5. Dentitio. Toothing. The pain of toothing often begins much earlier than is suspected; and is liable to produce convulsions; which are sometimes relieved, when the gum swells, and becomes inflamed; at other times a diarrhoea supervenes, which is generally esteemed a favourable circumstance, and seems to prevent the convulsions by supplying another means of relieving the pain of dentition by irritative exertion; and a consequent temporary exhaustion of sensorial power. See Class I. 1. 2. 5. Sect. XXXV. 2. 1.

The convulsions from toothing generally commence long before the appearance of the teeth; but as the two middle incisors of the lower jaw generally appear first, and then those of the upper, it is adviseable to lance the gums over these longitudinally in respect to the jaw-bones, and quite down to the periosteum, and through it.

As the convulsions attending the commencement of toothing are not only dangerous to life in their greatest degree, but are liable to induce stupor or insensibility by their continuance even in a less degree, the most efficacious means should be used to cure them.

M. M. Lance the gum of the expected teeth quite through the periosteum longitudinally. Venesection by the lancet or by two or three leeches. One grain of calomel as a purge. Tincture of jalap, five or six drops in water every three hours til it purges, to be repeated daily. After evacuations a small blister on the back or behind the ears. And lastly, two or three drops of laudanum according to the age of the child. Warm bath. See Class III. 1. 1. 5. and 6.

6. Priapismus chronicus. I have seen two cases, where an erection of the penis, as hard as horn, continued two or three weeks without any venereal desires, but not without some pain; the easiest attitude of the patients was lying upon their backs with their knees up. At length the corpus cavernosum urethrae became soft, and in another day or two the whole subsided. In one of them a bougie was introduced, hoping to remove some bit of gravel from the caput gallinaginis, camphor, warm bathing, opium, lime-water, cold aspersion, bleeding in the veins of the penis, were tried in vain. One of them had been a free drinker, had much gutta rosacea on his face, and died suddenly a few months after his recovery from this complaint. Was it a paralysis of the terminations of the veins, which absorb the blood from the tumid penis? or from the stimulus of indurated semen in the seminal vessels? In the latter case some venereal desires should have attended. Class III. 1. 2. 16.

The priapismus, which occurs to vigorous people in a morning before they awake, has been called the signum salutis, or banner of health, and is occasioned by the increase of our irritability or sensibility during sleep, as explained in Sect. XVIII. 15.

7. Distentio mamularum. The distention of the nipples of lactescent women is at first owing to the stimulus of the milk. See Sect. XIV. 8. and Sect. XVI. 5. See Class II. 1. 7. 10.

8. Descensus uteri. This is a very frequent complaint after bad labours, the fundus uteri becomes inverted and descends like the prolapsus ani.

M. M. All the usual pessaries are very inconvenient and ineffectual. A piece of soft sponge about two inches diameter introduced into the vagina gives great ease to these patients, and supports the uterus; it should have a string put through it to retract it by.

There are also pessaries now made of elastic gum, which are said to be easily worn, and to be convenient, from their having a perforation in their centre.

9. Prolapsus ani. The lower part of the rectum becomes inverted, and descends after every stool chiefly in children; and thus stimulates the sphincter ani like any other extraneous body.

M. M. It should be dusted over with very fine powder of gum sandarach, and then replaced. Astringent fomentations; as an infusion of oak-bark, or a slight solution of alum. Horizontal rest frequently in the day.

10. Lumbricus. Round worm. The round worm is suspected in children when the belly is tumid, and the countenance bloated and pale, with swelling of the upper lip. The generation of these worms is promoted by the too dilute state of the bile, as is evident in the fleuke-worm found in the biliary ducts and substance of the liver in sheep; and in water-rats, in the livers of which last animals they were lately detected in large numbers by Dr. Capelle. Transactions of the college at Philadelphia, v. i.

Now as the dilute state of the bile depends on the deficiency of the absorption of its thinner parts, it appears, that the tumid belly, and bloated countenance, and swelled upper lip, are a concomitant circumstance attending the general inactivity of the absorbent system; which is therefore to be esteemed the remote cause of the generation of worms.

The simplicity of the structure of worms probably enables them to exist in more various temperatures of heat; and their being endued with life prevents them from being destroyed by digestion in the stomach, probably in the same manner as the powers of life prevent the fermentation and putrefaction of the stomach itself. Hence I conclude, that worms are originally taken into our alimentary canal from without; as I believe similar worms of all kinds are to be found out of the body.

M. M. The round worm is destroyed by a cathartic with four or six grains of calomel; and afterwards by giving six or eight grains of filings of iron twice a day for a fortnight. See Hepatis tumor, Class I. 2. 3. 9. As worms are liable to come away in fevers, whether of the hectic or putrid kind, could they be removed by purulent matter, or rotten egg, or putrid flesh, since in those fevers from the enfeebled action of the intestines the faeces become highly putrid?

11. Taenia. Tape-worm consists of a chain of animals extending from the stomach to the anus. See Sect. XXXIX. 2. 3. It frequently exists in cats, rats, and geese, and probably in many other animals.

The worms of this genus possess a wonderful power of retaining life. Two of them, which were voided by a pointer dog in consequence of violent purgatives, each of which were several feet in length, had boiling water poured on them in a bason; which seemed not much to inconvenience them. When the water was cool, they were taken out and put into gin or whiskey of the strongest kind, in which their life and activity continued unimpaired; and they were at length killed by adding to the spirit a quantity of corrosive sublimate. Medic. Comment. for 1791, p. 370.

The tape-worm is cured by an amalgama of tin and quicksilver, such as is used on the back of looking-glasses; an ounce should be taken every two hours, till a pound is taken; and then a brisk cathartic of Glauber's salt two ounces, and common salts one ounce, dissolved in two wine pints of water, half a pint to be taken every hour till it purges. The worm extends from the stomach to the anus, and the amalgama tears it from the intestine by mechanical pressure, acting upon it the whole way. Electric shocks through the duodenum greatly assists the operation. Large doses of tin in powder. Iron filings in large doses. The powder of fern-root seems to be of no use, as recommended by M. Noufflier.

12. Ascarides. Thread-worms. These worms are said to be more frequent in some parts of this kingdom than in others, as near the fens of Lincolnshire. Do they escape from the body and become flies, like the bott-worm in horses? Do they crawl from one child to another in the same bed? Are they acquired from flies or worms, which are seen in putrid necessary houses, as these worms as well as the tapeworms, are probably acquired from without? this may account for their re-appearance a few weeks or months after they have been destroyed; or can this happen from the eggs or parts of them remaining?

Ascarides appear to be of two kinds, the common small ones like a thread; which has a very sharp head, as appears in the microscope; and which is so tender, that the cold air soon renders it motionless; and a larger kind above an inch long, and nearly as thick as a very small crow-quill, and which is very hard in respect to its texture, and very tenacious of life. One of these last was brought to me, and was immediately immersed in a strong solution of sugar of lead, and lived in it a very long time without apparent inconvenience.

M. M. Ascarides are said to be weakened by twenty grains of cinnabar and five of rhubarb taken every night, but not to be cured by this process. As these worms are found only in the rectum, variety of clysters have been recommended. I was informed of a case, where solutions of mercurial ointment were used as a clyster every night for a month without success. Clysters of Harrowgate water are recomended, either of the natural, or of the factitious, as described below, which might have a greater proportion of liver of sulphur in it. As the cold air soon destroys them, after they are voided, could clysters of iced water be used with advantage? or of spirit of wine and water? or of ether and water? Might not a piece of candle, about an inch long, or two such pieces, smeared with mercurial ointment, and introduced into the anus at night, or twice a day, be effectual by compressing their nidus, as well as by the poison of the mercury.

The clysters should be large in quantity, that they may pass high in the rectum, as two drams of tobacco boiled a minute in a pint of water. Or perhaps what might be still more efficacious and less inconvenient, the smoke of tobacco injected by a proper apparatus every night, or alternate nights, for six or eight weeks. This was long since recommended, I think by Mr. Turner of Liverpool; and the reason it has not succeeded, I believe to have been owing to the imperfections of the joints of the common apparatus for injecting the smoke of tobacco, so that it did not pass into the intestine, though it was supposed to do so, as I once observed. The smoke should be received from the apparatus into a large bladder; and it may then be certainly injected like the common clyster with sufficient force; otherwise oiled leathers should be nicely put round the joints of the machine; and a wet cloth round the injecting pipe to prevent the return of the smoke by the sides of it. Clysters of carbonated hydrogen gas, or of other factitious airs, might be tried.

Harrowgate water taken into the stomach, so as to induce six or seven stools every morning, for four or six weeks, is perhaps the most efficacious method in common use. A factitious Harrowgate water may be made probably of greater efficacy than the natural, by dissolving one ounce of marine salt, (called bay salt) and half an ounce of magnesia Glauber's salt, (called Epsom salt, or bitter purging salt) in twenty-eight ounces of water. A quarter or half a pint of this is to be taken every hour, or two hours in the morning, till it operates, with a tea-spoonful of a solution of liver of sulphur, which is to be made by putting an ounce of hepar sulphuris into half a pint of water. See Class IV. 1. 2. 9.

13. Dracunculus. A thin worm brought from the coast of Guinea. It is found in the interstices of the muscles, and is many yards long; it makes a small ulcer; which is cured by extracting an inch of the worm a day, and wrapping the extracted part slowly round a bit of tobacco pipe till next day, so as not to break it. I have twice seen long worms, like a thick horse-hair, in water in July in this country, which appeared hard and jointed.

14. Morpiones. Crab-lice. The excrement of this animal stains the linen, and appears like diluted blood.

M. M. Spirit of wine. Mercurial ointment, shaving the part. Oil destroys other insects, if they be quite covered with it, as the ticks on dogs, and would probably therefore destroy these. Its manner of operation is by stopping up or filling their spiracula, or breathing pores; a few drops of oil poured on a wasp, so as to cover it, destroys it in a few seconds.

