Diseases of the Stomach and Intestinal Tube,

are very universal and frequent maladies in both sexes, and throughout all orders and ages. The stomach and alimentary canal are furnished with numerous nerves; and the sensibility of the former very acute, especially at its upper extremity. The length of the human alimentary tube, from the mouth to the anus, is five or six times the length of the whole body: it is folded into many convolutions, as may be daily seen at shambles, on the opening of animals. Into this alimentary muscular and contractile sewer are incessantly heaped food and drink, besides a variety of copious secretions from the body, requisite in the process of digestion and assimilation of chyle, as saliva, pancreatick fluid, bile, mucus, and arterial exhalation from the whole of its internal surface.

Within the short space of a few weeks, the generality of mankind consume more food and drink than amounts to the whole weight of their bodies. This diurnal superfluity and load, together with the corrupted and abraded animal parts of the body, and the different secreted fluids, must again, in a few hours, be expelled through the principal human excretories; the fecal, urinary, perspiratory. In the healthy state, by far the smallest proportion of this diurnal superfluity is through the intestinal excretion: the greatest part is absorbed by the lacteals and lymphaticks, intermixed with the blood, and afterwards filtered by urine, perspiration, and in the puerperal state, milk. In cold climates and winters, especially if moist, the urine; in warm climates, the perspiration preponderates. But in these prodigious diversities ensue from exercise or rest, sleep and waking, passions of mind, the quantity or quality of food, cleanness of the skin, constitution, atmosphere, and the alternation with each other of these excretions. Again, when we reflect that from the small parotid glands, between a pint and a quart of saliva is secerned during the twenty-four hours; and on the prodigious secretion through the kidneys, we may easily conceive in the natural and morbid state, what a considerable quantity may be secerned from the liver, the largest of the abdominal viscera: making, however, some deduction for the slower circulation through the vena porta.

The chart of London diseases demand some criticism on that inextricable miscellany surfeits, stoppage of the stomach, vomiting, cholick and gripes, bloody flux. In the last century, surfeits make a monstrous article in the chronicle of deaths, amounting in some years to four hundred; whereas, during fifteen years of the present century, they sink down to only fifteen. Yet all are witnesses that good eating and gormandizing are not worn out of fashion in this metropolis. Medical men know that surfeits and intemperance are often merely predisposing or occasional causes of diseases: they may rouse latent disorders, or dispose the body to receive noxious impressions externally. The searches therefore formerly, as I suspect, made many of these reports from the ostensible cause which they imagined gave birth to the disease and mortality. At the same time, I am not contending for the delicacy and moderation of our forefathers appetites. They were unquestionably in the last century, and partly indeed from the cheapness of flesh-meat, and scarcity of vegetable nutriment, more carnivorous in their diet than the present generation.

Stoppage of the stomach also, is a morbid centaur in the last century. It would baffle the ingenuity of an antiquarian to decypher the true import of this term: severe sickness, or the word Abracadabra, would be full as intelligible. It is a vulgar name for rejection of food; and there are few diseases in which the stomach does not sympathize. What proportion of the mortality of infants, adults, or the sexes, are crammed into this absurd article, I submit to the reader’s criticism.

An important circumstance, and overlooked so far as I know, by all the calculators and criticks on the rise and fall of infant diseases in London, and especially of convulsions, is this. In the first column of 15 years, at the beginning of the present century, colick and gripes of the guts amount to 13668, but continue through every succeeding column to diminish; and in the last or fifth, dwindle to 769 only. What is meant by this complaint, colick and gripes? was it dysentery? We observe that bloody flux makes a separate, though small group, through all the five columns. Were these two diseases confounded in the annual reports? or may it not be alledged, that many infant diseases and deaths, which were formerly crowded into colick and gripes, are in modern times transferred to the vortex of convulsions? I am aware that, in reply, it may be suggested that drains, sewers, drier lodgings, less damp, alteration in diet, and the more plentiful use of vegetable and fermented liquors, have decreased dysenteric complaints in this city; and also, that Dr. Sydenham, in 1670 and 71, describes an autumnal dysentery as annually prevailing in London, and about two months in duration. Turning the subject into every possible view, I continue to suspect that numbers of infant diseases, and commonly terminating fatally in convulsions, were formerly heaped into gripes and colick; for during the last thirty years of the preceding century, they amount to the enormous number of 69,799.

