12. Hydrocephalus internus, or dropsy of the ventricles of the brain, is fatal to many children, and some adults. When this disease is less in quantity, it probably produces a fever, termed a nervous fever, and which is sometimes called a worm fever, according to the opinion of Dr. Gilchrist, in the Scots Medical essays. This fever is attended with great inirritability, as appears from the dilated pupils of the eyes, in which it corresponds with the dropsy of the brain. And the latter disease has its paroxysms of quick pulse, and in that respect corresponds with other fevers with inirritability.

The hydrocephalus internus is distinguished from apoplexy by its being attended with fever, and from nervous fever by the paroxysms being very irregular, with perfect intermissions many times in a day. In nervous fever the pain of the head generally affects the middle of the forehead; in hydrocephalus internus it is generally on one side of the head. One of the earliest criterions is the patient being uneasy on raising his head from the pillow, and wishing to lie down again immediately; which I suppose is owing to the pressure of the water on the larger trunks of the blood-vessels entering the cavity being more intolerable than on the smaller ones; for if the larger trunks are compressed, it must inconvenience the branches also; but if some of the small branches are compressed only, the trunks are not so immediately incommoded.

Blisters on the head, and mercurial ointment externally, with calomel internally, are principally recommended in this fatal disease. When the patient cannot bear to be raised up in bed without great uneasiness, it is a bad symptom. So I believe is deafness, which is commonly mistaken for stupor. See Class I. 2. 5. 6. And when the dilatation of the pupil of either eye, or the squinting is very apparent, or the pupils of both eyes much dilated, it is generally fatal. As by stimulating one branch of lymphatics into inverted motion, another branch is liable to absorb its fluid more hastily; suppose strong errhines, as common tobacco snuff to children, or one grain of turpeth mineral, (Hydrargyrus vitriolatus), mixed with ten or fifteen grains of sugar, was gradually blown up the nostrils? See Class I. 3. 2. 1. I have tried common snuff upon two children in this disease; one could not be made to sneeze, and the other was too near death to receive advantage. When the mercurial preparations have produced salivation, I believe they may have been of service, but I doubt their good effect otherwise. In one child I tried the tincture of Digitalis; but it was given with too timid a hand, and too late in the disease, to determine its effects. See Sect. XXIX. 5. 9.

As all the above remedies generally fail of success, I think frequent, almost hourly, shocks of electricity from very small charges might be passed through the head in all directions with probability of good event. And the use of the trephine, where the affected side can be distinguished. See Strabismus, Class I. 2. 5. 4. When one eye is affected, does the disease exist in the ventricule of that side?

13. Ascites. The dropsy of the cavity of the abdomen is known by a tense swelling of the belly; which does not sound on being struck like the tympany; and in which a fluctuation can be readily perceived by applying one hand expanded on one side, and striking the tumour on the other.

Effusions of water into large cavities, as into that of the abdomen or thorax, or into the ventricules of the brain or pericardium, are more difficult to be reabsorbed, than the effusion of fluids into the cellular membrane; because one part of this extensive sponge-like system of cells, which connects all the solid parts of the body, may have its power of absorption impaired, at the same time that some other part of it may still retain that power, or perhaps possess it in an increased degree; and as all these cells communicate with each other, the fluid, which abounds in one part of it, can be transferred to another, and thus be reabsorbed into the circulation.

In the ascites, cream of tartar has sometimes been attended with success; a dram or two drams are given every hour in a morning till it operates, and is to be repeated for several days; but the operation of tapping is generally applied to at last. Dr. Sims, in the Memoirs of the Medical Society of London, Vol. III. has lately proposed, what he believes to be a more successful method of performing this operation, by making a puncture with a lancet in the scar of the navel, and leaving it to discharge itself gradually for several days, without introducing a canula, which he thinks injurious both on account of the too sudden emission of the fluid, and the danger of wounding or stimulating the viscera. This operation I have twice known performed with less inconvenience, and I believe with more benefit to the patient, than the common method.

After the patient has been tapped, some have tried injections into the cavity of the abdomen, but hitherto I believe with ill event. Nor are experiments of this kind very promising of success. First because the patients are generally much debilitated, most frequently by spirituous potation, and have generally a disease of the liver, or of other viscera. And secondly, because the quantity of inflammation, necessary to prevent future secretion of mucus into the cavity of the abdomen, by uniting the peritoneum with the intestines or mesentery, as happens in the cure of the hydrocele, would I suppose generally destroy the patient, either immediately, or by the consequence of such adhesions.

This however is not the case in respect to the dropsy of the ovarium, or in the hydrocele.

14. Hydrops thoracis. The dropsy of the chest commences with loss of flesh, cold extremities, pale countenance, high coloured urine in small quantity, and general debility, like many other dropsies. The patient next complains of numbness in the arms, especially when elevated, with pain and difficulty of swallowing, and an absolute impossibility of lying down for a few minutes, or with sudden starting from sleep, with great difficulty of breathing and palpitation of his heart.

The numbness of the arms is probably owing more frequently to the increased action of the pectoral muscles in respiration, whence they are less at liberty to perform other offices, than to the connexion of nerves mentioned in Sect. XXIX. 5. 2. The difficulty of swallowing is owing to the compression of the oesophagus by the lymph in the chest; and the impossibility of breathing in an horizontal posture originates from this, that if any parts of the lungs must be rendered useless, the inability of the extremities of them must be less inconvenient to respiration; since if the upper parts or larger trunks of the air-vessels should be rendered useless by the compression of the accumulated lymph, the air could not gain admittance to the other parts, and the animal must immediately perish.

If the pericardium is the principal seat of the disease, the pulse is quick and irregular. If only the cavity of the thorax is hydropic, the pulse is not quick nor irregular.

If one side is more affected than the other, the patient leans most that way, and has more numbness in that arm.

The hydrops thoracis is distinguished from the anasarca pulmonum, as the patient in the former cannot lie down half a minute; in the latter the difficulty of breathing, which occasions him to rise up, comes on more gradually; as the transition of the lymph in the cellular membranes from one part to another of it is slower, than that of the effused lymph in the cavity of the chest.

The hydrops thoracis is often complicated with fits of convulsive breathing; and then it produces a disease for the time very similar to the common periodic asthma, which is perhaps owing to a temporary anasarca of the lungs; or to an impaired venous absorption in them. These exacerbations of difficult breathing are attended with cold extremities, cold breath, cold tongue, upright posture with the mouth open, and a desire of cold air, and a quick, weak, intermittent pulse, and contracted hands.

These exacerbations recur sometimes every two or three hours, and are relieved by opium, a grain every hour for two or three doses, with ether about a dram in cold water; and seem to be a convulsion of the muscles of respiration induced by the pain of the dyspnea. As in Class III. 1. 1. 9.

M. M. A grain of dried squill, and a quarter of a grain of blue vitriol every hour for six or eight hours, unless it vomit or purge. A grain of opium. Blisters. Calomel three grains every third day, with infusion of senna. Bark. Chalybeates. Puncture in the side.

Can the fluctuation in the chest be heard by applying the ear to the side, as Hippocrates asserts? Can it be felt by the hand or by the patient before the disease is too great to admit of cure by the paracentesis? Does this dropsy of the chest often come on after peripneumony? Is it ever cured by making the patient sick by tincture of digitalis? Could it be cured, if on one side only, by the operation of puncture between the ribs, and afterwards by inflaming the cavity by the admission of air for a time, like the cure of the hydrocele; the pleura afterwards adhering wholly to that lobe of the lungs, so as to prevent any future effusion of mucus?

15. Hydrops ovarii. Dropsy of the ovary is another incysted dropsy, which seldom admits of cure. It is distinguished from ascites by the tumour and pain, especially at the beginning, occupying one side, and the fluctuation being less distinctly perceptible. When it happens to young subjects it is less liable to be mistaken for ascites. It affects women of all ages, either married or virgins; and is produced by cold, fear, hunger, bad food, and other debilitating causes. I saw an elegant young lady, who was shortly to have been married to a sensible man, with great prospect of happiness; who, on being overturned in a chaise in the night, and obliged to walk two or three miles in wet, cold, and darkness, became much indisposed, and gradually afflicted with a swelling and pain on one side of the abdomen; which terminated in a dropsy of the ovary, and destroyed her in two or three years. Another young woman I recollect seeing, who was about seventeen, and being of the very inferior class of people, seemed to have been much weakened by the hardship of a cold floor, and little or no bed, with bad food; and who to these evils had to bear the unceasing obloquy of her neighbours, and the persecution of parish officers.

The following is abstracted from a letter of my friend Mr. Power, surgeon, at Bosworth in Leicestershire, on examining the body of an elderly lady who died of this disease, March 29, 1793. "On opening the abdomen I found a large cyst attached to the left ovarium by an elastic neck as thick as the little finger, and so callous as not to admit of being separated by scissars without considerable difficulty. The substance of the cyst had an appearance much resembling the gravid uterus near the full period of gestation, and was as thick. It had no attachment to the peritonaeum, or any of the viscera, except by the hard callous neck I have mentioned; so that the blood must with difficulty have been circulated through it for some time. Its texture was extremely tender, being easily perforated with the finger, was of a livid red colour, and evidently in a sphacelated state. It contained about two gallons of a fluid of the colour of port wine, without any greater tenacity. It has fallen to my lot to have opened two other patients, whose deaths were occasioned by incysted dropsy of the ovarium. In one of these the ovarium was much enlarged with eight or ten cysts on its surface, but there was no adhesion formed by any of the cysts to any other part; nor had the ovarium formed any adhesion with the peritonaeum, though in a very diseased state. In the other the disease was more simple, being only one cyst, without any attachment but to the ovarium.

