory vibration  of the heart or  arteries."   Of
this there are three varieties, viz : Cordis, Arterio-
sa,  and Complicata.  In the first the palpitation
is in  the  heart, in the second in the arteries,  and
in the third, in one or more of  the viscera.  This
affection is a symptom in  organic diseases of  the
heart, but occurs  also from causes less grave.   In
persons,  who are  called irritable, but who might
be better described as prone to sympathetic affec-
tions disproportionate to their cause, palpitation is
often found both in the heart and  in the abdomen;
and sometimes in the limbs.   In many persons the
use of some of the most common stimulants,  which
appear to possess  some narcotic  power, will pro-
duce this affection.  The cure must consist  in  the
removal of the exciting causes, when known,  and
in the restoration of the general tone of the  sys-
tem.  The remaining species of this genus will be
passed by.
  CCXCIX.   Genus  III.   Synclonus.    " Tremu-
lous, simultaneous, and chronic agitation  of various
muscles, especially when excited by the  will."   In
this genus there are five species, of which howev-
er only one is  common  with us.  In noticing this,
most of what is known respecting the  other spe-
cies may be brought into view.
  CCC.   Species 2.   S. Chorea.   "Alternately
tremulous and jerking motion of the face, legs  and
arms, especially when voluntarily called into  ac-
tion;  resembling the grimaces and gestures of buf- 
cl. iv»-or. »ti]       NERVOUS FUNCTION.      209

foons; usually  appearing before puberty."   This
disease  occurs mostly in  children of feeble consti-
tutions, or in those  of inactive habits ; sometimes in
those who are too closely devoted to study, while
growing fast.   It comes on most frequently at the
close of winter, or in the spring.   The disease  of-
ten terminates  spontaneously in from two to four
months.   It is represented as connected with, if not
dependant on an imperfect performance of the di-
gestive  functions,  and particularly on costiveness.
With us  this  has not appeared to be the case.
Where it is so,  a constant use of cathartics, till the
bowels are relieved, is essential  to the cure; and is
sometimes alone sufficient.  In my own experience
tonics have  proved  most  successful,  including
change of air.
   CCCI.   Order  IV.  Systatica.  "  Irritation or
inertness of the mind extending to  the  corporeal
senses, or the muscles ; or of the corporeal senses,
or the  muscles, extending to the mind."  In the
diseases of this class, at least those having an entire
claim to a place in it, the immediate cause of the
phenomena is seated in the brain or nervous system.
Now under the same morbid affection of those  parts,
both as to kind and extent, so far as we can discover,
the  effects on the functions are very various.  This
indeed  only  shows our limited knowledge of  the
relation between  the structure and functions of the
system affected.  But it serves to explain why  the
                   27 
210            Ji^MASHe^.          [ol. iv.-or. iv.

same causes  must  be assigned  for  diseases  of
this fourth order, as for those of the other orders
of this  class.   In  truth  we are obliged to say in
every case, that the disease is to be referred to a
sympathetic affection of  the brain and nerves, or
to an organic affection of the same, or to some affec-
tion of them sui generis, of which  the effects only
are known.  The  order  contains eight genera, to
which I shall venture to add a ninth.
  CCCII.   Genus I.  Agrypnia.   " Difficulty  or
inability of obtaining sleep."   The presence of a
strong  light or loud noise, pain, errors in diet,  an
unusual and especially an unpleasant lodging, great
interest in a subject purely intellectual, and still
more in one which  is accompanied by strong feel-
ing or moral emotion, may either of them prevent
sleeping.  The same effect maybe produced by va-
rious diseases, even though unaccompanied by pain.
Agrypnia  will occur more readily  in some persons
than in others, which may be referred  to peculiar-
ity of temperament; but there are few  persons,
in whom  it does  not occur  sometimes.  Relief
may often be obtained by simple  remedies.  But
in more obstinate cases, and  where the sleepless-
ness becomes habitual, the exciting cause must  be
obviated by the appropriate remedies.   In such
cases the disease is to be guarded against by avoid-
ing all  those articles of common  diet,  which pro- 
cl. iv.-or. iv.]       NERVOUS FUNCTION.       211

mote or produce  it;  by free muscular exercise in
the open air in the day-time,  and by  passing the
evening tranquilly in domestic society.   In the last
resort only, medicinal remedies should be employ-
ed.  If  there be any symptoms of  organic disease
connected  with  the  agrypnia, the  requisite me-
thods must be employed for that.