15. Pediculi. Lice. There is said to be a disease, in which these animals are propagated in indestructible numbers, so as to destroy the patient.

M. M. Cleanliness, mercurial ointment, stavis acria in powder, or the tincture of it in spirit of wine. Spirit of wine alone? Bath of oil?

* * * * *

ORDO I.

Increased Irritation.

GENUS V.

With Increased Actions of the Organs of Sense.

SPECIES.

1. Visus acrior. Acuter sight. There have been instances of people, who could see better in the gloom of the evening, than in the stronger light of the day; like owls, and bats, and many quadrupeds, and flying insects. When the eye is inflamed, great light becomes eminently painful, owing to the increased irritative motions of the retina, and the consequent increased sensation. Thus when the eye is dazzled with sudden light, the pain is not owing to the motion of the iris; for it is the contraction of the iris, which relieves the pain from sudden light; but to the too violent contractions of the moving fibres, which constitute the extremities of the optic nerve.

2. Auditus acrior. The irritative ideas of hearing are so increased in energy as to excite our attention. This happens in some diseases of the epileptic kind, and in some fevers. Hence the whispering of the currents of air in a room, the respiration of the company, and noises before unperceived, become troublesome; and sounds louder than usual, or unexpected, produce starting, and convulsions.

M. M. Put oil of almonds into the ears. Stop the meatus auditorius with cotton wool. Set the feet of the patient's bed on cushions, or suspend it by cords from the ceiling.

3. Olfactus acrior. The irritative ideas of smell from the increased action of the olfactive nerve excite our attention. Hence common odours are disagreeable; and are perceived from variety of objects, which were before thought inodorous. These are commonly believed to be hallucinations of the sense.

M. M. Snuff starch up the nostrils.

4. Gustus acrior. The irritative ideas of taste, as of our own saliva, and even of the atmospheric air, excite our attention; and common tastes are disagreeably strong.

M. M. Water. Mucilage. Vegetable acids. Scrape the tongue clean. Rub it with a sage-leaf and vinegar.

5. Tactus acrior. The irritative ideas of the nerves of touch excite our attention: hence our own pressure on the parts, we rest upon, becomes uneasy with universal soreness.

M. M. Soft feather-bed. Combed wool put under the patients, which rolls under them, as they turn, and thus prevents their friction against the sheets. Drawers of soft leather. Plasters of cerate with calamy.

6. Sensus caloris acrior. Acuter sense of heat occurs in some diseases, and that even when the perceptible heat does not appear greater than natural to the hand of another person. See Class I. 1. 2. See Sect. XIV. 8. All the above increased actions of our organs of sense separately or jointly accompany some fevers, and some epileptic diseases; the patients complaining of the perception of the least light, noises in their ears, bad smells in the room, and bad tastes in their mouths, with soreness, numbness, and other uneasy feels, and with disagreeable sensations of general or partial heat.

7. Sensus extensionis acrior. Acuter sense of extension. The sense of extension was spoken of in Sect. XIV. 7. and XXXII. 4. The defect of distention in the arterial system is accompanied with faintness; and its excess with sensations of fulness, or weight, or pressure. This however refers only to the vascular muscles, which are distended by their appropriated fluids; but the longitudinal muscles are also affected by different quantities of extension, and become violently painful by the excess of it.

These pains of muscles and of membranes are generally divided into acute and dull pains. The former are generally owing to increase of extension, as in pricking the skin with a needle; and the latter generally to defect of extension, as in cold head-aches; but if the edge of a knife, or point of a pin, be gradually pressed against the fibres of muscles or membranes, there would seem to be three states or stages of this extension of the fibres; which have acquired names according to the degree or kind of sensation produced by the extension of them; these are 1. titillation or tickling. 2. itching, and the 3. smarting; as described below. See Sect. XIV. 9.

8. Titillatio. Tickling is a pleasureable pain of the sense of extension above mentioned, and therefore excites laughter; as described in Sect. XXXIV. 1. 4. The tickling of the nostrils, which precedes the efforts of sneezing, is owing to the increased irritation occasioned by external stimulus; and is attended with a pleasureable sensation in consequence of the increased action of the part. When this action is exerted in a greater degree, the sensation becomes painful, and the convulsion of sneezing ensues; as the pain in tickling the soles of the feet of children is relieved by laughter.

A lady after a bruise on her nose by a fall was affected with incessant sneezing, and relieved by snuffing starch up her nostrils. Perpetual sneezings in the measles, and in catarrhs from cold, are owing to the stimulus of the saline part of the mucous effusion on the membrane of the nostrils. See Class II. 1. 1. 3.

9. Pruritus. Itching seems to be a greater degree of titillation, and to be owing to the stimulus of some acrid material, as the matter of the itch; or of the herpes on the scrotum, and about the anus; or from those universal eruptions, which attend some elderly people, who have drank much vinous spirit. It occurs also, when inflammations are declining, as in the healing of blisters, or in the cure of ophthalmia, as the action of the vessels is yet so great as to produce sensation; which, like the titillations that occasion laughter, is perpetually changing from pleasure to pain.

When the natural efforts of scratching do not relieve the pain of itching, it sometimes increases so as to induce convulsions and madness. As in the furor uterinus, and satyriasis, and in the sphincter ani and scrotum. See Class II. 1. 4. 14. IV. 2. 2. 6.

M. M. Warm bath. Fomentation. Alcohol externally. Poultice. Oiled silk. Mercurial ointments on small surfaces at once. See Class II. 1. 4. 12. Solutions of lead on small surfaces at once.

10. Dolor urens. Smarting follows the edge of a knife in making a wound, and seems to be owing to the distention of a part of a fibre, till it breaks. A smarting of the skin is liable to affect the scars left by herpes or shingles; and the callous parts of the bottoms of the feet; and around the bases of corns on the toes; and frequently extends after sciatica along the outside of the thigh, and of the leg, and part of the foot. All these may be owing to the stimulus of extension, by blood or serum being forced into vessels nearly coalesced.

M. M. Emplastrum de minio put like a bandage on the part. Warm fomentation. Oil and camphor rubbed on the part. Oil-silk covering. A blister on the part. Ether, or alcohol, suffered to evaporate on the part.

11. Consternatio. Surprise. As our eyes acquaint us at the same time with less than half of the objects, which surround us, we have learned to confide much in the organ of hearing to warn us of approaching dangers. Hence it happens, that if any sound strikes us, which we cannot immediately account for, our fears are instantly alarmed. Thus in great debility of body, the loud clapping of a door, or the fall of a fire-shovel, produces alarm, and sometimes even convulsions; the same occurs from unexpected sights, and in the dark from unexpected objects of touch.

In these cases the irritability is less than natural, though it is erroneously supposed to be greater; and the mind is busied in exciting a train of ideas inattentive to external objects; when this train of ideas is dissevered by any unexpected stimulus, surprise is excited; as explained in Sect. XVII. 3. 7. and XVIII. 17. then as the sensibility in these cases is greater, fear becomes superadded to the surprise; and convulsions in consequence of the pain of fear. See Sect. XIX. 2.

The proximate cause of surprise is the increased irritation induced by some violent stimulus, which dissevers our usual trains of ideas; but in diseases of inirritability the frequent starting or surprise from sounds not uncommon, but rather louder than usual, as the clapping of a door, shews, that the attention of the patient to a train of sensitive ideas was previously stronger than natural, and indicates an incipient delirium; which is therefore worth attending to in febrile diseases.

* * * * *

ORDO II.

Decreased Irritation.

GENUS I.

With decreased Action of the Sanguiferous System.

The reader should be here apprized, that the words strength and debility, when applied to animal motions, may properly express the quantity of resistance such motions may overcome; but that, when they are applied to mean the susceptibility or insusceptibility of animal fibres to motion, they become metaphorical terms; as in Sect. XII. 2. 1. and would be better expressed by the words activity and inactivity.

There are three sources of animal inactivity; first, the defect of the natural quantity of stimulus on those fibres, which have been accustomed to perpetual stimulus; as the arterial and secerning systems. When their accustomed stimulus is for a while intermitted, as when snow is applied to the skin of the hands, an accumulation of sensorial power is produced; and then a degree of stimulus, as of heat, somewhat greater than that at present applied, though much less than the natural quantity, excites the vessels of the skin into violent action. We must observe, that a deficiency of stimulus in those fibres, which are not subject to perpetual stimulus, as the locomotive muscles, is not succeeded by accumulation of sensorial power; these therefore are more liable to become permanently inactive after a diminution of stimulus; as in strokes of the palsy, this may be called inactivity from defect of stimulus.

2. A second source of animal inactivity exists, when the sensorial power in any part of the system has been previously exhausted by violent stimuli; as the eyes after long exposure to great light; or the stomach, to repeated spirituous potation; this may be termed inactivity from exhaustion of sensorial power. See Sect. XII. 2. 1.

3. But there is a third source of inactivity owing to the deficient production of sensorial power in the brain; and hence stimuli stronger than natural are required to produce the accustomed motions of the arterial system; in this case there is no accumulation of sensorial power produced; as in the inactivity owing to defect of stimulus; nor any previous exhaustion of it, as in the inactivity owing to excess of stimulus.

This third kind of inactivity causes many of the diseases of this genus; which are therefore in general to be remedied by such medicines as promote a greater production of sensorial power in the brain; as the incitantia, consisting of wine, beer, and opium, in small repeated quantities; and secondly of such as simply stimulate the arterial and glandular system into their natural actions; as small repeated blisters, spices, and essential oils. And lastly the sorbentia, which contribute to supply the more permanent strength of the system, by promoting the absorption of nourishment from the stomach, and intestines; and of the superfluous fluid, which attends the secretions.

SPECIES.