Diseases of the Stomach

are idiopathick and symptomatick. Under the present head we shall include inappetency, indigestion, nausea, vomiting, eructation, acidity, cardialgy, heartburn, regurgitation of bile, pica, soda, pyrosis, hiccup, rumination. Several of these are obvious symptoms, and are often complicated. Inappetency is generally accompanied with nausea. Foulness or feculence in the stomach, is indicated by weight and load in that region, anxiety, nausea, eructation, disagreeable taste in the mouth, foul tongue: the state of the gustatory organ is some index to that of the stomach. Acidity in excess will excite eructation, flatulence, heartburn, gnawing pain in that part, irregular appetite and craving, colicks, gripes, diarrhœa, vomiting. In infants, acidity is very frequently predominant; hence acid eructation, restlessness, gripes, green curdled feces, tumor of the abdomen, dyspnœa, sometimes costiveness, or diarrhœa, and sometimes dry cough, and muscular paleness and flaccidity. Of bilious regurgitation there are various gradations: with severe sickness at the stomach, nausea, bilious vomiting, bitter taste on the tongue, and its surface furred; inappetency, frequently colick; sometimes temporary jaundice. The cardialgy is a severe pain, threatening syncope. The pica an aversion to natural aliment, and craving for unusual. The bulimy is a monstrous appetency for food. The heartburn denotes a sensation of uneasiness, heat, and acrimony: the soda, or water-brash, a burning heat in the stomach and fauces, anxiety, acid eructation, exspuition of lymph, and fretting the edge of the teeth.

The pyrosis, or cardialgia-sputatoria, is more frequent and endemic in some countries than others; and, it is alledged, more amongst the poor than affluent, and amongst females than males; and of the former, the single and barren: it rarely occurs in puberty, or in old age. The pain at the stomach and back is often very severe, and with anxiety, until the torrent of watery fluid bursts forth, which, after continuing one or two days, intermits: but relapses are frequent, and the disease is contumacious. The hiccup, or sudden convulsive inspiration, is a complicated affliction of the stomach and diaphragm. Of rumination in the human species, there is scarce an instance in a generation.

The predisposing and occasional causes of the preceding diseases of the stomach are in general, weakness of the muscular coats; diseases of its nerves; small omentum; the digestive menstrua as bile, saliva, mucus, defective or depraved; frequent exspuition and waste of saliva; slow digestion, and food corrupted in the stomach; crudities in the stomach; vitiated chyle; excess of pituita, acidity, bile; relaxed pylorus, large stomach, calculi in the biliary ducts; scirrhus stomach, pancreas, liver, spleen, duodenum; mucus of the stomach abraded; ulcers, cancer, depression of the xiphoid cartilage; frequent emeticks and purgatives; valetudinarian regimen, too much physick, quackery, and care about health; gluttony, epicurism, pampered indulgence of that passion and appetite; frequent surfeits; dram-drinking; malt liquors in excess; the aliment in quantity or quality, or in multiplicity at one meal, injurious; ravenous ingurgitation at meals, and imperfect manducation; fat, rancid, corrupted, salted, and indigestible farinaceous food; tea, tobacco, watery liquids: in infancy, acid milk, sucking to excess, curdled milk in the stomach; superfluous acid generated in the stomach; too violent agitation in the nurse’s arms; passions of the nurse; too tight bandages; saliva swallowed in excess during dentition; too much vegetable diet and milk: to the catalogue of general causes may be added various depressing and cankering passions of mind; cares and troubles; want of sleep, intemperate study, sedentary life, unremitting application to sedentary business; moist cold air, foul air of cities; leaning forward on the stomach, and improper postures of the body; costiveness; suppression of salutary evacuations and cutaneous exanthemata; sanguineous plethora; conference of hereditary infirmity, bad health, old age, chlorosis, worms, gout, rheumatism, intermittent and remittent fevers, and of various other acute and chronic diseases; poisons; extraneous substances swallowed, contusions on the head; external injuries; blows and falls.

