Miss W. an elegant young lady of about twenty, applied a mercurial lotion to her face, which was covered with very small red points; which seemed to have been not acquired by any known or avoidable means; she was seized with inflammation of her liver, and after repeated bleeding and cathartics recovered, and in a few weeks the eruption appeared as before.

M. M. Five grains of calomel once a month, with a cathartic, five grains of rhubarb and a quarter of a grain of emetic tartar every night for many weeks. With this preparation mercurial plasters, made without turpentine, and applied every night, and taken off every morning, will sometimes succeed, and may be used with safety. But blistering the face all over the eruption, beginning with a part, succeeds better than any other means, as I have more than once experienced.—Something like this is mentioned in the Letters of Lady Mary Wortley Montague, who blistered her face with balsam of Mecca.

Mrs. F. had for many years had a disagreeably looking eruption on her chin, after a cathartic with calomel, she was advised to blister her whole chin; on the healing of the blister a few eruptions again appeared, which ceased on the application of a second blister. She took rhubarb five grains, and emetic tartar a quarter of a grain every night for many weeks.

Miss L. a young lady about eighteen, had tried variety of advice for pimples over the greatest part of her face in vain. She took the above medicines internally, and blistered her face by degrees all over and became quite beautiful. A spot or two now and then appeared, and on this account she frequently slept with parts of her face covered with mercurial plaster, made without turpentine, which was held on by a pasteboard mask, and taken off in the mornings; if any part of the plaster adhered, a little butter or oil destroyed the adhesion.

7. Odontitis. Inflammatory tooth-ach is occasioned by inflammation of the membranes of the tooth, or a caries of the bone itself. The gum sometimes suppurates, otherwise a swelling of the cheek succeeds by association, and thus the violence of the pain in the membranes of the tooth is relieved, and frequently cured; and when this happens the disease properly belongs to Class IV. as it so far resembles the translations of morbid actions in the gout and rheumatism.

At other times the tooth dies without caries, especially in people about sixty years of age, or before; and then it stimulates its involving membrane, like any other extraneous substance. The membrane then becomes inflamed and thickened, occasioning some pain, and the tooth rises upwards above the rest, and is gradually pushed out whole and undecayed; on its rising up a pus-like mucus is seen discharged from the gum, which surrounds it; and the gum seems to have left the tooth, as the fangs or roots of it are in part naked.

M. M. Where the tooth is sound it can only be saved by evacuations by venesection, and a cathartic; and after its operation two grains of opium, a blister may also be used behind the ear, and ether applied to the cheek externally. In slighter cases two grains of opium with or without as much camphor may be held in the mouth, and suffered to dissolve near the affected tooth, and be gradually swallowed. See Class I. 2. 4. 12. Odontalgia may be distinguished from otitis by the application of cold water to the affected tooth; for as the pain of common tooth-ach is owing to torpor, whatever decreases stimulus adds to the torpor and consequent pain; whereas the pain of an inflamed tooth being ceased by the increased action of the membranes of it is in some measure alleviated by the application of cold.

8. Otitis. Inflammation and consequent suppuration of some membranes of the internal ear frequently occur in children, who sleep in cold rooms, or near a cold wall, without a night-cap. If the bones are affected, they come out in a long process of time, and the child remains deaf of that ear. But in this case there is generally a fever attends this inflammation; and it then belongs to another genus.

M. M. A warmer night-cap. Warmish water should be gently syringed into the ear to keep it clean twice a day; and if it does not heal in a week, a little spirit of wine should be added; first about a fourth part, and it should be gradually increased to half rectified spirit and half water: if it continues long to discharge matter with a very putrid smell, the bones are injured, and will in time find their exit, during which time the ear should be kept clean by filling it with a weaker mixture of spirit of wine and water; or a solution of alum in water; which may be poured into the ear, as the head is inclined, and shook out again by turning the head, two or three times morning and evening. See Class II. 1. 4. 10.

9. Fistula lacrymalis. The lacrymal sack, with its puncta lacrymalia and nasal duct, are liable to be destroyed by suppuration without fever; the tears then run over the eyelids, and inflame the edges of them, and the cheeks, by their perpetual moisture, and saline acrimony.

M. M. By a nice surgical operation a new aperture is to be made from the internal corner of the eye into the nostril, and a silver tube introduced, which supplies the defect by admitting the tears to pass again into the nostril. See Melanges de Chirurgie par M. Pouteau; who thinks he has improved this operation.

10. Fistula in ano. A mucous discharge from the anus, called by some white piles, or matter from a suppurated pile, has been mistaken for the matter from a concealed fistula. A bit of cotton wool applied to the fundament to receive the matter, and renewed twice a day for a week or two, should always be used before examination with the probe. The probe of an unskilful empyric sometimes does more harm in the loose cellular membrane of these parts than the original ulcer, by making a fistula he did not find. The cure of a fistula in ano of those, who have been much addicted to drinking spirituous liquor, or who have a tendency to pulmonary consumption, is frequently of dangerous consequence, and is succeeded by ulcers of the lungs, and death.

M. M. Ward's paste, or 20 black pepper-corns taken after each meal twice a day; the pepper-corns should be cut each into two or three pieces. The late Dr. Monro of Edinburgh asserted in his lectures, that he had known a fistula in ano cured by injecting first a mixture of rectified spirit of wine and water; and by gradually increasing the strength of it, till the patient could bear rectified spirit alone; by the daily use of which at length the sides of the fistula became callous, and ceased to discharge, though the cavity was left. A French surgeon has lately affirmed, that a wire of lead put in at the external opening of the ulcer, and brought through the rectum, and twisted together, will gradually wear itself through the gut, and thus effect a cure without much pain. The ends of the leaden wire must be twisted more and more as it becomes loose. Or, lastly, it must be laid open by the knife.

11. Fistula urethrae. Where a stricture of the urethra exists, from whatever cause, the patient, in forcing the stream of urine through the structure, distends the urethra behind it; which after a time is liable to burst, and to become perforated; and some of the urine is pushed into the cellular membrane, occasioning fistulas, which sometimes have large surfaces producing much matter, which is pressed out at the time of making water, and has been mistaken for a catarrh of the bladder; these fistulas sometimes acquire an external opening in the perinaeum, and part of the urine is discharged that way.

Can this matter be distinguished from mucus of the bladder by the criterion delivered in Class II. 1. 6. 6?

M. M. The perpetual use of bougies, either of catgut or of caoutchouc. The latter may be had at No. 37, Red-lion street, Holborn, London. The former are easily made, by moistening the catgut, and keeping it stretched till dry, and then rounding one end with a pen-knife. The use of a warm bath every day for near an hour, at the heat of 94 or 96 degrees, for two or three months, I knew to be uncommonly successful in one case; the extensive fistulas completely healing. The patient should introduce a bougie always before he makes water, and endeavour to make it as slowly as possible. See Class I. 2. 3. 24.

