Part 2 — PART II. (continued 4)

5. Diarrhœa chylifera, cœliaca. Chyliferous diarrhœa. The chyle drank up by the lacteals of the upper intestines is poured into the lower ones by the retrograde motions of their lacteals, and appears in the dejections. This circumstance occurs at the beginning of diarrhœa crapulosa, where the patient has taken and digested more aliment than the system can conveniently receive, and thus eliminates a part of it; as appears when there is curdled chyle in some of the dejections. See Sect. XXIX. 4. 7. It differs from the lymphatic diarrhœa, as the chyliferous diabætes differs from the aqueous and mucaginous diabætes.

6. Diabætes. By the retrograde motions of the urinary lymphatics, an immense quantity of fluid is poured into the bladder. It is either termed chyliferous, or aqueous, or mucaginous, from the nature of the fluid brought into the bladder; and is either a temporary disease, as in hysteric women, in the beginning of intoxication, in worm cases, or in those exposed to cold damp air, or to great fear, or anxiety, or in the commencement of some dropsies; or it becomes chronical.

When the urinary lymphatics invert their motions, and pour their refluent contents into the bladder, some other branch of the absorbent system acts with greater energy to supply this fluid. If it is the intestinal branch, the chyliferous diabætes is produced: if it is the cutaneous or pulmonary branch, the aqueous diabætes is produced: and if the cellular or cystic branches, the mucaginous diabætes. In the two last the urine is pellucid, and contains no sugar.

In dropsies the fluid is sometimes absorbed, and poured into the bladder by the retrograde motions of the urinary lymphatics, as during the exhibition of digitalis. In the beginning of the dropsies of infirm gouty patients, I have frequently observed, that they make a large quantity of water for one night, which relieves them for several days. In these cases the patient previously feels a fulness about the precordia, with difficult respiration, and symptoms similar to those of hysteria. Perhaps a previous defect of absorption takes place in some part of the body in those hysteric cases, which are relieved by a copious discharge of pale urine. See Diabætes explained at large, Section XXIX. 4.

A discharge of blood sometimes attends the diabætes, which was occasionally a symptom of that disease in Mr. Brindley, the great navigable canal maker in this country. Which may be accounted for by the communication of a lymphatic branch with the gastric branch of the vena portarum, as discovered by J. F. Meckel. See Section XXVII. 2.

M. M. Alum. Earth of Alum. Cantharides. Calomel. Bark. Steel. Rosin. Opium. See Sect. XXIX. 4.

7. Sudor lymphaticus. Profuse sweats from the inverted motions of the cutaneous lymphatics, as in some fainting fits, and at the approach of death; and as perhaps in the sudor anglicanus. See Sect. XXIX. 5. These sweats are glutinous to the touch, and without increased heat of the skin; if the part is not covered, the skin becomes cold from the evaporation of the fluid. These sweats without heat sometimes occur in the act of vomiting, as in Sect. XXV. 9. and are probably the cause of the cold sweaty hands of some people. As mentioned in Sect. XXIX. 4. 9. in the case of R. Davis, which he cured by frequent application of lime. Though it is possible, that cold sweaty hands may also arise from the want of due absorption of the perspirable matter effused on them, and that the coldness may be owing to the greater evaporation in consequence.

The acid sweats described by Dr. Dobson, which he observed in a diabætic patient, and ascribes to the chyle effused on the skin, must be ascribed to the retrograde action of the cutaneous lymphatics. See Sect. XXIX. 6.

8. Sudor asthmaticus. The cold sweats in this disease only cover the head, arms, and breast, and are frequently exceedingly profuse. These sweats are owing to the inverted motions of the cutaneous lymphatics of the upper part of the body, and at the same time the increased absorption of the pulmonary absorbents: hence these sweats when profuse relieve the present fit of asthma. There is no other way to account for sweats appearing on the upper parts of the body only, but by the fluid having been absorbed by the lymphatic branch of the lungs, and effused on the skin by the retrograde movements of the cutaneous lymphatics; which join those of the lungs before they enter into the venous circulation. For if they were occasioned, as generally supposed, by the difficulty of the circulation of the blood through the lungs, the whole skin must be equally affected, both of the upper and lower parts of the body; for whatever could obstruct the circulation in the upper part of the venous system, must equally obstruct it in the lower part of it. See Sect. XXIX. 6. In the convulsive asthma these sweats do not occur; hence they may be distinguished; and might be called the hydropic asthma, and the epileptic asthma.

9. Translatio puris. Translation of matter from one part of the system to another can only be explained from its being absorbed by one branch of the lymphatic system, and deposited in a distant part by the retrograde motions of another branch; as mentioned Sect. XXIX. 7. 1. It is curious, that these translations of matter are attended generally, I believe, with cold fits; for less heat is produced during the retrograde action of this part of the system, as no secretion in the lymphatic glands of the affected branches can exist at the same time. Do any ineffectual retrograde motions occasion the cold fits of agues? The time when the gout of the liver ceases, and the gout in the foot commences, is attended with a cold fit, as I have observed in two instances, which is difficult to explain, without supposing the new vessels, or the matter produced on the inflamed liver, to be absorbed, and either eliminated by some retrograde motion, or carried to the newly inflamed part? See Class IV. 1. 2. 15.

10. Translatio lactis. Translation of milk to the bowels in puerperal fevers can only be explained by the milk being absorbed by the pectoral branch of lymphatics, and carried to the bowels by the retrograde motions of the intestinal lymphatics or lacteals. See many instances of this in Sect. XXIX. 7. 4.

11. Translatio urinæ. Translation of urine. There is a curious case related in the Transaction of the College of Physicians at Philadelphia, Vol. I. p. 96. of a girl, who labouring under an iscuria vomited her urine for many months; which could not be distinguished from that which was at other times drawn off by the catheter. After having taken much opium, she seems at length to have formed gravel, some of which was frequently brought up by vomiting. Dr. Senter ascribes this to the retrograde motions of the lymphatics of the stomach, and the increased ones of those of the bladder, and refers to those of Sect. XXIX. of this work; which section was first published in 1780; and to Macquire's Dictionary of Chemistry, Art. Urine.

The patient above described sometimes had a discharge of urine by the navel, and at other times by the rectum, and sometimes by urinous sweats.

ORDO III.

Retrograde Irritative Motions.

GENUS III.

Of the Sanguiferous System.

SPECIES.

1. Capillarium motus retrogressus. In microscopic experiments it is usual to see globules of blood regurgitate from the capillary vessels again and again, before they pass through them; and not only the mouths of the veins, which arise from these capillaries, are frequently seen by microscopes to regurgitate some particles of blood during the struggles of the animal; but a retrograde motion of the blood in the veins of these animals, from the very heart to the extremities of the limbs, is observable by intervals during the distresses of the dying creature. Haller, Elem. Phys. T. i. p. 216. See Section XXIX. 3. 8.

2. Palpitatio cordis. May not the ineffectual and weak unequal motions of the heart in hysteric cases be ascribed to the retrograde motions of it, which continue for a short time, or terminate in syncope? See Class IV. 3. 1. 6.

3. Anhelatio spasmodica. In some asthmas may not the difficulty of respiration arise from the inverted action of the finer branches of the bronchia, or of the pulmonary artery or vein, like those of the capillaries above described in No. 1. of this genus?

The Orders and Genera of the Second Class of Diseases.

CLASS II.

DISEASES OF SENSATION.

ORDO I.

Increased Sensation.

GENERA.

ORDO II.

Decreased Sensation.

GENERA.

ORDO III.

Retrograde Sensitive Motions.

GENERA.

The Orders, Genera, and Species, of the Second Class Of Diseases.

CLASS II.

DISEASES OF SENSATION.

ORDO I.

Increased Sensation.

GENUS I.

With Increased Action of the Muscles.

SPECIES.

1. Deglutitio.Deglutition.

2. Respiratio.Respiration.

3. Sternutatio.Sneezing.

4. Anhelitus.Panting.

5. Tussis ebriorum.Cough of inebriates.

6. Syngultus.Hiccough.

7. Asthma humorale.Humoral asthma.

8. Nictitatio sensitiva.Winking from pain.

9. Oscitatio et pandiculatio. Yawning and stretching.

10. Tenesmus.Tenesmus.

11. Stranguria.Strangury.

12. Parturitio.Parturition.

GENUS II.

With the Production of new Vessels by internal Membranes or Glands, with Fever.

SPECIES.

1. Febris sensitiva irritata. Sensitive irritated fever.

2. Ophthalmia interna.Inflammation of the eye.

3. Phrenitis.—— of the brain.

4. Peripneumonia.—— of the lungs.

—— trachealis.—— the croup.

5. Pleuritis.—— of the pleura.

6. Diaphragmitis.—— of the diaphragm.

7. Carditis.—— of the heart.

8. Peritonitis.—— of the peritoneum.

9. Mesenteritis.—— of the mesentery.

10. Gastritis.—— of the stomach.

11. Enteritis.—— of the bowels.

12. Hepatitis.—— of the liver.

13. Splenitis.—— of the spleen.

14. Nephritis.—— of the kidney.

15. Cystitis.—— of the bladder.

16. Hysteritis.—— of the womb.

17. Lumbago sensitiva.—— of the loins.

18. Ischias.—— of the pelvis.

19. Paronychia interna.—— beneath the nails.

GENUS III.

With the Production of new Vessels by external Membranes or Glands, with Fever.

SPECIES.

1. Febris sensitiva inirritata.Sensitive inirritated fever.

2. Erysipelas irritatum.Erysipelas irritated.

—— inirritatum.—— inirritated.

—— sensitivum.—— sensitive.

3. Tonsillitis interna.Angina internal.

—— superficialis.—— superficial.

—— inirritata.—— inirritated.

4. Parotitis suppurans.Mumps suppurative.

—— mutabilis.—— mutable.

—— felina.—— of cats.

5. Catarrhus sensitivus.Catarrh inflammatory.

6. —— contagiosus.—— contagious.

—— equinus et caninus.—— among horses and dogs.

7. Peripneumonia superficialis. Superficial peripneumony.

8. Pertussis.Chin-cough.

9. Variola discreta.Small-pox distinct.

—— confluens.—— confluent.