   CCCIII.   Genus II.   Dysphoria.  " Trouble-
some and restless uneasiness in the muscles ; increas-
ed sensibility; inability  of fixing the  attention."
A slight affection  of this kind arises from  many
causes, sufficiently familiar.   But in a  more grave
form it is a symptomatic affection attending various
diseases.   When  it appears to be the  predomi-
nant affection, and not the consequence of mental
embarrassment, it will commonly be found to arise
from some  labour in the digestive functions.   It
will accordingly be relieved temporarily by some
stimulant taken into the stomach, but more  effec-
tually by evacuating the alimentary  canal. Its re-
currence  is to be  prevented  by attention to diet
and regimen.
   CCCIV.  Genus III. Antipathia.  " Internal hor-
ror at the presence of particular objects or subjects;
with great restlessness or deliquium."  From vari-
ous causes we  associate with particular objects,
feelings of horror or disgust; and these associations
will be continued,  when the occasion  is forgotten.
But there  are certain aversions sometimes amount- 
 212            -HEMATICA.          [cl. iv.-or. iv.

 ing to horror, in respect to particular substances,
 which appear to arise from some idiosyncrasy; such
 as the aversion  to cheese in many persons.   This
 bears  some analogy to the peculiar effects of  the
 odour of roses and of other flowers on some in-
 dividuals; in whom they produce catarrh, or asth-
 ma.  It would seem that by some persons the odour
 of particular bodies  is perceived and is productive
 of antipathy; though  the  same odour is  not  per-
 ceived by people in general. A cure may be effect-
 ed, where association alone is the cause of the an-
 tipathy,  by making the offensive objects  familiar.
 Where an idiosyncrasy exists, it is  not easy,  and
 not always safe, to attempt to overcome it in the
 same way.
  CCCV.   Genus IV.  Cephalcsa.   " Aching pain
 in the  head; intolerance of light and sound ;  diffi-
 culty of  bending the mind to  mental operations."
 There are few symptoms, which occur in a greater
 variety of diseases  than head-ache.   It occurs in
 idiopathic fever, in those constitutional sympathies
 called  symptomatic fever,  and in local diseases of
 various parts of  the  body,  particularly of the ali-
 mentary  canal.   It also attends cephalitis and oth-
 er inflammations  about the head.  It arises also from
 tight ligatures about the head, from fatigue,  and
from other obvious remote causes.  But it also oc-
curs  without such obvious causes, without the con-
current symptoms  or subsequent evidence of or-
ganic disease of  the brain, and without any  cir- 
cl. iv.-or. iv.]       NERVOUS FUNCTION.     213

cumslance  to explain its nature.   It is probable
that the affection is not the same in all the cases
of this last  description.  Dr. Good  makes five
species of this genus.
   CCCVI.   Species  1.  C.  Gravans.   " Pain ob^
tuse ;  with a sense of heaviness extending over the
whole  head; sometimes  intermittent."   Dr. Good
regards this  affection as idiopathic. It is difficult
to be  satisfied in some cases, whether the brain
affects  the stomach, or the stomach the brain.  It
has however appeared to me that a torpor of the
stomach precedes in this disease;  and this happens
from errors in diet, or in regimen ; but not so rea-
dily in  some persons  as in  others.  Simple stimu-
lants to the  stomach will give temporary relief;
but a better relief is obtained by great moderation
in the quantity of food, using however  the  most
sapid which the appetite demands; and by expo-
sure in the  open air,  with  gentle  exercise.  For
prevention, care in diet,  laborious  exercise and re-
gular hours seem necessary.
   CCCVII.  Species 2.   C. Intensa.  " Pain ve-
hement, with a sense  of tension  over the whole
head :  periodic; often chronic."   Instances of this
species, which are idiopathic diseases so far as we
know,  are  occasionally seen by all extensive prac-
titioners.  In every case the various possible causes
are to be thought of, and to be made the subject
pf inquiry.  Cautious efforts may be made to over- 
214            aaaaTiCA.         [cl.iv.-or.iv.