12. Hepatitis chronica. Chronical inflammation of the liver. A collection of matter in the liver has frequently been found on dissection, which was not suspected in the living subject. Though there may have been no certain signs of such a collection of matter, owing to the insensibility of the internal parts of this viscus; which has thus neither been attended with pain, nor induced any fever; yet there may be in some cases reason to suspect the existence of such an abscess; either from a sense of fulness in the right hypochondre, or from transient pains sometimes felt there, or from pain on pressure, or from lying on the left side, and sometimes from a degree of sensitive fever attending it.

Dr. Saunders suspects the acute hepatitis to exist in the inflammation of the hepatic artery, and the chronical one in that of the vena portarum. Treatise on the Liver. Robinson. London.

13. Scrophula suppurans. Suppurating scrophula. The indolent tumors of the lymphatic glands are liable, after a long time, to regain their sensibility; and then, owing to their former torpor, an increased action of the vessels, beyond what is natural, with inflammation, is the consequence of their new life, and suppuration succeeds. This cure of scrophula generally happens about puberty, when a new energy pervades the whole system, and unfolds the glands and organs of reproduction.

M. M. See Class I. 2. 3. 21. Where scrophulous ulcers about the neck are difficult to heal, Dr. Beddoes was informed, in Ireland, that an empyric had had some success by inflaming them by an application of wood sorrel, oxalis acetosella, the leaves of which are bruised in a mortar, and applied on the ulcers for two or three days, and then some more lenient application is used.

A poor boy, about twelve years old, had a large scrophulous ulcer on one side of the chest beneath the clavicle, and another under his jaw; he was directed, about three weeks ago, to procure a pound of dry oak-bark from the tanners, and to reduce it to fine powder, and to add to it one ounce of white lead in fine powder, and to cover the ulcers daily with it, keeping it on by brown paper and a bandage. He came to me a few minutes ago, to shew me that both the ulcers are quite healed. The constant application of linen rags, moistened with a solution of an ounce of sugar of lead in a pint of water, I think I have seen equally efficacious.

14. Scorbutus suppurans. In the sea-scurvy there exists an inactivity of venous absorption, whence vibices and petechiae, and sometimes ulcers. As the column of blood pressing on the of origins of the veins of the lower extremities, when the body is erect, opposes the ascent of the blood in them, they are more frequently liable to become enlarged, and to produce varixes, or vibices, or, lastly, ulcers about the legs, than on the upper parts of the body. The exposure to cold is believed to be another cause of ulcers on the extremities; as happens to many of the poor in winter at Lisbon, who sleep in the open air, without stockings, on the steps of their churches or palaces. See Class I. 2. 1. 15.

M. M. A bandage spread with plaster to cover the whole limb tight. Rags dipped in a solution of sugar of lead. A warm flannel stocking or roller. White lead and oak bark, both in fine powder. Horizontal rest.

15. Scirrhus suppurans. When a scirrhus affects any gland of no great extent or sensibility, it is, after a long period of time, liable to suppurate without inducing fever, like the indolent tumors of the conglobate or lymphatic glands above mentioned; whence collections of matter are often found after death both in men and other animals; as in the liver of swine, which have been fed with the grounds of fermented mixtures in the distilleries. Another termination of scirrhus is in cancer, as described below. See Class I. 2. 3. 22.

16. Carcinoma. Cancer. When a schirrous tumor regains its sensibility by nature, or by any accidental hurt, new vessels shoot amongst the yet insensible parts of it, and a new secretion takes place of a very injurious material. This cancerous matter is absorbed, and induces swelling of the neighbouring lymphatic glands; which also become schirrous, and afterwards cancerous.

This cancerous matter does not seem to acquire its malignant or contagious quality, till the cancer becomes an open ulcer; and the matter secreted in it is thus exposed to the air. Then it evidently becomes contagious, because it not only produces hectic fever, like common matter in ulcers open to the air; but it also, as it becomes absorbed, swells the lymphatic glands in its vicinity; as those of the axilla, when the open cancer is on the breast. See Class II. 1. 3.

Hence exsection before the cancer is open is generally a cure; but after the matter has been exposed to the air, it is seldom of service; as the neighbouring lymphatic glands are already infected. I have observed some of these patients after the operation to have had diseased livers, which might either have previously existed, or have been produced by the fear or anxiety attending the operation.

Erosion with arsenic, after the cancer is become an open ulcer, has generally no better effect than exsection, but has been successful before ulceration. The best manner of using arsenic, is by mixing one grain with a dram of lapis calaminaris, and strewing on the cancer some of the powder every day, till the whole is destroyed.

Cancers on the face are said to arise from the periosteum, and that unless this be destroyed by the knife, or by caustics, the cancer certainly recurs. After the cancer becomes an open ulcer of some extent, a purulent fever supervenes, as from other open ulcers, and gradually destroys the patient. See Class II. 1. 6. 13.

Two very interesting cases have been lately published by Dr. Ewart, of Bath, in which carbonic acid gas, or fixed air, was kept constantly in contact with the open cancerous ulcers of the breast; which then healed like other common ulcers. This is rather to be ascribed to the exclusion of oxygen, than to any specific virtue in the carbonic acid. As in common ulcers the matter does not induce hectic fever, till it has been exposed to the air, and then probably united with oxygen.

The manner of applying the fixed air, is by including the cancer in one half or hemisphere of a large bladder; the edges are made to adhere to the skin by adhesive plaster, or perhaps a mixture of one part of honey with about twenty parts of carpenter's glue might better suit some tender skins. The bladder is then kept constantly filled with carbonic acid gas, by means of a pipe in the neck of it; and the matter let out at a small aperture beneath.

17. Arthrocele. Swelling of the joints seems to have its remote cause in the softness of the bones, for they could not swell unless they were previously softened, see Class I. 2. 2. 14. The epiphyses, or ends of the bones, being naturally of a looser texture, are most liable to this disease, and perhaps the cartilages and capsular ligaments may also become inflamed and swelled along with the heads of the bones. This malady is liable to distort the fingers and knees, and is usually called gout or rheumatism; the former of which is liable to disable the fingers by chalk-stones, and thence to have somewhat a similar appearance. But the arthrocele, or swelling of the joints, affects people who have not been intemperate in the use of fermented or spirituous liquors; or who have not previously had a regular gout in their feet; and in both these circumstances differs from the gout. Nor does it accord with the inflammatory rheumatism, as it is not attended with fever, and because the tumors of the joints never entirely subside. The pain or sensibility, which the bones acquire, when they are inflamed, may be owing to the new vessels, which shoot in them in their soft state, as well as to the distention of the old ones.

M. M. Half a grain of opium twice a day, gradually increased to a grain, but not further, for many months. Thirty grains of powder of bark twice a day for many months. Ten grains of bone-ashes, or calcined hartshorn, twice a day, with decoction of madder? Soda phosphorata?

18. Arthropuosis. Joint-evil. This differs from the former, as that never suppurates; these ulcers of the joints are generally esteemed to arise from scrophula; but as scrophula is a disease of the lymphatic or absorbent system, and this consists in the suppuration of the membranes, or glands, or cartilages about the joints, there does not seem a sufficient analogy to authorize their arrangement under the same name.

