Diseases of the External Senses;

including vision, hearing, smell, taste; to these we shall add the diseases of the voice and speech; obstructed deglutition; sterility, and morbid irritability of the generative organs. The derangement of those delicate and precious senses through which we derive such supreme delight; through whose avenues are conveyed into man the first rudiments of all his variegated ideas and knowledge, are important objects of medical scrutiny; notwithstanding very few from these causes are precipitated into the crater of mortality. I could, however, have wished to ascertain from registers, in conformity with my general plan, the proportion of cured and incurable; and especially the average of blind in a community.

Vision.

The principal diseases may be comprehended under opthalmia, fistula-lachrymalis, gutta-serena, cataract, specks on the cornea. I exclude some other natural defects, rather than diseases, such as myops, presbyops; for the cure of which the optician is the best physician.

Opthalmy, or inflammation of the eyes is a frequent complaint: it may be in the exterior membranes of the globe, or in the edges of the eye-lids; or may be a complication of both; it may be in one, or in both eyes; it may be general, partial, external, internal, temporary, chronic, idiopathick, symptomatick: of all which species there are various gradations. In this local malady there is commonly little or no fever; but heat, pain, redness, and inflammation; the vessels of the eyes seem gorged with blood; the anterior portion of the tunica sclerotica, and the conjunctiva, resemble a scarlet cloth, with impediment in vision, intolerance of light, lachrymation. In the inflammation of the cartilaginous ring of the eye-lids or tarsus, there is frequently some remains of small ulcerations in the sebaceous glands. The external is by far the most frequent form of opthalmy; and, under discreet management, is attended with trifling danger: sometimes, however, it is followed by specks on the cornea, or callosity, and blindness; and violent inflammation has extended to the interior parts of the eyes and retina. In the internal inflammation of the choroid and retina, no redness is perceptible externally; but there is excruciating pain, headach, intolerance of light, restlessness, often delirium, in a few instances, insanity: and if not relieved in the course of fourteen days, there is danger of incurable blindness.

Fistula lachrymalis. In this partial inflammation affecting the lachrymal sac and ducts, and obstructing the descent of the tears, or superfluous moisture of the eyes into the nose, this fluid necessarily trickles down the cheeks, and the eye is overflowed with water: on pressure of the internal angle and puncta lachrymalia, there is a discharge of glareous serum, by which the eye-lids, during sleep, are glewed together. The degrees of inflammation and obstruction are various. In the inveterate stages it may terminate in abscess, ulcers, and caries of the contiguous nasal bone.

Gutta-serena, amaurosis; in one or in both eyes, and in various gradations, from obscure vision to cheerless tenebrosity. To a spectator the eyes appear nearly as in health, only that the pupil is dilated and inanimate; the retina insensible to the rays of light, and the iris mute, without corresponding contraction or enlargement: a physiognomist might say, there are no sensitive emanations or magnetick rays emitted through this mental mirror. It attacks suddenly or gradually, and sometimes intermits; but in general it is chronic, and always dangerous; often irremediable: sometimes it is accompanied with headach in the anterior part over the eye-brows.

Cataract may affect one eye, but in general both: it arises from disease or opacity of the crystalline lens obstructing the visual rays in their course to the retina: the consistence and colour of the lens is various, white, pearl, green, yellow; and from these the oculist forms his prognostick: in couching the eye the pearl-coloured is preferred: the white is too soft; the green and yellow incurable; as is also that species wherein the strongest rays of light excite no contraction of the pupil. Cataracts in general are gradual in their formation; weeks, months.