come such as are most probable.   But no remedy
is to be  universally  relied on for the removal of
the disease.
  CCCVIII.  Species 3.   C.  Hemicrania.   "Pain
vehement: confined  to the forehead, or one side
of the head: often periodical."   When  not peri-
odical, pain  in  one side of the head seems  to be
produced by the same causes as pain or  aching in
the  whole head.  The periodic,  or intermittent
hemicrania is a  peculiar disease,  and is not rare
among us.  It very  commonly follows a  catarrhal
affection; but some  individuals are very liable to
it, and in them exposure  to  cold will produce it
directly, without the intervention of catarrh.  It
is quotidian, resembling intermittent fever in the
regularity of its intervals.   It yields to the  same
treatment, as is employed in intermittent fever.
   CCCIX.   Species 4.   C. Pulsatilis.   "Pain
pulsatory, chiefly at the temples;  often with sleep-
lessness, and a sense of drumming  in the ears."
This  pulsatory pain, as well as the limitation of
the pain to one side  when the head-ache is not pe-
riodic, may often be noticed in the common head-
ache from a gastric source.  The pulsation is mere-
ly an additional symptom,  not  characterizing a dis-
ease specifically distinct.
  CCCX.   Species  5.   C.  JYauseosa.    " Sick-
head-ache."  This disease has not  any  fatal ten-
dency ; but  in  many persons  from the frequency 
cl.iv.-or.iv.]       NERVOUS FUNCTION.      215

of its recurrence, and the time which it takes from
the business of life,  as well as from the sufferings
belonging to it, it becomes a malady  of great im-
portance.  The frequency  of the paroxysms, and
their severity are quite various in different persons;
in some  being so great as to prevent  all useful ex-
ercise of the mind for one third, and even a half
of the time.  The difficulty is first felt in the head,
in many  or most cases; consisting sometimes  in a
small pain about one temple, with  an  indefinite un-
easiness or exertion  of mind; at other times in a
dizziness, often accompanied by  transient  and  par-
tial blindness.   The  pain is often very severe ; but
in some  cases the sense  of confusion and tender-
ness in the head are alone regarded, the pain be-
ing tolerable.   Nausea does not always occur, nor
is the appetite always lost  under the  paroxysms.
  CCCXI.  The great question in regard to this
disease is, whether the brain, or the stomach is ori-
ginally in fault.  There is undoubtedly  a  strong
predisposition in some  persons  to this complaint,
while in others, it can hardly be produced by any
cause.   This predisposition may probably belong
to the brain.  But the exciting cause appears to be
some derangement of the digestive organs.  In the
treatment of this disease, much is gained by gentle
cathartics, taken at the very commencement of the
paroxysm.   But it is only by the most  extreme
watchfulness in diet, and by exercise that the dis-
ease can be prevented    The  exercise  must, in
/ 
216
HjlTMItTlCA.
[cl. iv .-or. i v.
some persons  be laborious.  Sometimes an unsus-
pected article  of diet, will long defeat  the good
effects of  remedies.
  CCCXII.  Genus V.   Dinus.   " Illusory gyra-
tion  of the person  while at rest,  or of objects
around the  person, with  hebetude of the senso-
rial powers."  Of this Dr. Good admits  only one
species  in the last edition of his Study of Medi-
cine.  Species  1.  D. Vertigo.   " Dizziness, with
a fear of  falling."   Dizziness cannot  be  regard-
ed as  any  other  thing   more than  a symptom.
Sometimes indeed, it is the most troublesome one;
and though  associated with others, it is not always
immediately accompanied  by them.   It arises
from diseases very different as to their importance.