The white swelling of the knee, when it suppurates, comes under this species, with variety of other ulcers attended with carious bones.

19. Caries ossium. A caries of the bones may be termed a suppuration of them; it differs from the above, as it generally is occasioned by some external injury, as in decaying teeth; or by venereal virus, as in nodes on the tibia; or by other matter derived to the bone in malignant fevers; and is not confined to the ends of them.

The separation of the dead bone from the living is a work of some time. See Sect. XXXIII. 3. 1.

* * * * *

ORDO I.

Increased Sensation.

GENUS V.

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

The ulcers, or eruptions, which are formed on the external skin, or on the mouth or throat, or on the air-cells of the lungs, or on the intestines, all of which are more or less exposed to the contact of the atmospheric air, which we breathe, and which in some proportion we swallow with our food and saliva; or to the contact of the inflammable air, or hydrogen, which is set at liberty by the putrefying aliment in the intestines, or by putrefying matter in large abscesses; all of them produce contagious matter; which, on being inoculated into the skin of another person, will produce fever, or a similar disease.

In some cases even the matter formed beneath the skin becomes in some degree contagious, at least so much so as to produce fever of the hectic or malignant kind, as soon as it has pierced through the skin, and has thus gained access to some kind of air; as the fresh puss of a common abscess; or the putrid pus of an abscess, which has been long confined; or of cancerous ulcers.

From this analogy there is reason to suspect, that the matter of all contagious diseases, whether with or without fever, is not infectious till it has acquired something from the air; which, by oxygenating the secreted matter, may probably produce a new acid. And secondly, that in hectic fever a part of the purulent matter is absorbed; or acts on the surface of the ulcer; as variolous matter affects the inoculated part of the arm. And that hectic fever is therefore caused by the matter of an open ulcer; and not by the sensation in the ulcer independent of the aerated pus, which lies on it. Which may account for the venereal matter from buboes not giving the infection, according to the experiments of the late Mr. Hunter, and for some other phenomena of contagion. See Variola discreta, Class II. 1. 3. 9.

SPECIES.

1. Gonorrhoea venerea. A pus-like contagious material discharged from the urethra after impure cohabitation, with smarting or heat on making water; which begins at the external extremity of the urethra, to which the contagious matter is applied, and where it has access to the air.

M. M. In this state of the venereal disease once venesection, with mild cathartics of senna and manna, with mucilage, as almond emulsion, and gum arabic, taken for two or three weeks, absolve the cure. Is camphor of use to relieve the ardor urinae? Do balsams increase or lessen the heat of urine? Neutral salts certainly increase the smarting in making water, by increasing the acrimony of the urine.

Can the discharge from the urethra be soon stopped by saturnine injections, or mercurial ones, or with solution of blue vitriol, at first very dilute, and gradually made stronger? And at the same time lest the syphilis, or general disease, should supervene, the patient might take a quarter of a grain of corrosive sublimate of mercury twice a day, as directed below?

2. Syphilis. Venereal disease. The contagion shews itself in ulcers on the part first inoculated, as chancres; ulcers on the tonsils succeed, with eruption on the skin, especially about the roots of the hair; afterwards on other parts of the skin, terminating in dry scabs; and lastly, with pain and swelling of the bones.

The corona veneris, or crown of Venus, consists of the eruptions at the roots of the hair appearing most round the forehead; which is occasioned by this part being more exposed to the air; which we observed, at the beginning of this genus, either produces or increases the virulence of contagious matter. But it is difficult to conceive from this history, why the throat should be first affected; as it cannot be supposed, that the disease is so often taken by the saliva, like the small-pox, though this may sometimes occur, perhaps very often. The connection between the genitals in men and the throat, is treated of in Class IV. 1. 2. 7. Hydrophobia.

M. M. A quarter of a grain of corrosive sublimate of mercury, taken thrice a day for five or six weeks, made into a pill with breadcrumbs, or dissolved in a spoonful of brandy and water, is a very efficacious and almost certain cure. When it does not succeed, it is owing either to the drug being bad, or to its having precipitated from the brandy, or from its being spoiled in the pill by long keeping. Opium contributes much to expedite the cure both of the simple gonorrhoea, and of venereal ulcers, by increasing absorption both from the mucous membrane, and from the surface of ulcers.

3. Lepra. Leprosy. Leprosy of the Greeks. The skin is rough with white branny scales, which are full of chinks; often moist beneath, and itching. The scales on the head or arms of some drinking people are a disease of this kind. The perspirable matter designed for the purpose of lubricating the external skin is secreted in this disease in a too viscid state, owing to the inflammation of the subcutaneous vessels; and, as the absorbents act too strongly at the same time, a viscid mucus is left adhering to the surface of the skin.

In the leprosy of the Jews, described in the thirteenth and fourteenth chapters of Leviticus, the depression of the sore beneath the surface of the skin, and the hairs in it becoming white, seem to have been the principal circumstances, which the priest was directed to attend to for the purpose of ascertaining the disease.

M. M. Essence of antimony from 20 drops to 100 twice or thrice a day, with half a pint of decoction of elm-bark; or tincture of cantharides from 20 to 60 drops four times a day; or sublimate of mercury, with much diluting fluid. Acid of vitriol? Perhaps the cure chiefly depends on much dilution with water, from two to four pints a day, in which elm-bark, or pine-buds, or juniper-tops, may be boiled. Bath or Buxton water drank in large quantities. Warm bath. Oil-skin bound on the part to confine the perspirable matter. Ointment of tar and suet; or poultice for two or three days, and then cerate with lapis calaminaris. Diet of raisins and bread. Abstinence from wine, beer, and all spirits.

4. Elephantiasis. Leprosy of the Arabs. A contagious disease; the skin is thickened, wrinkled, rough, unctuous, destitute of hair, without any sensation of touch in the extremities of the limbs; the face deformed with tubercles; the voice hoarse, and with a nasal tone. Cullen.

5. Framboesia. Yaws is said to be contagious and hereditary. It principally affects the negroes in the West Indies. Edinb. Essays, Vol. VI.

6. Psora. Itch. A contagious prurient eruption. There are two kinds of itch, that which appears between the fingers, and under the joints of the knees and elbows; and that which seldom is seen in these places, but all over the other parts of the body. The latter is seldom thought to be the itch, as it does not easily infect even a bedfellow, and resists the usual means of cure by brimstone.

If the itch be cured too hastily by rubbing mercurial or arsenical preparations over the whole body, or on too great a part of it, many bad symptoms are produced; as weakness of digestion, with pale bloated countenance, and tendency to dropsy. I have twice seen St. Vitus's dance occur from the use of a mercurial girdle; and once a swelled liver. I have also seen a swelled spleen and swelled legs from the external use of arsenic in the cure of the itch. And very numerous and large phlegmons commonly succeed the too hasty cure of it by other means.