—— inoculata.—— inoculated.

10. Rubeola irritata.Measles irritated.

—— inirritata.—— inirritated.

11. Scarlatina mitis.Scarlet fever mild.

—— maligna.—— malignant.

12. Miliaria sudatoria.Miliary fever sudatory.

—— irritata.—— irritated.

—— inirritata.—— inirritated.

13. Pestis.Plague.

—— vaccina.—— of horned cattle.

14. Pemphigus.Bladdery fever.

15. Varicella.Chicken-pox.

16. Urticaria.Nettle rash.

17. Aptha sensitiva.Thrush sensitive.

—— irritata.—— irritated.

—— inirritata.—— inirritated.

18. Dysenteria.Bloody flux.

19. Gastritis superficialis.Superficial inflam. of the stomach.

20. Enteritis superficialis.—— of the bowels.

GENUS IV.

With the Production of new Vessels by internal Membranes or Glands, without Fever.

SPECIES.

1. Ophthalmia superficialis. Ophthalmy superficial.

—— lymphatica.—— lymphatic.

—— equina.—— of horses.

2. Pterigion.Eye-wing.

3. Tarsitis palpebrarum.Red eyelids.

4. Hordeolum.Stye.

5. Paronychia superficialis.Whitlow.

6. Gutta rosea hepatica.Pimpled face hepatic.

—— stomatica.—— stomatic.

—— hereditaria.—— hereditary.

7. Odontitis.Inflamed tooth.

8. Otitis.—— ear.

9. Fistula lacrymalis.Fistula lacrymalis.

10. Fistula in ano.Fistula in ano.

11. Fistula urethræ.Fistula urethræ.

12. Hepatitis chronica.Chronical hepatitis.

13. Scrophula suppurans.Suppurating scrophula.

14. Scorbutus suppurans.Suppurating scurvy.

15. Schirrus suppurans.Suppurating schirrus.

16. Carcinoma.Cancer.

17. Arthrocele.Swelling of the joints.

18. Arthropuosis.Suppuration of the joints.

19. Caries ossium.Caries of the bones.

GENUS V.

With the Production of new Vessels by external Membranes or Glands, without Fever.

SPECIES.

1. Gonorrhœa venerea. Clap.

2. Syphilis.Venereal disease.

3. Lepra.Leprosy.

4. Elephantiasis.Elephantiasis.

5. Framboesia.Framboesia.

6. Psora.Itch.

7. Psora ebriorum.Itch of drunkards.

8. Herpes.Herpes.

9. Zona ignea.Shingles.

10. Annulus repens.Ring-worm.

11. Tinea capitis.Scald-head.

12. Crusta lactea.Milk-crust.

13. Trichoma.Plica polonica.

GENUS VI.

With Fever consequent to the Production of new Vessels or Fluids.

SPECIES.

1. Febris sensitiva.Sensitive fever.

2. —— a pure clauso.Fever from concealed matter.

3. —— a vomica.—— from vomica.

4. —— ab empyemate.—— from empyema.

5. —— mesenterica.—— mesenteric.

6. —— a pure aerato.—— from aerated matter.

7. —— a phthisi.—— from consumption.

8. —— scrophulosa.—— scrophulous.

9. —— ischiadica.—— from ischias.

10. —— arthropuodica.—— from joint-evil.

11. —— a pure contagioso.—— from contagious matter.

12. —— variolosa secundaria. —— secondary of small-pox.

13. —— carcinomatosa.—— cancarous.

14. —— venerea.—— venereal.

15. —— a sanie contagiosa.—— from contagious sanies.

16. —— puerpera.—— puerperal.

17. —— a sphacelo.—— from sphacelus.

GENUS VII.

With increased Action of the Organs of Sense.

SPECIES.

1. Delirium febrile.Delirium of fevers.

2. —— maniacale.—— maniacal.

3. —— ebrietatis.—— of drunkenness.

4. Somnium.Dreams.

5. Hallucinatio visûs.Deception of sight.

6. —— auditus.—— of hearing.

7. Rubor a calore.Blush from heat.

8. —— jucunditatis.—— from joy.

9. Priapismus amatorius. Amorous priapism.

10. Distentio mamularum.Distention of the nipples.

ORDO II.

Decreased Sensation.

GENUS I.

With decreased Action of the general System.

SPECIES.

1. Stultitia insensibilis. Folly from insensibility.

2. Tædium vitæ.Irksomeness of life.

3. Paresis sensitiva.Sensitive debility.

GENUS II.

With decreased Actions of particular Organs.

SPECIES.

1. Anorexia.Want of appetite.

2. Adipsia.Want of thirst.

3. Impotentia.Impotence.

4. Sterilitas.Barrenness.

5. Insensibilitas artuum. Insensibility of the limbs.

6. Dysuria insensitiva.Insensibility of the bladder.

7. Accumulatio alvina.Accumulation of feces.

ORDO III.

Retrograde Sensitive Motions.

GENUS I.

Of Excretory Ducts.

SPECIES.

Motus retrogressus Retrograde motion.

1. —— ureterum.—— of the ureters.

2. —— urethræ.—— of the urethra.

3. —— ductus choledoci. —— of the bile-duct.

CLASS II.

DISEASES OF SENSATION.

ORDO I.

Increased Sensation.

GENUS I.

With Increased Action of the Muscles.

The actions belonging to this genus are those which are immediately excited by the sensations of pain or pleasure, but which are neither followed by inflammation, nor by convulsion. The former of which belong to the subsequent genera of this order, and the latter to the class of voluntary motions.

The criterion between the actions, which are the immediate consequence of painful sensation, and convulsive actions properly so called, consists in the former having a tendency to dislodge the stimulating cause, which induces the painful sensation; and the latter being exerted for the purpose of expending the sensorial power, and thus dulling or destroying the general sensation of the system. See Class III. 1.

There is a degree of heat produced in the affected part by these sensitive actions without inflammation, but in much less quantity than when attended by inflammation; as in the latter there is a production of new vessels. See Sect. XXXIII. 2. 3.

Some of the species of this genus cannot properly be termed diseases in their natural state, but become so by their defect or excess, and are here inserted to facilitate the explanation of the others.

SPECIES.

1. Deglutitio. Swallowing our food is immediately caused by the pleasureable sensation occasioned by its stimulus on the palate or fauces and is acquired long before the nativity of the animal. Afterwards the pain of hunger previously produces the various voluntary exertions to procure the proper material, but the actions of masticating and of swallowing it are effected by the sensorial power of sensation; which appears by their not being always controulable by the will, as when children in vain attempt to swallow nauseous drugs. See Class IV. 1. 3. 1. The masticated food stimulates the palate, which is an organ of sense, into so much action, as to produce agreeable sensation; and the muscles subservient to deglutition are brought into action by the sensation thus produced. The pleasureable sensation is the proximate cause; the action of the fibres of the extremities of the nerves of taste is the remote cause; the sensorial power of irritation exciting these fibres of the nerves of taste into increased action is the pre-remote cause; the action of the muscles of deglutition is the proximate effect; the pushing the food into the stomach is the remote effect; and the nutrition of the body is the post-remote effect.

Though the muscles subservient to deglutition have their actions previously associated, so as to be excited into synchronous tribes or successive trains, either by volition, as when we swallow a disagreeable drug; or by sensation, as when we swallow agreeable food; or by irritation, as when we inattentively swallow our saliva; yet do all those three kinds of deglutition belong to the respective classes of volition, sensation, and irritation; because the first links of these tribes or trains of muscular action are excited by those sensorial powers, and the associated links, which accompany or succeed them, are excited by the combined powers either of volition, or of sensation, or of irritation, along with that of association.

2. Respiratio. Respiration is immediately caused by the sensorial power of sensation in consequence of the baneful want of vital air; and not from the accumulation of blood in the lungs, as that might be carried on by inhaling azote alone, without the oxygenous part of the atmosphere. The action of respiration is thus similar to that of swallowing our food to appease the pain of hunger; but the lungs being surrounded with air, their proper pabulum, no intermediate voluntary exertions are required, as in hunger, to obtain and prepare the wanted material.

Respiration is similar to slow combustion; the oxygenous part of the atmosphere is received through the moist membranes, which line the air-cells of the lungs, and uniting with the inflammable part of the blood generates an acid, probably the phosphoric acid; a portion of carbonic acid is likewise produced in this process; as appears by repeatedly breathing over lime-water, which then becomes turbid. See Botanic Garden, P. I. Canto I. l. 401. note.

3. Sternutatio. Sneezing consists of muscular actions produced by the sensorial faculty of sensation; and is an effort to dislodge, by means of air forcibly impelled through the nostrils, some material; which stimulates the membrane, which lines them, into too great action, and might thence injure the sense of smell which is diffused on it.

In this operation the too great action of the vessels of the membrane of the nostrils is the remote cause; the sensation thence induced is the proximate cause; and the muscular actions are the proximate effect.

This action of sneezing frequently precedes common respiration in new-born children, but I believe not always; as like the latter it cannot have been previously acquired in the uterus.

It is produced in some people by sudden light, as by looking up at the sky in a morning, when they come out of a gloomy bed-chamber. It then becomes an associate action, and belongs to Class IV. 1. 2. 2.

M. M. When it is exerted to excess it may be cured by snuffing starch up the nostrils. See Class I. 1. 2. 13.

4. Anhelitus. Panting. The quick and laborious breathing of running people, who are not accustomed to violent exercise, is occasioned by the too great conflux of blood to the lungs. As the sanguiferous system, as well as the absorbent system, is furnished in many parts of its course with valves, which in general prevent the retrograde movement of their contained fluids; and as all these vessels, in some part of their course, lie in contact with the muscles, which are brought into action in running, it follows that the blood must be accelerated by the intermitted swelling of the bellies of the muscles moving over them.