Cholera Morbus

is much more frequent in tropical and warm climates; and in northern regions in the summer and autumnal seasons; especially in unusually hot summers. The disease is not unfrequent in this island and metropolis; nor is it entirely restricted to the warm season only. The symptoms are sickness and nausea, succeeded by violent vomiting and purging, of a bilious nature, with gripes, tenesmus, tension of the abdomen, anxiety, great prostration of strength, intense thirst, cardialgy, and sometimes muscular spasms in the lower extremities. The vomiting and purging either commence about the same time, or alternate with each other: and throughout its rapid race there is seldom any fever. It is often a salutary effort of nature, by which a superfluity of bile is disembogued; and in cases of ordinary violence, may continue a day or two, and then cease. In more tremendous assaults it sometimes proves fatal in twenty-four hours; portentous omens of which are violent vomiting and purging, sudden prostration of strength, quick weak pulse, hiccup, fainting, cold sweats and extremities. The predisposing and occasional causes are, hot climate and seasons; in warm climates extreme heat and dry weather, succeeded by a fall of rain and coolness of the atmosphere; sudden changes of weather; increased secretion of bile and corrupted bile; surfeits, intemperance, accumulation of feculence in the intestines and liver; excess of food or drink without sufficient exercise; indolence, luxurious living and sedentary life; malt liquors; passions of mind; repulsion of cutaneous eruptions; gout; poisons; worms; symptomatick in intermittent and remittent fevers.

Dysentery,

bloody flux, spurious remittent. This contagious disease has been before mentioned, under remitting and autumnal fevers. It is called by the sagacious Morton, the Spurious Remittent turned on the intestines; and by Sydenham also, who, perhaps undeservedly, is panegyrized as a superior oracle, the Fever of the Season turned on the bowels. The general symptoms are, frequent stools with severe colick, gripes, and tenesmus, or urgency to exonerate the intestines: these evacuations are slimy, generally with intermixture of blood, and fragments of feces concreted into hard globules, and unusually fetid. It is also accompanied with sickness at the stomach and pain, inappetency, vomiting, flatulence, restlessness, foul tongue, and more or less fever. When fatal, many are destroyed between the seventh and twentieth days; but when moderate, it may be protracted much longer. Relapses are frequent on any irregularity or intemperance. The causes, warm climates and seasons, marshy effluvia; cold nights followed by warm days; sudden suppression of perspiration, especially in warm climates; exposure to cold and moist air and rains, and wet cloaths and beds; long continuance of sultry and dry weather; excess and corruption of bile; symptomatick; dysenterick contagion from privies, beds, &c.——Vid. Remittent Fevers.

Diarrhœa,

ventris profluvium; including the different species, the celiaca, lienteria, morbus hepaticus, niger, atrabilis. In the simple diarrhœa, the evacuation by the anus is unnaturally frequent and liquid. In the celiaca, or chylous diarrhœa, the aliments and chyle are ejected: and in the lienteria, like a bucket whirling into a well, food is no sooner taken than discharged. The morbus hepaticus is without pain or tenesmus, with flux of blood and serum, or like ink; in colour and consistence various. Diarrhœa is accompanied with gripes; but not so excruciating as in the dysentery, with inappetency, dry skin, thirst, hectic heat: but no considerable fever; nor is it contagious. In the severity and evacuation there are varieties: and in some cases it is salutary. The causes, excess of food and drink, or acrid putrescent aliment; new fermented liquors; vegetable laxative food; feculence in the intestines, stercorous, pituitous; vitiated digestion, with morbid irritability of the intestinal tube; irritability of this muscular canal, and increase of its peristaltic motion; atonia; excess and acrimony of bile, warm climates, broken constitutions, cachexy, chronic dysentery, immoderate flux of humours to the intestinal tube, and exhalation by the arterial extremities of that canal; suppression of perspiration, and of other evacuations; superfluity of serous humours; impediments in the absorption and passages of the chyle; obstruction in the vena portarum; laxity of the pylorus; palsy of the sphincter ani; ulcers of the stomach, repelled gout, and rash; sudden passions of mind; nervous irritation; erosion or rupture of the blood-vessels on the interior surface; obstruction of the spleen; acrid dissolution of the blood; colliquative; worms; symptomatic in fevers; purgatives; poisons. In infancy, acidity, dentition, and saliva swallowed to excess; corrupted milk and chyle, thin laxative vegetable diet; errors of the nurse in diet; gravel in the kidneys.