There does not appear a strict analogy between the hasty cure of the itch, and the retrocession of the pustles in the secondary fever of the small-pox; because in that the absorption of the matter is evinced by the swelling of the face and hands, as the pustles recede, as explained in Class II. 1. 3. 9. Variola discreta. And a fever is produced by this absorption; neither of which happen, when the pustles of the itch are destroyed by mercury or arsenic.

Nor can these inconveniences, which occur on the too hasty cure of the itch, be explained by those which follow the cure of some kinds of gutta rosea, Class II. 1. 4. 6. as in those the eruptions on the face were an associated disease with inflammation of the liver or stomach, which they were accustomed to relieve; whereas the itch is not known to have had any previous catenation with other diseases.

In the itch there exists not only great irritation in the production of the pustles, but great sensation is caused by their acrimony afterwards; insomuch that the pain of itching, without the interrupted smarting occasioned by scratching, would be intolerable. This great excitement of the two sensorial powers of irritation and sensation is so great, when the pustles are diffused over the whole surface of the body, that a torpor succeeds the sudden ceasing of it; which affects those parts of the system, which were most catenated with the new motions of the skin, as the stomach, whence indigestion and flatulency; or which are generally most liable to fall into torpor, as the numerous glands, which form the liver. Whence the diseases consequent to the hasty cure of the itch are diseases of debility, as tumid viscera, oedematous swellings, and St. Vitus's dance, which is a debility of association. In the same manner indigestion, with green evacuations, are said to follow an injudicious application of cerussa to stop too hastily the exsudation behind the ears of children, Class I. 1. 2. 9. And dropsies are liable to succeed the cure of old ulcers of the legs, which have long stimulated the system.

M. M. The size of a large pea, of an ointment consisting of one part of white precipitate of mercury to six parts of hogs' lard well triturated together, to be rubbed on a part of the body every night, and washed off with soap and water next morning, till every part is cleared; with lac sulphuris twenty grains to be taken every morning inwardly. Warm saline bath, with white vitriol in it. Flowers of sulphur mixed with thick gruel, with hogs fat. With either of which the body may be smeared all over.

7. Psora ebriorum. Elderly people, who have been much addicted to spirituous drinks, as beer, wine, or alcohol, are liable to an eruption all over their bodies; which is attended with very afflicting itching, and which they probably propagate from one part of their bodies to another with their own nails by scratching themselves. I saw fatal effects in one such patient, by a too extensive use of a solution of lead; the eruption disappeared, he became dropsical, and died; I suppose from the too suddenly ceasing of the great stimulus caused by the eruptions over the whole skin, as in the preceding article.

M. M. The patient should gradually accustom himself to half his usual quantity of vinous potation. The warm bath, with one pound of salt to every three gallons. Mercurial ointments on small parts of the skin at a time. A grain of opium at night instead of the usual potation of wine or beer.

8. Herpes. Herpes consists of gregarious spreading excoriations, which are succeeded by branny scales or scabs. In this disease there appears to be a deficient absorption of the subcutaneous mucus, as well as inflammation and increased secretion of it. For the fluid not only excoriates the parts in its vicinity by its acrimony, but is very saline to the taste, as some of these patients have assured me; I believe this kind of eruption, as well as the tinea, and perhaps all other cutaneous eruption, is liable to be inoculated in other parts of the body by the finger-nails of the patients in scratching themselves.

It is liable to affect the hands, and to return at distant periods; and is probably a secondary disease, as well as the zona ignea, or shingles, described below.

M. M. Poultice the eruption with bread and milk, or raw carrots grated, for two or three whole days, to dilute or receive the discharged fluid, and abate the inflammation; then cover the parts with fresh cerate mixed with lapis calaminaris. On the parts not excoriated mercurial ointment, made of one part of white calx of mercury and six of hogs' fat. Internally, after venesection, gentle repeated cathartics. Lastly, the bark. Acid of vitriol. Bolus Armeniae, or testacia. Antimonials. Decoction of interior bark of elm.

9. Zona ignea. Shingles. This eruption has been thought a species of herpes by some writers, and by others a species of erysipelas. Yellow or livid vesicles appear, producing a corrosive ichor, which is sometimes attended with a degree of fever. It is said to infest sometimes the thorax and ribs, but its most general situation is on the small of the back, over one kidney, extending forward over the course of one of the ureters.

There is reason to suspect, that this also is a secondary or sympathetic disease, as well as the preceding one; but future observations are required, before it can be removed to the fourth class, or diseases of association. In three patients I have been induced to believe, that the eruption on the loins was a translation of inflammation from the external membrane of the kidney to the skin. They had, for a day or two before the appearance of the eruption, complained of a dull pain on the region of one kidney, but without vomiting; by which it was distinguished from nephritis interna, or gravel; and without pain down the outside of the thigh, by which it was distinguished from sciatica. In other situations the shingles may sympathize with other internal membranes, as in a case published by Dr. Russel (De Tabe Glandulari), where the retrocession of the shingles was succeeded by a serious dyspnaea.

M. M. Venesection, if the pulse is strong. Calomel three or four grains, very mild repeated cathartics. Poultice for a few days, then cerate of lapis calaminaris, as in herpes. A grain of emetic tartar dissolved in a pint of water, and taken so as to empty the stomach and intestines, is said much to hasten the cure; compresses soaked in a saturnine solution are recommended externally on the eruption; and cerate where there are ulcerations. Desanet's Surgical Journal, Vol. II. p. 378. If this be a vicarious disease, it should continue half a lunation; lest, on its ceasing, the bad habits of motion of the primary disease should not have been so perfectly dissevered, but that they may recur.

10. Annulus repens. Ring-worm. A prurient eruption formed in a circle, affecting children, and would seem to be the work of insects, according to the theory of Linnaeus, who ascribes the itch and dysentery to microscopic animalcula. These animalcula are probably the effect, and not the cause, of these eruptions; as they are to be seen in all putrescent animal fluids. The annular propagation of the ring-worm, and its continuing to enlarge its periphery, is well accounted for by the acrimony of the ichor or saline fluid eroding the skin in its vicinity.

M. M. Cover the eruption daily with ink. With white mercurial ointment, as described above in herpes. With solution of white vitriol ten grains to an ounce. These metallic calces stimulate the absorbents into stronger action, whence the fluid has its saline part reabsorbed, and that before it has access to the air, which probably adds to its acrimony by oxygenating it, and thus, producing a new acid.

11. Tinea. Scald head. This contagious eruption affects the roots of the hair, and is generally most virulent around the edges of the hair on the back part of the head; as the corona veneris appears most on the edges of the hair on the forepart of the head; for in these parts the eruption about the roots of the hair is most exposed to the external air, by which its acrimony or noxious quality is increased.

The absorption of the matter thus oxygenated swells the lymphatics of the neck by its stimulus, occasioning many little hard lumps beneath the seat of the eruption; when this happens, the sooner it is cured the better, lest the larger lymphatics of the neck should become affected.