1. Febris inirritativa. Inirritative fever. This is the typhus mitior, or nervous fever of some writers; it is attended with weak pulse without inflammation, or symptoms of putridity, as they have been called. When the production of sensorial power in the brain is less than usual, the pulse becomes quick as well as weak; and the heart sometimes trembles like the limbs of old age, or of enfeebled drunkards; and when this force of the contractions of the heart and arteries is diminished, the blood is pushed on with less energy, as well as in less quantity, and thence its stimulus on their sides is diminished in a duplicate ratio. In compressions of the brain, as in apoplexy, the pulse becomes slower and fuller; for in that disease, as in natural sleep, the irritative motions of the heart and arteries are not diminished, volition alone is suspended or destroyed.

If the absorption of the terminations of the veins is not equally impaired with the force of the heart and arteries, the blood is taken up by the veins the instant it arrives at their extremities; the capillary vessels are left empty, and there is less resistance to the current of the blood from the arteries; hence the pulse becomes empty, as well as weak and quick; the veins of the skin are fuller than the arteries of it; and its appearance becomes pale, bluish, and shrunk. See Class II. 1. 3. 1.

When this pulse persists many hours, it constitutes the febris inirritativa, or typhus, or nervous fever, of some writers; it is attended with little heat, the urine is generally of a natural colour, though in less quantity; with great prostration of strength, and much disturbance of the faculties of the mind. Its immediate cause seems to be a deficient secretion of the sensorial power from the inaction of the brain; hence almost the whole of the sensorial power is expended in the performance of the motions necessary to life, and little of it can be spared for the voluntary actions of the locomotive muscles, or organs of sense, see Class I. 2. 5. 3. Its more remote cause may be from a paralysis or death of some other part of the body; as of the spleen, when a tumour is felt on the left side, as in some intermittents; or of the kidnies, when the urine continues pale and in small quantity. Does the revivescence of these affected parts, or their torpor, recurring at intervals, form the paroxysms of these fevers? and their permanent revivescence establish the cure? See Class IV. 2. 1. 19.

M. M. Wine and opium in small quantities repeated every three hours alternately; small repeated blisters; warm but fresh air; sorbentia; nutrientia; transfusion of blood. Small electric shocks passed through the brain in all directions. Oxygene air?

2. Paresis inirritativa. Inirritative debility. A defective action of the irritative motions without increase of the frequency of the pulse. It continues three or four weeks like a fever, and then either terminates in health, or the patient sinks into one kind of apoplexy, and perishes. Many symptoms, which attend inirritative fevers, accompany this disease, as cold hands and feet at periodic times, scurf on the tongue, want of appetite, muddy urine, with pains of the head, and sometimes vertigo, and vomiting.

This disease differs from the inirritative fever by the pulse not being more frequent than in health. The want of appetite and of digestion is a principal symptom, and probably is the cause of the universal debility, which may be occasioned by the want of nourishment. The vertigo is a symptom of inirritability, as shewn in Class IV. 2. 1. 16. the muddy urine is owing to increased absorption from the bladder in consequence of the diminished cutaneous and cellular absorption, as in anasarca, explained in Sect. XXIX. 5. 1. and is therefore a consequence of the inirritability of that part of the system; the foul tongue is owing to an increased absorption of the thinner part of the mucus in consequence of the general deficiency of fluid, which should be absorbed by the skin and stomach. The sickness is owing to decreased action of the stomach, which is probably the primary disease, and is connected with the vertigo.

M. M. An emetic. Calomel, grains iv. once or twice. Then a blister. Peruvian bark. Valerian. Columbo. Steel. Opium and wine in small quantities, repeated alternately every three hours. Small electric percussions through the stomach.

3. Somnus interruptus. Interrupted sleep. In some fevers, where the inirritability is very great, when the patient falls asleep, the pulse in a few minutes becomes irregular, and the patient awakes in great disorder, and fear of dying, refusing to sleep again from the terror of this uneasy sensation. In this extreme debility there is reason to believe, that some voluntary power during our waking hours is employed to aid the irritative stimuli in carrying on the circulation of the blood through the lungs; in the same manner as we use voluntary exertions, when we listen to weak sounds, or wish to view an object by a small light; in sleep volition is suspended, and the deficient irritation alone is not sufficient to carry on the pulmonary circulation. This explanation seems the most probable one, because in cases of apoplexy the irritative motions of the arterial system do not seem to be impaired, nor in common sleep. See Incubus III. 2. 1. 13.

M. M. Opium in very small doses, as three drops of laudanum. A person should watch the patient, and awaken him frequently; or he should measure the time between slumber and slumber by a stop-watch, and awaken the patient a little before he would otherwise awake; or he should keep his finger on the pulse, and should forcibly awaken him, as soon as it becomes irregular, before the disorder of the circulation becomes so great as to disturb him. See Class I. 2. 1. 9. and Sect. XXVII. 2.

4. Syncope. Fainting consists in the decreased action of the arterial system; which is sometimes occasioned by defect of the stimulus of distention, as after venesection, or tapping for the dropsy. At other times it arises from great emotions of the mind, as in sudden joy or grief. In these cases the whole sensorial power is exerted on these interesting ideas, and becomes exhausted. Thus during great surprise or fear the heart stops for a time, and then proceeds with throbbing and agitation; and sometimes the vital motions become so deranged, as never to recover their natural successive action; as when children have been frightened into convulsions. See Sect. XII. 7. 1.

Miss ——, a young lady of Stafford, in travelling in a chaise was so affected by seeing the fall of a horse and postillion, in going down a hill, though the carriage was not overturned, that she fainted away, and then became convulsed, and never spoke afterwards; though she lived about three days in successive convulsions and stupor.

5. Haemorrhagia venosa. A bleeding from the capillaries arising from defect of venous absorption, as in some of those fevers commonly termed putrid. When the blood stagnates in the cellular membrane, it produces petechiae from this torpor or paralysis of the absorbent mouths of the veins. It must be observed, that those people who have diseased livers, are more liable to this kind of haemorrhages, as well as to the haemorrhagia arteriosa; the former, because patients with diseased livers are more subject to paralytic complaints in general, as to hemiplegia, and to dropsy, which is a paralysis of the lymphatics; and the latter is probably owing to the delay of the circulation in the vena porta by the torpor of this hepatic vessel, when the liver is not much enlarged; and to its pressure on the vena cava, when it is much enlarged.

M. M. Vitriolic acid, opium, steel, bark. Sponge bound on the part. Steel dissolved in spirit of wine externally. Flour.

6. Haemorrhois cruenta. In the bleeding piles the capillary vessels of the rectum become distended and painful from the defect of the venous absorption of the part, and at length burst; or the mucous glands are so dilated as to give a passage to the blood; it is said to observe lunar periods.

M. M. Venesection, poultices, cathartics, spice, cold bath, and sorbentia. External compression by applying lint, sponge, or cotton. Internal compression by applying a bit of candle smeared with mercurial ointment. Strangulate the tumid piles with a silk string. Cut them off. See Class I. 2. 3. 22.

Mrs. —— had for twelve or fifteen years, at intervals of a year or less, a bleeding from the rectum without pain; which however stopped spontaneously after she became weakened, or by the use of injections of brandy and water. Lately the bleeding continued above two months, in the quantity of many ounces a day, till she became pale and feeble to an alarming degree. Injections of solutions of lead, of bark and salt of steel, and of turpentine, with some internal astringents, and opiates, were used in vain. An injection of the smoke of tobacco, with ten grains of opium mixed with the tobacco, was used, but without effect the two first times on account of the imperfection of the machine; on the third time it produced great sickness, and vertigo, and nearly a fainting fit; from which time the blood entirely stopped. Was this owing to a fungous excrescence in the rectum; or to a blood-vessel being burst from the difficulty of the blood passing through the vena porta from some hepatic obstruction, and which had continued to bleed so long? Was it stopped at last by the fainting fit? or by the stimulus of the tobacco?

7. Haemorrhagia renum. Haemorrhage from the kidnies, when attended with no pain, is owing to defect of venous absorption in the kidney. When attended with pain on motion, it is owing to a bit of gravel in the ureter or pelvis of the kidney; which is a much more frequent disease than the former. See Sect. XXVII. 1.

M. M. 1. Venesection in small quantity, calomel, bark, steel, an opiate; cold immersion up to the navel, the upper part of the body being kept cloathed. Neville-Holt water. 2. Alcalized water aerated. Much diluent liquids. Cool dress. Cool bed-room.

Cows are much subject to bloody urine, called foul water by the farmers; in this disease about sixty grains of opium with or without as much rust of iron, given twice a day, in a ball mixed with flour and water, or dissolved in warm water, or warm ale, is, I believe, an efficacious remedy, to which however should be added about two quarts of barley or oats twice a day, and a cover at night, if the weather be cold.

8. Haemorrhagia Hepatis. Haemorrhage from the liver. It sometimes happens in those, who have the gutta rosea, or paralytic affections owing to diseased livers induced by the potation of fermented liquors, that a great discharge of black viscid blood occasionally comes away by stool, and sometimes by vomiting: this the ancients called Melancholia, black bile. If it was bile, a small quantity of it would become yellow or green on dilution with warm water, which was not the case in one experiment which I tried; it must remain some time in the intestines from its black colour, when it passes downwards, and probably comes from the bile-ducts, and is often a fatal symptom. When it is evacuated by vomiting it is less dangerous, because it shews greater remaining irritability of the intestinal canal, and is sometimes salutary to those who have diseased livers.

M. M. An emetic. Rhubarb, steel, wine, bark.

9. Haemoptoe venosa. Venous haemoptoe frequently attends the beginning of the hereditary consumptions of dark-eyed people; and in others, whose lungs have too little irritability. These spittings of blood are generally in very small quantity, as a tea-spoonful; and return at first periodically, as about once a month; and are less dangerous in the female than in the male sex; as in the former they are often relieved by the natural periods of the menses. Many of these patients are attacked with this pulmonary haemorrhage in their first sleep; because in feeble people the power of volition is necessary, besides that of irritation, to carry on respiration perfectly; but, as volition is suspended during sleep, a part of the blood is delayed in the vessels of the lungs, and in consequence effused, and the patient awakes from the disagreeable sensation. See Class I. 2. 1. 3. II. 1. 6. 6. III. 2. 1. 10.