It occurs  in idiopathic diseases of the  brain;  in
diseases of  the eyes and  ears; in consequence  of
powerful or confused impressions on the organs  of
sense, or  of sudden and  strong affections of the
mind;  in  consequence of sudden shocks  of the
whole  body;  in cases of disorder in the diges-
tive organs; of great weakness, and of spasmodic
diseases.   It is obviously seated in the brain; but
what is the precise state of that  organ,  under
which it arises, cannot be ascertained.  Dr. Good
has offered an ingenious hypothesis on  the subject,
but it is founded on physiological principles, which
have  never been demonstrated to be true.  The
treatment must have reference to the disease from
which the dizziness arises. 
cl. iv.-or. iv.]      NERVOUS  FUNCTION.       217

  CCCXIII.  Genus VI.   Syncope.  "Motion of
the heart and lungs, feeble or imperfect:  diminish-
ed sensibility : inability  of utterance."  Two  spe-
cies  only  are admitted  by  Dr. Good in his last
work.    Species  1.    S. Simplex.   " Occurring
suddenly  and  accidentally, and  ceasing without
any  tendency to  a recurrence."  The disposition
to this  affection is very various; so that in  some
persons it scarcely happens under any circumstan-
ces,  while in others  it is produced by very slight
causes.   This difference is not dependent on dif-
ference in strength alone.   Syncope differs in du-
ration,  and  is often accompanied by  spasmodic
affections.   Its occasional causes are numerous and
various.  It occurs more readily in the erect,  than
in the supine posture.   In  the treatment, it is al-
ways most  important,  and is often  sufficient to
place the patient  in the horizontal position.  Then
some stimulant, external or internal, may be ap-
plied.   But regard is always to be paid  to the im-
mediate cause of the  affection.   Though  this  is
commonly placed among nervous diseases, it  may
be doubted whether it  belongs there.
   CCCXIV.   Species 2.   S. Recurrens.  "Re-
curring at periods more or less regular;  occasional
palpitation of the heart during the intervals; and un-
quiet respiration  during the paroxysm."  This may
occur from some  of the same causes, which occasion
the first species, when they are permanent.  But it
also occurs from  causes of a more grave character,
                  28 
218
NEUROTICA.
[cl. iv.-or. iv.
of which perhaps the worst is  an organic disease
of the heart.  The treatment must have reference
to the cause.  Accordingly depletion is required in
some cases, and  tonics,  with stimulants, in others.
The same narcotics, which produce  palpitation,
may also occasion this species of syncope ;  and the
disuse of those articles  will then give relief.
  CCCXV.    Genus VII.   Syspasia.   "Clonic
spasm; diminished sensibility;  inability of utter-
ance."  Comatose spasm.   This genus contains
three species.   Species  I.  S.  Convulsio.  "Mus-
cular agitation violent;  teeth gnashing; hands for-
cibly  clenched;  transient."   There  is  much  va-
riety  in the circumstances and  duration  of  this
disease.  In  itself it is always  alarming;  but  the
real danger  is to be  estimated  from its cause.   It
is a sympathetic affection ordinarily, if not always.
It is produced by a great variety of causes ; such
as the performance of natural functions, when at-
tended with unusual difficulty ; substances received
into the stomach which are offensive either from
their own nature, such as narcotics, or  from their
quantity, or from the state of the stomach ; and af-
fections of  the  mind.   But these causes do  not
act with  equal  readiness  in all persons;  so  that
there would seem often to  be some predisposition
to the disease.   Hence some persons are frequent-
ly affected by it, especially in infancy  and child-
hood.  This predisposition appears  in some  ca-
ses to  be  connected with  some  peculiarity in  the 
CL. IV.-OR. IV.]
NERVOUS FUNCTION.      219
form of the head.  Powerful causes may produce
the disease in any person.
  CCCXVI.  In the treatment, the exciting cause
is to be ascertained, if possible, and the indications
then become clear.   The teeth are to be regard-
ed in infants, the state of the sexual functions in
females, the state of the alimentary canal in all sub-
jects.   Also it is  to  be ascertained whether  any
poison  can have been  recently  employed,  and
whether  the mind  has been  peculiarly affected.
In  obstinate  or  severe  cases, if the subject be
plethoric, if robust, if his head be large, or there
is  any  appearance  of vascular  fulness about  it,
blood-letting is  useful.   After evacuations,  if the
disease continue, there is  often benefit in  warm
bathing, in fetid stimulants, in anti-spasmodics, and
in opiates.  To prevent a recurrence, cold bathing,
tonics, or occasional blood-letting, according to the
character  of the subject,  and simple, moderate
diet, with free  exercise in the  open  air,  are the
remedies to be  relied on.