M. M. The art of curing these eruptions consists, first, in abating the inflammation, and consequent secretion of a noxious material. Secondly, to prevent its access to the air, which so much increases its acrimony. And thirdly, to promote the absorption of it, before it has been exposed to the air; for these purposes venesection once, and gentle cathartics, which promote absorption by emptying the blood-vessels. Next poultices and fomentations, with warm water, abate inflammation by diluting the saline acrimony of the secreted fluid, and abating the painful sensation. Afterwards cerate joined with some metallic calx, as of zinc or lead, or solution of lead, mercury, or copper, or iron, which may stimulate the absorbent system into stronger action.

Cover the shaved head with tar and suet, and a bladder; this, by keeping the air from the secreted fluid, much contributes to its mildness, and the stimulus of the tar increases its absorption. See the three preceding species of this genus.

12. Crusta lactea. Milk-crust is a milder disease than tinea, affecting the face as well as the hairy scalp of very young children. It is not infectious, nor liable to swell the lymphatics in its vicinity like the tinea.

M. M. Cover the eruption with cerate made with lapis calaminaris, to be renewed every day. Mix one grain of emetic tartar with forty grains of chalk, and divide into eight papers, one to be taken twice a day, or with magnesia alba, if stools are wanted. The child should be kept cool and much in the air.

13. Trichoma. Plica polonica. A contagious disease, in which the hair is said to become alive and bleed, forming inextricable knots or plaits of great length, like the fabled head of Medusa, with intolerable pain, so as to confine the sufferer on his bed for years.

* * * * *

ORDO I.

Increased Sensation.

GENUS VI.

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

SPECIES.

1. Febris sensitiva. Sensitive fever, when unmixed with either irritative or inirritative fever, may be distinguished from either of them by the less comparative diminution of muscular strength; or in other words, from its being attended with less diminution of the sensorial power of irritation. An example of unmixed sensitive fever may generally be taken from the pulmonary consumption; in this disease patients are seen to walk about with ease, and to do all the common offices of life for weeks, and even months, with a pulse of 120 strokes in a minute; while in other fevers, whether irritated or inirritated, with a pulse of this frequency, the patient generally lies upon the bed, and exerts no muscular efforts without difficulty.

The cause of this curious phenomenon is thus to be understood; in the sensitive fever a new sensorial power, viz. that of sensation, is superadded to that of irritation; which in other fevers alone carries on the increased circulation. Whence the power of irritation is not much more exhausted than in health; and those muscular motions, which are produced in consequence of it, as those which are exerted in keeping the body upright in walking, riding, and in the performance of many customary actions, are little impaired. For an account of the irritated sensitive fever, see Class II. 1. 2. 1.; for the inirritated sensitive fever, Class II. 1. 3. 1. IV. 2. 4. 11.

2. Febris a pure clauso. Fever from inclosed matter is generally of the irritated sensitive kind, and continues for many weeks, and even months, after the abscess is formed; but is distinguished from the fever from aerated matter in open ulcers, because there are seldom any night-sweats, or colliquative diarrhoea in this, as in the latter. The pulse is also harder, and requires occasional venesection, and cathartics, to abate the inflammatory fever; which is liable to increase again every three or four days, till at length, unless the matter has an exit, it destroys the patient. In this fever the matter, not having been exposed to the air, has not acquired oxygenation; in which a new acid, or some other noxious property, is produced; which acts like contagion on the constitution inducing fever-fits, called hectic fever, which terminate with sweats or diarrhoea; whereas the matter in the closed abscess is either not absorbed, or does not so affect the circulation as to produce diurnal or hectic fever-fits; but the stimulus of the abscess excites so much sensation as to induce perpetual pyrexia, or inflammatory fever, without such marked remissions. Nevertheless there sometimes is no fever produced, when the matter is lodged in a part of little sensibility, as in the liver; yet a white pus-like sediment in those cases exists I believe generally in the urine, with occasional wandering pains about the region of the liver or chest.

3. Vomica. An abscess in the lungs is sometimes produced after peripneumony, the cough and shortness of breath continue in less degree, with difficulty in lying on the well side, and with sensitive irritated fever, as explained in the preceding article.

The occasional increase of fever, with hard pulse and sizy blood, in these patients, is probably owing to the inflammation of the walls of the vomica; as it is attended with difficulty of breathing, and requires venesection. Mr. B——, a child about seven years old, lived about five weeks in this situation, with a pulse from 150 to 170 in a minute, without sweats, or diarrhoea, or sediment in his water, except mucus occasionally; and took sufficient nourishment during the whole time. The blood taken was always covered with a strong cupped size, and on his death three or four pints of matter were found in one side of the chest; which had probably, but lately, been effused from a vomica. This child was frequently induced to swing, both in a reciprocating and in a rotatory swing, without any apparent absorption of matter; in both these swings he expressed pleasure, and did not appear to be vertiginous.

M. M. Repeated emetics. Digitalis? Perseverance in rotatory swinging. See Class II. 1. 6. 7.

Mr. I. had laboured some months under a vomica after a peripneumony, he was at length taken with a catarrh, which was in some degree endemic in March 1795, which occasioned him to sneeze much, during which a copious haemorrhage from the lungs occurred, and he spit up at the same time half a pint of very fetid matter, and recovered. Hence errhines may be occasionally used with advantage.

4. Empyema. When the matter from an abscess in the lungs finds its way into the cavity of the chest, it is called an empyema. A servant man, after a violent peripneumony, was seized with symptoms of empyema, and it was determined, after some time, to perform the operation; this was explained to him, and the usual means were employed by his friends to encourage him, "by advising him not to be afraid." By which good advice he conceived so much fear, that he ran away early next morning, and returned in about a week quite well. Did the great fear promote the absorption of the matter, like the sickness occasioned by digitalis? Fear renders the external skin pale; by this continued decrease of the action of the absorbents of the skin might not those of the lungs be excited into greater activity? and thus produce increased pulmonary absorption by reverse sympathy, as it produces pale urine, and even stools, by direct sympathy?

M.M. Digitalis?

5. Febris Mesenterica. Fever from matter formed in the mesentery is probably more frequent than is suspected. It commences with pain in the bowels, with irritated sensitive fever; and continues many weeks, and even months, requiring occasional venesection, and mild cathartics; till at length the continuance of the pyrexia, or inflammatory fever, destroys the patient. This is an affection of the lymphatic glands, and properly belongs to scrophula; but as the matter is not exposed to the air, no hectic fever, properly so called, is induced.

6. Febris a pure aerato. Fever from aerated matter. A great collection of matter often continues a long time, and is sometimes totally absorbed, even from venereal buboes, without producing any disorder in the arterial system. At length, if it becomes putrid by its delay, and one part of the matter thus becomes aerated by the air given out by the other part; or if the ulcer has been opened, so that any part of it has been exposed to the air for but one day, a hectic fever is produced. Whence the utility arises of opening large abscesses by setons, as in that case little or no hectic fever is induced; because the matter is squeezed out by the side of the spongy threads of cotton, and little or no air is admitted; or by tapping the abscess with a trocar, as mentioned in ischias, Class II. 1. 2. 18.