M. M. Wake the patient every two or three hours by an alarum clock. Give half a grain of opium at going to bed, or twice a day. Onions, garlic, slight chalybeates. Issues. Leeches applied once a fortnight or month to the hemorrhoidal veins to produce a new habit. Emetics after each period of haemoptoe, to promote expectoration, and dislodge any effused blood, which might by remaining in the lungs produce ulcers by its putridity. A hard bed, to prevent too sound sleep. A periodical emetic or cathartic once a fortnight.

10. Palpitatio cordis. The palpitation of the heart frequently attends the haemoptoe above mentioned; and consists in an ineffectual exertion of the heart to push forwards its contents in due time, and with due force. The remote cause is frequently some impediment to the general circulation; as the torpor of the capillaries in cold paroxysms of fever, or great adhesions of the lungs. At other times it arises from the debility of the action of the heart owing to the deficient sensorial power of irritation or of association, as at the approach of death.

In both these cases of weak exertion the heart feels large to the touch, as it does not completely empty itself at each contraction; and on that account contracts more frequently, as described in Sect. XXXII. 2. 2. Another kind of palpitation may sometimes arise from the retrograde motions of the heart, as in fear. See Class I. 3. 1. 2. and IV. 3. 1. 6.

11. Menorrhagia. Continued flow of the catamenia. The monthly effusion of blood from the uterus or vagina is owing to a torpor of the veins of those membranes in consequence of the defect of venereal stimulus; and in this respect resembles the mucus discharged in the periodical venereal orgasm of the female quadrupeds, which are secluded from the males. The menorrhagia, or continued flow of this discharge, is owing to a continued defect of the venous absorption of the membranes of the uterus or vagina. See Class IV. 2. 4. 7.

M. M. Venesection in small quantity. A cathartic. Then opium, a grain every night. Steel. Bark. A blister. Topical aspersion with cold water, or cold vinegar.

12. Dysmenorrhagia. A difficulty of menstruation attended with pain. In this complaint the torpor of the uterine vessels, which precedes menstruation, is by sympathy accompanied with a torpor of the lumbar membranes, and consequent pain; and frequently with cold extremities, and general debility. The small quantity and difficulty of the discharge is owing to arterial inactivity, as in chlorosis. Whence it happens, that chalybeate medicines are of efficacy both to stop or prevent too great menstruation, and to promote or increase deficient menstruation; as the former is owing to inirritability of the veins, and the latter of the arteries of the uterus. See Article IV. 2. 6. in the Materia Medica.

M. M. Opium, steel, pediluvium. Warm bath.

13. Lochia nimia. Too great discharge after delivery. In that unnatural practice of some hasty accoucheurs of introducing the hand into the uterus immediately after the delivery of the child, and forcibly bringing away the placenta, it frequently happens, that a part of it is left behind; and the uterus, not having power to exclude so small a portion of it, is prevented from complete contraction, and a great haemorrhage ensues. In this circumstance a bandage with a thick compress on the lower part of the belly, by appressing the sides of the uterus on the remaining part of the placenta, is likely to check the haemorrhage, like the application of a pledget of any soft substance on a bleeding vessel.

In other cases the lochia continues too long, or in too great quantity, owing to the deficiency of venous absorption.

M. M. An enema. An opiate. A blister. Slight chalybeates. Peruvian bark. Clothes dipped in cold vinegar and applied externally. Bandages on the limbs to keep more blood in them for a time have been recommended.

14. Abortio spontanea. Some delicate ladies are perpetually liable to spontaneous abortion, before the third, or after the seventh, month of gestation. From some of these patients I have learnt, that they have awakened with a slight degree of difficult respiration, so as to induce them to rise hastily up in bed; and have hence suspected, that this was a tendency to a kind of asthma, owing to a deficient absorption of blood in the extremities of the pulmonary or bronchial veins; and have concluded from thence, that there was generally a deficiency of venous absorption; and that this was the occasion of their frequent abortion. Which is further countenanced, where a great sanguinary discharge precedes or follows the exclusion of the fetus.

M. M. Opium, bark, chalybeates in small quantity. Change to a warmer climate. I have directed with success in four cases half a grain of opium twice a day for a fortnight, and then a whole grain twice a day during the whole gestation. One of these patients took besides twenty grains of Peruvian bark for several weeks. By these means being exactly and regularly persisted in, a new habit became established, and the usual miscarriages were prevented.

Miscarriages more frequently happen from eruptive fevers, and from rheumatic ones, than from other inflammatory diseases. I saw a most violent pleurisy and hepatitis cured by repeated venesection about a week or ten days before parturition; yet another lady whom I attended, miscarried at the end of the chicken pox, with which her children were at the same time affected. Miscarriages towards the termination of the small pox are very frequent, yet there have been a few instances of children, who have been born with the eruption on them. The blood in the small pox will not inoculate that disease, if taken before the commencement of the secondary fever; as shewn in Sect. XXXIII. 2. 10. because the contagious matter is not yet formed, but after it has been oxygenated through the cuticle in the pustules, it becomes contagious; and if it be then absorbed, as in the secondary fever, the blood of the mother may become contagious, and infect the child. The same mode of reasoning is applicable to the chicken pox. See Class IV. 3. 1. 7.

15. Scorbutus. Sea-scurvy is caused by salt diet, the perpetual stimulus of which debilitates the venous and absorbent systems. Hence the blood is imperfectly taken up by the veins from the capillaries, whence brown and black spots appear upon the skin without fever. The limbs become livid and edematous, and lastly ulcers are produced from deficient absorption. See Sect. XXXIII. 3. 2. and Class II. 1. 4. 13. For an account of the scurvy of the lungs, see Sect. XXVII. 2.

M. M. Fresh animal and vegetable food. Infusion of malt. New beer. Sugar. Wine. Steel. Bark. Sorbentia. Opium?

16. Vibices. Extravasations of blood become black from their being secluded from the air. The extravasation of blood in bruises, or in some fevers, or after death in some patients, especially in the parts which were exposed to pressure, is owing to the fine terminations of the veins having been mechanically compressed so as to prevent their absorbing the blood from the capillaries, or to their inactivity from disease. The blood when extravasated undergoes a chemical change before it is sufficiently fluid to be taken up by the lymphatic absorbents, and in that process changes its colour to green and then yellow.

17. Petechiae. Purple spots. These attend fevers with great venous inirritability, and are probably formed by the inability of a single termination of a vein, whence the corresponding capillary becomes ruptured, and effuses the blood into the cellular membrane round the inert termination of the vein. This is generally esteemed a sign of the putrid state of the blood, or that state contrary to the inflammatory one. As it attends some inflammatory diseases which are attended with great inirritability, as in the confluent small pox. But it also attends the scurvy, where no fever exists, and it therefore simply announces the inactivity of the terminations of some veins; and is thence indeed a bad symptom in fevers, as a mark of approaching inactivity of the whole sanguiferous system, or death. The blue colour of some children's arms or faces in very cold weather is owing in like manner to the torpor of the absorbent terminations of the veins, whence the blood is accumulated in them, and sometimes bursts them.

* * * * *

ORDO II.

Decreased Irritation.

GENUS II.

Decreased Action of the Secerning System.

These are always attended with decrease of partial, or of general heat; for as the heat of animal bodies is the consequence of their various secretions, and is perpetually passing away into the ambient air, or other bodies in contact with them; when these secretions become diminished, or cease, the heat of the part or of the whole is soon diminished, or ceases along with them.

SPECIES.

1. Frigus febrile. Febrile coldness. There is reason to believe, that the beginning of many fever-fits originates in the quiescence of some part of the absorbent system, especially where they have been owing to external cold; but that, where the coldness of the body is not owing to a diminution of external heat, it arises from the inaction of some part of the secerning system. Hence some parts of the body are hot whilst other parts are cold; which I suppose gave occasion to error in Martyn's Experiments; where he says, that the body is as hot in the cold paroxysms of fevers as at other times.

After the sensorial power has been much diminished by great preceding activity of the system, as by long continued external heat, or violent exercise, a sudden exposure to much cold produces a torpor both greater in degree and over a greater portion of the system, by subtracting their accustomed stimulus from parts already much deprived of their irritability. Dr. Franklin in a letter to M. Duberge, the French translator of his works, mentions an instance of four young men, who bathed in a cold spring after a day's harvest work; of whom two died on the spot, a third on the next morning, and the other survived with difficulty. Hence it would appear, that those, who have to travel in intensely cold weather, will sooner perish, who have previously heated themselves much with drams, than those who have only the stimulus of natural food; of which I have heard one well attested instance. See Article VII. 2. 3. Class III. 2. 1. 17.

Frigus chronicum. Permanent coldness. Coldness of the extremities, without fever, with dry pale skin, is a symptom of general debility, owing to the decreased action of the arterial system, and of the capillary vessels; whence the perspirable matter is secreted in less quantity, and in consequence the skin is less warm. This coldness is observable at the extremities of the limbs, ears, and nose, more than in any other parts: as a larger surface is here exposed to the contact of the air, or clothes, and thence the heat is more hastily carried away.

The pain, which accompanies the coldness of the skin, is owing to the deficient exertion of the subcutaneous vessels, and probably to the accumulation of sensorial power in the extremities of their nerves. See Sect. XII. 5. 3. XIV. 6. XXXII. 3. and Class I. 2. 4. 1.