   CCCXVII.   Species  2.  S.  Hysteria.   "Con-
vulsive struggling,  alternately remitting,  and  ex-
acerbating; rumbling in the bowels;  sense of suf-
focation;  drowsiness;  urine copious and limpid;
 temper fickle."   This disease differs from the last
 rather as a variety, perhaps, than a species.   It
 has, however, its own peculiar characteristics, and
 for the most part its own causes.  Its greatest pecu-
 liarity perhaps, is the appearance of moral emotion 
220
NEUROTICA.
[cl. iv.-or. iv.
 which attends it, though not produced by a moral
 cause.   Cases of double consciousness belong to this
 disease.   Hysteria occurs  mostly in females after
 puberty, and before middle age. It is not dependent
 on strength nor on debility of constitution, for it
 occurs under both.  Present relief  is  obtained, ac-
 cording to circumstances, from blood-letting, vomit-
 ing, purging,  fetid  stimulants,  warm bathing, or
 opium.   When habitual, full  occupation  of body
 and mind, simple  diet, and care in  respect to the
 bowels must be enjoined;  but especially the state
 of  the menses must be regarded.  Local bleeding
 and vesication  near the sexual organs is occasion-
 ally beneficial.
   CCCXVIII.  Species 3.   S. Epilepsia.  "Spas-
 modic agitation and distortion,  chiefly of the mus-
 cles of the face,  without sensation or conscious-
 ness ; recurring at periods  more  or  less regular."
 This disease  may  occur  at  any period  of life.
 When it commences in childhood, it sometimes ceas-
 es at the age of puberty.  But  generally, at what-
 ever period it occurs, its attacks continue through
 life; yet the frequency  of these attacks,  as well
 as their  severity, is exceedingly various.  There
sometimes are, but oftener are not,  precursors to
 the attacks.   In the intervals the intellectual func-
 tions may be performed in the most perfect  man-
ner; but often the powers on which  these depend,
more or less gradually become impaired, and even
madness or idiocy are ultimately produced.   This 
CL. 1V.-0R. IV.]
NERVOUS  FUNCTION.
221
 is not a consequence of the spasmodic disease, but
 a concomitant effect of its cause.
   CCCXIX.  The predisposing cause of epilepsy
 seems to be some peculiar state of the brain;  in
 some  cases original,  in others induced by foreign
 causes.   What  this state is,  we cannot expect  to
 know, while  we are  so ignorant in respect to the
 mode of  action  in this organ.   The  paroxysms oc-
 cur without obvious exciting causes in many cases;
 but in some, these  causes  may be  discovered.
 They are rendered more  frequent, and are aggra-
 vated, by plethora.   The exciting causes are the
 same which induce many  other diseases, where a
 predisposition exists.   In some instances an inflam-
 mation in some part of the body acts as an excit-
 ing cause, and  then the paroxysms become very fre-
 quent and severe.  The intervals  are then passed
 in a state of  stupor,  and  the inflammation  is not
 manifested.   Death ensuing,  the real cause is not
 discovered except by dissection.
   CCCXX.    In  the  treatment of epilepsy we
 cannot  derive any indication from the  proximate
 cause, as we are ignorant of it.  Experience  shows
 that some narcotics  will  often  prevent the par-
 oxysms, at least for a season.  But on the disuse of
 those articles, the  paroxysms  return,  and  some-
times with more violence.  In vigorous subjects,
by diminishing the vascular fulness, we may  some-
times afford  great relief.   In  all cases great  tem-
perance, in  the  broadest  sense,  is highly benefi- 
222              NEUROTICA.        [cl. iv.-or. iv.

cial.  Various articles, deemed  tonics, but  not of
the stimulant kind, have occasionally been thought
useful in this disease.
  CCCXXI.  Genus VIII.   Cams.   "Muscular
immobility;  mental  or corporeal  torpitude,  or
both."  Dr. Good has  included  in this  genus six
species, of which only three will be  particularly
noticed.  Species  4.   Lethargus.  " Mental  and
corporeal torpitude,  with deep quiet sleep."  This
disease  occurs  in  very various degrees, and  for
shorter  or longer periods.  It is  undoubtedly con-
nected in some cases with  pressure on the  brain;
but may arise also from  peculiar states of this or-
gan, produced by other causes.   The  appearance
of the patient, the general character of his con-
stitution, and the preceding and accompanying  cir-
cumstances, will guide us in some measure, in  dis-
tinguishing the state of this organ.  In most cases,
local bleeding, and in some, general bleeding may
be  employed.    Afterwards, stimulants may be
useful;  and in some cases these  alone  should be
employed.