The difficulty of breathing, with which, very fat people are immediately affected on exercise, is owing to the pressure of the accumulated fat on the veins, arteries, and lymphatics; and which, by distending the skin, occasions it to act as a tight bandage on the whole surface of the body. Hence when the muscles are excited into quicker action, the progress of the blood in the veins, and of the lymph and chyle in the absorbent system, is urged on with much greater force, as under an artificial bandage on a limb, explained in Art. IV. 2. 10. and in Sect. XXXIII. 3. 2. Hence the circulation is instantly quickened to a great degree, and the difficulty of breathing is the consequence of a more rapid circulation through the lungs. The increased secretion of the perspirable matter is another consequence of this rapid circulation; fat people, when at rest, are believed to perspire less than others, which may be gathered from their generally having more liquid stools, more and paler urine, and to their frequently taking less food than many thin people; and lastly, from the perspiration of fat people being generally more inodorous than that of lean ones; but when corpulent people are put in motion, the sweat stands in drops on their skins, and they "lard the ground" as they run. The increase of heat of corpulent people on exercise, is another consequence of their more rapid circulation, and greater secretion. See Class I. 2. 3. 17.

Other causes of difficult or quick respiration will be treated of under Asthma, Pertussis, Peripneumony, Tonsillitis.

5. Tussis ebriorum. Sensitive cough is an exertion of the muscles used in expiration excited into more violent action by the sensorial power of sensation, in consequence of something which too powerfully stimulates the lungs. As the saline part of the secreted mucus, when the absorption of it is impeded; or the too great viscidity of it, when the absorption is increased; or the too great quantity of the mucus, when the secretion is increased; or the inflammation of the membranes of the lungs; it is an effort to dislodge any of these extraneous materials.

Of this kind is the cough which attends free-drinkers after a debauch; it consists of many short efforts to cough, with a frequent expuition of half a tea-spoonful of frothy mucus, and is attended with considerable thirst. The thirst is occasioned by the previous dissipation of the aqueous parts of the blood by sensible or insensible perspiration; which was produced by the increased action of the cutaneous and pulmonary capillaries during the stimulus of the wine. In consequence of this an increased absorption commences to replace this moisture, and the skin and mouth become dry, and the pulmonary mucus becomes inspissated; which stimulates the bronchia, and is raised into froth by the successive currents of air in evacuating it. This production of froth is called by some free-drinkers "spitting sixpences" after a debauch. This subsequent thirst, dry mouth, and viscid expectoration in some people succeeds the slightest degree of intoxication, of which it may be esteemed a criterion. See Class IV. 2. 1. 8.

As coughs are not always attended with pain, the muscular actions, which produce them, are sometimes excited by the sensorial faculty of irritation, as in Class I. 1. 2. 8. I. 1. 3. 4. I. 1. 4. 3. I. 2. 3. 4. Coughs are also sometimes convulsive, as in Class III. 1. 1. 10. and sometimes sympathetic, as Class IV. 2. 1. 7.

M. M. Venesection, when the cough is attended with inflammation. Mucilages. Opium. Torpentia. Blister.

6. Singultus. Hiccough is an exertion of the muscles used in inspiration excited into more violent action by the sensorial power of sensation, in consequence of something which too powerfully stimulates the cardia ventriculi, or upper orifice of the stomach. As when solid food is too hastily taken without sufficient dilution. And is an effort to dislodge that offensive material, and push it to some less sensible part of the stomach, or into the middle of the contained aliment.

At the end of fatal fevers it may arise from the acrimony of the undigested aliment, or from a part of the stomach being already dead, and by its weight or coldness affecting the surviving part with disagreeable sensation. The pain about the upper orifice of the stomach is the proximate cause, the too great or too little action of the fibres of this part of the stomach is the remote cause, the action of the muscles used in inspiration is the proximate effect, and the repercussion of the offending material is the remote effect.

Hiccough is sometimes sympathetic, occasioned by the pain of gravel in the kidney or ureter, as in Class IV. 1. 1. 7. and is sometimes a symptom of epilepsy or reverie, as in Sect. XIX. 2.

M. M. Oil of cinnamon from one drop gradually increased to ten, on sugar, or on chalk. Opium. Blister. Emetic.

7. Asthma humorale. The humoral asthma probably consists in a temporary anasarca of the lungs, which may be owing to a temporary defect of lymphatic absorption. Its cause is nevertheless at present very obscure, since a temporary deficiency of venous absorption, at the extremities of the pulmonary or bronchial veins, might occasion a similar difficulty of respiration. See Abortio, Class I. 2. 1. 14. Or it might be supposed, that the lymph effused into the cavity of the chest might, by some additional heat during sleep, acquire an aerial form, and thus compress the lungs; and on this circumstance the relief, which these patients receive from cold air, would be readily accounted for.

The paroxysms attack the patient in his first sleep, when the circulation through the lungs in weak people wants the assistance of the voluntary power. Class I. 2. 1. 3. And hence the absorbents of the lungs are less able to fulfil the whole of their duty. And part of the thin mucus, which is secreted into the air-cells, remains there unabsorbed, and occasions the difficult respiration, which awakes the patient. And the violent exertions of the muscles of respiration, which succeed, are excited by the pain of suffocation, for the purpose of pushing forwards the blood through the compressed capillaries, and to promote the absorption of the effused lymph.

In this the humoral differs from the convulsive asthma, treated of in Class III. 1. 1. 10. as in that there is probably no accumulated fluid to be absorbed; and the violent respiration is only an exertion for the purpose of relieving pain, either in the lungs or in some distant part, as in other convulsions, or epilepsy; and in this respect the fits of humoral and convulsive asthma essentially differ from each other, contrary to the opinion expressed without sufficient consideration in Sect. XVIII. 15.

The patients in the paroxysms both of humoral and convulsive asthma find relief from cold air, as they generally rise out of bed, and open the window, and put out their heads; for the lungs are not sensible to cold, and the sense of suffocation is somewhat relieved by there being more oxygen contained in a given quantity of cold fresh air, than in the warm confined air of a close bed-chamber.

I have seen humoral asthma terminate in confirmed anasarca, and destroy the patient, who had been an excessive drinker of spirituous potation. And M. Savage asserts, that this disease frequently terminates in diabetes; which seems to shew, that it is a temporary dropsy relieved by a great flow of urine. Add to this, that these paroxysms of the asthma are themselves relieved by profuse sweats of the upper parts of the body, as explained in Class I. 3. 2. 8. which would countenance the idea of their being occasioned by congestions of lymph in the lungs.

The congestion of lymph in the lungs from the defective absorption of it is probably the remote cause of humoral asthma; but the pain of suffocation is the immediate cause of the violent exertions in the paroxysms. And whether this congestion of lymph in the air-cells of the lungs increases during our sleep, as above suggested, or not; the pain of suffocation will be more and more distressing after some hours of sleep, as the sensibility to internal stimuli increases during that time, as described in Sect. XVIII. 15. For the same reason many epileptic fits, and paroxysms of the gout, occur during sleep.

In two gouty cases, complicated with jaundice, and pain, and sickness, the patients had each of them a shivering fit, like the commencement of an ague, to the great alarm of their friends; both which commenced in the night, I suppose during their sleep; and the consequence was a cessation of the jaundice, and pain about the stomach, and sickness; and instead of that the gout appeared in their extremities. In these cases I conjecture, that there was a metastasis not only of the diseased action from the membranes of the liver to those of the foot; but that some of the new vessels, or new fluids, which were previously produced in the inflamed liver, were translated to the feet during the cold fit, by the increased absorption of the hepatic lymphatics, and by the retrograde motions of those of the affected limbs.

This I think resembles in some respects a fit of humoral asthma, where stronger motions of the absorbent vessels of the lungs are excited, and retrograde ones of the correspondent cutaneous lymphatics; whence the violent sweats of the upper parts of the body only are produced; and for a time the patient becomes relieved by the metastasis and elimination of the offending material by sensitive exertion. For a further account of this intricate subject see Class III. 1. 1. 10.

M. M. To relieve the paroxysm a tea-spoonful of ether may be given mixed with water, with 10 drops of laudanum, to be repeated three or four times. Venesection. An emetic. A blister. Afterwards the Peruvian bark, with a grain of opium at night, and two or three of aloes. A flannel shirt in winter, but not in summer. Issues. Digitalis?

In this species of asthma, there is great reason to believe, that the respiration of an atmosphere, with an increased proportion of oxygen, will prove of great advantage; some well-observed and well-attested cases of which are published by Dr. Beddoes; as this purer air invigorates the circulation, and the whole system in consequence, perhaps not only by its stimulus, but by its supplying the material from which the sensorial power is extracted or fabricated. In spasmodic asthma, on the contrary, Dr. Ferriar has found undoubted benefit from an atmosphere mixed with hydrogen. See Sect. XVIII. 15. and Class III. 1. 1. 10.

8. Nictitatio sensitiva. Winking of the eyes is performed every minute, without our attention, for the purpose of diffusing the tears over them, which are poured into the eye a little above the external corner of it, and which are afterwards absorbed by the lacrymal points above and below the internal corner of it. When this operation is performed without our attention, it is caused by the faculty of irritation, and belongs to Class I. 1. 4. 1. but when it is produced by a stronger stimulus of any extraneous material in the eye, so as to cause pain, the violent and frequent nictitation is caused by the faculty of sensation.

This disease is sometimes produced by the introversion of the edge of the lower eyelid, which bends the points of the hairs of the eyelash upon the ball of the eye, which perpetually stimulate it into painful sensation. This introversion of the eyelid is generally owing to a tumor of the cellular membrane below the edge of the eyelid, and though a very troublesome complaint may often be cured by the following simple means. A little common plaster spread on thin linen, about a quarter of an inch long, must be rolled up so as to be about the size of a crow-quill, this must be applied immediately below the eyelash on the outside of the eye; and must be kept on by another plaster over it. This will then act as a slight compression on the tumor under the eyelash, and will prevent the hairs from touching the eye-ball. In a week or two the compression will diminish the tumor it lies over, and cure this painful deformity.

9. Oscitatio et pandiculatio. Yawning and stretching of the limbs is produced either by a long inactivity of the muscles now brought into action, as sometimes happens after sleep, or after listening a long time to a dull narrative; or it is produced by a too long continued action of the antagonist muscles. In the former case there is an accumulation of sensorial power during the quiescence of the muscles now brought into action; which probably constitutes the pain or wearisomeness of a continued attitude. In the latter case there is an exhaustion of sensorial power in the muscles, which have lately been acting violently, and a consequent accumulation in the muscles, which are antagonists to them, and which were at rest.