In this fever the pulse is about 120 in a minute, and its access is generally in an evening, and sometimes about noon also, with sweats or purging towards morning, or urine with pus-like sediment; and the patients bear this fever better than any other with so quick a pulse; and lastly, when all the matter from a concealed ulcer is absorbed, or when an open ulcer is healed, the hectic fever ceases. Here the absorbed matter is supposed to produce the fever, and the diarrhoea, sweats, or copious muddy urine, to be simply the consequence of increased secretion, and not to consist of the purulent matter, which was supposed to be absorbed from the ulcer. See Sudor calidus, Class I. 1. 2. 3.

The action of the air on ulcers, as we have already shewn, increases the acrimony of the purulent matter, and even converts it into a weaker kind of contagious matter; that is, to a material inducing fever. This was ascribed to the union of the azotic part of the atmosphere with the effused pus in Sect. XXVIII. 2. but by contemplating more numerous facts and analogies, I am now induced to believe, that it is by the union of oxygen with it; first, because oxygen so greedily unites with other animal substances, as the blood, that it will pass through a moist bladder to combine with it, according to the experiment of Dr. Priestley. Secondly, because the poisons of venomous creatures are supposed to be acids of different kinds, and are probably formed by the contact of air after their secretion. And lastly, because the contagious matter from other ulcers, as in itch, or small-pox, are formed on external membranes, and are probably combinations of animal matter and oxygen, producing other new acids; but further experiments must determine this question.

It was thought a subject of consequence by the Aesculapian Society at Edinburgh, to find a criterion which should distinguish pus from mucus, for the purpose of more certainly discovering the presence of ulcers in pulmonary diseases, or in the urinary passages. For this purpose that society offered their first gold medal, which was conferred on the late Mr. Charles Darwin, in the year 1778, for his experiments on this subject. From which he deduces the following conclusions:

"1. Pus and mucus are both soluble in the vitriolic acid, though in very different proportions, pus being much the less soluble.

2. The addition of water to either of these compounds decomposes it; the mucus thus separated, either swims on the mixture, or forms large flocci in it; whereas the pus falls to the bottom, and forms on agitation a uniform turbid mixture.

3. Pus is diffusible through a diluted vitriolic acid, though mucus is not; the same occurs with water, or a solution of sea salt.

4. Nitrous acid dissolves both pus and mucus; water added to the solution of pus produces a precipitate; and the fluid above becomes clear and green; while water and the solution of mucus form a dirty coloured fluid.

5. Alkaline lixivium dissolves (though sometimes with difficulty) mucus, and generally pus.

6. Water precipitates pus from such a solution, but does not mucus.

7. Where alkaline lixivium does not dissolve pus, it still distinguishes it from mucus; as it then prevents its diffusion through water.

8. Coagulable lymph is neither soluble in diluted nor concentrated vitriolic acid.

9. Water produces no change on a solution of serum in alkaline lixivium, until after long standing, and then only a very slight sediment appears.

10. Corrosive sublimate coagulates mucus, but does not pus.

From the above experiments it appears, that strong vitriolic acid and water, diluted vitriolic acid, and caustic alkaline lixivium and water will serve to distinguish pus from mucus; that the vitriolic acid can separate it from coagulable lymph, and alkaline lixivium from serum.

And hence, when a person has any expectorated material, the composition of which he wishes to ascertain, let him dissolve it in vitriolic acid, and in caustic alkaline lixivium; and then add pure water to both solutions: and if there is a fair precipitation in each, he may be assured that some pus is present. If in neither a precipitation occurs, it is a certain test, that the material is entirely mucus. If the material cannot be made to dissolve in alkaline lixivium by time and trituration, we have also reason to believe that it is pus." Experiments on Pus and Mucus. Cadell. London.

7. Phthisis pulmonalis. In pulmonary consumption the fever is generally supposed to be the consequence of the stimulus of absorbed matter circulating in the blood-vessels, and not simply of its stimulus on their extremities in the surface of the ulcers; as mentioned in Class II. 1. 5. and Class II. 1. 3. 9. The ulcers are probably sometimes occasioned by the putrid acrimony of effused blood remaining in the air-cells of the lungs after an haemoptoe. See Class I. 2. 1. 9. The remote cause of consumption is ingeniously ascribed by Dr. Beddoes to the hyper-oxygenation of the blood, as mentioned Section XXVIII. 2.

As the patients liable to consumption are of the inirritable temperament, as appears by the large pupils of their eyes; there is reason to believe, that the haemoptoe is immediately occasioned by the deficient absorption of the blood at the extremities of the bronchial vein; and that one difficulty of healing the ulcers is occasioned by the deficient absorption of the fluids effused into them. See Sect. XXX. 1. and 2.

The difficulty of healing pulmonary ulcers may be owing, as its remote cause, to the incessant motion of all the parts of the lungs; whence no scab, or indurated mucus, can be formed so as to adhere on them. Whence these naked ulcers are perpetually exposed to the action of the air on their surfaces, converting their mild purulent matter into a contagious ichor; which not only prevents them from healing, but by its action on their circumferences, like the matter of itch or tinea, contributes to spread them wider. See the preceding article, and Sect. XXXIII. 2. 7. where the pulmonary phthisis is supposed to be infectious.

This acidifying principle is found in all the metallic calces, as in lapis calaminaris, which is a calciform ore of zinc; and in cerussa, which is a calx of lead; two materials which are powerful in healing excoriations, and ulcers, in a short time by their external application. How then does it happen, that the oxygen in the atmosphere should prevent pulmonary ulcers from healing, and even induce them to spread wider; and yet in its combination with metals, it should facilitate their healing? The healing of ulcers consists in promoting the absorption of the fluids effused into them, as treated of in Section XXXIII. 3. 2. Oxygen in combination with metals, when applied in certain quantity, produces this effect by its stimulus; and the metallic oxydes not being decomposed by their contact with animal matter, no new acid, or contagious material, is produced. So that the combined oxygen, when applied to an ulcer, simply I suppose promotes absorption in it, like the application of other materials of the articles sorbentia or incitantia, if applied externally; as opium, bark, alum. But in the pulmonary ulcers, which cannot protect themselves from the air by forming a scab, the uncombined oxygen of the atmosphere unites with the purulent matter, converting it into a contagious ichor; which by infection, not by erosion, enlarges the ulcers, as in the itch or tinea; which might hence, according to Dr. Beddoes's ingenious theory of consumption, be induced to heal, if exposed to an atmosphere deprived of a part of its oxygen. This I hope future experiments will confirm, and that the pneumatic medicine will alleviate the evils of mankind in many other, as well as in this most fatal malady.

M. M. First, the respiration of air lowered by an additional quantity of azote, or mixed with some proportion of hydrogen, or of carbonic acid air, may be tried; as described in a late publication of Dr. Beddoes on the medicinal use of factitious airs. Johnson, London. Or lastly, by breathing a mixture of one tenth part of hydro-carbonate mixed with common air, according to the discovery of Mr. Watt, which has a double advantage in these cases, of diluting the oxygen of the atmospheric air, and inducing sickness, which increases pulmonary absorption, as mentioned below. An atmosphere diluted with fixed air (carbonic acid) might be readily procured by setting tubs of new wort, or fermenting beer, in the parlour and lodging-room of the patient. For it is not acids floating in the air, but the oxygen or acidifying principle, which injures or enlarges pulmonary ulcers by combining with the purulent matter.