M. M. A blister. Incitantia, nutrientia, sorbentia. Exercise. Clothes. Fire. Joy. Anger.

2. Pallor fugitivus. The fugitive paleness, which accompanies the coldness of the extremities, is owing to a less quantity of blood passing through the capillaries of the skin in a given time; where the absorbent power of the veins is at the same time much diminished, a part of the blood lingers at their junction with the capillary arteries, and a bluish tinge is mixed with the paleness; as is seen in the loose skin under the eye-lids, and is always a mark of temporary debility. See Class II. 1. 4. 4. Where the paleness of the skin is owing to the deficiency of red globules in the blood, it is joined with a yellowish tinge; which is the colour of the serum, with which the blood then abounds, as in chlorosis, and in torpor or paralysis of the liver, and is often mistaken for a superabundance of bile.

A permanent paleness of the skin is owing to the coalescence of the minute arteries, as in old age. See Class I. 2. 2. 9. There is another source of paleness from the increased absorption of the terminations of the veins, as when vinegar is applied to the lips. See Sect. XXVII. 1. and another from the retrograde motions of the capillaries and fine extremities of the arteries. See Class II. 3. 1. 1.

M. M. A blister, nutrientia, incitantia, exercise, oxygene gas.

3. Pus parcius. Diminished pus. Dryness of ulcers. In the cold fits of fever all the secretions are diminished, whether natural or artificial, as their quantity depends on the actions of the glands or capillaries, which then share in the universal inaction of the system. Hence the dryness of issues and blisters in great debility, and before the approach of death, is owing to deficient secretion, and not to increased absorption.

M. M. Opium, wine in very small quantities, Peruvian bark.

4. Mucus parcior. Diminished mucus. Dryness of the mouth and nostrils. This also occurs in the cold fits of intermittents. In these cases I have also found the tongue cold to the touch of the finger, and the breath to the back of one's hand, when opposed to it, which are very inauspicious symptoms, and generally fatal. In fevers with inirritability it is generally esteemed a good symptom, when the nostrils and tongue become moist after having been previously dry; as it shews an increased action of the mucous glands of those membranes, which were before torpid. And the contrary to this is the facies Hippocratica, or countenance so well described by Hippocrates, which is pale, cold, and shrunk; all which are owing to the inactivity of the secerning vessels, the paleness from there being less red blood passing through the capillaries, the coldness of the skin from there being less secretion of perspirable matter, and the shrunk appearance from there being less mucus secreted into the cells of the cellular membrane. See Class IV. 2. 4. 11.

M. M. Blisters. Incitantia.

5. Urina parcior pallida. Paucity of pale urine, as in the cold fits of intermittents; it appears in some nervous fevers throughout the whole disease, and seems to proceed from a palsy of the kidnies; which probably was the cause of the fever, as the fever sometimes ceases, when that symptom is removed: hence the straw-coloured urine in this fever is so far salutary, as it shews the unimpaired action of the kidnies.

M. M. Balsams, essential oil, asparagus, rhubarb, a blister. Cantharides internally.

6. Torpor hepaticus. Paucity of bile from a partial inaction of the liver; hence the bombycinous colour of the skin, grey stools, urine not yellow, indigestion, debility, followed by tympany, dropsy, and death.

This paralysis or inirritability of the liver often destroys those who have been long habituated to much fermented liquor, and have suddenly omitted the use of it. It also destroys plumbers, and house-painters, and in them seems a substitute for the colica saturnina. See Sect. XXX.

M. M. Aloe and calomel, then the bark, and chalybeates. Mercurial ointment rubbed on the region of the liver. Rhubarb, three or four grains, with opium half a grain to a grain twice a day. Equitation, warm bath for half an hour everyday.

7. Torpor Pancreatis. Torpor of the pancreas. I saw what I conjectured to be a tumour of the pancreas with indigestion, and which terminated in the death of the patient. He had been for many years a great consumer of tobacco, insomuch that he chewed that noxious drug all the morning, and smoaked it all the afternoon. As the secretion from the pancreas resembles saliva in its general appearance, and probably in its office of assisting digestion, by preventing the fermentation of the aliment; as would appear by the experiments of Pringle and Macbride; there is reason to suspect, that a sympathy may exist between the salivary and pancreatic glands; and that the perpetual stimulus of the former by tobacco might in process of time injure the latter. See Tobacco, Article III. 2. 2.

8. Torpor renis. Inirritability or paralysis of the kidnies is probably frequently mistaken for gravel in them. Several, who have lived rather intemperately in respect to fermented or spirituous liquors, become suddenly seized about the age of sixty, or later, with a total stoppage of urine; though they have previously had no symptoms of gravel. In these cases there is no water in the bladder; as is known by the introduction of the catheter, of which those made of elastic gum are said to be preferable to metallic ones; or it may generally be known by the shape of the abdomen, either by the eye or hand. Bougies and catheters of elastic gum are sold at N^o 37, Red Lion-street, Holborn, London.

M. M. Electric shocks, warm bath. Emetics. See calculus renis, Class I. 1. 3. 9. When no gravel has been previously observed, and the patient has been a wine-drinker rather than an ale-drinker, the case is generally owing to inirritability of the tubuli uriniferi, and is frequently fatal. See Class I. 2. 4. 20.

9. Punctae mucosae vultus. Mucous spots on the face. These are owing to the inactivity of the excretory ducts of the mucous glands; the thinner part of this secretion exhales, and the remainder becomes inspissated, and lodges in the duct; the extremity of which becomes black by exposure to the air.

M. M. They may be pressed out by the finger-nails. Warm water. Ether frequently applied. Blister on the part?

10. Maculae cutis fulvae. Morphew or freckles. Tawny blotches on the skin of the face and arms of elderly people, and frequently on their legs after slight erysipelas. The freckles on the face of younger people, who have red hair, seem to be a similar production, and seem all to be caused by the coalescence of the minute arteries or capillaries of the part. In a scar after a wound the integument is only opake; but in these blotches, which are called morphew and freckles, the small vessels seem to have become inactive with some of the serum of the blood stagnating in them, from whence their colour. See Class III. 1. 2. 12.

M. M. Warm bathing. A blister on the part?

11. Canities. Grey hair. In the injection of the vessels of animals for the purposes of anatomical preparations, the colour of the injected fluid will not pass into many very minute vessels; which nevertheless uncoloured water, or spirits, or quicksilver will permeate. The same occurs in the filtration of some coloured fluids through paper, or very fine sand, where the colouring matter is not perfectly dissolved, but only diffused through the liquid. This has led some to imagine, that the cause of the whiteness of the hair in elderly people may arise from the diminution, or greater tenuity, of the glandular vessels, which secrete the mucus, which hardens into hair; and that the same difference of the tenuity of the secerning vessels may possibly make the difference of colour of the silk from different silk-worms, which is of all shades from yellow to white.

But as the secreted fluids are not the consequence of mechanical filtration, but of animal selection; we must look out for another cause, which must be found in the decreasing activity of the glands, as we advance in life; and which affects many of our other secretions as well as that of the mucus, which forms the hair. Hence grey hairs are produced on the faces of horses by whatever injures the glands at their roots, as by corrosive blisters; and frequently on the human subject by external injuries on the head; and sometimes by fevers. And as the grey colour of hair consists in its want of transparency, like water converted into snow; there is reason to suppose, that a defect of secreted moisture simply may be the cause of this kind of opacity, as explained in Cataracta, Class I. 2. 2. 13.

M. M. Whatever prevents the inirritability and insensibility of the system, that is, whatever prevents the approach of old age, will so far counteract the production of grey hairs, which is a symptom of it. For this purpose in people, who are not corpulent, and perhaps in those who are so, the warm bath twice or thrice a week is particularly serviceable. See Sect. XXXIX. 5. 1. on the colours of animals, and Class I. 1. 2. 15.

12. Callus. The callous skin on the hands and feet of laborious people is owing to the extreme vessels coalescing from the perpetual pressure they are exposed to.

As we advance in life, the finer arteries lose their power of action, and their sides grow together; hence the paleness of the skins of elderly people, and the loss of that bloom, which is owing to the numerous fine arteries, and the transparency of the skin, that encloses them.

M. M. Warm bath. Paring the thick skin with a knife. Smoothing it with a pumice stone. Cover the part with oiled silk to prevent the evaporation of the perspirable matter, and thus to keep it moist.

13. Cataracta is an opacity of the crystalline lens of the eye. It is a disease of light-coloured eyes, as the gutta serena is of dark ones. On cutting off with scissars the cornea of a calf's eye, and holding it in the palm of one's hand, so as to gain a proper light, the artery, which supplies nutriment to the crystalline humour, is easily and beautifully seen; as it rises from the centre of the optic nerve through the vitreous humour to the crystalline. It is this point, where the artery enters the eye through the cineritious part of the optic nerve, (which is in part near the middle of the nerve,) which is without sensibility to light; as is shewn by fixing three papers, each of them about half an inch in diameter, against a wall about a foot distant from each other, about the height of the eye; and then looking at the middle one, with one eye, and retreating till you lose sight of one of the external papers. Now as the animal grows older, the artery becomes less visible, and perhaps carries only a transparent fluid, and at length in some subjects I suppose ceases to be pervious; then it follows, that the crystalline lens, losing some fluid, and gaining none, becomes dry, and in consequence opake; for the same reason, that wet or oiled paper is more transparent than when it is dry, as explained in Class I. 1. 4. 1. The want of moisture in the cornea of old people, when the exhalation becomes greater than the supply, is the cause of its want of transparency; and which like the crystalline gains rather a milky opacity. The same analogy may be used to explain the whiteness of the hair of old people, which loses its pellucidity along with its moisture. See Class I. 2. 2. 11.

M. M. Small electric shocks through the eye. A quarter of a grain of corrosive sublimate of mercury dissolved in brandy, or taken in a pill, twice a day for six weeks. Couching by depression, or by extraction. The former of these operations is much to be preferred to the latter, though the latter is at this time so fashionable, that a surgeon is almost compelled to use it, lest he should not be thought an expert operator. For depressing the cataract is attended with no pain, no danger, no confinement, and may be as readily repeated, if the crystalline should rise again to the centre of the eye. The extraction of the cataract is attended with considerable pain, with long confinement, generally with fever, always with inflammation, and frequently with irreparable injury to the iris, and consequent danger to the whole eye. Yet has this operation of extraction been trumpeted into universal fashion for no other reason but because it is difficult to perform, and therefore keeps the business in the hands of a few empyrics, who receive larger rewards, regardless of the hazard, which is encountered by the flattered patient.