These involuntary motions are often seen in paralytic limbs, which are at the same time completely disobedient to the will; and are frequently observable in very young children; and from thence we may conclude, that these motions are learnt before nativity; as puppies are seen to open their mouths before the membranes are broken. See Sect. XVI. 2.

Where these motions are observed in limbs otherwise paralytic, it is an indication that electric shocks may be employed with advantage, as the excitability of the limb by irritation is not extinct, though it be disobedient both to volition and sensation.

10. Tenesmus consists in violent and frequent ineffectual efforts to discharge the contents of the rectum, owing to pain of the sphincter. The pain is produced by indurated feces, or by some acrid material, as the acidity of indigested aliment; and the efforts are attended with mucus from the pained membrane. The feces must sometimes be taken away by the end of a marrow-spoon, as cathartics and even clyster will pass without removing them. It is sometimes caused by sympathy with the urethra, when there is a stone at the neck of the bladder. See Class II. 2. 2. 7. and IV. 1. 2. 8.

M. M. Fomentation, an enema with mucilage and laudanum.

The common exclusion of the feces from the rectum is a process similar to this, except that the muscles of the sphincter ani, and those of the abdomen, which act along with them by the combined powers of sensation and association, are in tenesmus excited by painful sensation, and in the latter by a sensation, which may in some instances be almost called pleasurable, as relieving us from a painful one in the exclusion of the feces.

11. Stranguria. Strangury consists in painful efforts to discharge the contents of the urinary bladder. It is generally owing to a stone in the sphincter of the bladder; or to the inflammation of the neck of it occasioned by cantharides. It is sometimes caused by sympathy with the piles; and then is liable in women to occasion convulsions, from the violence of the pain without inflammation. See Class IV. 2. 2. 2. and 3.

M. M. Fomentation clyster with oil and laudanum, push the stone back with a bougie; if from cantharides give half a pint of warm water every ten minutes. Mucilage of gum arabic and tragacanth.

The natural evacuation of the urine is a process similar to this, except that the muscular fibres of the bladder, and the muscles of the abdomen, which act in concert with them by the combined powers of sensation and of association, are, in the former case of strangury, excited into action by painful sensation; and in the latter by a sensation, which may almost be termed pleasurable, as it relieves us from a previous uneasy one.

The ejectio feminis is another process in some respects similar to strangury, as belonging to the same sensible canal of the urethra, and by exciting into action the accelerator muscles; but in the strangury these muscles are excited into action by painful sensation, and in the ejection of the semen by pleasureable sensation.

12. Parturitio. Parturition is not a disease, it is a natural process, but is more frequently unfortunate in high life than amongst the middle class of females; which may be owing partly to fear, with which the priests of Lucina are liable to inspire the ladies of fashion to induce them to lie in in town; and partly to the bad air of London, to which they purposely resort.

There are however other causes, which render parturition more dangerous to the ladies of high life; such as their greater general debility from neglect of energetic exercise, their inexperience of the variations of cold and heat, and their seclusion from fresh air. To which must be added, that great source of the destruction of female grace and beauty, as well as of female health, the tight stays, and other bandages, with which they are generally tortured in their early years by the active folly of their friends, which by displacing many of the viscera impedes their actions, and by compressing them together produces adhesions of one part to another, and affects even the form and aperture of the bones of the pelvis, through which the nascent child must be protruded.

As parturition is a natural, not a morbid process, no medicine should be given, where there is no appearance of disease. The absurd custom of giving a powerful opiate without indication to all women, as soon as they are delivered, is, I make no doubt, frequently attended with injurious, and sometimes with fatal consequences. See Class II. 1. 2. 16.

Another thing very injurious to the child, is the tying and cutting the navel-string too soon; which should always be left till the child has not only repeatedly breathed, but till all pulsation in the cord ceases. As otherwise the child is much weaker than it ought to be; a part of the blood being left in the placenta, which ought to have been in the child; and at the same time the placenta does not so naturally collapse, and withdraw itself from the sides of the uterus, and is not therefore removed with so much safety and certainty. The folly of giving rue or rhubarb to new-born children, and the danger of feeding them with gruel instead of milk, is spoken of in Class I. 1. 2. 5. and II. 1. 2. 16.

ORDO I.

Increased Sensation.

GENUS II.

With the Production of new Vessels by internal Membranes or Glands, with Fever.

In the first class of diseases two kinds of fevers were described, one from excess, and the other from defect of irritation; and were in consequence termed irritative, and inirritative fevers. In this second class of diseases another kind of fever occurs, which is caused by excess of sensation, and termed in consequence Sensitive Fever. But there is no fever from defect of sensation, because the circulation is carried on in health without our consciousness, that is, without any sensation attending it.

But as excess of sensation may exist with excess or defect of irritation, two other kinds of fever arise from a combination of sensitive fever with the irritative, and inirritative ones. Making five kinds in all.

1. Irritative fever, described in Class I. 1. 1. 1.

2. Inirritative fever. Class I. 2. 1. 1.

3. Sensitive fever. Class II. 1. 6. 1.

4. Sensitive irritated fever. Class II. 1. 2. 1.

5. Sensitive inirritated fever. Class II. 1. 3. 1.

As the sensitive irritated fever attends all the diseases enumerated under the genus about to be described, it is placed at the head of it. And as the sensitive inirritated fever accompanies the greatest number of the species enumerated under the third genus of this order, it is placed at the head of them. And as the sensitive fever attends the diseases of the sixth genus, it is placed at the head of them. But as every febrile paroxysm consists of disordered tribes or trains of associated motions, it may be doubted, whether they ought not all to have been placed in the fourth class, amongst the diseases of association. See Class IV. 2. 4. 11.

All the subsequent species of this genus are attended with sensitive irritated fever; there are nevertheless some superficial inflammations, which affect the same situations without much fever, as the scrophulous ophthalmy and spurious peripneumony, which belong to other genera.

Inflammation is uniformly attended with the production or secretion of new fibres constituting new vessels; this therefore may be esteemed its essential character, or the criterion of its existence. The extension of the old vessels seems rather a consequence than a cause of the germination, or pullulation, of these new ones; for the old vessels may be enlarged, and excited with unusual energy, without any production of new ones, as in the blush of shame or of anger.

When these new vessels are formed, if they are not reabsorbed into the circulation, they secrete a new fluid called purulent matter; which generally opens itself a passage on the external skin, and produces an ulcer, which either gradually heals, or spreads, and is the cause of hectic fever; or they secrete contagious matter, which has the property of exciting the same kind of inflammation, and of producing the same kind of contagious matter, when inserted by inoculation into the skin of other persons. These contagious matters form ulcers, which either heal spontaneously, or by art; or continue to spread, and destroy the patient, by other kinds of hectic fever.

In this genus there is an increase of the sensorial power of irritation as well as of sensation; whence great arterial energy is produced, and the pulse becomes strong and full, as well as quick; and the coats of the arteries feel hard under the finger, being themselves thickened and distended by inflammation. The blood drawn, especially at the second bleeding, is covered with a tough size; which is probably the mucus from the inflamed internal surface of the arteries, increased in quantity, and more coagulable than in its natural state; the thinner part being more perfectly absorbed by the increased action of the inflamed absorbents. See Sect. XXXIII. 2. 2. This is rendered more probable, because the hard feel of the pulse, and the abundance of coagulable lymph commence, exist, and cease together.

Great heat is produced from the new chemical combinations arising in the secretion of new fibres, and great pain from the distention of old ones, or from their increased action. The increased quantity of sensation from a topical inflammation or phlegmon is the immediate cause of the febris sensitiva irritata, or inflammatory fever; as when it arises from the pain of pleurisy, or paronychia; but generally an irritative fever precedes this topical inflammation, which occurs during the hot fit of it; and then the irritative fever is changed into a sensitive irritated fever, by the additional cause of the sensorial power of sensation besides that of irritation.

SPECIES.

1. Febris sensitiva irritata. Sensitive irritated fever, or inflammatory fever. Phlegmasia. A strong full pulse, with inflammation of the coats of the arteries, constitutes this disease. It originates from some topical inflammation, which, if the fever is not subdued, terminates in suppuration; and differs from irritative fever in respect to the painful sensation which accompanies it. For as pleasurable sensation is the cause of the growth of the new vessels, and distention of the old ones, in the natural enlargement of the body during our infancy; so a painful sensation is the cause of the unnatural production of new vessels, and enlargement of old ones in inflammatory diseases.

When matter is thus formed in any internal viscus, or in the cellular membrane, as in the lungs or liver; so long as this abscess remains without admission of air, this inflammatory fever is liable to continue, receiving only temporary relief by bleeding or emetics, or cathartics; till the patient, after a month, or two, or three, expires. But, if air be admitted to these internal abscesses, this kind of fever is changed into a hectic fever in a single day. It also sometimes happens, that when the abscess remains unopened to the air, if the matter has become putrid, that hectic fever supervenes, with colliquative sweats, or diarrhœa; the matter in both cases is sometimes absorbed, and the sides of the abscess grow together again without an external aperture. See Class II. 1. 4. 1. and 2. Another termination of inflammation is in gangrene, but this belongs to the inflammation of the external skin; as the production of purulent matter belongs to inflammation of the internal or mucous membranes. Thus when the external skin is the seat of inflammation, as in erythema, or erysipelas, and produces sensitive irritated fever, no collection of purulent matter can be formed; but a material oozes out, and lies upon the surface, like that in the confluent small-pox, and the cuticle at length peels off, or gangrene supervenes. It must be noted, that these kinds of inflammation can exist together; and some parts of the cellular membrane may suppurate at the same time that the external skin is affected with erythema, or erysipelas.