Colick.

From slight or serious attacks of this torture, few of the community are exempted. We here associate together the inflammatory, spasmodic, saturnine, bilious, flatulent, the infantile colick, and other species. Colick is generally a temporary disease; and with which some, much more than others, are afflicted at intervals. Inflammation of the intestines ileus, volvulus, enteritis; generally sudden assault of excruciating, fixed, and increasing pain, in some degree affecting the whole abdomen, but more pungent about the navel; with nausea, frequent vomiting of food and drink, and sometimes of intestinal feculence; obstinate costiveness, severe gripes, eructation, flatulence: the fever sometimes succeeding, sometimes preceding, the local pain; and of which there are exacerbations and remissions, and various gradations. The pulse at the beginning is not remarkably full nor frequent, from which fatal mistakes and irremediable procrastination, have often ensued in medical practice: the urine is in small quantity, or suppressed. It is much more frequent in the narrow than the wide part of the intestinal tube. In the rectum, constant tenesmus, excretion of mucus; and in the male sex strangury are natural consequences and symptoms. Inflammation or nephritick paroxisms in the kidneys and ureters, with which it has been confounded, are hereafter discriminated.

It is extremely dangerous and precipitate; frequently destroying in a few days, sometimes in one day, and is seldom protracted beyond nine. There is less danger in young than in old persons: abatement of pain, cessation of nausea and vomiting, discharge of flatulence and of feces, softer and freer pulse, are favourable symptoms: unfavourable are, unconquerable costiveness, immoderate vomiting, tumid belly, eructation, hiccup, cold extremities, gangrene; abscess rarely. Inflammation is sometimes the effect, and not the original cause of colick.

Under the spasmodick colick may be classed the colica pictonum, saturnina, plumbeia, and dry belly-ach of the West Indies. The symptoms, writhing pain in the abdomen, about the loins and back; retraction of the navel towards the spine, dysury, ischury, or strangury; costiveness with difficulty removed, and the feces in conglobated lumps, vomiting, anxiety, depression of spirits. In the saturnine the countenance is sometimes of a leaden colour, and there is a saccharine taste on the tongue. This infests various classes of artificers: sometimes terminating in chronic colick, in palsy of the lower extremities, and in convulsions.

Bilious colick is accompanied with severe pain in the stomach and intestines, nausea, sickness, vomiting of bile, costiveness, bitter taste on the tongue, anxiety, dejection of spirits, dysury, often flatulence. Its duration is short, but it is prone to return on any intemperance or irregularity; sometimes it ends in jaundice. Flatulent colick is distinguished by the pain being mobile, without much nausea or vomiting, or hard pulse and thirst, or fever; by considerable unusual distention of the abdomen, and flatulent explosion upwards and downwards; and sometimes efforts to vomit until the flatulence is ejected: respiration is also more or less interrupted.

The infant colick is very frequent, and infinitely more fatal in those years than the London bills represent. Infants scream lamentably, and cannot be appeased; they contract and draw up their legs to the belly, are restless, sometimes costive; but often there is concomitant diarrhœa and green feces, vomiting, flatulent explosion; and sometimes the breath smells sour; in some the urine is suppressed; and many die convulsed.