"As the ovarium is a part not necessary to life, and dropsies of this kind are so generally fatal in the end, I think I shall be induced, notwithstanding the hazard attending wounds, which penetrate the cavity of the abdomen, to propose the extirpation of the diseased part in the first case, which occurs to me, in which I can with precision say, that the ovarium is the seat of the disease, and the patient in other respects tolerably healthy; as the cavity of the abdomen is often opened in other cases without bad consequences."

An argument, which might further countenance the operation thus proposed by Mr. Power, might be taken from the disease frequently affecting young persons; from its being generally in these subjects local and primary; and not like the ascites, produced or accompanied with other diseased viscera; and lastly, as it is performed in adult quadrupeds, as old sows, with safety, though by awkward operators.

16. Anasarca pulmonum. The dropsy of the cellular membrane of the lungs is usually connected with that of the other parts of the system. As the cells of the whole cellular membrane communicate with each other, the mucaginous fluid, which remains in any part of it for want of due absorption, sinks down to the most depending cells; hence the legs swell, though the cause of the disease, the deficiency of absorption, may be in other parts of the system. The lungs however are an exception to this, since they are suspended in the cavity of the thorax, and have in consequence a depending part of their own.

The anasarca of the lungs is known by the difficulty of respiration accompanied with swelled legs, and with a very irregular pulse. This last circumstance has generally been ascribed to a dropsy at the same time existing in the pericardium, but is more probably owing to the difficult passage of the blood through the lungs; because I found on dissection, in one instance, that the most irregular pulse, which I ever attended to, was owing to very extensive adhesions of the lungs; insomuch that one lobe intirely adhered to the pleura; and secondly, because this kind of dropsy of the lungs is so certainly removed for a time along with the anasarca of the limbs by the use of digitalis.

This medicine, as well as emetic tartar, or squill, when given so as to produce sickness, or nausea, or perhaps even without producing either in any perceptible degree, by affecting the lymphatics of the stomach, so as either to invert their motion, or to weaken them, increases by reverse sympathy the action, and consequent absorbent power of these lymphatics, which open into the cellular membrane. But as those medicines seldom succeed in producing an absorption of those fluids, which stagnate in the larger cavities of the body, as in the abdomen, or chest, and do generally succeed in this difficulty of breathing with irregular pulse above described, I conclude that it is not owing to an effusion of lymph into the pericardium, but simply to an anasarca of the lungs.

M. M. Digitalis. See Art. V. 2. 1. Tobacco. Squill. Emetic tartar (antimonium tartarizatum). Then Sorbentia. Chalybeates. Opium half a grain twice a day. Raisin wine and water, or other wine and water, is preferred to the spirit and water, which these patients have generally been accustomed to.

The usual cause of anasarca is from a diseased liver, and hence it most frequently attends those, who have drank much fermented or spirituous liquors; but I suspect that there is another cause of anasarca, which originates from the brain; and which is more certainly fatal than that, which originates from a diseased liver. These patients, where the anasarca originates from, or commences in, the brain, have not other symptoms of diseased liver; have less difficulty of breathing at the beginning; and hold themselves more upright in their chair, and in walking. In this kind of dropsy I suspect the digitalis has less or no effect; as it particularly increases the absorption from the lungs.

17. Obesitas. Corpulency may be called an anasarca or dropsy of fat, since it must be owing to an analogous cause; that is, to the deficient absorption of fat compared to the quantity secreted into the cells which contain it. See Class II. 1. 1. 4.

The method of getting free from too much fat without any injury to the constitution, consists, first, in putting on a proper bandage on the belly, so that it can be tightened or relaxed with ease, as a tightish under waistcoat, with a double row of buttons. This is to compress the bowels and increase their absorption, and it thus removes one principal cause of corpulency, which is the looseness of the skin. Secondly, he should omit one entire meal, as supper; by this long abstinence from food the absorbent system will act on the mucus and fat with greater energy. Thirdly, he should drink as little as he can with ease to his sensations; since, if the absorbents of the stomach and bowels supply the blood with much, or perhaps too much, aqueous fluid, the absorbents of the cellular membrane will act with less energy. Fourthly, he should use much salt or salted meat, which will increase the perspiration and make him thirsty; and if he bears this thirst, the absorption of his fat will be greatly increased, as appears in fevers and dropsies with thirst; this I believe to be more efficacious than soap. Fifthly, he may use aerated alcaline water for his drink, which may be supposed to render the fat more fluid,—or he may take soap in large quantities, which will be decomposed in the stomach. Sixthly, short rest, and constant exercise.

18. Splenis tumor. Swellings of the spleen, or in its vicinity, are frequently perceived by the hand in intermittents, which are called Ague-cakes, and seem owing to a deficiency of absorption in the affected part.

Mr. Y——, a young man about twenty-five years of age, who lived intemperately, was seized with an obstinate intermittent, which had become a continued fever with strong pulse, attended with daily remission. A large hard tumour on the left side, on the region of the spleen, but extending much more downward, was so distinctly perceptible, that one seemed to get one's fingers under the edge of it, much like the feel of the brawn or shield on a boar's shoulder. He was repeatedly bled, and purged with calomel, had an emetic, and a blister on the part, without diminishing the tumour; after some time he took the Peruvian bark, and slight doses of chalybeates, and thus became free from the fever, and went to Bath for several weeks, but the tumour remained. This tumour I examined every four or five years for above thirty years. His countenance was pale, and towards the end of his life he suffered much from ulcers on his legs, and died about sixty, of general debility; like many others, who live intemperately in respect to the ingurgitation of fermented or spirituous liquors.

As this tumour commenced in the cold fit of an intermittent fever, and was not attended with pain, and continued so long without endangering his life, there is reason to believe it was simply occasioned by deficient absorption, and not by more energetic action of the vessels which constitute the spleen. See Class II. 1. 2. 13.

M. M. Venesection. Emetic, cathartic with calomel; then sorbentia, chalybeates, Peruvian bark.

19. Genu tumor albus. White swelling of the knee, is owing to deficient absorption of the lymphatics of the membranes including the joint, or capsular ligaments, and sometimes perhaps of the gland which secretes the synovia; and the ends of the bones are probably affected in consequence.

I saw an instance, where a caustic had been applied by an empiric on a large white swelling of the knee, and was told, that a fluid had been discharged from the joint, which became anchylosed, and healed without loss of the limb.

M. M. Repeated blisters on the part early in the disease are said to cure it by promoting absorption; saturnine solutions externally are recommended. Bark, animal charcoal, as burnt sponge, opium in small doses. Friction with the hand.

20. Bronchocele. Swelled throat. An enlargement of the thyroid glands, said to be frequent in mountainous countries, where river water is drank, which has its source from dissolving snows. This idea is a very ancient one, but perhaps not on that account to be the more depended upon, as authors copy one another. Tumidum guttur quis miratur in alpibus, seems to have been a proverb in the time of Juvenal. The inferior people of Derby are much subject to this disease, but whether more so than other populous towns, I can not determine; certain it is, that they chiefly drink the water of the Derwent, which arises in a mountainous country, and is very frequently blackened as it passes through the morasses near its source; and is generally of a darker colour, and attended with a whiter foam, than the Trent, into which it falls; the greater quantity and whiteness of its froth I suppose may be owing to the viscidity communicated to it by the colouring matter. The lower parts of the town of Derby might be easily supplied with spring water from St. Alkmond's well; or the whole of it from the abundant springs near Bowbridge: the water from which might be conveyed to the town in hollow bricks, or clay-pipes, at no very great expence, and might be received into frequent reservoirs with pumps to them; or laid into the houses.

M. M. Twenty grains of burnt sponge with ten of nitre made with mucilage into lozenges, and permitted to dissolve slowly under the tongue twice a day, is asserted to cure in a few months; perhaps other animal charcoal, as candle-snuffs, might do the same.

I have directed in the early state of this disease a mixture of common salt and water to be held in the mouth, particularly under the tongue, for a few minutes, four or six times a day for many weeks, which has sometimes succeeded, the salt and water is then spit out again, or in part swallowed. Externally vinegar of squills has been applied, or a mercurial plaster, or fomentations of acetated ammoniac; or ether. Some empirics have applied caustics on the bronchocele, and sometimes, I have been told, with success; which should certainly be used where there is danger of suffocation from the bulk of it. One case I saw, and one I was well informed of, where the bronchocele was cured by burnt sponge, and a hectic fever supervened with colliquative sweats; but I do not know the final event of either of them.

De Haen affirms the cure of bronchocele to be effected by flowers of zinc, calcined egg-shells, and scarlet cloth burnt together in a close crucible, which was tried with success, as he assured me, by a late lamented physician, my friend, Dr. Small of Birmingham; who to the cultivation of modern sciences added the integrity of ancient manners; who in clearness of head, and benevolence of heart, had few equals, perhaps no superiors.