M. M. Venesection. Cathartics. Diluents. Cool air. Torpentia. Cold Bath? See Sect. XII. 6.

The increased arterial action in this sensitive irritated fever is not simply owing to the increased irritability of the arterial system, or to the stimulus of the distention of the vessels, but also to the increased acrimony or pungency of the blood; which has now so far changed its nature as to become more fluid, more dense, and to be loaded with coagulable lymph. Hence it becomes necessary not only to lessen the quantity of blood by venesection and by cathartics, but also to dilute its acrimony, or pungency, by the introduction of aqueous and mucilaginous fluids, such as barley water, cream and water, sugar and water, weak broths; to which may be added so much of some vegetable essential oil, as may render them grateful to the stomach, and thus promote their absorption, as by infusing parsley or cellery and turneps in the broth; or by balm, mint, or sage teas.

The following species of this genus only distinguish the situation of the part previously inflamed, and which is the remote cause of the sensitive irritated, or inflammatory fever, which attends it.

2. Ophthalmia interna. Inflammation of the eye is attended with the production of new vessels, which spread over the tunica adjunctiva, and over the cornea; these new vessels are easily seen, as they lie on a white ground, and give ocular demonstration of their production in inflammation. When this inflammation of the cornea suppurates, it is liable to leave little ulcers, which may be seen beneath the surface in the form of little excavations; and as these heal, they are liable to be covered with an opake scar. This scar, in some months or years, is liable to wear away, and become transparent, without the assistance of any polishing powder, as of very finely levigated glass, as some have recommended. But when the cornea is affected through all its thickness, the return of its transparency becomes hopeless. See Class I. 1. 3. 14.

In violent degrees of ophthalmy the internal parts, as the retina, optic artery, iris, ciliary process, become inflamed, as well as the external ones; hence the least light admitted to the eye occasions intolerable pain. This curious circumstance cannot be owing to the action of light on the inflamed vessels of the cornea; it therefore shews, that the extremity of the optic nerve or retina is also rendered more exquisitely sensible to light, by partaking of the inflammation; and I have been told, that red colours are in these cases sometimes painfully perceived even in perfect darkness. This shews that the retina is excited into motion by the stimulus of light; and that, when it is inflamed, these motions give great pain, like those of other inflamed parts, as the muscles, or membranes. And secondly, that the ideas of colours consist in the motions of the retina; which ideas occasion pain, when the extremity of the moving nerve is inflamed.

M. M. Venesection. Cathartics. Diluents. Torpentia. Frequently moisten the eye with cold water by means of a rag. Cool airy room. Darkness. When the inflammation begins to decline, white vitriol gr. vi. in an ounce of water is more efficacious to moisten the eye than solutions of lead. Tincture of opium diluted. New vessels from the inflamed tunica adnata frequently spread like a fly's wing upon the transparent cornea, which is then called Pterigium. To stop the growth of this, the principal vessels should be cut through with a lancet. When the inflammation begins to decline, after due evacuation any stimulating material put into the eye increases the absorption, which soon removes the new red vessels; which has given rise to a hundred famous eye-waters, and eye-doctors; if these stimulating materials are used too soon, the inflammation is increased by them. See Sect. XXXII. 2. 10.

There is another ophthalmia, which attends weak children, and is generally esteemed a symptom of scrophula, as described in Class II. 1. 4. 1. and another, which is of venereal origin, mentioned in Class II. 1. 5. 2. both which may be termed ophthalmia superficialis.

3. Phrenitis. Inflammation of the brain is attended with intolerance of light and sound; which shews, that the extremities of the nerves of those senses are at the same time inflamed; it is also attended with great pain of the head, with watchfulness, and furious delirium. The violent efforts, these patients are said sometimes to exert, are owing to the increased secretion of sensorial power in the brain; as all other inflamed glands have a greater circulation of blood passing through them, and a greater secretion in consequence of their peculiar fluids, as in the hepatitis much more bile is generated.

M. M. Venesection. Cathartics. Torpentia. Foment the head with cold water for hours together. Or with warm water. Cool airy room. Afterwards cupping on the occiput. Leeches to the temples. When the patient is weakened a blister on the head, and after further exhaustion five or six drops of tincture of opium.

4. Peripneumonia. Inflammation of the lungs. The pulse is not always hard, sometimes soft; which is probably owing to a degree of sickness or inaction of the stomach; with dull pain of the chest; respiration constantly difficult, sometimes with erect posture; the face bloated and purplish; cough generally with moist expectoration, often stained with blood.

When the difficulty of respiration is very great, the patient is not able to cough; in this situation, after copious bleeding, the cough is liable to return, and is so far a favourable symptom, as it shews some abatement of the inflammation.

A peripneumony frequently occurs in the chin-cough, and destroys the patient, except immediate recourse be had to the lancet, or to four or five leeches; when blood cannot be otherwise taken.

The peripneumony is very fatal to young children, especially as I believe it is frequently mistaken for a spasmodic asthma, or for the croup, or cynanche trachealis of Cullen. Both which, however, when they occur, require immediate venesection by the lancet or by leeches, as well as the peripneumony.

The croup is an inflammation of the upper part, and the peripneumony of the lower part of the same organ, viz. the trachea or windpipe. See Class I. 1. 3. 4. But as the inflammation is seldom I suppose confined to the upper part of the trachea only, but exists at the same time in other parts of the lungs, and as no inflammation of the tonsils is generally perceptible, the uncouth name of cynanche trachealis should be changed for peripneumonia trachialis. The method of cure consists in immediate and repeated bleeding. A vomit. A grain of calomel or other mild cathartic. Bathing in subtepid water, and in breathing over the steam of warm water, with or without a little vinegar in it. And lastly, by keeping the child raised high in bed.

Inflammation of the lungs is also liable to occur in the measles, and must be attacked by venesection at any time of the disease; otherwise either a present death, or an incurable consumption, is the consequence.

The peripneumony is frequently combined with inflammation of the pleura, and sometimes with that of the diaphragm; either of these may generally be distinguished, not only by the pain which attends inflammation of these membranes, but by inspecting the naked chest, and observing whether the patient breathes more by elevating the ribs, or by depressing the diaphragm.

A crisis happens in children about the sixth day with much pale urine, which must be waited for after evacuations have been used, as far as can be done with safety; in this situation the warm bath twice a day, and small blisters repeatedly in succession, are of peculiar service.

After the termination of peripneumony a collection of coagulable lymph is frequently left in the cavity of the chest unabsorbed; or a common anasarca of the lungs occurs from the present inaction of the absorbent vessels, which had previously been excited too violently. This difficulty of breathing is cured or relieved by the exhibition of digitalis. See Art. IV. 2. 8.

M. M. The lancet is the anchor of hope in this disease; which must be repeated four or five times, or as often as the fever and difficulty of breathing increase, which is generally in the evening; antimonials, diluents, repeated small blisters about the chest, mucilage, pediluvium, warm bath. Is a decoction of seneka-root of use? Do not neutral salts increase the tendency to cough by their stimulus, as they increase the heat of urine in gonorrhœa? Children in every kind of difficult breathing, from whatever cause, should be kept as upright in bed as may be, and continually watched; since, if they slip down, they are liable to be immediately suffocated. After the patient is greatly debilitated, so that no further evacuation can be admitted, and the difficult breathing and cough continue, I have given four or five drops of tincture of opium, that is, about a quarter of a grain of solid opium, with great advantage, and I believe in several cases I have saved the patient. A greater quantity of opium in this state of debility cannot be used without hazarding the life of the person. This small quantity of an opiate should be given about six in the evening, or before the access of the evening paroxysm, and repeated three or four nights, or longer.

There is a peripneumony with weak pulse, which may be termed peripneumonia inirritata, as described in Sect. XXVII. 2. which belongs to this place. See also Superficial Peripneumony, Class II. 1. 3. 7.

5. Pleuritis. Pleurisy. Inflammation of the pleura, with hard pulse, pain chiefly of the side, pungent, particularly increased during inspiration; lying on either side uneasy, the cough very painful, dry at the beginning, afterwards moist, often bloody.

One cause of pleurisy is probably a previous adhesion of the lungs to a part of the pleura, which envelops them. This in many cases has been produced in infancy, by suffering children to lie too long on one side. Or by placing them uniformly on one side of a fire, or window, to which they will be liable always to bend themselves.

When matter is produced during peripneumony or pleurisy in one side of the chest, so long as it is a concealed vomica, the fever continues, if the disease be great, for many weeks, and even months; and requires occasional venesection, till the patient sinks under the inflammatory or sensitive irritated fever. But if air be admitted, by a part of the abscess opening itself a way into the air-vessels of the lungs, a hectic fever, with colliquitive sweats or diarrhœa, supervenes, and frequently destroys the patient; or the abscess heals the lungs adhering to the pleura.

M. M. The lancet must be used copiously, and repeated as often as the pain and difficult respiration increase. A blister on the pained part. Antimonial preparations. Diluents. Cool air. Do neutral salts increase the tendency to cough? Pediluvium or semicupium frequently repeated.

6. Diaphragmitis. Inflammation of the diaphragm. Pain round the lower ribs as if girt with a cord. Difficult respiration performed only by elevating the ribs and in an erect posture. The corners of the mouth frequently retracted into a disagreeable smile, called risus Sardonicus.

Those animals, which are furnished with clavicles, or collar-bones, not only use their foremost feet as hands, as men, monkies, cats, mice, squirrels, &c. but elevate their ribs in respiration as well as depress the diaphragm for the purpose of enlarging the cavity of the chest. Hence an inflammation of the diaphragm is sudden death to those animals, as horses and dogs, which can only breaths by depressing the diaphragm; and is I suppose the cause of the sudden death of horses that are over-worked; whereas, in the human animal, when the diaphragm is inflamed, so as to render its motions impossible from the pain they occasion, respiration can be carried on, though in a less perfect manner, by the intercostal muscles in the elevation of the ribs. In pleurisy the ribs are kept motionless, and the respiration is performed by the diaphragm, as may be readily seen on inspecting the naked chest, and which is generally a bad symptom; in the diaphragmitis the ribs are alternately elevated, and depressed, but the lower part of the belly is not seen to move.

M. M. As in pleurisy and peripneumony. When the patient becomes delirious, and smiles disagreeably by intervals, and is become so weak, that evacuations by the lancet could be used no further, and I have almost despaired of my patient, I have found in two or three instances, that about five or six drops of tinct. thebaic, given an hour before the evening exacerbation, has had the happiest effect, and cured the patient in this case, as well as in common peripneumony; it must be repeated two or three evenings, see Class II. 1. 2. 4. as the exacerbation of the fever and difficult respiration and delirium generally increase towards night.