  CCCXXII.  Species 5.   C. Apoplexia. "Men-
tal  and  corporeal torpitude with pulsation and op-
pressive, mostly stertorous, sleep."   This disease
is sudden in its attack, in many cases without  any
precursory symptoms.   Sudden pain or  distress in
the head,  confusion of  mind, partial  paralysis or
convulsive  spasms are  the most common precur-
sors; and these last sometimes supervene after the 
cl. iv.-or. iv.]      NERVOUS  FUNCTION.
223
apoplexy has become confirmed.   It has certainly
appeared to me to  belong to particular  families.
But it has  appeared  still more  certainly  that dis-
eases  of the brain generally belong to certain fami-
lies.   Apoplexy often occurs in men  with large
heads, and  short necks, and of florid complexions.
It affects the sedentary and the intemperate.  It is
most  common in those who  are past  the middle
age.   It sometimes subsides spontaneously, but of-
ten leaves the patient paralytic,  and with the mind
impaired.  It is produced by pressure on the brain ;
but a given pressure does not always  produce  it.
We have to take into the account the suddenness,
with  which the pressure is induced.  A permanent
cause of pressure is often found after death; but
no doubt an additional temporary pressure is also
requisite in these cases.   It seems probable that in
some  cases the structure of the brain is  partially
injured, as in mollifies cerebri, in the first instance;
and then a slight pressure may occasion apoplexy.
The  temporary pressure may be induced by local
plethora.  This  may arise from different  causes,
among  which a disordered stomach  is the most
frequent.  Some  particular  articles  of food  ap-
pear  especially to  produce  that disorder  of  the
stomach, which causes apoplexy.
   CCCXXIII.  In the treatment the  leading indr-
cation is  to diminish the pressure on the  head.
This  cannot be effected very suddenly,  if at all,
 unless when  vascular fulness  is  a cause of  the 
224               NEUROTICA.       [cl. iv.-or. iv.

pressure.   Then it may be effected directly by
blood-letting, which must  sometimes be very co-
pious.  But in feeble and relaxed subjects, espe-
cially when from the previous state of the stomach,
or from food recently taken, that organ is supposed
to be in  fault,  bleeding is  not  to  be  employed.
In such cases  vomiting is  necessary;  and,  in all,
purging should  follow the first evacuations.   Lo-
cal bleeding is sometimes useful.  Likewise blood
should be  solicited  to  the  lower  extremities.
When the  vascular actions are strong, there  is a
benefit in making cold applications to the head.
When the urgent symptoms have abated, and be-
fore  this  in the feeble, vesication about and on the
head is advantageous.  The stupor continuing, af-
ter other remedies, stimulants  which are active,
but  transient,  and especially  such  as act on the
sensibility, may  be properly employed.   The  dis-
ease is very apt to recur,  however slight the  first
attack, and however perfect the recovery.  Hence
by diet and  regimen, the patient should endeavour
to preserve general tone and vigour, but to avoid all
approaches to  plethora, and to strong vascular ac-
tion, and all causes which may delay the return of
venous blood from the head.
   CCCXXIV.   Species 6.  C.  Paralysis.  "Cor-
poreal torpitude and muscular immobility, more or
less general, but without somnolency."   A partial
loss of sensibility, and a partial loss of the influence
of volition on the organs of locomotion and voice, are 
cl. iv.-or. iv.]     NERVOUS FUNCTION.
225
 common consequences of apoplexy.  Commonly the
 palsy is limited to one side of the body, and some-
 times much more limited.  Accompanying it, there
 is often an injury of the mind, in one or more of its
 powers; and the control over the passions and emo-
 tions is diminished.  But  all this happens without
 preceding apoplexy, the attack being equally sud-
 den.  For,  as  the  proximate cause of apoplexy
 abating,  palsy may occur; so,  a like  cause, not
 operating to  a great extent,  may induce palsy
 alone.   A more gradual accession of palsy may be
 referred to other causes.   Whatever local disease
 injures the structure of the brain,  or destroys its
 power in any part,  may induce palsy.   A  limited
 paralytic affection  may be  produced by a disease
 in or pressure on the medulla spinalis, or a nerve,
 the  encephalon being sound.  The treatment of
 palsy may be deduced from principles already dis-
cussed, a due regard being had to all the circum-
 stances  of  each case.  First, all causes acting on
 the brain or nerves, are to be  removed; and, se-
 cond, the torpor is to be overcome by stimulants.