21. Scrophula. King's evil is known by tumours of the lymphatic glands, particularly of the neck. The upper lip, and division of the nostrils is swelled, with a florid countenance, a smooth skin, and a tumid abdomen. Cullen. The absorbed fluids in their course to the veins in the scrophula are arrested in the lymphatic or conglobate glands; which swell, and after a great length of time, inflame and suppurate. Materials of a peculiar kind, as the variolous and venereal matter, when absorbed in a wound, produce this torpor, and consequent inflammation of those lymphatic glands, where they first arrive, as in the axilla and groin. There is reason to suspect, that the tonsils frequently become inflamed, and suppurate from the matter absorbed from carious teeth; and I saw a young lady, who had both the axillary glands swelled, and which suppurated; which was believed to have been caused by her wearing a pair of new green gloves for one day, when she had perspired much, and was much exhausted and fatigued by walking; the gloves were probably dyed in a solution of verditer.

These indolent tumours of the lymphatic glands, which constitute the scrophula, originate from the inirritability of those glands; which therefore sooner fall into torpor after having been stimulated too violently by some poisonous material; as the muscles of enfeebled people sooner become fatigued, and cease to act, when exerted, than those of stronger ones. On the same account these scrophulous glands are much longer in acquiring increase of motion, after having been stimulated into inactivity, and either remain years in a state of indolence, or suppurate with difficulty, and sometimes only partially.

The difference between scrophulous tumours, and those before described, consists in this; that in those either glands of different kinds were diseased, or the mouths only of the lymphatic glands were become torpid; whereas in scrophula the conglobate glands themselves become tumid, and generally suppurate after a great length of time, when they acquire new sensibility. See Sect. XXXIX. 4. 5.

These indolent tumours may be brought to suppurate sometimes by passing electric shocks through them every day for two or three weeks, as I have witnessed. It is probable, that the alternate application of snow or iced water to them, till they become painfully cold, and then of warm flannel or warm water, frequently repeated, might restore their irritability by accumulation of sensorial power; and thence either facilitate their dispersion, or occasion them to suppurate. See Class II. 1. 4. 13.

This disease is very frequent amongst the children of the poor in large towns, who are in general ill fed, ill lodged, and ill clothed; and who are further weakened by eating much salt with their scanty meal of insipid vegetable food, which is seldom of better quality than water gruel, with a little coarse bread in it. See diarrhoea of infants, Class I. 1. 2. 5. Scrophulous ulcers are difficult to heal, which is owing to the deficiency of absorption on their pale and flabby surfaces, and to the general inirritability of the system. See Class I. 1. 3. 13.

M. M. Plentiful diet of flesh-meat and vegetables with small-beer. Opium, from a quarter of a grain to half a grain twice a day. Sorbentia. Tincture of digitalis, thirty drops twice a day. Externally sea-bathing, or bathing in salt and water, one pound to three gallons, made warm. The application of Peruvian bark in fine powder, seven parts, and white lead, (cerussa) in fine powder one part, mixed together and applied on the ulcers in dry powder, by means of lint and a bandage, to be renewed every day. Or very fine powder of calamy alone, lapis calaminaris. If powder of manganese?

22. Schirrus. After the absorbent veins of a gland cease to perform their office, if the secerning arteries of it continue to act some time longer, the fluids are pushed forwards, and stagnate in the receptacles or capillary vessels of the gland; and the thinner part of them only being resumed by the absorbent system of the gland, a hard tumour gradually succeeds; which continues like a lifeless mass, till from some accidental violence it gains sensibility, and produces cancer, or suppurates. Of this kind are the schirrous glands of the breasts, of the lungs, of the mesentery, and the scrophulous tumours about the neck and the bronchocele.

Another seat of schirrus is in the membranous parts of the system, as of the rectum intestinum, the urethra, the gula or throat; and of this kind is the verucca or wart, and the clavus pedum, or corns on the toes. A wen sometimes arises on the back of the neck, and sometimes between the shoulders; and by distending the tendinous fascia produces great and perpetual pain.

M. M. Mercurial ointment. Cover the part with oiled silk. Extirpation. Electric shocks through the tumour. An issue into the substance of the wen. Opium. Ether externally.

23. Schirrus recti intestini. Schirrus of the rectum. A schirrus frequently affects a canal, and by contracting its diameter becomes a painful and deplorable disease. The canals thus obstructed are the rectum, the urethra, the throat, the gall-ducts, and probably the excretory ducts of the lymphatics, and of other glands.

The schirrus of the rectum is known by the patient having pain in the part, and being only able to part with liquid feces, and by the introduction of the finger; the swelled part of the intestine is sometimes protruded downwards, and hangs like a valve, smooth and hard to the touch, with an aperture in the centre of it. See a paper on this subject by J. Sherwin. Memoirs of a London Medical Society, Vol. II. p. 9.

M. M. To take but little solid food. Aperient medicines. Introduce a candle smeared with mercurial ointment. Sponge-tent. Clysters with forty drops of laudanum. Introduce a leathern canula, or gut, and then either a wooden maundril, or blow it up with air, so as to distend the contracted part as much as the patient can bear. Or spread mercurial plaster on thick soft leather, and roll it up with the plaster outwards to any thickness and length, which can be easily introduced and worn; or two or three such pieces may be introduced after each other. The same may be used to compress bleeding internal piles. See Class I. 2. 1. 6.

24. Schirrus urethrae. Schirrus of the urethra. The passage becomes contracted by the thickened membrane, and the urine is forced through with great difficulty, and is thence liable to distend the canal behind the stricture; till at length an aperture is made, and the urine forces its way into the cellular membrane, making large sinuses. This situation sometimes continues many months, or even years, and so much matter is evacuated after making water, or at the same time, by the action of the muscles in the vicinity of the sinuses, that it has been mistaken for an increased secretion from the bladder, and has been erroneously termed a catarrh of the bladder. See a paper by Dr. R. W. Darwin in the Medical Memoirs.

M. M. Distend the part gradually by catgut bougies, which by their compression will at the same time diminish the thickness of the membrane, or by bougies of elastic gum, or of horn boiled soft. The patient should gain the habit of making water slowly, which is a matter of the utmost consequence, as it prevents the distention, and consequent rupture, of that part of the urethra, which is between the stricture and the neck of the bladder.

When there occurs an external ulcer in the perinaeum, and the urine is in part discharged that way, the disease can not be mistaken. Otherwise from the quantity of matter, it is generally supposed to come from the bladder, or prostate gland; and the urine, which escapes from the ruptured urethra, mines its way amongst the muscles and membranes, and the patient dies tabid, owing to the want of an external orifice to discharge the matter. See Class II. 1. 4. 11.

25. Schirrus oesophagi. A schirrus of the throat contracts the passage so as to render the swallowing of solids impracticable, and of liquids difficult. It affects patients of all ages, but is probably most frequently produced by swallowing hard angular substances, when people have lost their teeth; by which this membrane is over distended, or torn, or otherwise injured.

M. M. Put milk into a bladder tied to a canula or catheter; introduce it past the stricture, and press it into the stomach. Distend the stricture gradually by a sponge-tent fastened to the end of whale-bone, or by a plug of wax, or a spermaceti candle, about two inches long; which might be introduced, and left there with a string only fixed to it to hang out of the mouth, to keep it in its place, and to retract it by occasionally; for which purpose the string must be put through a catheter or hollow probang, when it is to be retracted. Or lastly introduce a gut fixed to a pipe; and then distend it by blowing wind into it. The swallowing a bullet with a string put through it, to retract it on the exhibition of an emetic, has also been proposed. Externally mercurial ointment has been much recommended. Poultice. Oiled silk. Clysters of broth. Warm bath of broth. Transfusion of blood into a vein three or four ounces a day? See Class III. 1. 1. 15.

I directed a young woman about twenty-two years of age, to be fed with new milk put into a bladder, which was tied to a catheter, and introduced beyond the stricture in her throat; after a few days her spirits sunk, and she refused to use it further, and died. Above thirty years ago I proposed to an old gentleman, whose throat was entirely impervious, to supply him with a few ounces of blood daily from an ass, or from the human animal, who is still more patient and tractable, in the following manner. To fix a silver pipe about an inch long to each extremity of a chicken's gut, the part between the two silver ends to be measured by filling it with warm water; to put one end into the vein of a person hired for that purpose, so as to receive the blood returning from the extremity; and when the gut was quite full, and the blood running through the other silver end, to introduce that end into the vein of the patient upwards towards the heart, so as to admit no air along with the blood. And lastly, to support the gut and silver ends on a water plate, filled with water of ninety-eight degrees of heat, and to measure how many ounces of blood was introduced by passing the finger, so as to compress the gut, from the receiving pipe to the delivering pipe; and thence to determine how many gut-fulls were given from the healthy person to the patient. See Class IV. 2. 4. 11. Mr. —— considered a day on this proposal, and then another day, and at length answered, that "he now found himself near the house of death; and that if he could return, he was now too old to have much enjoyment of life; and therefore he wished rather to proceed to the end of that journey, which he was now so near, and which he must at all events soon go, than return for so short a time." He lived but a few days afterwards, and seemed quite careless and easy about the matter.

26. Lacteorum inirritabilitas. Inirritability of the lacteals is described in Sect. XXVIII. under the name of paralysis of the lacteals; but as the word paralysis has generally been applied to the disobedience of the muscles to the power of volition, the name is here changed to inirritability of the lacteals, as more characteristic of the disease.