The stimulus of this small quantity of opium on a patient previously so much debilitated, acts by increasing the exertion of the absorbent vessels, in the same manner as a solution of opium, or any other stimulant, put on an inflamed eye after the vessels are previously emptied by evacuations, stimulates the absorbent system, so as to cause the remaining new vessels to be immediately reabsorbed. Which same stimulants would have increased the inflammation, if they had been applied before the evacuations. See Class II. 1. 2. 2. Sect. XXXIII. 3. 1. When the sanguiferous system is full of blood, the absorbents cannot act so powerfully, as the progress of their contents is opposed by the previous fulness of the blood-vessels; whence stimulants in that case increase the action of the secerning system more than of the absorbent one; but after copious evacuation this resistance to the progress of the absorbed fluids is removed; and when stimulants are then applied, they increase the action of the absorbent system more than that of the secerning one. Hence opium given in the commencement of inflammatory diseases destroys the patient; and cures them, if given in very small doses at the end of inflammatory diseases.

7. Carditis. Inflammation of the heart is attended with unequal intermitting pulse, palpitation, pain in the middle of the sternum, and constant vomiting. It cannot certainly be distinguished from peripneumony, and is perhaps always combined with it.

8. Peritonitis. Inflammation of the peritonæum is known by pain all over the abdomen, which is increased on erecting the body. It has probably most frequently a rheumatic origin. See Class II. 1. 2. 17.

9. Mesenteritis. Inflammation of the mesentery is attended with pains like colic, and with curdled or chyle-like stools. It is a very frequent and dangerous disease, as the production of matter more readily takes place in it than in any other viscus. The consequence of which, after a hard labour, is probably the puerperal fever, and in scrophulous habits a fatal purulent fever, or hopeless consumption.

M. M. Venesection. Warm bath. Emollient clysters.

10. Gastritis. In inflammation of the stomach the pulse is generally soft, probably occasioned by the sickness which attends it. The pain and heat of the stomach is increased by whatever is swallowed, with immediate rejection of it. Hiccough.

This disease may be occasioned by acrid or indigestible matters taken into the stomach, which may chemically or mechanically injure its interior coat. There is however a slighter species of inflammation of this viscus, and perhaps of all others, which is unattended by much fever; and which is sometimes induced by drinking cold water, or eating cold insipid food, as raw turnips, when the person has been much heated and fatigued by exercise. For when the sensorial power has been diminished by great exertion, and the stomach has become less irritable by having been previously stimulated by much heat, it sooner becomes quiescent by the application of cold. In consequence of this slight inflammation of the stomach an eruption of the face frequently ensues by the sensitive association of this viscus with the skin, which is called a surfeit. See Class IV. 1. 2. 13. and II. 1. 4. 6. and II. 1. 3. 19.

M. M. Venesection. Warm bath. Blister. Anodyne clysters. Almond soap. See Class II. 1. 3. 17.

11. Enteritis. Inflammation of the bowels is often attended with soft pulse, probably owing to the concomitant sickness; which prevents sometimes the early use of the lancet, to the destruction of the patient. At other times it is attended with strong and full pulse like other inflammations of internal membranes. Can the seat of the disease being higher or lower in the intestinal canal, that is, above or below the valve of the colon, produce this difference of pulse by the greater sympathy of one part of the bowels with the stomach than another? In enteritis with strong pulse the pain is great about the navel, with vomiting, and the greatest difficulty in procuring a stool. In the other, the pain and fever is less, without vomiting, and with diarrhœa. Whence it appears, that the enteritis with hard quick pulse differs from Ileus, described in Class I. 3. 1. 6. only in the existence of fever in the former and not the latter, the other symptoms generally corresponding; and, secondly, that the enteritis with softer quick pulse, differs from the cholera described in Class I. 3. 1. 5. only in the existence of fever in the former, and not the latter, the other symptoms being in general similar. See Class II. 1. 3. 20.

Inflammation of the bowels sometimes is owing to extraneous indigestible substances, as plum-stones, especially of the damasin, which has sharp ends. Sometimes to an introsusception of one part of the intestine into another, and very frequently to a strangulated hernia or rupture. In respect to the first, I knew an instance where a damasin stone, after a long period of time, found its way out of the body near the groin. I knew another child, who vomited some damasin stones, which had lain for near twenty hours, and given great pain about the navel, by the exhibition of an emetic given in repeated doses for about an hour. The swallowing of plum-stones in large quantities, and even of cherry-stones, is annually fatal to many children. In respect to the introsusception and hernia, see Ileus, Class I. 3. 1. 6.

M. M. Repeated venesection. Calomel from ten to twenty grains given in small pills as in Ileus; these means used early in the disease generally succeed. After these evacuations a blister contributes to stop the vomiting. Warm bath. Crude mercury. Aloes one grain-pill every hour will frequently stay in the stomach. Glauber's salt dissolved in pepper-mint water given by repeated spoonfuls.

When the patient is much reduced, opium in very small doses may be given, as a quarter of a grain, as recommended in pleurisy. If the pain suddenly ceases, and the patient continues to vomit up whatever is given him, it is generally fatal; as it indicates, that a mortification of the bowel is already formed. Some authors have advised to join cathartic medicines with an opiate in inflammation of the bowels, as recommended in colica saturnina. This may succeed in slighter cases, but is a dangerous practice in general; since, if the obstruction be not removed by the evacuation, the stimulus of the opium is liable to increase the action of the vessels, and produce mortification of the bowel, as I think I have seen more than once.

12. Hepatitis. Inflammation of the liver is attended with strong quick pulse; tension and pain of the right side; often pungent as in pleurisy, oftner dull. A pain is said to affect the clavicle, and top of the right shoulder; with difficulty in lying on the left side; difficult respiration; dry cough; vomiting; hiccough.

There is another hepatitis mentioned by authors, in which the fever, and other symptoms, are wanting, or are less violent; as described in Class II. 1. 4. 12. and which is probably sometimes relieved by eruptions of the face; as in those who are habituated to the intemperate use of fermented liquors.

M. M. Hepatic inflammation is very liable to terminate in suppuration, and the patient is destroyed by the continuance of a fever with sizy blood, but without night-sweats, or diarrhœa, as in other unopened abscesses. Whence copious and repeated venesection is required early in the disease, with repeated doses of calomel, and cathartics. Warm bath. Towards the end of the disease small doses of opium before the evening paroxysms, and lastly the Peruvian bark, and chalybeate wine, at first in small doses, as 20 drops twice a day, and afterwards, if necessary, in larger. See Art. IV. 2. 6.

Mrs. C. a lady in the last month of her pregnancy, was seized with violent hepatitis, with symptoms both of peripneumony and of pleurisy, for it seldom happens in violent inflammations, that one viscus alone is affected; she wanted then about a fortnight of her delivery, and after frequent venesection, with gentle cathartics, with fomentation or warm bath, she recovered and was safely delivered, and both herself and child did well. Rheumatic and eruptive fevers are more liable to induce abortion.

13. Splenitis. Inflammation of the spleen commences with tension, heat, and tumour of the left side, and with pain, which is increased by pressure. A case is described in Class I. 2. 3. 18. where a tumid spleen, attended with fever, terminated in schirrus of that viscus.

14. Nephritis. Inflammation of the kidney seems to be of two kinds; each of them attended with different symptoms, and different modes of termination. One of them I suppose to be an inflammation of the external membrane of the kidney, arising from general causes of inflammation, and accompanied with pain in the loins without vomiting; and the other to consist in an inflammation of the interior parts of the kidney, occasioned by the stimulus of gravel in the pelvis of it, which is attended with perpetual vomiting, with pain along the course of the ureter, and retraction of the testis on that side, or numbness of the thigh.

The former of these kinds of nephritis is distinguished from lumbago by its situation being more exactly on the region of the kidney, and by its not being extended beyond that part; after three or four days I believe this inflammation is liable to change place; and that a herpes or erysipelas, called zona, or shingles, breaks out about the loins in its stead; at other times it is cured by a cathartic with calomel, with or without previous venesection.

The other kind of nephritis, or inflammation of the interior part of the kidney, generally arises from the pain occasioned by the stimulus of a stone entering the ureter from the pelvis of the kidney; and, which ceases when the stone is protruded forwards into the bladder; or when it is returned into the pelvis of the kidney by the retrograde action of the ureter. The kidney is nevertheless inflamed more frequently, though in a less degree, from other causes; especially from the intemperate ingurgitation of ale, or other fermented or spirituous liquors. This less degree of inflammation is the cause of gravel, as that before mentioned is the effect of it. The mucus secreted to lubricate the internal surface of the uriniferous tubes of the kidney becomes secreted in greater quantity, when these vessels are inflamed; and, as the correspondent absorbent vessels act more energetically at the same time, the absorption of its more fluid parts is more powerfully effected; on both these accounts the mucus becomes both changed in quality and more indurated. And in this manner stones are produced on almost every mucous membrane of the body; as in the lungs, bowels, and even in the pericordium, as some writers have affirmed. See Class I. 1. 3. 9.

M. M. Venesection. Ten grains of calomel given in small pills, then infusion of sena with oil. Warm bath. Then opium a grain and half. See Class I. 1. 3. 9. for a further account of the method of cure.

15. Cystitis. Inflammation of the bladder is attended with tumor and pain of the lower part of the belly; with difficult and painful micturition; and tenesmus. It generally is produced by the existence of a large stone in the bladder, when in a great degree; or is produced by common causes, when in a slighter degree.

The stone in the bladder is generally formed in the kidney, and passing down the ureter into the bladder becomes there gradually increased in size; and this most frequently by the apposition of concentric spheres, as may be seen by sawing some of the harder calculi through the middle, and polishing one surface. These new concretions superinduced on the nucleus, which descended from the kidney, as described in Class I. 1. 3. 9. and in the preceding article of this genus, is not owing to the microcosmic salt, which is often seen to adhere to the sides of chamber-pots, as this is soluble in warm water, but to the mucus of the bladder, as it rolls along the internal surface of it. Now when the bladder is slightly inflamed, this mucus of its internal surface is secreted in greater quantity, and is more indurated by the absorption of its more liquid part at the instant of secretion, as explained in Class I. 1. 3. 9. and II. 1. 2. 14. and thus the stimulus and pain of a stone in the bladder contributes to its enlargement by inflaming the interior coat of it.