A friend of mine returned yesterday from London after an absence of many weeks; he had a cataract in a proper state for the operation, and in spite of my earnest exhortation to the contrary, was prevailed upon to have it extracted rather than depressed. He was confined to his bed three weeks after the operation, and is now returned with the iris adhering on one side so as to make an oblong aperture; and which is nearly, if not totally, without contraction, and thus greatly impedes the little vision, which he possesses. Whereas I saw some patients couched by depression many years ago by a then celebrated empyric, Chevalier Taylor, who were not confined above a day or two, that the eye might gradually be accustomed to light, and who saw as well as by extraction, perhaps better, without either pain, or inflammation, or any hazard of losing the eye.

As the inflammation of the iris is probably owing to forcing the crystalline through the aperture of it in the operation of extracting it, could it not be done more safely by making the opening behind the iris and ciliary process into the vitreous humour? but the operation would still be more painful, more dangerous, and not more useful than that by depressing it.

14. Innutritio ossium. Innutrition of the bones. Not only the blood effused in vibices and petechiae, or from bruises, as well as the blood and new vessels in inflamed parts, are reabsorbed by the increased action of the lymphatics; but the harder materials, which constitute the fangs of the first set of teeth, and the ends of exfoliating bones, and sometimes the matter of chalk-stones in the gout, the coagulable lymph, which is deposited on the lungs, or on the muscles after inflammation of those parts, and which frequently produces difficulty of breathing, and the pains of chronic rheumatism, and lastly the earthy part of the living bones are dissolved and absorbed by the increased actions of this system of vessels. See Sect. XXXIII. 3. 1.

The earthy part of bones in this disease of the innutrition of them seems to suffer a solution, and reabsorption; while the secerning vessels do not supply a sufficient quantity of calcareous earth and phosphoric acid, which constitute the substance of bones. As calcareous earth abounds every where, is the want of phosphoric acid the remote cause? One cause of this malady is given in the Philosophic Transactions, where the patient had been accustomed to drink large quantities of vinegar. Two cases are described by Mr. Gouch. In one case, which I saw, a considerable quantity of calcareous earth, and afterwards of bone-ashes, and of decoction of madder, and also of sublimate of mercury, were given without effect. All the bones became soft, many of them broke, and the patient seemed to die from the want of being able to distend her chest owing to the softness of the ribs.

M. M. Salt of urine, called sal microcosmicum, phosphorated soda. Calcined hartshorn. Bone-ashes. Hard or petrifying water, as that of Matlock, or such as is found in all limestone or marly countries. The calcareous earth in these waters might possibly be carried to the bones, as madder is known to colour them. Warm bath. Volatile or fixed alcali as a lotion on the spine, or essential oils.

The innutrition of the bones is often first to be perceived by the difficulty of breathing and palpitation of the heart on walking a little faster than usual, which I suppose is owing to the softness of the ends of the ribs adjoining to the sternum; on which account they do not perfectly distend the chest, when they are raised by the pectoral and intercostal muscles with greater force than usual. After this the spine becomes curved both by the softness of its vertebrae, and for the purpose of making room for the disturbed heart. See Species 16 of this genus.

As these patients are pale and weak, there would seem to be a deficiency of oxygene in their blood, and in consequence a deficiency of phosphoric acid; which is probably produced by oxygene in the act of respiration.

Mr. Bonhome in the Chemical Annals, August, 1793, supposes the rickets to arise from the prevalence of vegetable or acetous acid, which is known to soften bones out of the body. Mr. Dettaen seems to have espoused a similar opinion, and both of them in consequence give alcalies and testacea. If this theory was just, the soft bones of such patients should shew evident marks of such acidity after death; which I believe has not been observed. Nor is it analogous to other animal facts, that nutritious fluids secreted by the finest vessels of the body should be so little animalized, as to retain acetous or vegetable acidity.

The success attending the following case in so short a time as a fortnight I ascribed principally to the use of the warm bath; in which the patient continued for full half an hour every night, in the degree of heat, which was most grateful to her sensation, which might be I suppose about 94. Miss ——, about ten years of age, and very tall and thin, has laboured under palpitation of her heart, and difficult breathing on the least exercise, with occasional violent dry cough, for a year or more, with dry lips, little appetite either for food or drink, and dry skin, with cold extremities. She has at times been occasionally worse, and been relieved in some degree by the bark. She began to bend forwards, and to lift up her shoulders. The former seemed owing to a beginning curvature of the spine, the latter was probably caused to facilitate her difficult respiration.

M. M. She used the warm bath, as above related; which by its warmth might increase the irritability of the smallest series of vessels, and by supplying more moisture to the blood might probably tend to carry further the materials, which form calcareous or bony particles, or to convey them in more dilute solution. She took twice a day twenty grains of extract of bark, twenty grains of soda phosphorata, and ten grams of chalk, and ten of calcined hartshorn mixed into a powder with ten drops of laudanum; with flesh food both to dinner and supper; and port wine and water instead of the small beer, she had been accustomed to; she lay on a sofa frequently in a day, and occasionally used a neck-swing.

15. Rachitis. Rickets. The head is large, protuberant chiefly on the forepart. The smaller joints are swelled; the ribs depressed; the belly tumid, with other parts emaciated. This disease from the innutrition or softness of the bones arose about two centuries ago; seems to have been half a century in an increasing or spreading state; continued about half a century at its height, or greatest diffusion; and is now nearly vanished: which gives reason to hope, that the small-pox, measles, and venereal disease, which are all of modern production, and have already become milder, may in process of time vanish from the earth, and perhaps be succeeded by new ones! See the preceding species.

16. Spinae distortio. Distortion of the spine is another disease originating from the innutrition or softness of the bones. I once saw a child about six years old with palpitation of heart, and quickness of respiration, which began to have a curvature of the spine; I then doubted, whether the palpitation and quick respiration were the cause or consequence of the curvature of the spine; suspecting either that nature had bent the spine outwards to give room to the enlarged heart; or that the malformation of the chest had compressed and impeded the movements of the heart. But a few weeks ago on attending a young lady about ten years old, whose spine had lately began to be distorted, with very great difficulty and quickness of respiration, and alarming palpitation of the heart, I convinced myself, that the palpitation and difficult respiration were the effect of the change of the cavity of the chest from the distortion of the spine; and that the whole was therefore a disease of the innutrition or softness of the bones.

For on directing her to lie down much in the day, and to take the bark, the distortion became less, and the palpitation and quick respiration became less at the same time. After this observation a neck-swing was directed, and she took the bark, madder, and bone-ashes; and she continues to amend both in her shape and health.

Delicate young ladies are very liable to become awry at many boarding schools. This is occasioned principally by their being obliged too long to preserve an erect attitude, by sitting on forms many hours together. To prevent this the school-seats should have either backs, on which they may occasionally rest themselves; or desks before them, on which they may occasionally lean. This is a thing of greater consequence than may appear to those, who have not attended to it.

When the least tendency to become awry is observed, they should be advised to lie down on a bed or sofa for an hour in the middle of the day for many months; which generally prevents the increase of this deformity by taking off for a time the pressure on the spine of the back, and it at the same time tends to make them grow taller. Young persons, when nicely measured, are found to be half an inch higher in a morning than at night; as is well known to those, who inlist very young men for soldiers. This is owing to the cartilages between the bones of the back becoming compressed by the weight of the head and shoulders on them during the day. It is the same pressure which produces curvatures and distortions of the spine in growing children, where the bones are softer than usual; and which may thus be relieved by an horizontal posture for an hour in the middle of the day, or by being frequently allowed to lean on a chair, or to play on the ground on a carpet.

Young ladies should also be directed, where two sleep in a bed, to change every night, or every week, their sides of the bed; which will prevent their tendency to sleep always on the same side; which is not only liable to produce crookedness, but also to occasion diseases by the internal parts being so long kept in uniform contact as to grow together. For the same reason they should not be allowed to sit always on the same side of the fire or window, because they will then be inclined too frequently to bend themselves to one side.

Another great cause of injury to the shape of young ladies is from the pressure of stays, or other tight bandages, which at the same time cause other diseases by changing the form or situation of the internal parts. If a hard part of the stays, even a knot of the thread, with which they are sewed together, is pressed hard upon one side more than the other, the child bends from the side most painful, and thus occasions a curvature of the spine. To counteract this effect such stays, as have fewest hard parts, and especially such as can be daily or weekly turned, are preferable to others.



Where frequent lying down on a sofa in the day-time, and swinging frequently for a short time by the hands or head, with loose dress, do not relieve a beginning distortion of the back; recourse may be had to a chair with stuffed moveable arms for the purpose of suspending the weight of the body by cushions under the arm-pits, like resting on crutches, or like the leading strings of infants. From the top of the back of the same chair a curved steel bar may also project to suspend the body occasionally, or in part by the head, like the swing above mentioned. The use of this chair is more efficacious in straightening the spine, than simply lying down horizontally; as it not only takes off the pressure of the head and shoulders from the spine, but at the same time the inferior parts of the body contribute to draw the spine straight by their weight; or lastly, recourse may be had to a spinal machine first described in the Memoires of the academy of surgery in Paris, Vol. III. p. 600, by M. Le Vacher, and since made by Mr. Jones, at N^o 6, North-street, Tottenham-court Road, London, which suspends the head, and places the weight of it on the hips. This machine is capable of improvement by joints in the bar at the back of it, to permit the body to bend forwards without diminishing the extension of the spine.