27. Lymphaticorum inirritabilitas. The inirritability of the cellular and cutaneous lymphatics is described in Sect. XXIX. 5. 1. and in Class I. 2. 3. 16. The inirritability of the cutaneous lymphatics generally accompanies anasarca, and is the cause of the great thirst in that malady. At the same time the cellular lymphatics act with greater energy, owing to the greater derivation of sensorial power to them in consequence of the less expenditure of it by the cutaneous ones; and hence they absorb the fat, and mucus, and also the thinner parts of the urine. Whence the great emaciation of the body, the muddy sediment, and the small quantity of water in this kind of dropsy.

* * * * *

ORDO II.

Decreased Irritation.

GENUS IV.

With Decreased Actions of other Cavities and Membranes.

Many of the diseases of this genus are attended with pain, and with cold extremities, both which cease on the exhibition of wine or opium; which shews, that they originate from deficient action of the affected organ. These pains are called nervous or spasmodic, are not attended with fever, but are frequently succeeded by convulsions and madness; both which belong to the class of volition. Some of them return at periods, and when these can be ascertained, a much less quantity of opium will prevent them, than is necessary to cure them, when they are begun; as the vessels are then torpid and inirritable from the want of sensorial power, till by their inaction it becomes again accumulated.

Our organs of sense properly so called are not liable to pain from the absence of their appropriated stimuli, as from darkness or silence; but the other senses, which may be more properly called appetites, as those by which we perceive heat, hunger, thirst, lust, want of fresh air, are affected with pain from the defect or absence of their accustomed stimuli, as well as with pleasure by the possession of them; it is probable that some of our glands, whose sense or appetite requires or receives something from the circulating blood, as the pancreas, liver, testes, prostate gland, may be affected with aching or pain, when they cannot acquire their appropriated fluid.

Wherever this defect of stimulus occurs, a torpor or inaction of the organ ensues, as in the capillaries of the skin, when exposed to cold; and in the glands, which secrete the gastric juice, when we are hungry. This torpor however, and concomitant pain, which is at first owing to defect of stimulus, is afterwards induced by other associations or catenations, and constitutes the beginning of ague fits.

It must be further observed, that in the diseases of pain without fever, the pain is frequently not felt in the part where the cause of the disease resides; but is induced by sympathy with a distant part, whose irritability or sensibility is greater or less than its own. Thus a stone at the neck of the bladder, if its stimulus is not very great, only induces the pain of strangury at the glans penis. If its stimulus be greater, it then induces pain at the neck of the bladder. The concretions of bile, which are protruded into the neck of the gall-bladder, when the disease is not very great, produce pain at the other extremity of the bile-duct, which enters the duodenum immediately under the pit of the stomach; but, when the disease is great from the largeness of the bile-stone, the pain is felt in the region of the liver at the neck of the gall-bladder.

It appears from hence, that the pains enumerated in this genus are consequences of the inactivity of the organ; and, as they do not occasion other diseases, should be classed according to their proximate cause, which is defective irritation; there are nevertheless other pains from defect of stimulus, which produce convulsions, and belong to Class III. 1. 1.; and others, which produce pains of some distant part by association, and belong to Class IV. 2. 2.

SPECIES.

1. Sitis. Thirst. The senses of thirst and of hunger seem to have this connection, that the former is situated at the upper end, and the latter at the lower end of the same canal. One about the pharinx, where the oesophagus opens into the mouth, and the other about the cardia ventriculi, where it opens into the stomach. The extremities of other canals have been shewn to possess correspondent sensibilities, or irritabilities, as the two ends of the urethra, and of the common gall-duct. See IV. 2. 2. 2. and 4.

The membrane of the upper end of the gullet becomes torpid, and consequently painful, when there is a deficiency of aqueous fluid in the general system; it then wants its proper stimulus. In the same manner a want of the stimulus of more solid materials at the other end of the canal, which terminates in the stomach, produces hunger; as mentioned in Sect. XIV. 8. The proximate causes of both of them therefore consist in deficient irritation, when they are considered as pains; because these pains are in consequence of the inactivity of the organ, according to the fifth law of animal causation. Sect. IV. 5. But when they are considered as desires, namely of liquid or solid aliment, their proximate cause consists in the pain of them, according to the sixth law of animal causation. So the proximate cause of the pain of coldness is the inactivity of the organ, and perhaps the consequent accumulation of sensorial power in it; but the pain itself, or the consequent volition, is the proximate cause of the shuddering and gnashing the teeth in cold fits of intermittent fevers. See Class I. 2. 2. 1.

Thirst may be divided into two varieties alluding to the remote cause of each, and may be termed sitis calida, or warm thirst, and sitis frigida, or cold thirst. The remote cause of the former arises from the dissipation of the aqueous parts of our fluids by the increased secretion of perspirable matter, or other evacuations. And hence it occurs in hot fits of fever, and after taking much wine, opium, spice, salt, or other drugs of the Art. incitantia or secernentia. The thirst, which occurs about three hours after eating a couple of red herrings, to a person unaccustomed to salted meat, is of this kind; the increased action of the cutaneous vessels dissipates so much of our fluids by insensible perspiration, as to require above two quarts of water to restore the fluidity of the blood, and to wash the salt out of the system. See Art. III. 2. 1.

M. M. Cold water. Vegetable acids. Warm bath.

The remote cause of sitis frigida, or cold thirst, is owing to the inaction of the cutaneous, pulmonary, urinary, and cellular absorbents; whence the blood is deprived of the great supply of moisture, which it ought to receive from the atmosphere, and from the cells of the cellular membrane, and from other cysts; this cause of thirst exists in dropsies, and in the cold fits of intermittents. The desire of fluids, like that of solids, is liable to acquire periods, and may therefore readily become diseased by indulgence in liquids grateful to the palate.

Of diseased thirst, the most common is either owing to defect of the action of the numerous absorbent vessels on the neck of the bladder, in which the patient makes much paleish water; or to the defective absorption of the skin and lungs, in which the patient makes but little water, and that high-coloured, and with sediment. In both the tongue and lips are liable to become very dry. The former in its greatest degree attends diabaetes, and the latter anasarca.

M. M. Warm water, warm wine, warm bath. Opium. Cold bath. Iced water. Lemonade. Cyder.

2. Esuries. Hunger has been fancifully ascribed to the sides of the stomach rubbing against each other, and to the increased acidity of the gastric juice corroding the coats of it. If either of these were the cause of hunger, inflammation must occur, when they had continued some time; but, on the contrary, coldness and not heat are attendant on hunger; which evinces, that like thirst it is owing to the inactivity of the membrane, which is the seat of it; while the abundant nerves about the cardia ventriculi, and the pain of hunger being felt in that part, gives great reason to conclude, that it is there situated.

The sense of hunger as well as of thirst is liable to acquire habits in respect to the times of its returning painfulness, as well as in respect to the quantity required to satiate its appetency, and hence may become diseased by indulgence, as well as by want of its appropriate stimulus. Those who have been accustomed to distend their stomach by large quantities of animal and vegetable food, and much potation, find a want of distention, when the stomach is empty, which occasions faintness, and is mistaken for hunger, but which does not appear to be the same sensation. I was well informed, that a woman near Lichfield, who eat much animal and vegetable food for a wager, affirmed, that since distending her stomach so much, she had never felt herself satisfied with food; and had in general taken twice as much at a meal, as she had been accustomed to, before she eat so much for a wager.

3. Nausea sicca. Dry nausea. Consists in a quiescence or torpor of the mucous or salivary glands, and precedes their inverted motions, described in nausea humida, Class I. 3. 2. 3. In the same manner as sickness of the stomach is a quiescence of that organ preceding the action of vomiting, as explained in Sect. XXXV. 1. 3. This is sometimes induced by disagreeable drugs held in the mouth, at other times of disgustful ideas, and at other times by the association of these actions with those of the stomach; and thus according to its different proximate causes may belong to this, or to the second, or to the fourth class of diseases.

M. M. Lemonade. Tasteful food. A blister. Warm bath.

4. Aegritudo ventriculi. Sickness of stomach is produced by the quiescence or inactivity of that organ, as is explained in Sect. XXXV. 1. 3. It consists in the state between the usual peristaltic motions of that organ, in the digestion of our aliment, and the retrograde motions of it in vomiting; for it is evident, that the direct motions of it from the cardia to the pylorus must stop, before those in a contrary direction can commence. This sickness, like the nausea above described, is sometimes produced by disgustful ideas, as when nasty objects are seen, and nasty stories related, as well as by the exhaustion of the sensorial power by the stimulus of some emetic drugs, and by the defect of the production of it, as in enfeebled drunkards.

Sickness may likewise consist in the retrograde motions of the lymphatics of the stomach, which regurgitate into it the chyle or lymph, which they have lately absorbed, as in Class I. 3. 2. 3. It is probable, that these two kinds of sickness may be different sensations, though they have acquired but one name; as one of them attends hunger, and the other repletion; though either of them may possibly be induced by association with nauseous ideas.

M. M. A blister on the back. An emetic. Opium. Crude mercury. Covering the head in bed. See Sect. XXV. 16. Class IV. 1. 1. 2. and 3.