M. M. Venesection. Warm bath. Diluents. Anodyne clysters. See Class I. 1. 3. 9.

16. Hysteritis. Inflammation of the womb is accompanied with heat, tension, tumor, and pain of the lower belly. The os uteri painful to the touch. Vomiting. This disease is generally produced by improper management in the delivery of pregnant women. I knew an unfortunate case, where the placenta was left till the next day; and then an unskilful accoucheur introduced his hand, and forcibly tore it away; the consequence was a most violent inflammatory fever, with hard throbbing pulse, great pain, very sizy blood, and the death of the patient. Some accoucheurs have had a practice of introducing their hand into the uterus immediately after the birth of the child, to take away the placenta; which they said was to save time. Many women I believe have been victims to this unnatural practice.

Others have received injury, where inflammation has been beginning, by the universal practice of giving a large dose of opium immediately on delivery, without any indication of its propriety; which, though a proper and useful medicine, where the patient is too feeble, when given in a small dose, as 10 drops of tincture of opium, or half a grain of solid opium, must do a proportionate injury, when it is given improperly; and as delivery is a natural process, it is certainly more wise to give no medicines, except there be some morbid symptom, which requires it; and which has only been introduced into custom by the ill-employed activity of the Priests or Priestesses of Lucina; like the concomitant nonsense of cramming rue or rheubarb into the mouth of the unfortunate young stranger, who is thus soon made to experience the evils of life. See Class II. 1. 1. 12. and I. 1. 2. 5. Just so some over-wise beldames force young ducks and turkeys, as soon as they are hatched, to swallow a peppercorn.

M. M. Venesection repeatedly; diluents; fomentation; the patient should be frequently raised up in bed for a short time, to give opportunity of discharge to the putrid lochia; mucilaginous clysters. See Febris Puerpera.

17. Lumbago sensitiva. Sensitive lumbago. When the extensive membranes, or ligaments, which cover the muscles of the back are torpid, as in the cold paroxysm of ague, they are attended with pain in consequence of the inaction of the vessels, which compose them. When this inaction continues without a consequent renewal or increase of activity, the disease becomes chronical, and forms the lumbago frigida, or irritativa, described in Class I. 2. 4. 16. But when this cold fit or torpor of these membranes, or ligaments or muscles of the back, is succeeded by a hot fit, and consequent inflammation, a violent inflammatory fever, with great pain, occurs, preventing the erect posture of the body; and the affected part is liable to suppurate, in which case a very dangerous ulcer is formed, and a part of one of the vertebrae is generally found carious, and the patient sinks after a long time under the hectic fever occasioned by the aerated or oxygenated matter.

This disease bears no greater analogy to rheumatism than the inflammation of the pleura, or any other membranous inflammation; and has therefore unjustly been arranged under that name. It is distinguished from nephritis, as it is seldom attended with vomiting, I suppose never, except the ureter happens to be inflamed at the same time.

The pain sometimes extends on the outside of the thigh from the hip to the ankle, heel, or toes, and is then called sciatica; and has been thought to consist in an inflammation of the theca, or covering of the sciatic nerve, as the pain sometimes so exactly attends the principal branches of that nerve. See Class I. 2. 4. 15. 16.

M. M. Venesection repeatedly; calomel; gentle cathartics; diluents; warm bath; poultice on the back, consisting of camomile flowers, turpentine, soap, and opium; a burgundy-pitch plaster. A debility of the inferior limbs from the torpor of the muscles, which had previously been too much excited, frequently occurs at the end of this disease; in this case electricity, and issues on each side of the lumber vertebræ, are recommended. See Class I. 2. 4. 16.

18. Ischias. The ischias consists of inflammatory fever, with great pain about the pelvis, the os coccigis, and the heads of the thigh-bones, preventing the patient from walking or standing erect, with increase of pain on going to stool. This malady, as well as the preceding, has been ascribed to rheumatism; with which it seems to bear no greater analogy, than the inflammations of any other membranes.

The patients are left feeble, and sometimes lame after this disease; which is also sometimes accompanied with great flow of urine, owing to the defective absorption of its aqueous parts; and with consequent thirst occasioned by the want of so much fluid being returned into the circulation; a lodgment of fæces in the rectum sometimes occurs after this complaint from the lessened sensibility of it. See Class I. 2. 4. 15.

M. M. Venesection; gentle cathartics; diluents; fomentation; poultice with camomile flowers, turpentine, soap, and opium; afterwards the bark. See Class I. 1. 3. 5.

When this inflammation terminates in suppuration the matter generally can be felt to fluctuate in the groin, or near the top of the thigh. In this circumstance, my friend Mr. Bent, Surgeon near Newcastle in Staffordshire, proposes to tap the abscess by means of a trocar, and thus as often as necessary to discharge the matter without admitting the air. Might a weak injection of wine and water, as in the hydrocele, be used with great caution to inflame the walls of the abscess, and cause them to unite? See Class II. 1. 6. 9.

19. Paronychia interna. Inflammation beneath the finger-nail. The pain occasioned by the inflammatory action and tumor of parts bound down between the nail on one side and the bone on the other, neither of which will yield, is said to occasion so much pain as to produce immediate delirium, and even death, except the parts are divided by a deep incision; which must pass quite through the periosteum, as the inflammation is said generally to exist beneath it. This disease is thus resembled by the process of toothing in young children; where an extraneous body lodged beneath the periosteum induces pain and fever, and sometimes delirium, and requires to be set at liberty, by the lancet.

ORDO I.

Increased Sensation.

GENUS III.

With the Production of new Vessels by external Membranes or Glands with Fever.

The diseases of this genus are perhaps all productive of contagious matter; or which becomes so by its exposure to the air, either through the cuticle, or by immediate contact with it; such are the matters of the small-pox and measles. The purulent matter formed on parts covered from the air by thicker membranes or muscles, as in the preceding genus, does not induce fever, and cannot therefore be called contagious; but it acquires this property of producing fever in a few hours, after the abscess has been opened, so as to admit the air to its surface, and may then be said to consist of contagious miasmata. This kind of contagious matter only induces fever, but does not produce other matter with properties similar to its own; and in this respect it differs from the contagious miasmata of small-pox or measles, but resembles those which have their origin in crowded jails; for these produce fever only, which frequently destroys the patient; but do not produce other matters similar to themselves; as appears from none of those, who died of the jail-fever, caught at the famous black assizes at Oxford, at the beginning of this century, having infected their physicians or attendants.

If indeed the matter has continued so long as to become putrid, and thus to have given out air from a part of it, it acquires the power of producing fever; in the same manner as if the ulcer had been opened, and exposed to the common air; instances of which are not unfrequent. And from these circumstances it seems probable, that the matters secreted by the new vessels formed in all kinds of phlegmons, or pustles, are not contagious, till they have acquired something from the atmosphere, or from the gas produced by putrefaction; which will account for some phenomena in the lues venerea, cancer, and of other contagious secretions on the skin without fever, to be mentioned hereafter. See Class II. 1. 4. 14.

The theory of contagion has been perplexed by comparing it with fermenting liquors; but the contagious material is shewn in Section XXXIII. to be produced like other secreted matters by certain animal motions of the terminations of the vessels. Hence a new kind of gland is formed at the terminations of the vessels in the eruptions of the small-pox; the animal motions of which produce from the blood variolous matter; as other glands produce bile or saliva. Now if some of this matter is introduced beneath the cuticle of a healthy person, or enters the circulation, and excites the extremities of the blood-vessels into those kinds of diseased motions, by which it was itself produced, either by irritation or association, these diseased motions of the extremities of the vessels will produce other similar contagious matter. See Sect. XXXIII. 2. 5. and 9. Hence contagion seems to be propagated two ways; one, by the stimulus of contagious matter applied to the part, which by an unknown law of nature excites the stimulated vessels to produce a similar matter; as in venereal ulcers, which thus continue to spread; or as when variolous matter is inserted beneath the cuticle; or when it is supposed to be absorbed, and diffused over the body mixed with the blood, and applied in that manner to the cutaneous glands. The other way, by which contagion seems to be diffused, is by some distant parts sympathizing or imitating the motions of the part first affected; as the stomach and skin in the eruptions of the inoculated small-pox, or in the bite of a mad dog; as treated of in Sect. XXII. 3. 3.

In some of the diseases of this genus the pulse is strong, full, and hard, constituting the sensitive irritated fever, as described in the preceding genus; as in one kind of erysipelas, which requires repeated venesection. In others the arterial action is sometimes moderate, so as to constitute the sensitive fever, as in the inoculated small-pox; where the action of the arteries is neither increased by the sensorial power of irritation, as in the sensitive irritated fever; nor decreased by the defect of that power, as in the sensitive inirritated fever. But in the greatest number of the diseases of this genus the arterial action is greatly diminished in respect to strength, and consequently the frequency of pulsation is proportionally increased, as explained in Sect XXXII. 2. 1. Which is owing to the deficiency of the sensorial power of irritation joined with the increase of that of sensation, and thus constitutes the sensitive inirritated fever; as in Scarlatina with gangrenous tonsils.

From this great debility of the action of the arteries, there appears to be less of the coagulable lymph or mucus secreted on their internal surfaces; whence there is not only a defect of that buff or size upon the blood, which is seen on the surface of that, which is drawn in the sensitive irritated fever; but the blood, as it cools, when it has been drawn into a bason, scarcely coagulates; and is said to be dissolved, and is by some supposed to be in a state of actual putrefaction. See Sect. XXXIII. 1. 3. where the truth of this idea is controverted. But in the fevers of both this genus and the preceding one great heat is produced from the chemical combinations in the secretions of new vessels and fluids, and pain or uneasiness from the distention of the old ones; till towards the termination of the disease sensation ceases, as well as irritation, with the mortification of the affected parts, and the death of the patient.