The predisposing and occasional causes of injured vision and of opthalmy, external violence and blows; sudden suppression of perspiration; extraneous bodies or acrids admitted within the eye-lids; acrid metallic fumes, and noxious exhalations; long exposure to confined smoke, especially from wood fires; smoky houses and cottages; acrid collyria; epidemick state of the air, and infection; long continuance of wet weather; long exposure of the eyes to the rays of strong light, to snow, or luminous objects; cold streams of air; suppression of salutary evacuations, or cutaneous eruptions, and of chronic ulcers; acrimony of the blood; interruption to the free return of blood from the head; frequent intoxication: nocturnal studies; long want of sleep, grief, tears; small tubercles within the eye-lids; ulcerated eye-lids; variolous: morbillous; scrophulous; venereal; erysipelatous; rheumatick; catarrhal; intermittent; herpes; cancerous. Of fistula-lachrymalis, inflammation of the lachrymal sac, or ducts. Of gutta-serena, plethora, distention of the vessels of the retina; palsy of the optick nerves, general or partial; diseases of the brain, or of the retina; profuse and suppressed evacuations; excess of venery; chronic headach; ebriety; cachexy; venereal; intermittent; symptomatick in the irregular gout, apoplexy, &c. Of the cataract, opacity of the crystalline lens. The general causes of injured vision, exclusive of opthalmy, may be briefly enumerated; and are long attention to minute objects; weakness of the power to contract the pupil; faults of the globe; defect of the aqueous humour, its impurity or density; opacity of the lens, or of the vitreous humour; the retina callous or too sensible; faults of the optic nerves; contraction, concretion, flaccidity of the pupil; gibbous or convex lens, or too near and flat; dropsical eye; spasm, or palsy of the ocular muscles; diseases and ulcerations of the eye-lids and ciliary glands; ulcers and fistula, specks and scars, in the cornea; films growing from the angle of the eye; the eye-lids inverted, elongated, concreted; various diseases of the brain from internal or external causes.

Hearing,

injured by deafness; noise in the ears, inflammation. The first is a frequent infirmity in old age. The causes, faults in the original structure of this curious and complex organ; defect of the auricle, straitness of the external auditory tube, its obstruction or concretion: the tympanum relaxed, callous, obstructed with hardened wax, mucus, serum, ulcers, luxuriant flesh; caries, luxation of the small auditory bones; obstruction of the vestibule, cochlea, labrynth: the membranes lax, dry, indurated; palsy, and spasm of the internal auditory muscles; constriction and obstruction of the eustachian tube; colds, catarrh, obstructed perspiration, rheumatism, plethora, suppressed evacuations; disorders of the stomach, costiveness; nervous, loud explosions, age, fever, soporous diseases, and diseases of the auditory nerves, and of the brain; symptomatick in several diseases. Inflammation of the ear excites excruciating pain, sometimes delirium.

Smelling

too acute, or blunt, or unnatural. The causes, the membrane lining the nose rigid, dry, deficiency or excess of its mucus tense, irritable, obstructed, scirrhous, callous, carious, stifled with polypus, snuff; palsy of the olfactory nerves; diseases of the brain; sordes and pus in the olfactory sinusses; and also in the mouth, gums, teeth, tongue, larynx, fauces; foul effluvia from the stomach.

Sternutation is symptomatick in several diseases; but sometimes, is a primary malady, it has been known to infest hours, days, or even weeks. The causes, epidemick influence of the air; suppressed nasal hemorrhage, or cutaneous eruptions; venereal; worms, or abscess in the sinusses; disease of the brain.

Taste.

The causes affecting the principal gustatory organ, the tongue: sordes of the tongue and mouth in various diseases; the saliva in quantity or quality diseased, and either depraved from the blood, or from washing over diseased parts of the mouth or palate; tension or laxity of the gustatory organ, or papillæ; faults of the lingual nerves; diseases of the stomach, fauces, nose, tongue, lips, &c.

Voice and Speech.

The immense multiplicity of objects, and the distance to the end of our literary journey, check us from expatiating upon this prolifick topick. Under it may be included hoarse, guttural, stridulous, deadened, stifled voice, or sound at the glottis; stammering, lisping, defect and impediments in articulation, muteness. The causes, defect or waste of mucus by exertion of the voice; destruction of the mucus ducts of the larynx; its cartilages ossified; injury of the recurrent nerves; laxity and palsy of the muscles of the glottis and contiguous cartilages; venereal; changes of weather; symptomatic in several diseases. Voice and speech may be injured in all the various parts of their complicated organization; the larynx, the pharynx, the tongue, uvula, fauces, nose, palate, gums, teeth, lips.