5. Cardialgia. Heartburn originates from the inactivity of the stomach, whence the aliment, instead of being subdued by digestion, and converted into chyle, runs into fermentation, producing acetous acid. Sometimes the gastric juice itself becomes so acid as to give pain to the upper orifice of the stomach; these acid contents of the stomach, on falling on a marble hearth, have been seen to produce an effervescence on it. The pain of heat at the upper end of the gullet, when any air is brought up from the fermenting contents of the stomach, is to be ascribed to the sympathy between these two extremities of the oesophagus rather than to the pungency of the carbonic gas, or fixed air; as the sensation in swallowing that kind of air in water is of a different kind. See Class I. 3. 1. 3. and IV. 2. 2. 5.

M. M. This disease arising from indigestion is often very pertinacious, and afflicting; and attended with emaciation of the body from want of sufficient chyle. As the saliva swallowed along with our food prevents its fermentation, as appears by the experiments of Pringle and Macbride, some find considerable relief by chewing parched wheat, or mastic, or a lock of wool, frequently in a day, when the pain occurs, and by swallowing the saliva thus effused; a temporary relief is often obtained from antiacids, as aerated alcaline water, Seltzer's water, calcareous earths, alcaline salts made into pills with soap, soap alone, tin, milk, bitters. More permanent use may be had from such drugs as check fermentation, as acid of vitriol; but still more permanent relief from such things as invigorate the digestion, as a blister on the back; a due quantity of vinous spirit and water taken regularly. Steel. Temperance. A sleep after dinner. A waistcoat made so tight as slightly to compress the bowels and stomach. A flannel shirt in winter, not in summer. A less quantity of potation of all kinds. Ten black pepper-corns swallowed after dinner. Half a grain of opium twice a day, or a grain. The food should consist of such things as do not easily ferment, as flesh, shell-fish, sea-biscuit, toasted cheese. I have seen toasted cheese brought up from the stomach 24 hours after it had been swallowed, without apparently having undergone any chemical change. See Class II. 1. 3. 17. and IV. 1. 2. 13.

6. Arthritis Ventriculi. Sickness of the stomach in gouty cases is frequently a consequence of the torpor or inflammation of the liver, and then it continues many days or weeks. But when the patient is seized with great pain at the stomach with the sensation of coldness, which they have called an ice-bolt, this is a primary affection of the stomach, and destroys the patient in a few hours, owing to the torpor or inaction of that viscus so important to life.

This primary gout of the stomach, as it is a torpor of that viscus, is attended with sensation of coldness, and with real defect of heat, in that part, and may thence be distinguished from the pain occasioned by the passage of a gall-stone into the duodenum, as well as by the weak pulse, and cold extremities; to which must be added, that it affects those only, who have been long afflicted with the gout, and much debilitated by its numerous attacks.

M. M. Opium. Vinous spirit. Volatile alcali. Spice. Warmth applied externally to the stomach by hot cloths or fomentation.

7. Colica flatulenta. The flatulent colic arises from the too great distention of the bowel by air, and consequent pain. The cause of this disease is the inactivity or want of sufficiently powerful contraction of the coats of the bowel, to carry forwards the gas given up by the fermenting aliment. It is without fever, and generally attended with cold extremities.

It is distinguished, first, from the pain occasioned by the passage of a gall-stone, as that is felt at the pit of the stomach, and this nearer the navel. Secondly, it is distinguished from the colica saturnina, or colic from lead, as that arising from the torpor of the liver, or of some other viscus, is attended with greater coldness, and with an aching pain; whereas the flatulent cholic being owing to distention of the muscles of the bowel, the pain is more acute, and the coldness less. Thirdly, it is distinguished from inflammation of the bowels, or ileus, as perpetual vomiting and fever attend this. Fourthly, it is distinguished from cholera, because that is accompanied with both vomiting and diarrhoea. And lastly, from the colica epileptica, or hysteric colic, as that is liable to alternate with convulsion, and sometimes with insanity; and returns by periods.

M. M. Spirit of wine and warm water, one spoonful of each. Opium one grain. Spice. Volatile alcali. Warm fomentation externally. Rhubarb.

8. Colica saturnina. Colic from lead. The pain is felt about the navel, is rather of an aching than acute kind at first, which increases after meals, and gradually becomes more permanent and more acute. It terminates in paralysis, frequently of the muscles of the arm, so that the hand hangs down, when the arm is extended horizontally. It is not attended with fever, or increase of heat. The seat of the disease is not well ascertained, it probably affects some part of the liver, as a pale bluish countenance and deficiency of bile sometimes attends or succeeds it, with consequent anasarca; but it seems to be caused immediately by a torpor of the intestine, whether this be a primary or secondary affection, as appears from the constipation of the bowels, which attends it; and is always produced in consequence of the great stimulus of lead previously used either internally for a length of time, or externally on a large surface.

A delicate young girl, daughter of a dairy farmer, who kept his milk in leaden cisterns, used to wipe off the cream from the edges of the lead with her finger; and frequently, as she was fond of cream, licked it from her finger. She was seized with the saturnine colic, and semi-paralytic wrists, and sunk from general debility.

A feeble woman about 40 years of age sprained her ancle, and bruised her leg and thigh; and applied by ill advice a solution of lead over the whole limb, as a fomentation and poultice for about a fortnight. She was then seized with the colica saturnina, lost the use of her wrists, and gradually sunk under a general debility.

M. M. First opium one or two grains, then a cathartic of senna, jalap, and oil, as soon as the pain is relieved. Oleum ricini. Alum. Oil of almonds. A blister on the navel. Warm bath. The stimulus of the opium, by restoring to the bowel its natural irritability in this case of painful torpor, assists the action of the cathartic.

9. Tympanitis. Tympany consists in an elastic tumor of the abdomen, which sounds on being struck. It is generally attended with costiveness and emaciation. In one kind the air is said to exist in the bowels, in which case the tumor is less equal, and becomes less tense and painful on the evacuation of air. In the other kind the air exists in the cavity of the abdomen, and sometimes is in a few days exchanged for water, and the tympany becomes an ascites.

Air may be distinguished in the stomach of many people by the sound on striking it with the fingers, and comparing the sound with that of a similar percussion on other parts of the bowels; but towards the end of fevers, and especially in the puerperal fever, a distention of the abdomen by air is generally a fatal symptom, though the ease, and often cheerfulness, of the patient vainly flatters the attendants.

M. M. In the former case a clyster-pipe unarmed may be introduced, and left some time in the rectum, to take off the resistance of the sphincter, and thus discharge the air, as it is produced from the fermenting or putrefying aliment. For this purpose, in a disease somewhat similar in horses, a perforation is made into the rectum on one side of the sphincter; through which fistula the air, which is produced in such great excess from the quantity of vegetable food which they take, when their digestions are impaired, is perpetually evacuated. In both cases also, balsams, essential oil, spice, bandage on the abdomen, and, to prevent the fermentation of the aliment, acid of vitriol, saliva. See Class I. 2. 4. 5.

10. Hypochondriasis. The hypochondriac disease consists in indigestion and consequent flatulency, with anxiety or want of pleasureable sensation. When the action of the stomach and bowels is impaired, much gas becomes generated by the fermenting or putrescent aliment, and to this indigestion is catenated languor, coldness of the skin, and fear. For when the extremities are cold for too long a time in some weak constitutions, indigestion is produced by direct sympathy of the skin and the stomach, with consequent heart-burn, and flatulency. The same occurs if the skin be made cold by fear, as in riding over dangerous roads in winter, and hence conversely fear is produced by indigestion or torpor of the stomach by association.

This disease is confounded with the fear of death, which is an insanity, and therefore of a totally different nature. It is also confounded with the hysteric disease, which consists in the retrograde motions of the alimentary canal, and of some parts of the absorbent system.

The hypochondriasis, like chlorosis, is sometimes attended with very quick pulse; which the patient seems to bear so easily in these two maladies, that if an accidental cough attends them, they may be mistaken for pulmonary consumption; which is not owing primarily to the debility of the heart, but to its direct sympathy with the actions of the stomach.

M. M. Blister. A plaster on the abdomen of Burgundy pitch. Opium a grain twice a day. Rhubarb six grains every night. Bark. Steel. Spice. Bath-water. Siesta, or sleep after dinner. Uniform hours of meals. No liquor stronger than small beer, or wine and water. Gentle exercise on horseback in the open air uniformly persisted in. See Cardialgia, I. 2. 4. 5.

11. Cephalaea. Head-ach frequently attends the cold paroxysm of intermittents; afflicts inebriates the day after intoxication; and many people who remain too long in the cold bath. In all which cases there is a general inaction of the whole system, and as these membranes about the head have been more exposed to the variations of heat and cold of the atmosphere, they are more liable to become affected so far as to produce sensation, than other membranes; which are usually covered either with clothes, or with muscles, as mentioned in Sect. XXXIII. 2. 10.

The promptitude of the membranes about the scalp to sympathize with those of other parts of the system is so great, that this cephalaea without fever, or quickness of pulse, is more frequently a secondary than a primary disease, and then belongs to Class IV. 2. 2. 7. The hemicrania, or partial head-ach, I believe to be almost always a disease from association; though it is not impossible, but a person may take cold on one side of the head only. As some people by sitting always on the same side of the fire in winter are liable to render one side more tender than the other, and in consequence more subject to pains, which have been erroneously termed rheumatic. See Class IV. 2. 2. 7. & 8.