The predisposing and occasional causes of colick, inflammatory, spasmodick, bilious, and of most other species are, acrid matter of aliment, medicines, poisons; acrid putrid bile; obstruction of the intestinal tube by indurated feculence, hair-balls, cherry-stones, calculi, steatome, volvulus, intusesception, contraction of the intestines in some part; scirrhus, cancer, severe colick, spasm, ruptures; wounds of the intestines; the aliments, pickles, condiments, and luxuries of the table, cooked, prepared, or preserved in lead or copper vessels not well tinned; the lead corroded from clayed vessels used for domestick purposes; wine adulterated with lead; cyder pressed in leaden cisterns; effluvia of lead to which painters and some metallurgies are exposed; excess or acrimony of bile; broken constitutions in tropical climates; acrid chyle; particular food or drink; new fermented liquors; sudden suppression of perspiration; cold wet feet; sudden passions of mind; flatulence and elastic air pent up; muscular and nervous spasms; plethora menstrual, lacteal, hemorrhoidal, scorbutick, rheumatick, arthritick, hysterick, nephritick; calculi in the biliary ducts; epidemick; aneurism of the aorta; turgid gall-bladder; spasm in the abdominal muscles, violent vomiting. In infancy, corrupted meconium, crudity, and sour or adulterated milk; suction to excess; acrid bile; the mother or nurse fasting too long before the infant sucks; corrupted unwholesome milk of nurses; nurses addicted to passion, to dram-drinking; insufficient exercise of the infant; tight rollers round its abdomen; dentition; worms.

Gall-Stones,

calculi cystici. We have no account of this disease in ancient records. Until the beginning of the present century, it had escaped the vigilance of medical observation. But it is now known, that biliary concretions are, perhaps, not less frequent than those in the urinary organs. Gall-stones infest more the adult, old, and sedentary; and it is alledged, more females than males. The symptoms at first are dubious, and are all to be weighed together in forming a diagnostick. In attempting to descend throughout the gall-ducts, they excite direful pain at the pit of the stomach and hepatick region, darting to the back, with restlessness, anxiety, dyspnœa, jaundice-colour of the eyes, costiveness, and commonly vomiting: the pain is aggravated by coughing or sneezing, and sometimes ascends to the right shoulder and arm; but the pulse and circulation are not accelerated.

In the expulsion of these calculi, there are usually reiterated paroxisms, or exacerbations and remissions of pain. The continuance of the paroxisms is from a few hours to days, weeks, or even months; but the latter is rare; during which period either no stone is discharged, or one or many stones are successively protruded. Their immediate expulsion is accompanied with a sensation, as of something bursting in that part, or of a fluid rushing into the intestines; and often some tenderness is there left behind. The calculi vary in shape, colour, consistence, size, and number; from a pea to a walnut, and from one to dozens and scores. It is generally a tedious and chronic disease, and may continue many years; often thro’ life. It is seldom immediately dangerous, unless, as in nephritis, inflammation is kindled, or during pregnancy. When chronic and inveterate, it may terminate in jaundice, cachexy, dropsy. The symptoms of calculi in the gall-bladder are obscure; such as weight, uneasiness, dull heavy pain at intervals, sometimes temporary jaundice, cachexy, and diseases of the stomach. The causes, hereditary, viscid, tenacious bile, sedentary life, depressing passions, spirituous liquors; often ambiguous.

Whether any calculous concretions are formed in the pancreatick duct, is yet unexplored by authors. The pancreatick fluid is nearly similar to the saliva, which separates a tartarous sediment on the teeth.

Jaundice,

icterus, morbus regius. Some of the eastern nations have naturally this complexion. The mortality by jaundice is not inconsiderable, amounting in the London bills, in the last thirty years of the preceding century, to 2169; and in the present century is doubled. The symptoms, heaviness and aversion to motion, itching and dryness of the skin, yellowness of the tunica-conjunctiva of the eyes, and also of the skin; the urine of a saffron-colour, and tinging linen; objects appear yellow; there is thirst, bitter taste in the tongue, bitter and yellow saliva, inappetency, indigestion, costiveness, and frequently pale-coloured feces. Sometimes, though very rarely, jaundice is local and not general. Jaundice may be critical, symptomatick, idiopathick, periodick, chronick. From gall-stones it is generally periodical; and such are prone to relapses. The prognosticks are more favourable with natural sweats; in recent than in chronic; in youth than in old age; in robust than in weak persons; in yellow than mulatto tinge; and when not complicated with other dangerous diseases, especially dropsy. Its duration and termination is various; from a few days to weeks, and months.