Another easy method of adding carbonic acid gas to the air of a room, would be by means of an apparatus invented by Mr. Watt, and sold by Bolton and Watt at Birmingham, as described in Dr. Beddoes' Treatise on Pneumatic Medicine. Johnson, London. It consists of an iron pot, with an arm projecting, and a method of letting water drop by slow degrees on chalk, which is to be put into the iron pot, and exposed to a moderate degree of heat over a common fire. By occasionally adding more and more chalk, carbonic acid gas might be carried through a tin pipe from the arm of the iron pot to any part of the room near the patient, or from an adjoining room. In the same manner a diffusion of solution of flowers of zinc might be produced and breathed by the patient, and would be likely much to contribute to the healing of pulmonary ulcers; as observed by Mr. Watt. See the treatise above mentioned.

Breathing over the vapour of caustic volatile alkali might easily be managed for many hours in a day; which might neutralize the acid poison formed on pulmonary ulcers by the contact of oxygen, and thus prevent its deleterious quality, as other acids become less caustic, when they are formed into neutral salts with alkalis. The volatile salt should be put into a tin canister, with two pipes like horns from the top of it, one to suck the air from, and the other to admit it.



Secondly, the external ulcers in scrophulous habits are pale and flabby, and naturally disinclined to heal, the deposition of fluids in them being greater than the absorption; these ulcers have their appearance immediately changed by the external application of metallic calxes, and the medicines of the article Sorbentia, such as cerussa and the bark in fine powder, see Class I. 2. 3. 21. and are generally healed in a short time by these means. Induced by these observations, I wished to try the external application of such powders to ulcers in the lungs, and constructed a box with a circulating brush in it, as described in the annexed plate; into this box two ounces of fine powder of Peruvian bark were put, and two drams of cerussa in fine powder; on whirling the central brush, part of this was raised into a cloud of powder, and the patient, applying his mouth to one of the tin pipes rising out of the box, inhaled this powder twice a day into his lungs. I observed it did not produce any cough or uneasiness. This patient was in the last stage of consumption, and was soon tired of the experiment, nor have I had such patients as I wished for the repetition of it. Perhaps a fine powder of manganese, or of the flowers of zinc, or of lapis calaminaris, might be thus applied to ulcers of the lungs with greater advantage? Perhaps air impregnated with flowers of zinc in their most comminuted state, might be a better way of applying this powder to the lungs, as discovered by Mr. Watt. See Dr. Beddoes on Pneumatic Medicine. Johnson.

Thirdly, as the healing of an ulcer consists in producing a tendency to absorption on its surface greater than the deposition on it; see Sect. XXXIII. 3. 2. other modes of increasing pulmonary absorption, which are perhaps more manageable than the preceding ones, may be had recourse to; such as by producing frequent nausea or sickness. See Sect. XXIX. 5. 1. and Art. IV. 2. The great and sudden absorption of fluid from the lungs in the anasarca pulmonum by the sickness induced by the exhibition of digitalis, astonishes those who have not before attended to it, by emptying the swelled limbs, and removing the difficulty of breathing in a few hours.

The most manageable method of using digitalis is by making a saturated tincture of it, by infusing two ounces of the powder of the leaves in a mixture of four ounces of rectified spirit of wine, and four ounces of water. Of this from 30 to 60 drops, or upwards, from a two-ounce phial, are to be taken twice in the morning part of the day, and to be so managed as not to induce violent sickness. If sickness nevertheless comes on, the patient must for a day or two omit the medicine; and then begin it again in reduced doses.

Mr. ——, a young man about twenty, with dark eyes, and large pupils, who had every symptom of pulmonary ulcers, I believed to have been cured by digitalis, and published the case in the Transactions of the College, Vol. III. But about two years afterwards I heard that he relapsed and died. Mr. L——, a corpulent man, who had for some weeks laboured under a cough with great expectoration, with quick pulse, and difficulty of breathing, soon recovered by the use of digitalis taken twice a day; and though this case might probably be a peripneumonia notha, or catarrh, it is here related as shewing the power of pulmonary absorption excited by the use of this drug.

Another method of inducing sickness, and pulmonary absorption in consequence, is by sailing on the sea; by which many consumptive patients have been said to have received their cure; which has been erroneously ascribed to sea-air, instead of sea-sickness; whence many have been sent to breathe the sea-air on the coasts, who might have done better in higher situations, where the air probably contains less oxygen gas, which is the heaviest part of it. See a Letter from Dr. T. C. below.

A third method of inducing sickness, and consequent pulmonary absorption, is by the vertigo occasioned by swinging; which has lately been introduced into practice by Dr. Smith, (Essay on Pulmonary Consumption), who observed that by swinging the hectic pulse became slower, which is explained in Class IV. 2. 1. 10. The usual way of reciprocating swinging, like the oscillations of a pendulum, produces a degree of vertigo in those, who are unused to it; but to give it greater effect, the patient should be placed in a chair suspended from the ceiling by two parallel cords in contact with each other, the chair should then be forcibly revolved 20 or 40 times one way, and suffered to return spontaneously; which induces a degree of sickness in most adult people, and is well worthy an exact and pertinacious trial, for an hour or two, three or four times a day for a month.

The common means of promoting absorption in ulcers, and of thickening the matter in consequence, by taking the bark and opium internally, or by metallic salts, as of mercury, steel, zinc, and copper, in small quantities, have been repeatedly used in pulmonary consumption; and may have relieved some of the symptoms. As mercury cures venereal ulcers, and as pulmonary ulcers resemble them in their not having a disposition to heal, and in their tendency to enlarge themselves, there were hopes, from analogy, that it might have succeeded. Would a solution of gold in aqua regia be worth trying? When vinegar is applied to the lips, it renders them instantly pale, by promoting the venous absorption; if the whole skin was moistened with warmish vinegar, would this promote venous absorption in the lungs by their sympathy with the skin? The very abstemious diet on milk and vegetables alone is frequently injurious. Flesh-meat once a day, with small wine and water, or small beer, is preferable. Half a grain of opium twice a day, or a grain, I believe to be of great use at the commencement of the disease, as appears from the subsequent case.

Miss ——, a delicate young lady, of a consumptive family, when she was about eighteen, had frequent cough, with quick pulse, a pain of her side, and the general appearances of a beginning consumption. She took about five drops of laudanum twice a day in a saline draught, which was increased gradually to ten. In a few weeks she recovered, was afterwards married, bore three or four children, and then became consumptive and died.

The following case of hereditary consumption is related by a physician of great ability and very extensive practice; and, as it is his own case, abounds with much nice observation and useful knowledge; and, as it has been attended with a favourable event, may give consolation to many, who are in a similar situation; and shews that Sydenham's recommendation of riding as a cure for consumption is not so totally ineffectual, as is now commonly believed.