M. M. The method of cure consists in rendering the habit more robust, by gentle constant exercise in the open air, flesh diet, small beer at meals with one glass of wine, regular hours of rest and rising, and of meals. The cloathing about the head should be warmer during sleep than in the day; because at that time people are more liable to take cold; that is, the membranous parts of it are more liable to become torpid. As explained in Sect. XVIII. 15. In respect to medicine, two drams of valerian root in powder three or four times a day are recommended by Fordyce. The bark. Steel in moderate quantities. An emetic. A blister. Opium, half a grain twice a day. Decayed teeth should be extracted, particularly such as either ache, or are useless. Cold bath between 60 and 70 degrees of heat. Warm bath of 94 or 98 degrees every day for half an hour during a month. See Class IV. 2. 2. 7. and 8.

A solution of arsenic, about the sixteenth part of a grain, is reported to have great effect in this disease. It should be taken thrice a day, if it produces no griping or sickness, for two or three weeks. A medicine of this kind is sold under the name of tasteless ague-drops; but a more certain method of ascertaining the quantity is delivered in the subsequent materia medica, Art. IV. 2. 6.

12. Odontalgia. Tooth-ach. The pain has been erroneously supposed, where there is no inflammation, to be owing to some acrid matter from a carious tooth stimulating the membrane of the alveolar process into violent action and consequent pain; but the effect seems to have been mistaken for the cause, and the decay of the tooth to have been occasioned by the torpor and consequent pain of the diseased membrane.

First, because the pain precedes the decay of the tooth in regard to time, and is liable to recur, frequently for years, without certainly being succeeded at last by a carious tooth, as I have repeatedly observed.

Secondly, because any stimulant drug, as pyrethrum, or oil of cloves, applied to the tooth, or ether applied externally to the cheek, so far from increasing the pain, as they would do if the pained membrane, already acted too strongly, that they frequently give immediate relief like a charm.

And thirdly, because the torpor, or deficient action of the membrane, which includes the diseased tooth, occasions the motions of the membranes most connected with it, as those of the cheek and temples, to act with less than their natural energy; and hence a coldness of the cheek is perceived easily by the hand of the patient, comparing it with the other cheek; and the pain of hemicrania is often produced in the temple of the affected side.

This coldness of the cheek in common tooth-ach evinces, that the pain is not then caused by inflammation; because in all inflammations so much heat is produced in the secretions of new vessels and fluids, as to give heat to the parts in vicinity. And hence, as soon as the gum swells and inflames along with the cheek, heat is produced, and the pain ceases, owing to the increased exertions of the torpid membrane, excited by the activity of the sensorial power of sensation; which previously existed in its passive state in the painful torpid membrane. See Odontitis, Class II. 1. 4. 7. and IV. 2. 2. 8.

M. M. If the painful tooth be found, venesection. Then a cathartic. Afterwards two grains of opium. Camphor and opium, one grain of each held in the mouth; or a drop or two of oil of cloves put on the painful tooth. Ether. If the tooth has a small hole in it, it should be widened within by an instrument, and then stopped with leaf-gold, or leaf-lead; but should be extracted, if much decayed. It is probable that half a small drop of a strong solution of arsenic, put carefully into the hollow of a decayed aching tooth, would destroy the nerve without giving any additional pain; but this experiment requires great caution, lest any of the solution should touch the tongue or gums.

Much cold or much heat are equally injurious to the teeth, which are endued with a fine sensation of this universal fluid. The best method of preserving them is by the daily use of a brush, which is not very hard, with warm water and fine charcoal dust. A lump of charcoal should be put a second time into the fire till it is red hot, as soon as it becomes cool the external ashes should be blown off, and it should be immediately reduced to fine powder in a mortar, and kept close stopped in a phial. It takes away the bad smell from decayed teeth, by washing the mouth with this powder diffused in water immediately. The putrid smell of decaying stumps of teeth may be destroyed for a time by washing the mouth with a weak solution of alum in water. If the calcareous crust upon the teeth adheres very firmly, a fine powder of pumice-stone may be used occasionally, or a tooth instrument.

Acid of sea-salt, much diluted, may be used; but this very rarely, and with the greatest caution, as in cleaning sea-shells. When the gums are spongy, they should be frequently pricked with a lancet. Should black spots in teeth be cut out? Does the enamel grow again when it has been perforated or abraded?

13. Otalgia. Ear-ach sometimes continues many days without apparent inflammation, and is then frequently removed by filling the ear with laudanum, or with ether; or even with warm oil, or warm water. See Class II. 1. 4. 8. This pain of the ear, like hemicrania, is frequently the consequence of association with a diseased tooth; in that case the ether should be applied to the cheek over the suspected tooth, or a grain of opium and as much camphor mixed together and applied to the suspected tooth. In this case the otalgia belongs to the fourth class of diseases.

14. Pleurodyne chronica. Chronical pain of the side. Pains of the membranous parts, which are not attended with fever, have acquired the general name of rheumatic; which should, nevertheless, be restricted to those pains which exist only when the parts are in motion, and which have been left after inflammation of them; as described in Class I. 1. 3. 12. The pain of the side here mentioned affects many ladies, and may possibly have been owing to the pressure of tight stays, which has weakened the action of the vessels composing some membranous part, as, like the cold head-ach, it is attended with present debility; in one patient, a boy about ten years old, it was attended with daily convulsions, and was supposed to have originated from worms. The disease is very frequent, and generally withstands the use of blisters on the part; but in some cases I have known it removed by electric shocks repeated every day for a fortnight through the affected side.

Pains of the side may be sometimes occasioned by the adhesion of the lungs to the pleura, after an inflammation of them; or to the adhesion of some abdominal viscera to their cavity, or to each other; which also are more liable to affect ladies from the unnatural and ungraceful pressure of tight stays, or by sitting or lying too long in one posture. But in these cases the pain should be more of the smarting, than of the dull kind.

M. M. Ether. A blister. A plaster of Burgundy pitch. An issue or seton on the part. Electric shocks. Friction on the part with oil and camphor. Loose dress. Frequent change of posture both in the day and night. Internally opium, valerian, bark.

15. Sciatica frigida. Cold sciatica. The pain along the course of the sciatic nerve, from the hip quite down to the top of the foot, when it is not attended with fever, is improperly termed either rheumatism or gout; as it occurs without inflammation, is attended with pain when the limb is at rest; and as the pain attends the course of the nerve, and not the course of the muscles, or of the fascia, which contains them. The theory of Cotunnius, who believed it to be a dropsy of the sheath of the nerve, which was compressed by the accumulated fluid, has not been confirmed by dissection. The disease seems to consist of a torpor of this sheath of the nerve, and the pain seems to be in consequence of this torpor. See Class II. 1. 2. 18.

M. M. Venesection. A cathartic. And then one grain of calomel and one of opium every night for ten successive nights. And a blister, at the same time, a little above the knee-joint on the outside of the thigh, where the sciatic nerve is not so deep seated. Warm bath. Cold bath. Cover the limb with oiled silk, or with a plaster-bandage of emplastrum de minio.

16. Lumbago frigida. Cold lumbago. When no fever or inflammation attends this pain of the loins, and the pain exists without motion, it belongs to this genus of diseases, and resembles the pain of the loins in the cold fit of ague. As these membranes are extensive, and more easily fall into quiescence, either by sympathy, or when they are primarily affected, this disease becomes very afflicting, and of great pertinacity. See Class II. 1. 2. 17.

M. M. Venesection. A cathartic. Issues on the loins. Adhesive plaster on the loins. Blister on the os sacrum. Warm bath. Cold bath. Remove to a warmer climate in the winter. Loose dress about the waist. Friction daily with oil and camphor.

17. Hysteralgia frigida. Cold pain of the uterus preceding or accompanying menstruation. It is attended with cold extremities, want of appetite, and other marks of general debility.

M. M. A clyster of half a pint of gruel, and 30 drops of laudanum; or a grain of opium and six grains of rhubarb every night. To sit over warm water, or go into a warm bath.

18. Proctalgia frigida. Cold pain at the bottom of the rectum previous to the tumor of the piles, which sometimes extends by sympathy to the loins; it seems to be similar to the pain at the beginning of menstruation, and is owing to the torpor or inirritability of the extremity of the alimentary canal, or to the obstruction of the blood in its passage through the liver, when that viscus is affected, and its consequent delay in the veins of the rectum, occasioning tumors of them, and dull sensations of pain.

M. M. Calomel. A cathartic. Spice. Clyster, with 30 drops of laudanum. Sitting over warm water. If chalybeates after evacuation? See Class I. 2. 3. 23. and I. 2. 1. 6.

19. Vesicae felleae inirritabilitas. The inirritability of the gall-bladder probably occasions one kind of icterus, or jaundice; which is owing to whatever obstructs the passage of bile into the duodenum. The jaundice of aged people, and which attends some fevers, is believed to be most frequently caused by an irritative palsy of the gall-bladder; on which account the bile is not pressed from the cyst by its contraction, as in a paralysis of the urinary bladder.

A thickening of the coats of the common bile-duct by inflammation or increased action of their vessels so as to prevent the passage of the bile into the intestine, in the same manner as the membrane, which lines the nostrils, becomes thickened in catarrh so as to prevent the passage of air through them, is probably another frequent cause of jaundice, especially of children; and generally ceases in about a fortnight, like a common catarrh, without the aid of medicine; which has given rise to the character, which charms have obtained in some countries for curing the jaundice of young people.