The predisposing and occasional causes are, sand, mucus, or inspissated bile in the biliary ducts, especially the ductus communis; tumors compressing the biliary ducts, or their concretion; scirrhous duodenum; spasmodic, and flatulent colick obstructing the intestinal orifice of the biliary ducts; violent passions of mind; strong emeticks or purgatives; sudden refrigeration of the body; hepatic obstruction and inflammation; languid circulation through the vena porta, sedentary life; warm climates and broken constitutions; excess of bile and re-absorption; cachexy; depraved state of the blood; symptomatick in some intermittent and remittent fevers, pregnancy, scurvy, obstructed spleen; venomous bites and stings. In infants, excess of bile and meconium, or distention of the duodenum obstructing the biliary excretory.

Worms.

In assigning an adequate share of mortality to worms, the London bills, probably, are defective. During the last thirty years of the preceding century, they are rated at only fourteen hundred; and continue decreasing throughout the present century. Perhaps a portion of verminous mortality is confounded with colick and gripes, or with hectic emaciation. Worms infest most in infancy and childhood; but seldom until after ablactation; and then, probably, more of the children of the necessitous than of the affluent. The principal species of human worms are the rotunda, or lumbricalis, the tænia or lata, the cucurbitina, and the ascarides: these are again, but with superfluous subtility, subdivided by nosologists. The rotunda or lumbricalis, has most resemblance to an earth-worm; it is forked at both ends, but paler: in length various, from inches to feet: and often many are entangled together in clusters. The tænia has some resemblance to tape, consisting of numerous joints, or coherent links, about an inch or more distant, and often many yards in length: this is most frequent in the adult age. The ascarides are extremely numerous, active, and minute, like fine needles, or the cuttings of white thread; and generally burrow in the lower extremity of the intestinal tube of children: the former species wallow through all parts of the alimentary canal.

Verminous symptoms are numerous, various, and all extremely ambiguous, unless worms are discharged with the feces: feculence in the stomach and intestines may occasion all the other symptoms: such as pale countenance; fugaceous flushing of the face and cheeks, and circumscribed spots of redness; itching of the nose; swelling of the upper lip and nose, and lower eye-lids; dilatation of the pupil; grinding of the teeth; fetid breath, and eructation; flow of saliva; irregular, impaired, or voracious appetite, nausea, vomiting, colick, gripes and sudden screams from the violence of pain; tumid and enlarged belly; costiveness, or diarrhœa and fetid stools; the urine sometimes like milk; sudden startings in sleep, frightful dreams; palpitation of the heart; dry hectic cough, atrophy; various nervous symptoms, epilepsy, tetanus, convulsions. The ascarides excite irritation about the anus, tenesmus, and dysury. These intestinal insects are often most tormenting when the stomach and intestines are empty. Sometimes they excite a symptomatick and slow fever, with hot skin, quick pulse, thirst; and the children are then confined to bed. But without fever, children pursue their usual amusements. The causes, improper diet for these years, as cheese, farinaceous, legumens, fruits, saccharine, putrid diet or unwholesome aliment, hereditary weak constitution, moist air: the ova of the insects swallowed with the air, food, or drink.

Hemorrhoides,

piles. Is a frequent and very universal disease in both sexes, and most so during the adult stages and decline of life; and by which the lives of many are incommoded and harassed. They are distinguished into the blind and open, the external and internal; and are temporary, periodical, and chronic. The blind piles denote small imperforated lumps and tumors about the margin of the anus. Sometimes the tumours and hemorrhage from the anus ensue without any previous disease of the body; but generally some antecedent or accompanying disorder is felt; such as vertigo, headach, pain of the back and loins, oppression in the breast, colick, dysury, some fever and heat. The approaching hemorrhage is with sense of fulness, heat, itching, and pain about the anus, with tenesmus, costiveness, and conglobated feces; and sometimes is preceded by a serous discharge, or this sometimes is substituted for red blood. The quantity of sanguineous extravasation is various in different persons, and in the same person at different periods: from the internal vessels of the rectum it is more profuse than from the external; and is generally during, or after the fecal discharge: in other cases it is without fecal efforts, and then in larger debilitating streams, but rarely immediately fatal. These tumors, or sanguinous torrents, are almost always periodical, and at various intervals. They are often salutary, if moderate, especially if bad health preceded; and also as preservatives. In the decline of life, when the hemorrhoidal flux has been frequent, but suddenly ceases, they are in danger of apoplexy or palsy. On the other hand, in excess, it may exhaust the body, injure the health, and terminate in dropsy or consumption. Or sometimes hemorrhoidal tumours inflame, suppurate, and form fistulas in ano.