Dysenteria, as well as tonsillitis and aphtha, are enumerated amongst the diseases of external membranes, because they are exposed either to the atmospheric air, which is breathed, and swallowed with our food and saliva; or they are exposed to the inflammable air; or hydrogen, which is generated in the intestines; both which contribute to produce or promote the contagious quality of these fluids; as mentioned in Class II. 1. 5.

It is not speaking accurate language, if we say, that in the diseases of this genus the fever is contagious; since it is the material produced by the external membranes, which is contagious, after it has been exposed to air; while the fever is the consequence of this contagious matter, and not the cause of it. As appears from the inoculated small-pox, in which the fever does not commence, till after suppuration has taken place in the inoculated arm, and from the diseases of the fifth genus of this order, where contagion exists without fever. See Class II. 1. 5. and II. 1. 3. 18.

SPECIES.

1. Febris sensitiva inirritata. Sensitive inirritated fever. Typhus gravior. Putrid malignant fever. Jail fever. The immediate cause of this disease is the increase of the sensorial power of sensation, joined with the decrease of the sensorial power of irritation; that is, it consists in the febris sensitiva joined with the febris inirritativa of Class I. 2. 1. 1. as the febris sensitiva irritata of the preceding genus consists of the febris sensitiva joined with the febris irritativa of Class I. 1. 1. 1. In both which the word irritata, and inirritata, are designed to express more or less irritation than the natural quantity; and the same when applied to some of the diseases of this genus.

This fever is frequently accompanied with topical inflammation, which is liable, if the arterial strength is not supported, to end in sphacelus; and as mortified parts, such as sloughs of the throat, if they adhere to living parts, soon become putrid from the warmth and moisture of their situation; these fevers have been termed putrid, and have been thought to owe their cause to what is only their consequence. In hot climates this fever is frequently induced by the exhalations of stagnating lakes or marshes, which abound with animal substances; but which in colder countries produce fevers with debility only, as the quartan ague, without inflammation.

The sensitive inirritated, or malignant, fever is also frequently produced by the putrid exhalations and stagnant air in prisons; but perhaps most frequently by contact or near approach of the persons, who have resided in them. These causes of malignant fevers contributed to produce, and to support for a while, the septic and antiseptic theory of them; see Sect. XXXIII. 1. 3. The vibices or bruises, and petechiæ or purples, were believed to be owing to the dissolved state of the blood by its incipient putrefaction; but hydrostatical experiments have been made, which shew the sizy blood of the patient in sensitive irritated or inflammatory fever, with strong pulse, is more fluid, while it is warm, than this uncoagulable blood taken in this sensitive inirritated, or malignant fever; from whence it is inferred, that these petechiæ, and vibices, are owing to the deficient power of absorption in the terminations of the veins, See Class I. 2. 1. 5.

This sensitive inirritated fever, or typhus gravior, is distinguished from the inirritative fever, or typhus mitior, in the early stages of it, by the colour of the skin; which in the latter is paler, with less heat, owing to the less violent action of the capillaries; in this it is higher coloured, and hotter, from the greater energy of the capillary action in the production of new vessels. In the more advanced state petechiæ, and the production of contagious matter from inflamed membranes, as the aphthæ of the mouth, or ulcers of the throat, distinguishes this fever from the former. Delirium, and dilated pupils of the eyes, are more frequent in nervous fevers; and stupor with deafness more frequent attendants on malignant fevers. See Class I. 2. 5. 6.

There is another criterion discernible by the touch of an experienced finger; and that is, the coat of the artery in inflammatory fevers, both those attended with strength of pulsation, and these with weak pulsation, feels harder, or more like a cord; for the coats of the arteries in these fevers are themselves inflamed, and are consequently turgid with blood, and thence are less easily compressed, though their pulsations are nevertheless weak: when the artery is large or full with an inflamed coat, it is called hard; and when small or empty with an inflamed coat, it is called sharp, by many writers.

M. M. The indications of cure consist, 1. In procuring a regurgitation of any offensive material, which may be lodged in the long mouths of the lacteals or lymphatics, or in their tumid glands. 2. To excite the system into necessary action by the repeated exhibition of nutrientia, sorbentia, and incitantia; and to preserve the due evacuation of the bowels. 3. To prevent any unnecessary expenditure of sensorial power. 4. To prevent the formation of ulcers, or to promote the absorption in them, for the purpose of healing them.

1. One ounce of wine of ipecacuanha, or about ten grains of the powder, should be given as an emetic. After a few hours three or four grains of calomel should be given in a little mucilage, or conserve. Where something swallowed into the stomach is the cause of the fever, it is liable to be arrested by the lymphatic glands, as the matter of the small-pox inoculated in the arm is liable to be stopped by the axillary lymphatic gland; in this situation it may continue a day or two, or longer, and may be regurgitated during the operation of an emetic or cathartic into the stomach or bowel, as evidently happens on the exhibition of calomel, as explained in Sect. XXIX. 7. 2. For this reason an emetic and cathartic, with venesection, if indicated by the hardness and fulness of the pulse, will very frequently remove fevers, if exhibited on the first, second, or even third day.

2. Wine and opium, in small doses repeated frequently, but so that not the least degree of intoxication follows, for in that case a greater degree of debility is produced from the expenditure of sensorial power in unnecessary motions. Many weak patients have been thus stimulated to death. See Sect. XII. 7. 8. The Peruvian bark should be given also in repeated doses in such quantity only as may strengthen digestion, not impede it. For these purposes two ounces of wine, or of ale, or cyder, should be given every six hours; and two ounces of decoction of bark, with two drachms of the tincture of bark, and six drops of tincture of opium, should be given also every six hours alternately; that is, each of them four times in twenty-four hours. As much rhubarb as may induce a daily evacuation, should be given to remove the colluvies of indigested materials from the bowels; which might otherwise increase the distress of the patient by the air it gives out in putrefaction, or by producing a diarrhœa by its acrimony; the putridity of the evacuations are in consequence of the total inability of the digestive powers; and their delay in the intestines, to the inactivity of that canal in respect to its peristaltic motions.

The quantities of wine or beer and opium, and bark, above mentioned, may be increased by degrees, if the patient seems refreshed by them; and if the pulse becomes slower on their exhibition; but this with caution, as I have seen irrecoverable mischief done by greater quantities both of opium, wine, and bark, in this kind of fever; in which their use is to strengthen the digestion of the weak patient, rather than to stop the paroxysms of fever; but when they are administered in intermittents, much larger quantities are necessary.

The stimulus of small blisters applied in succession, one every three or four days, when the patient becomes weak, is of great service by strengthening digestion, and by preventing the coldness of the extremities, owing to the sympathy of the skin with the stomach, and of one part of the skin with another.

In respect to nutriment, the patient should be supplied with wine and water, with toasted bread, and sugar or spice in it; or with sago with wine; fresh broth with turnips, cellery, parsley; fruit; new milk. Tea with cream and sugar; bread pudding, with lemon juice and sugar; chicken, fish, or whatever is grateful to the palate of the sick person, in small quantity repeated frequently; with small beer, cyder and water, or wine and water, for drink, which may be acidulated with acid of vitriol in small quantities.

3. All unnecessary motions are to be checked, or prevented. Hence horizontal posture, obscure room, silence, cool air. All the parts of the skin, which feel too hot to the hand, should be exposed to a current of cool air, or bathed with cold water, whether there are eruptions on it or not. Wash the patient twice a day with cold vinegar and water, or cold salt and water, or cold water alone, by means of a sponge. If some parts are too cold, as the extremities, while other parts are too hot, as the face or breast, cover the cold parts with flannel, and cool the hot parts by a current of cool air, or bathing them as above.

4. For the healing of ulcers, if in the mouth, solution of alum in water about 40 grains to an ounce, or of blue vitriol in water, one grain or two to an ounce may be used to touch them with three or four times a day. Of these perhaps a solution of alum is to be preferred, as it instantly takes away the stench from ulcers I suppose by combining with the volatile alcali which attends it. For this purpose a solution of alum of an ounce to a pint of water should be frequently injected by means of a syringe into the mouth. If there are ulcers on the external skin, fine powder of bark seven parts, and cerusia in fine powder one part, should be mixed, and applied dry on the sore, and kept on by lint, and a bandage.

As sloughs in the mouth are frequently produced by the previous dryness of the membranes, which line it, this dryness should be prevented by frequently moistening them, which may be effected by injection with a syringe, or by a moist sponge, or lastly in the following manner. Place a glass of wine and water, or of milk and sugar, on a table by the bedside, a little above the level of the mouth of the patient; then, having previously moistened a long piece of narrow listing, or cloth, or flannel, with the same liquor, leave one end of it in the glass, and introduce the other into the mouth of the patient; which will thus be supplied with a constant oozing of the fluid through the cloth, which acts as a capillary syphon.

The viscid phlegm, which adheres to the tongue, should be coagulated by some austere acid, as by lemon-juice evaporated to half its quantity, or by crab-juice; and then it may be scraped off by a knife, or rubbed off by flannel, or a sage leaf dipped in vinegar, or in salt and water.

2. Erysipelas, St. Anthony's fire, may be divided into three kinds, which differ in their method of cure, the irritated, the inirritated, and the sensitive erysipelas.

Erysipelas irritatum is attended with increase of irritation besides increase of sensation; that is, with strong, hard, and full pulse, which requires frequent venesection, like other inflammations with arterial strength. It is distinguished from the phlegmonic inflammations of the last genus by its situation on the external habit, and by the redness, heat, and tumour not being distinctly circumscribed; so that the eye or finger cannot exactly trace the extent of them.

When the external skin is the seat of inflammation, and produces sensitive irritated fever, no collection of matter is formed, as when a phlegmon is situated in the cellular membrane beneath the skin; but the cuticle rises as beneath a blister-plaster, and becomes ruptured; and a yellow material oozes out, and becomes inspissated, and lies upon its surface; as is seen in this kind of erysipelas, and in the confluent small-pox; or if the new vessels are reabsorbed the cuticle peels off in scales. This difference of the termination of erysipelatous and phlegmonic inflammation seems to be owing in part to the less distensibility of the cuticle than of the cellular membrane, and in part to the ready exhalation of the thinner parts of the secreted fluids through its pores.