 In these efforts  we often fail;  but whether we do
so, or not,  care is to be taken, as after apoplexy,
to guard against fresh attacks of the disease.
  CCCXXV.   Genus  IX.  Cephalitodes.    "De-
lirium;  tremor  of  the-muscles;  watchfulness."
Species 1.   C. Ebriosus.  " Countenance much al-
tered in  colour and expression; exhibiting vague
anxiety; great restlessness; often convulsions; or-
                     29 
226
NEUROTICA.        [cl. iv.-or. iv.]
ganic system  variously diseased;  in persons ha-
bitually accustomed to use ardent spirits."  There
is only one  species of this disease.  It evidently be-
longs to this order, but cannot be placed under any
of the genera formed by Dr. Good.   He has inclu-
ded it under Alusia Hypochondrias; but it cannot
belong to an order containing diseases affecting on-
ly the intellectual function ; for the functions of
perception  and motion are likewise  affected.  As
this disease has been mistaken for inflammation of
the brain, and no doubt often treated as such,  it
seems entitled to a name, which signifies its likeness
to Cephalitis.  The same  subject is commonly at-
tacked two, three or more times with Cephalito-
des Ebriosus; but it ultimately terminates in death,
and sometimes does so on the first attack.
  CCCXXVI.  The proximate  cause  of this dis-
ease appears to be seated  properly in the nervous
system, as such. In some instances there have been
found determination of blood to and  perhaps some
inflammation in the brain, but this seems rather the
consequence than the cause of the disease, and at
least is not  essential to it.   The  treatment of this
disease cannot be  founded  on our knowledge of the
nature of the proximate cause.   It has been regu-
lated principally by a regard to  the watchfulness,
which is so characteristic  a symptom.   This  is
to be overcome by the use of opium.  But when
the  state  of the  circulation, or that of the ali-
mentary  canal  forbids  the use  of  opium  these
states are to be  altered by  the appropriate treat-
ment, as  in other  diseases. 
NOTE.—ERRATA.
227
   Note.—Dr. Good's  fifth  class consists of  dis-
eases, which  for the most part, will be noticed in
the  lectures  on obstetrics.   The seventh class is
made  up of diseases, which may be called  Surgical.
I therefore  have not  noticed  these two classes in
the text-book.  But neither have I the sixth class.
The principal reasons  are,  that  the time allotted
for the course will not allow  a full consideration of
all  the subjects,  which might  be embraced in it;
and  that the  most important diseases of this class
are  ordinarily presented during the winter at the
Hospital and  there made  the  subjects of clinical
lectures.  The principles, which  apply to diseases
of this  class, do  not  differ  from  those  already
brought  into  view.
                     ERRATA.

In the running title to pages 195. 197.  199. for " Organic Function" read
                     " Sanguineous Function."
 "      "     page  201, for "cl.  iv. or. iv." read " cl. ii>. or. i."
 "      "      "    202,  for "Haematica" " cl.  iv.  or. iv." read
                     "Neurotica" " cl. iv. or. ii."
 "      "      "    203, for "cl.  iv. or. iv." read "cl.iv. or. Hi."  .
 "      "      "    204,  for "Haematica" "cl.  iv.  or. iv." read
                     " Neurotica" " cl. iv. or. Hi."
 "      "      "    205, for " cl.  iv. or. iv." read " cl. iv. or. Hi."
 "      "      "    206,  for "Haematica" " cl. iv.  or. iv." read
                     il Neurotica" "c/. iv. or. Hi."
 "      "      "    207, for " cl. iv. or. iv." read " cl. iv. or. Hi."
 "      "      "    208,  for "Haematica" "cl. iv.  or. iv." read
                     " Neurotica" " cl. iv. or. Hi."
 "      "     pages  210. 212. 214.  216. for " Haematica" read
                     "Neurotica." 
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