The predisposing and occasional causes hereditary; plethora, dense blood, luxurious living, indolence and stimulating diet; intemperance, especially in spirituous liquors; dried indigestible diet; suppression of the menses, and their final cessation, and of other critical evacuations; obstructions of the liver, spleen, of the mesenteric and hemorrhoidal veins; reiterated and severe colick; abrasion of the intestinal mucus; acrid purges; acrimony of the blood; costiveness, and hardened feces; worms; sitting too long on the necessary, and over-warm steams, or stoves; long sitting, riding, and compression of the hemorrhoidal veins; diseases of the vagina, womb, and neck of the bladder; prolapsus ani; pregnancy; rupture of the extremities of the iliac arteries; effusion of blood into the cellular texture of the intestines, near its extremity.

Vomiting of Blood,

hematomosis, vomitus cruentus, is a very rare disease. It is said to be more frequent in females than males; and is an adult malady. The symptoms, weight, straitness, and anxiety at the region of the stomach; nausea, cardialgy, efforts to vomit, and discharge of blood without coughing: the colour depends upon the time it has lain in the stomach, and is with various intermixtures of food, bile, pituita: there is also great prostration of strength, and proneness to faint. The quantity of this extravasation is various, from ounces to pounds; and frequently some portion descends by the anus. It is extremely dangerous, either immediately, or in its consequences. If with fever and great force in the discharge, it may destroy in a few paroxisms; or if chronic, may end in dropsy, consumption, or diseases of the stomach and intestines. Slight eruptions have relieved chronic maladies of the liver and spleen, hypochondriasm, hystericks, and intermittents. From obstructed menses it is much less alarming. The causes, obstructions of the liver, spleen, menses, hemorrhoids; scirrhus of the stomach and liver, or spleen; suppression of habitual discharges or evacuations, or old ulcers; dregs of intermittent fevers; scorbutick; acrids and poisons swallowed, and violent efforts to vomit; worms; violent passions; external injuries.

Poisons. By poisons conveyed through the mouth or wounds, very few of the community are destroyed. The ancient Asiaticks, Greeks, and Romans, were infected with the silly infatuation and apprehension of constantly swallowing poison in their aliment. This was not an epidemical error of the rabble, but had spread amongst their emperors and philosophers: hence the pompous and absurd compositions of mithridate, theriac, and other poisonous antidotes. None of the two hundred genera of the quadruped creation, nor of birds, are poisonous; and very few of the fish, or of the numerous insects and reptiles. Out of the many thousand genera of the vegetable creation, the poisonous are comparatively trifling: such are the napelli, apocyna, strammonium, solanum, laurus, aconitum, manchinel, cicuta, opium, and a few others; some of which, however, are powerful remedies. Of the mineral, the metals and semi-metals, arsenick excepted, the preparations of lead, copper, and mercury, are also amongst the potent remedies.

Of poisons, some corrode or burn, others are septic; and by far the greatest number attack the vital principle, by either violent irritation or torpidity: some have a more deadly malignity than others, and are more speedily destructive. Most of the vegetable poisons excite narcotic, stupifying, vertiginous, lethargic, convulsive, and emetic symptoms, affecting the brain, external senses, heart, and stomach. The minerals, as arsenick and corrosive sublimate, excite symptoms of inflammation in the stomach, in the most violent degree; and both copper and lead of spasmodic colick also. From their readier solution in the stomach, the vegetable poisons, except by the symptoms, can rarely be subjected to ocular detection; but by certain chymical analysis, when in any considerable quantity, the mineral may be discovered. Arsenick has a milky whiteness, is gritty and insipid; part of it swims in water, like a pale film, the greatest part sinking to the bottom undissolved: thrown on a red-hot iron plate, it does not flame, but rises in thick white fumes, which have an offensive smell of garlick, and cover cold iron held over them with thick flowers: arsenick inclosed between two plates of copper, then put into the fire and made red-hot, changes copper white. Copper is soluble in all acids, and assumes a blue colour when corroded by any acid or saline substance. Preparations of lead have a peculiar sweet taste; and wine adulterated with lead is detected by any alkali, which renders the mixture turbid, and precipitates the metal. These observations are a part of medical jurisprudence; and we shall hereafter touch upon it, under Female Abortion, and External Violence, especially injuries of the head.