The objections of this machine of M. Vacher, which is made by Mr. Jones, are first, that it is worn in the day-time, and has a very unsightly appearance. Mr. Jones has endeavoured to remedy this, by taking away the curved bar over the head, and substituting in its place a forked bar, rising up behind each ear, with webs fastened to it, which pass under the chin and occiput. But this is not an improvement, but a deterioration of M. Vacher's machine, as it prevents the head from turning with facility to either side. Another objection is, that its being worn, when the muscles of the back are in action, it is rather calculated to prevent the curvature of the spine from becoming greater, than to extend the spine, and diminish its curvature.



For this latter purpose I have made a steel bow, as described in the annexed plate, which receives the head longitudinally from the forehead to the occiput; having a fork furnished with a web to sustain the chin, and another to sustain the occiput. The summit of the bow is fixed by a swivel to the board going behind the head of the bed above the pillow. The bed is to be inclined from the head to the feet about twelve or sixteen inches. Hence the patient would be constantly sliding down during sleep, unless supported by this bow, with webbed forks, covered also with fur, placed beneath the chin, and beneath the occiput. There are also proper webs lined with fur for the hands to take hold off occasionally, and also to go under the arms. By these means I should hope great advantage from gradually extending the spine during the inactivity of the muscles of the back; and that it may be done without disturbing the sleep of the patient, and if this should happen, the bow is made to open by a joint at the summit of it, so as to be instantly disengaged from the neck by the hand of the wearer. This bow I have not yet had opportunity to make use of, but it may be had from Mr. Harrison, whitesmith, Bridge-gate, Derby.

It will be from hence easily perceived, that all other methods of confining or directing the growth of young people should be used with great skill; such as back-boards, or bandages, or stocks for the feet; and that their application should not be continued too long at a time, lest worse consequences should ensue, than the deformity they were designed to remove. To this may be added, that the stiff erect attitude taught by some modern dancing masters does not contribute to the grace of person, but rather militates against it; as is well seen in one of the prints in Hogarth's Analysis of Beauty; and is exemplifyed by the easy grace of some of the ancient statues, as of the Venus de Medici, and the Antinous, and in the works of some modern artists, as in a beautiful print of Hebe feeding an Eagle, painted by Hamilton, and engraved by Eginton, and many of the figures of Angelica Kauffman.

Where the bone of one of the vertebrae of the back has been swelled on both sides of it, so as to become protuberant, issues near the swelled part have been found of great service, as mentioned in Species 18 of this genus. This has induced me to propose in curvatures of the spine, to put an issue on the outside of the curve, where it could be certainly ascertained, as the bones on the convex side of the curve must be enlarged; in one case I thought this of service, and recommend the further trial of it.

In the tendency to curvature of the spine, whatever strengthens the general constitution is of service; as the use of the cold bath in the summer months. This however requires some restriction both in respect to the degree of coldness of the bath, the time of continuing in it, and the season of the year. Common springs, which are of forty-eight degrees of heat, are too cold for tender constitutions, whether of children or adults, and frequently do them great and irreparable injury. The coldness of river water in the summer months, which is about sixty-eight degrees, or that of Matlock, which is about sixty-eight, or of Buxton, which is eighty-two, are much to be preferred. The time of continuing in the bath should be but a minute or two, or not so long as to occasion a trembling of the limbs from cold. In respect to the season of the year, delicate children should certainly only bathe in the summer months; as the going frequently into the cold air in winter will answer all the purposes of the cold bath.

17. Claudicatio coxaria. Lameness of the hip. A nodding of the thigh-bone is said to be produced in feeble children by the softness of the neck or upper part of that bone beneath the cartilage; which is naturally bent, and in this disease bends more downwards, or nods, by the pressure of the body; and thus renders one leg apparently shorter than the other. In other cases the end of the bone is protruded out of its socket, by inflammation or enlargement of the cartilages or ligaments of the joint, so that it rests on some part of the edge of the acetabulum, which in time becomes filled up. When the legs are straight, as in standing erect, there is no verticillary motion in the knee-joint; all the motion then in turning out the toes further than nature designed, must be obtained by straining in some degree this head of the thigh-bone, or the acetabulum, or cavity, in which it moves. This has induced me to believe, that this misfortune of the nodding of the head by the bone, or partial dislocation of it, by which one leg becomes shorter than the other, is sometimes occasioned by making very young children stand in what are called stocks; that is with their heels together, and their toes quite out. Whence the socket of the thigh-bone becomes inflamed and painful, or the neck of the bone is bent downward and outwards.

In this case there is no expectation of recovering the straightness of the end of the bone; but these patients are liable to another misfortune, that is, to acquire afterwards a distortion of the spine; for as one leg is shorter than the other, they sink on that side, and in consequence bend the upper part of their bodies, as their shoulders, the contrary way, to balance themselves; and then again the neck is bent back again towards the lame side, to preserve the head perpendicular; and thus the figure becomes quite distorted like the letter S, owing originally to the deficiency of the length of one limb. The only way to prevent this curvature of the spine is for the child to wear a high-heeled shoe or patten on the lame foot, so as to support that side on the same level with the other, and thus to prevent a greater deformity.

I have this day seen a young lady about twelve, who does not limp or waddle in walking; but nevertheless, when she stands or sits, she sinks down towards her right side, and turns out that toe more than the other. Hence, both as she sits and stands, she bends her body to the right; whence her head would hang a little over her right shoulder; but to replace this perpendicularly, she lifts up her left shoulder and contracts the muscles on that side of the neck; which are therefore become thicker and stronger by their continued action; but there is not yet any very perceptible distortion of the spine.

As her right toe is turned outward rather more than natural, this shews the disease to be in the hip-joint; because, when the limb is stretched out, the toe cannot turn horizontally in the least without moving the end of the thigh-bone; although when the knee is bent, the toe can be turned through one third or half of a circle by the rotation of the tibia and fibula of the leg round each other. Hence if children are set in stocks with their heels touching each other as they sit, and are then made to rise up, till they stand erect, the socket or head of the thigh-bone becomes injured, especially in those children, whose bones are soft; and a shortness of that limb succeeds either by the bending of the neck of the thigh-bone, or by its getting out of the acetabulum; and a consequent rising of one shoulder, and a curvature of the spine is produced from so distant a cause.

M. M. An elastic cushion made of curled hair should be placed under the affected hip, whenever she sits; or should be fitted to the part by means of drawers, so that she cannot avoid sitting on it. A neck-swing, and lying down in the day, should be occasionally used to prevent or remove any curvature of the spine. The rest as in Species 13 and 15 of this genus.

18. Spina protuberans. Protuberant spine. One of the bones of the spine swells, and rises above the rest. This is not an uncommon disease, and belongs to the innutrition of the bones, as the bone must become soft before it swells; which softness is owing to defect of the secretion of phosphorated calcareous earth. The swelling of the bone compresses a part of the brain, called the spinal marrow, within the cavity of the back-bones; and in consequence the lower limbs become paralytic, attended sometimes with difficulty of emptying the bladder and rectum.

M. M. Issues put on each side of the prominent bone are of great effect, I suppose, by their stimulus; which excites into action more of the sensorial powers of irritation and sensation, and thus gives greater activity to the vascular system in their vicinity. The methods recommended in distortion of the spine are also to be attended to.

19. Spina bifida. Divided spine, called also Hydrorachitis, as well as the Hydrocephalus externus, are probably owing in part to a defect of ossification of the spine and cranium; and that the collection of fluid beneath them may originate from the general debility of the system; which affects both the secerning, and absorbent vessels.

A curious circumstance, which is affirmed to attend the spina bifida, is, that on compressing the tumor with the hand gently, the whole brain becomes affected, and the patient falls asleep. I suppose the same must happen on compressing the hydrocephalus externus? See Sect. XVIII. 20.

20. Ossis palati defectus. A defect of the bone of the palate, which frequently accompanies a division of the upper lip, occurs before nativity; and is owing to the deficient action of the secerning system, from whence the extremities are not completed. From a similar cause I have seen the point of the tongue deficient, and one joint of the two least fingers, and of the two least toes, in the same infant; who was otherwise a fine girl. See Sect. XXXIX. 4. 4.

The operation for the hare-lip is described by many surgical writers; but there is a person in London, who makes very ingenious artificial palates; which prevents that defect of speech, which attends this malformation. This factitious palate consists of a thin plate of silver of the shape and form of the roof of the mouth; from the front edge to the back edge of this silver plate four or five holes are made in a straight line large enough for a needle to pass through them; on the back of it is then sewed a piece of sponge; which when expanded with moisture is nearly as large as the silver plate. This sponge is slipped through the division of the bone of the palate, so as to lie above it, while the silver plate covers the aperture beneath, and is suspended by the expanding sponge. This is removed every night and washed, and returned into its place in the morning; on this account it is convenient to have five or six of them, for the sake of cleanliness. I have been more particular in describing this invention, as I do not know the name, or place of residence, of the maker.

* * * * *

ORDO II.

Decreased Irritation.

GENUS III.

The Decreased Action of the Absorbent System.

Some decrease of heat attends these diseases, though in a less degree than those of the last genus, because the absorbent system of glands do not generate so much heat in their healthy state of action as the secerning system of glands, as explained in Class I. 1. 3.

SPECIES.

1. Mucus faucium frigidus. Cold mucus from the throat. Much mucus, of rather a saline taste, and less inspissated than usual, is evacuated from the fauces by hawking, owing to the deficient absorption of the thinner parts of it. This becomes a habit in some elderly people, who are continually spitting it out of their mouths; and has probably been brought on by taking snuff, or smoking tobacco; which by frequently stimulating the fauces have at length rendered the absorbent vessels less excitable by the natural stimulus of the saline part of the secretion, which ought to be reabsorbed, as soon as secreted.

M. M. A few grains of powder of bark frequently put into the mouth, and gradually diffused over the fauces. A gargle of barley water.

2. Sudor frigidus. The cold dampness of the hands of some people is caused by the deficient absorption of perspirable matter; the clammy or viscid feel of it is owing to the mucous part being left upon the skin. The coldness is produced both by the decreased action of the absorbent system, and by the evaporation of a greater quantity of the perspirable matter into the air, which ought to have been absorbed.