Sterility of the sexes:

no inconsiderable number of both sexes are incapacitated from exercising that important and divine function of giving creation to their own species. The causes in the male sex are, palsy, or torpidity of the penis, or its nerves, or generative organs; the penis short, monstrous in size, its prepuce straitned; impediments in the urethra and seminal ducts; testicles, epididymidis, vasa deferentia; the semen inert, vapid, aqueous, scanty; weakness of the ejecting or accelerator muscles; corpulency; too tense erection; old age; castration, manustupration, too frequent coition, extreme chastity, venereal disease, inebriety, broken constitution, tabes-dorsalis. In the female sex, original structure of some part of the generative machinery of the ovarium, fallopian tubes, womb, vagina, labia, clitoris; straitness, concretion, obstruction of the vagina or womb from inflammation, scirrhus, polypus; cold frigid temperament; promiscuous coition; excess of venery, irritability; fluor albus, obstructed menses, irregular menstruation, cachexy.

Morbid irritability of the genitals,

including priapism, pollution, furor uterinus. Of involuntary pollution we have treated under dorsal tabes. In our climate the uterine mania rarely occurs in that extreme of indecency described by authors. The woman at first is bashful and silent; the pulse and circulation are agitated on mentioning a venereal topick; by significant looks and gestures she betrays her passion; and if disappointed, becomes low-spirited, anxious, and wastes in flesh. The same has happened to some women who had the mortification to be linked with impotent husbands. Sometimes, however, this universal passion has burst into a flame; the woman losing all sense of shame, soliciting, with obscenity in speech and gestures, the embraces of the other sex; and raving on this theme with maniacal insanity. The causes, acrid serum, spasm, inflammation of the urethra, vagina, or other generative organs; irritation of the bladder, womb, rectum; obstructed menses; fluor albus, heat, excoriation of the vagina, venereal; stimulating, acrid, diureticks, and emmenagogues; stimulating diet and drink, excess of venery, manustupration, libidinous books, prints; protrusion of the vagina.

Deglutition interrupted: we very rarely meet with this similitude of tantalus, wherein food or drink is either swallowed with difficulty and pain, or totally interrupted in its descent to the stomach, and regurgitated by the mouth or nose. The causes spasmodick constriction of the œsophagus, and in various parts of the tube; palsy of the muscles of deglutition; tumors or scirrhus in the pharynx, œsophagus, pylorus, trachea, thyroid or dorsal glands; aneurism and enlargement of the aorta, ulcers in the œsophagus; luxation of the os hyoides; compression of the pharyngeal nerves; cachexy, worms, crudity, passions, extraneous substances stuck in the throat. The spasmodick is periodical and painful; and also affects the voice: in the lower part of the œsophagus it excites pain between the shoulders; sometimes eructation and vomiting.

Manducation. Diseases of the teeth are the principal impediments to the exercise of this function. There are few adults who cannot describe the pangs of tooth-ach from their own feelings. It is generally intermittent, seldom dangerous to life, except during the first dentition of infancy. Its constant symptoms, pain, flow of saliva, restlessness: its variable symptoms, swelled face, carious loosened teeth; fistula, exostoses of the gums and jaws. The causes, inflammation of the periosteum of the teeth, gums, or jaw; suppressed perspiration; moist air; catarrhal defluxion; suppressed habitual evacuations, nasal hemorrhage and venesection; plethora; intermittent, scorbutick, arthritick; rheumatick; caries of the teeth; sugar eat; beetle and tobacco chewed, acrimony of blood or saliva; spirituous liquors; mercury; suppuration in the maxillary sinusses and gums; spunginess and flaccidity of the gums and periosteum; irritation and disorder of the fifth pair of nerves.