Hydrophobia.

This disease may be classed with the mental, or with poisons, and spasmodic affections of the superior part of the alimentary canal. There are very few instances of this disease in Britain: it is, notwithstanding, one of the modern hobgoblins, in which we rival the folly of the ancients respecting alimentary poisons. It should first be indisputably ascertained whether the dog, or other animal, was mad or not: we have a thousand false alarms, forgeries, and falsehoods in this respect. Dogs, especially puppies, are subject to periodical short fits, in which they run about as if mad, barking incessantly, and with a querulous angry voice. The symptoms of a mad dog, as described by authors, are, he suddenly becomes mopish, peevish, and morose; has an aversion to food and drink; an unusual look about his eyes; he runs about disorderly, forgets his master; his voice changes to a shrill bark; he suffers no one to approach, or to handle him, but bites at those who attempt it; he deserts his own habitation, running with his head and tail drooping; the tongue hangs out of his mouth, covered with foam and slaver; other dogs fly from him with horror; he attempts to bite all who fall in his way; he flies from water and rivers, and at length falls down exhausted, and dies on the third or fourth day after the first appearance of the disease. It is also agreed, that canine madness is more general in hot climates, and in the hottest summers of northern. But unfortunately hitherto, in most cases, probably nineteen out of twenty, the mania of dogs has not been incontrovertibly decided; as in cases even at the commencement, when it is very dubious, dogs are very improperly and impolitickly destroyed, instead of being confined in a place of security, to observe whether the poison is fermenting in them. Hence, probably, much ideal terror and horror; and boasted, though impotent, virtues of many vulgar nostrums, panaceas, and antidotes.

In the human species, Hydrophobia, phrenitis latrans, rabies canina, aquæ fugax, is described, for I never saw an instance of it, in the following progressive train of symptoms; some days or weeks after the bite and wound, heaviness, lassitude, disturbed sleep, frightful dreams, restlessness, melancholy, pain in the wounded part; exacerbation during the phases and changes of the moon; aversion to food and drink, pain in the throat, difficulty or impracticability of swallowing, fluids especially; and horror, or even convulsions, at the sight of any fluid; in some, delirium; in others, the senses perfect. There are some instances of recovery in the stages of hydrophobia. The diseases from other venomous bites and stings are transferred to the future class of external accidents.

P. S. In the preceding group of diseases may be included two, which I had no opportunity to introduce sooner: these are costiveness, and nasal hemorrhage. Costiveness, it is true, is frequently symptomatic in many diseases, but is also idiopathic; and the suppression of this excretory during several days, occasions vertigo, headach, disturbed sleep, inappetency, indigestion, flatulence, colick, &c. The causes, obstruction or constriction of the intestinal tube; faults in its muscular fibres, diminution of irritability by age or disease; defect of mucus, bile, especially cystic bile, its inertness; costive food and drink, and medicines; too little drink; excessive discharge, by perspiration or urine; indolence, and hard feces. Nasal hemorrhage predominates principally in the adolescent age, and towards puberty and manhood, and more amongst the male sex: the hemorrhage is generally periodical at irregular intervals, usually from one nostril, and slight, or in torrents: and there are instances on record of many quarts of blood being discharged within a few days. After puberty it commonly abates, and some years later ceases. The hemorrhage is very seldom immediately fatal; and more dangerous diseases have followed its rash suppression. The causes will be comprehended from those of hemorrhages in general.