The spissitude of the bile is another cause of jaundice, as mentioned in Class I. 1. 3. 8. This also in children is a disease of little danger, as the gall-ducts are distensible, and will the easier admit of the exclusion of gall-stones; but becomes a more serious disease in proportion to the age of the patient, and his habits of life in respect to spirituous potation.

A fourth cause of jaundice is the compression of the bile-duct by the enlargement of an inflamed or schirrous liver; this attends those who have drank much spirituous liquor, and is generally succeeded by dropsy and death.

M. M. Repeated emetics. Mild cathartics. Warm bath. Electricity. Bitters. Then steel, which, when the pain and inflammation is removed by evacuations, acts like a charm in removing the remainder of the inflammation, and by promoting the absorption of the new vessels or fluids; like the application of any acrid eye-water at the end of ophthalmia; and thus the thickened coats of the bile-duct become reduced, or the enlargement of the liver lessened, and a free passage is again opened for the bile into the intestine. Ether with yolk of egg is recommended, as having a tendency to dissolve inspissated bile. And a decoction of madder is recommended for the same purpose; because the bile of animals, whose food was mixed with madder, was found always in a dilute state. Aerated alcaline water, or Seltzer's water. Raw cabbage, and other acrid vegetables, as water-cresses, mustard. Horses are said to be subject to inspissated bile, with yellow eyes, in the winter season, and to get well as soon as they feed on the spring grass.

The largest bile-stone I have seen was from a lady, who had parted with it some years before, and who had abstained above ten years from all kinds of vegetable diet to prevent, as she supposed, a colic of her stomach, which was probably a pain of the biliary duct; on resuming the use of some vegetable diet, she recovered a better state of health, and formed no new bilious concretions.

A strong aerated alcaline water is sold by J. Schweppe, No. 8, King's-street, Holborn. See Class I. 1. 3. 10.

20. Pelvis renalis inirritabilitas. Inirritability of the pelvis of the kidney. When the nucleus of a stone, whether it be inspissated mucus, or other matter, is formed in the extremity of any of the tubuli uriniferi, and being detached from thence falls into the pelvis of the kidney, it is liable to lodge there from the want of due irritability of the membrane; and in that situation increases by new appositions of indurated animal matter, in the same manner as the stone of the bladder. This is the general cause of haemorrhage from the kidney; and of obtuse pain in it on exercise; or of acute pain, when the stone advances into the ureter. See Class I. 1. 3. 9.

* * * * *

ORDO II.

Decreased Irritation.

GENUS V.

Decreased Action of the Organs of Sense.

SPECIES.

1. Stultitia inirritabilis. Folly from inirritability. Dulness of perception. When the motions of the fibrous extremities of the nerves of sense are too weak to excite sensation with sufficient quickness and vigour. The irritative ideas are nevertheless performed, though perhaps in a feeble manner, as such people do not run against a post, or walk into a well. There are three other kinds of folly; that from deficient sensation, from deficient volition, and from deficient association, as will be mentioned in their places. In delirium, reverie, and sleep, the power of perception is abolished from other causes.

2. Visus imminutus. Diminished vision. In our approach to old age our vision becomes imperfect, not only from the form of the cornea, which becomes less convex, and from its decreased transparency mentioned in Class I. 2. 3. 26.; but also from the decreased irritability of the optic nerve. Thus, in the inirritative or nervous fever, the pupil of the eye becomes dilated; which in this, as well as in the dropsy of the brain, is generally a fatal symptom. A part of the cornea as well as a part of the albuginea in these fevers is frequently seen during sleep; which is owing to the inirritability of the retina to light, or to the general paresis of muscular action, and in consequence to the less contraction of the sphincter of the eye, if it may be so called, at that time.

There have been instances of some, who could not distinguish certain colours; and yet whose eyes, in other respects, were not imperfect. Philos. Transact. Which seems to have been owing to the want of irritability, or the inaptitude to action, of some classes of fibres which compose the retina. Other permanent defects depend on the diseased state of the external organ. Class I. 1. 3. 14. I. 2. 3. 25. IV. 2. 1. 11.

3. Muscae volitantes. Dark spots appearing before the eyes, and changing their apparent place with the motions of the eyes, are owing to a temporary defect of irritability of those parts of the retina, which have been lately exposed to more luminous objects than the other parts of it, as explained in Sect. XL. 2. Hence dark spots are seen on the bed-clothes by patients, when the optic nerve is become less irritable, as in fevers with great debility; and the patients are perpetually trying to pick them off with their fingers to discover what they are; for these parts of the retina of weak people are sooner exhausted by the stimulus of bright colours, and are longer in regaining their irritability.

Other kinds of ocular spectra, as the coloured ones, are also more liable to remain in the eyes of people debilitated by fevers, and to produce various hallucinations of sight. For after the contraction of a muscle, the fibres of it continue in the last situation, till some antagonist muscles are exerted to retract them; whence, when any one is much exhausted by exercise, or by want of sleep, or in fevers, it is easier to let the fibres of the retina remain in their last situation, after having been stimulated into contraction, than to exert any antagonist fibres to replace them.

As the optic nerves at their entrance into the eyes are each of them as thick as a crow-quill, it appears that a great quantity of sensorial power is expended during the day in the perpetual activity of our sense of vision, besides that used in the motions of the eye-balls and eyelids; as much I suppose as is expended in the motions of our arms, which are supplied with nerves of about the same diameters. From hence we may conclude, that the light should be kept from patients in fevers with debility, to prevent the unnecessary exhaustion of the sensorial power. And that on the same account their rooms should be kept silent as well as dark; that they should be at rest in an horizontal posture; and be cooled by a blast of cool air, or by washing them with cold water, whenever their skins are warmer than natural.

4. Strabismus. Squinting is generally owing to one eye being less perfect than the other; on which account the patient endeavours to hide the worst eye in the shadow of the nose, that his vision by the other may not be confused. Calves, which have an hydatide with insects inclosed in it in the frontal sinus on one side, turn towards the affected side; because the vision on that side, by the pressure of the hydatide, becomes less perfect; and the disease being recent, the animal turns round, expecting to get a more distinct view of objects.

In the hydrocephalus internus, where both eyes are not become insensible, the patient squints with only one eye, and views objects with the other, as in common strabismus. In this case it may be known on which side the disease exists, and that it does not exist on both sides of the brain; in such circumstances, as the patients I believe never recover as they are now treated, might it not be adviseable to perforate the cranium over the ventricule of the affected side? which might at least give room and stimulus to the affected part of the brain?

M. M. If the squinting has not been confirmed by long habit, and one eye be not much worse than the other, a piece of gauze stretched on a circle of whale-bone, to cover the best eye in such a manner as to reduce the distinctness of vision of this eye to a similar degree of imperfection with the other, should be worn some hours every day. Or the better eye should be totally darkened by a tin cup covered with black silk for some hours daily, by which means the better eye will be gradually weakened by the want of use, and the worse eye will be gradually strengthened by using it. Covering an inflamed eye in children for weeks together, is very liable to produce squinting, for the same reason.

5. Amaurosis. Gutta serena. Is a blindness from the inirritability of the optic nerve. It is generally esteemed a palsy of the nerve, but should rather be deemed the death of it, as paralysis has generally been applied to a deprivation only of voluntary power. This is a disease of dark eyes only, as the cataract is a disease of light eyes only. At the commencement of this disease, very minute electric shocks should be repeatedly passed through the eyes; such as may be produced by putting one edge of a piece of silver the size of a half-crown piece beneath the tongue, and one edge of a piece of zinc of a similar size between the upper lip and the gum, and then repeatedly bringing their exterior edges into contact, by which means very small electric sparks become visible in the eyes. See additional note at the end of the first volume, p. 567. and Sect. XIV. 5.

M. M. Minute electric shocks. A grain of opium, and a quarter of a grain of corrosive sublimate of mercury, twice a day for four or six weeks. Blister on the crown of the head.

6. Auditus imminutus. Diminished hearing. Deafness is a frequent symptom in those inflammatory or sensitive fevers with debility, which are generally called putrid; it attends the general stupor in those fevers, and is rather esteemed a salutary sign, as during this stupor there is less expenditure of sensorial power.

In fevers of debility without inflammation, called nervous fevers, I suspect deafness to be a bad symptom, arising like the dilated pupil from a partial paralysis of the nerve of sense. See Class IV. 2. 1. 15.

Nervous fevers are supposed by Dr. Gilchrist to originate from a congestion of serum or water in some part of the brain, as many of the symptoms are so similar to those of hydrocephalus internus, in which a fluid is accumulated in the ventricules of the brain; on this idea the inactivity of the optic or auditory nerves in these fevers may arise from the compression of the effused fluid; while the torpor attending putrid fever may depend on the meninges of the brain being thickened by inflammation, and thus compressing it; now the new vessels, or the blood, which thickens inflamed parts, is more frequently reabsorbed, than the effused fluid from a cavity; and hence the stupor in one case is less dangerous than in the other.

In inflammatory or sensitive fevers with debility, deafness may sometimes arise from a greater secretion and absorption of the ear-wax, which is very similar to the bile, and is liable to fill the meatus auditorius, when it is too viscid, as bile obstructs the gall-ducts.

M. M. In deafness without fever Dr. Darwin applied a cupping-glass on the ear with good effect, as described in Phil. Trans. Vol. LXIV. p. 348. Oil, ether, laudanum, dropped into the ears.