M. M. Wash the hands in lime water, or with a small quantity of volatile alcali in water.

3. Catarrhus frigidus. The thin discharge from the nostrils in cold weather. The absorbent vessels become torpid by the diminution of external heat, sooner than the secerning ones, which are longer kept warm by the circulating blood, from which they select the fluid they secrete; whereas the absorbent vessels of the nostrils drink up their fluids, namely the thin and saline part of the mucus, after it has been cooled by the atmosphere. Hence the absorbents ceasing to act, and the secerning vessels continuing some time longer to pour out the mucus, a copious thin discharge is produced, which trickles down the nostrils in cold weather. This discharge is so acrid as to inflame the upper lip; which is owing to the neutral salts, with which it abounds, not being reabsorbed; so the tears in the fistula lacrymalis inflame the cheek. See Class I. 1. 2. 7.

4. Expectoratio frigida. Cold expectoration. Where the pulmonary absorption is deficient, an habitual cough is produced, and a frequent expectoration of thin saline mucus; as is often seen in old enfeebled people. Though the stimulus of the saline fluid, which attends all secretions, is not sufficient to excite the languid absorbent vessels to imbibe it; yet this saline part, together with the increased quantity of the whole of the secreted mucus, stimulates the branches of the bronchia, so as to induce an almost incessant cough to discharge it from the lungs. A single grain of opium, or any other stimulant drug, as a wine-posset with spirit of hartshorn, will cure this cold cough, and the cold catarrh of the preceding article, like a charm, by stimulating the torpid mouths of the absorbents into action. Which has given rise to an indiscriminate and frequently pernicious use of the warm regimen in coughs and catarrhs of the warm or inflammatory kind, to the great injury of many.

M. M. Half a grain of opium night and morning promotes the absorption of the more fluid and saline parts, and in consequence thickens the mucus, and abates its acrimony. Warm diluent drink, wine-whey, with volatile alcali.

5. Urina uberior pallida. On being exposed naked to cold air, or sprinkled with cold water, a quantity of pale urine is soon discharged; for the absorbents of the bladder become torpid by their sympathy with those of the skin; which are rendered quiescent by the diminution of external heat; but the kidnies continue to secrete the urine, and as no part of it is absorbed, it becomes copious and pale. This happens from a similar cause in cold fits of agues; and in less degree to many debilitated constitutions, whose extremities are generally cold and pale. The great quantity of limpid water in hysteric cases, and in diabaetes, belongs to Class I. 3. 1. 10. I. 3. 2. 6.

M. M. Tincture of cantharides, opium, alum, sorbentia. Flannel shirt in cold weather. Animal food. Beer. Wine. Friction. Exercise. Fire.

6. Diarrhoea frigida. Liquid stools are produced by exposing the body naked to cold air, or sprinkling it with cold water, for the same reason as the last article.

But this disease is sometimes of a dangerous nature; the intestinal absorption being so impaired, that the aliment is said to come away undiminished in quantity, and almost unchanged by the powers of digestion, and is then called lientery.

The mucus of the rectum sometimes comes away like pellucid hartshorn jelly, and liquefies by heat like that, towards the end of inirritative fevers, which is owing to the thinner part of the mucus not being absorbed, and thus resembles the catarrh of some old people.

M. M. Opium, campechy wood, armenian bole. Blister. Flannel shirt in cold weather. Clysters with opium. Friction on the bowels morning and night. Equitation twice a day.

7. Fluor albus frigidus. Cold fluor albus. In weak constitutions, where this discharge is pellucid and thin, it must proceed from want of absorption of the mucous membrane of the vagina, or uterus, and not from an increased secretion. This I suspect to be the most frequent kind of fluor albus; the former one described at Class I. 1. 2. 11. attends menstruation, or is a discharge instead of it, and thus resembles the venereal orgasm of female quadrupeds. The discharge in this latter kind being more saline, is liable to excoriate the part, and thus produce smarting in making water; in its great degree it is difficult to cure.

M. M. Increase the evacuation by stool and by perspiration, by taking rhubarb every night, about six or ten grains with one grain of opium for some months. Flannel shirt in winter. Balsam copaiva. Gum kino, bitters, chalybeates, friction over the whole skin with flannel morning and night. Partial cold bath, by sprinkling the loins and thighs, or sponging them with cold water. Mucilage, as isinglass boiled in milk; blanc mange, hartshorn jelly, are recommended by some. Tincture of cantharides sometimes seems of service given from ten to twenty drops or more, three or four times a day. A large plaster of burgundy pitch and armenian bole, so as to cover the loins and lower part of the belly, is said to have sometimes succeeded by increasing absorption by its compression in the manner of a bandage. A solution of metallic salts, as white vitriol, sixty grains to a pint; or an infusion of oak-bark may be injected into the vagina. Cold bath.

8. Gonorrhoea frigida. Cold gleet. Where the gleet is thin and pellucid, it must arise from the want of absorption of the membranes of the urethra, rather than from an increased secretion from them. This I suppose to be a more common disease than that mentioned at Class I. 1. 2. 10.

M. M. Metallic injections, partial cold bath, internal method as in the fluor albus above described. Balsam of copaiva. Tincture of cantharides.

9. Hepatis tumor. The liver becomes enlarged from defect of the absorption of mucus from its cells, as in anasarca, especially in feeble children; at the same time less bile is secreted from the torpid circulation in the vena portae. And as the absorbents, which resume the thinner parts of the bile from the gall-bladder and hepatic ducts, are also torpid or quiescent, the bile is more dilute, as well as in less quantity. From the obstruction of the passage of the blood through the compressed vena porta these patients have tumid bellies, and pale bloated countenances; their paleness is probably owing to the deficiency of the quantity of red globules in the blood in consequence of the inert state of the bile.

These symptoms in children are generally attended with worms, the dilute bile and the weak digestion not destroying them. In sleep I have seen fleuke-worms in the gall-ducts themselves among the dilute bile; which gall-ducts they eat through, and then produce ulcers, and the hectic fever, called the rot. See Class I. 1. 4. 10. and Article IV. 2. 6.

M. M. After a calomel purge, crude iron-filings are specific in this disease in children, and the worms are destroyed by the returning acrimony and quantity of the bile. A blister on the region of the liver. Sorbentia, as worm-seed, santonicum. Columbo. Bark.

10. Chlorosis. When the defect of the due action of both the absorbent and secerning vessels of the liver affects women, and is attended with obstruction of the catamenia, it is called chlorosis; and is cured by the exhibition of steel, which restores by its specific stimulus the absorbent power of the liver; and the menstruation, which was obstructed in consequence of debility, recurs.

Indigestion, owing to torpor of the stomach, and a consequent too great acidity of its contents, attend this disease; whence a desire of eating chalk, or marl. Sometimes a great quantity of pale urine is discharged in a morning, which is owing to the inaction of the absorbents, which are distributed on the neck of the bladder, during sleep. The swelling of the ankles, which frequently attends chlorosis, is another effect of deficient action of the absorbent system; and the pale countenance is occasioned by the deficient quantity of red globules of blood, caused by the deficient quantity or acrimony of the bile, and consequent weakness of the circulation. The pulse is so quick in some cases of chlorosis, that, when attended with an accidental cough, it may be mistaken for pulmonary consumption. This quick pulse is owing to the debility of the heart from the want of stimulus occasioned by the deficiency of the quantity, and acrimony of the blood.

M. M. Steel. Bitters. Constant moderate exercise. Friction with flannel all over the body and limbs night and morning. Rhubarb five grains, opium half a grain, every night. Flesh diet, with small beer, or wine and water. The disease continues some months, but at length subsides by the treatment above described. A bath of about eighty degrees, as Buxton Bath, is of service; a colder bath may do great injury.

11. Hydrocele. Dropsy of the vagina testis. Dropsies have been divided into the incysted and the diffused, meaning those of the cellular membrane, the cells of which communicate with each other like a sponge, and those of any other cavity of the body. The collections of mucous fluids in the various cells and cavities of the body arise from the torpor of the absorbent vessels of those parts. It is probable, that in dropsies attended with great thirst the cutaneous absorbents become paralytic first; and then from the great thirst, which is thus occasioned by the want of atmospheric moisture, the absorption of the fat ensues; as in fevers attended with great thirst, the fat is quickly taken up. See Obesitas I. 2. 3. 17. Some have believed, that the cellular and adipose membranes are different ones; as no fat is ever deposited in the eye-lids or scrotum, both which places are very liable to be distended with the mucilaginous fluid of the anasarca, and with air in Emphysema. Sometimes a gradual absorption of the accumulated fluid takes place, and the thinner parts being taken up, there remains a more viscid fluid, or almost a solid in the part, as in some swelled legs, which can not easily be indented by the pressure of the finger, and are called scorbutic. Sometimes the paralysis of the absorbents is completely removed, and the whole is again taken up into the circulation.

The Hydrocele is known by a tumor of the scrotum, which is without pain, gradually produced, with fluctuation, and a degree of pellucidity, when a candle is held behind it; it is the most simple incysted dropsy, as it is not in general complicated with other diseases, as ascites with schirrous liver, and hydrocephalus internus, with general debility. The cure of this disease is effected by different ways; it consists in discharging the water by an external aperture; and by so far inflaming the cyst and testicle, that they afterwards grow together, and thus prevent in future any secretion or effusion of mucus; the disease is thus cured, not by the revivescence of the absorbent power of the lymphatics, but by the prevention of secretion by the adhesion of the vagina to the testis. This I believe is performed with less pain, and is more certainly manageable by tapping, or discharging the fluid by means of a trocar, and after the evacuation of it to fill the cyst with a mixture of wine and water for a few minutes till the necessary degree of stimulus is produced, and then to withdraw it; as recommended by Mr. Earle. See also Medical Commentaries by Dr. Duncan, for 1793.