7. Olfactus imminutus. Inactivity of the sense of smell. From our habits of trusting to the art of cookery, and not examining our food by the smell as other animals do, our sense of smell is less perfect than theirs. See Sect. XVI. 5. Class IV. 2. 1. 16.

M. M. Mild errhines.

8. Gustus imminutus. Want of taste is very common in fevers, owing frequently to the dryness or scurf of the tongue, or external organ of that sense, rather than to any injury of the nerves of taste. See Class. I. 1. 3. 1. IV. 2. 1. 16.

M. M. Warm subacid liquids taken frequently.

9. Tactus imminutus. Numbness is frequently complained of in fevers, and in epilepsy, and the touch is sometimes impaired by the dryness of the cuticle of the fingers. See Class IV. 2. 1. 16.

When the sense of touch is impaired by the compression of the nerve, as in sitting long with one thigh crossed over the other, the limb appears larger, when we touch it with our hands, which is to be ascribed to the indistinctness of the sensation of touch, and may be explained in the same manner as the apparent largeness of objects seen through a mist. In this last case the minute parts of an object, as suppose of a distant boy, are seen less distinctly, and therefore we instantly conceive them to be further from the eye, and in consequence that the whole subtends a larger angle, and thus we believe the boy to be a man. So when any one's fingers are pressed on a benumbed limb, the sensation produced is less than it should be, judging from visible circumstances; we therefore conceive, that something intervened between the object and the sense, for it is felt as if a blanket was put between them; and that not being visibly the case, we judge that the limb is swelled.

The sense of touch is also liable to be deceived from the acquired habits of one part of it acting in the vicinity of another part of it. Thus if the middle finger be crossed over either of the fingers next to it, and a nut be felt by the two ends of the fingers so crossed at the same time, the nut appears as if it was two nuts. And lastly, the sense of touch is liable to be deceived by preconceived ideas; which we believe to be excited by external objects, even when we are awake. It has happened to me more than once, and I suppose to most others, to have put my hands into an empty bason standing in an obscure corner of a room to wash them, which I believed to contain cold water, and have instantly perceived a sensation of warmth, contrary to that which I expected to have felt.

In some paralytic affections, and in cold fits of ague, the sensation of touch has been much impaired, and yet that of heat has remained, See Sect. XIV. 6.

M. M. Friction alone, or with camphorated oil, warm bath. Ether. Volatile alcali and water. Internally spice, salt. Incitantia. Secernentia.

10. Stupor. The stupor, which occurs in fevers with debility, is generally esteemed a favourable symptom; which may arise from the less expenditure of sensorial power already existing in the brain and nerves, as mentioned in species 6 of this genus. But if we suppose, that there is a continued production of sensorial power, or an accumulation of it in the torpid parts of the system, which is not improbable, because such a production of it continues during sleep, to which stupor is much allied, there is still further reason for believing it to be a favourable symptom in inirritable fevers; and that much injury is often done by blisters and other powerful stimuli to remove the stupor. See Sect. XII. 7. 8. and XXXIII. 1. 4.

Dr. Blane in his Croonian Lecture on muscular motion for 1788, among many other ingenious observations and deductions, relates a curious experiment on salmon, and other fish, and which he repeated upon eels with similar event.

"If a fish, immediately upon being taken out of the water, is stunned by a violent blow on the head, or by having the head crushed, the irritability and sweetness of the muscles will be preserved much longer, than if it had been allowed to die with the organs of sense entire. This is so well known to fishermen, that they put it in practice, in order to make them longer susceptible of the operation called crimping. A salmon is one of the fish least tenacious of life, insomuch, that it will lose all signs of life in less than half an hour after it is taken out of the water, if suffered to die without any farther injury; but if, immediately after being caught, it receives a violent blow on the head, the muscles will shew visible irritability for more than twelve hours afterwards."

Dr. Blane afterwards well remarks, that "in those disorders in which the exercise of the senses is in a great measure destroyed, or suspended, as in the hydrocephalus, and apoplectic palsy, it happens not uncommonly, that the appetite and digestion are better than in health."

* * * * *

ORDO III.

Retrograde Irritative Motions.

GENUS I.

Of the Alimentary Canal.

The retrograde motions of our system originate either from defect of stimulus, or from defect of irritability. Thus sickness is often induced by hunger, which is a want of stimulus; and from ipecacuanha, in which last case it would seem, that the sickness was induced after the violence of the stimulus was abated, and the consequent torpor had succeeded. Hence spice, opium, or food relieves sickness.

The globus hystericus, salivation, diabaetes, and other inversions of motion attending hysteric paroxysms, seem to depend on the want of irritability of those parts of the body, because they are attended with cold extremities, and general debility, and are relieved by wine, opium, steel, and flesh diet; that is, by any additional stimulus.

When the longitudinal muscles are fatigued by long action, or are habitually weaker than natural, the antagonist muscles replace the limb by stretching it in a contrary direction; and as these muscles have had their actions associated in synchronous tribes, their actions cease together. But as the hollow muscles propel the fluids, which they contain, by motions associated in trains; when one ring is fatigued from its too great debility, and brought into retrograde action; the next ring, and the next, from its association in train falls into retrograde action. Which continue so long as they are excited to act, like the tremors of the hands of infirm people, so long as they endeavour to act. Now as these hollow muscles are perpetually stimulated, these retrograde actions do not cease as the tremors of the longitudinal muscles, which are generally excited only by volition. Whence the retrograde motions of hollow muscles depend on two circumstances, in which they differ from the longitudinal muscles, namely, their motions being associated in trains, and their being subject to perpetual stimulus. For further elucidation of the cause of this curious source of diseases, see Sect. XXIX. 11. 5.

The fluids disgorged by the retrograde motions of the various vascular muscles may be distinguished, 1. From those, which are produced by secretion, by their not being attended by increase of heat, which always accompanies increased secretion. 2. They may be distinguished from those fluids, which are the consequence of deficient absorption, by their not possessing the saline acrimony, which those fluids possess; which inflames the skin or other membranes on which they fall; and which have a saline taste to the tongue. 3. They may be distinguished from those fluids, which are the consequence both of increased secretion and absorption, as these are attended with increase of warmth, and are inspissated by the abstraction of their aqueous parts. 4. Where chyle, or milk, are found in the feces or urine, or when other fluids, as matter, are translated from one part of the system to another, they have been the product of retrograde action of lymphatic or other canals. As explained in Sect. XXIX. 8.

SPECIES.

1. Ruminatio. In the rumination of horned cattle the retrograde motions of the oesophagus are visible to the eye, as they bring up the softened grass from their first stomach. The vegetable aliment in the first stomach of cattle, which have filled themselves too full of young clover, is liable to run into fermentation, and distend the stomach, so as to preclude its exit, and frequently to destroy the animal. To discharge this air the farmers frequently make an opening into the stomach of the animal with success. I was informed, I believe by the late Dr. Whytt of Edinburgh, that of twenty cows in this situation two had died, and that he directed a pint of gin or whisky, mixed with an equal quantity of water, to be given to the other eighteen; all of which eructed immense quantities of air, and recovered.

There are histories of ruminating men, and who have taken pleasure in the act of chewing their food a second time. Philos. Transact.

2. Ructus. Eructation. An inverted motion of the stomach excluding through its upper valve an elastic vapour generated by the fermentation of the aliment; which proceeds so hastily, that the digestive power does not subdue it. This is sometimes acquired by habit, so that some people can eruct when they please, and as long as they please; and there is gas enough generated to supply them for this purpose; for by Dr. Hale's experiments, an apple, and many other kinds of aliment, give up above six hundred times their own bulk of an elastic gas in fermentation. When people voluntarily eject the fixable air from their stomachs, the fermentation of the aliment proceeds the faster; for stopping the vessels, which contain new wines, retards their fermentation, and opening them again accelerates it; hence where the digestion is impaired, and the stomach somewhat distended with air, it is better to restrain than to encourage eructations, except the quantity makes it necessary. When wine is confined in bottles the fermentation still proceeds slowly even for years, till all the sugar is converted into spirit; but in the process of digestion, the saccharine part is absorbed in the form of chyle by the bibulous mouths of the numerous lacteals, before it has time to run into the vinous fermentation.

3. Apepsia. Indigestion. Water-qualm. A few mouthfuls of the aliment are rejected at a time for some hours after meals. When the aliment has had time to ferment, and become acid, it produces cardialgia, or heart-burn. This disease is perhaps generally left after a slight inflammation of the stomach, called a surfeit, occasioned by drinking cold liquors, or eating cold vegetables, when heated with exercise. This inflammation of the stomach is frequently, I believe, at its commencement removed by a critical eruption on the face, which differs in its appearance as well as in its cause from the gutta rosea of drunkards, as the skin round the base of each eruption is less inflamed. See Class II. 1. 4. 6.. This disease differs from Cardialgia, Class I. 2. 4. 5. in its being not uniformly attended with pain of the cardia ventriculi, and from its retrograde motions of a part of the stomach about the upper orifice of it. In the same manner as hysteria differs from hypochondriasis; the one consisting in the weakness and indigestion of the same portions of the alimentary canal, and the other in the inverted motions of some parts of it. This apepsia or water-qualm continues many years, even to old age; Mr. G—— of Lichfield suffered under this disease from his infancy; and, as he grew old, found relief only from repeated doses of opium.