"J. C. aged 27, with black hair, and a ruddy complexion, was subject to cough from the age of puberty, and occasionally to spitting of blood. His maternal grandfather died of consumption under thirty years of age, and his mother fell a victim to this disease, with which she had long been threatened, in her 43d year, and immediately after she ceased to have children. In the severe winter of 1783-4, he was much afflicted with cough; and being exposed to intense cold, in the month of February he was seized with peripneumony. The disease was violent and dangerous, and after repeated bleedings as well as blisterings, which he supported with difficulty, in about six weeks he was able to leave his bed. At this time the cough was severe, and the expectoration difficult. A fixed pain remained on the left side, where an issue was inserted; regular hectic came on every day about an hour after noon, and every night heat and restlessness took place, succeeded towards morning by general perspiration.

The patient, having formerly been subject to ague, was struck with the resemblance of the febrile paroxysm, with what he had experienced under that disease, and was willing to flatter himself it might be of the same nature. He therefore took bark in the interval of fever, but with an increase of his cough, and this requiring venesection, the blood was found highly inflammatory. The vast quantity of blood which he had lost from time to time, produced a disposition to fainting, when he resumed the upright posture, and he was therefore obliged to remain almost constantly in a recumbent position. Attempting to ride out in a carriage, he was surprised to find that he could sit upright for a considerable time, while in motion, without inconvenience, though, on stopping the carriage, the disposition to fainting returned.

At this time, having prolonged his ride beyond the usual length, he one day got into an uneven road at the usual period of the recurrence of the hectic paroxysms, and that day he missed it altogether. This circumstance led him to ride out daily in a carriage at the time the febrile accession might be expected, and sometimes by this means it was prevented, sometimes deferred, and almost always mitigated.

This experience determined him to undertake a journey of some length, and Bristol being, as is usual in such cases, recommended, he set out on the 19th of April, and arrived there on the 2d of May. During the greater part of this journey (of 175 miles) his cough was severe, and being obliged to be bled three different times on the road, he was no longer able to sit upright, but at very short intervals, and was obliged to lie at length in the diagonal of a coach. The hectic paroxysms were not interrupted during the journey, but they were irregular and indistinct, and the salutary effects of exercise, or rather of gestation, were impressed on the patient's mind.

At Bristol he stayed a month, but reaped no benefit. The weather was dry and the roads dusty; the water insipid and inert. He attempted to ride on horseback on the downs, but was not able to bear the fatigue for a distance of more than a hundred yards. The necessity of frequent bleedings kept down his strength, and his hectic paroxysms continued, though less severe. At this time, suspecting that his cough was irritated by the west-winds bearing the vapour from the sea, he resolved to try the effects of an inland situation, and set off for Matlock in Derbyshire.

During the journey he did not find the improvement he expected, but the nightly perspirations began to diminish; and the extraordinary fatigue he experienced proceeded evidently from his travelling in a post-chaise, where he could not indulge in a recumbent position. The weather at Bristol had been hot, and the earth arid and dusty. At Matlock, during the month of June 1784, there was almost a perpetual drizzle, the soil was wet, and the air moist and cold. Here, however, the patient's cough began to abate, and at intervals he found an opportunity of riding more or less on horseback. From two or three hundred yards at a time, he got to ride a mile without stopping; and at length he was able to sit on horseback during a ride from Mason's Bath to the village of Matlock along the Derwent, and round on the opposite banks, by the works of Mr. Arkwright, back to the house whence he started, a distance of five miles. On dismounting, however, he was seized with diliquium, and soon after the strength he had recovered was lost by an attack of the haemorrhoids of the most painful kind, and requiring much loss of blood from the parts affected.

On reflection, it appeared that the only benefit received by the patient was during motion, and continued motion could better be obtained in the course of a journey than during his residence at any particular place. This, and other circumstances of a private but painful nature, determined him to set out from Matlock on a journey to Scotland. The weather was now much improved, and during the journey he recruited his strength. Though as yet he could not sit upright at rest for half an hour together without a disposition to giddiness, dimness of sight, and deliquium, he was able to sit upright under the motion of a post-chaise during a journey of from 40 to 70 miles daily, and his appetite began to improve. Still his cough continued, and his hectic flushings, though the chills were much abated and very irregular.

The salutary effects of motion being now more striking than ever, he purchased a horse admirably adapted to a valetudinarian in Dumfriesshire, and being now able to sit on horseback for an hour together, he rode out several times a day. He fixed his residence for a few weeks at Moffat, a village at the foot of the mountains whence the Tweed, the Clyde, and the Annan, descend in different directions; a situation inland, dry, and healthy, and elevated about three hundred feet above the surface of the sea. Here his strength recovered daily, and he began to eat animal food, which for several months before he had not tasted. Persevering in exercise on horseback, he gradually increased the length of his rides, according to his strength, from four to twenty miles a day; and returning on horseback to Lancashire by the lakes of Cumberland, he arrived at Liverpool on the first of September, having rode the last day of his journey forty miles.

The two inferences of most importance to be drawn from this narrative, are, first, the extraordinary benefit derived from gestation in a carriage, and still more the mixture of gestation and exercise on horseback, in arresting or mitigating the hectic paroxysm; and secondly, that in the florid consumption, as Dr. Beddoes terms it, an elevated and inland air is in certain circumstances peculiarly salutary; while an atmosphere loaded with the spray of the sea is irritating and noxious. The benefit derived in this case from exercise on horseback, may lead us to doubt whether Sydenham's praise of this remedy be as much exaggerated as it has of late been supposed. Since the publication of Dr. C. Smyth on the effects of swinging in lowering the pulse in the hectic paroxysm, the subject of this narrative has repeated his experiments in a great variety of cases, and has confirmed them. He has also repeatedly seen the hectic paroxysm prevented, or cut short, by external ablution of the naked body with tepid water.

So much was his power of digestion impaired or vitiated by the immense evacuations, and the long continued debility he underwent, that after the cough was removed, and indeed for several years after the period mentioned, he never could eat animal food without heat and flushing, with frequent pulse and extreme drowsiness. If this drowsiness was encouraged, the fever ran high, and he awoke from disturbed sleep, wearied and depressed. If it was resolutely resisted by gentle exercise, it went off in about an hour, as well as the increased frequency of the pulse. This agitation was however such as to incapacitate him during the afternoon for study of any kind. The same effects did not follow a meal of milk and vegetables, but under this diet his strength did not recruit; whereas after the use of animal food it recovered rapidly, notwithstanding the inconvenience already mentioned. For this inconvenience he at last found a remedy in the use of coffee immediately after dinner, recommended to him by his friend Dr. Percival. At first this remedy operated like a charm, but by frequent use, and indeed by abuse, it no longer possesses its original efficacy.

Dr. Falconer, in his Dissertation on the Influence of the Passions and Affections of the Mind on Health and Disease, supposes that the cheerfulness which attends hectic fever, the ever-springing hope, which brightens the gloom of the consumptive patient, increases the diseased actions, and hastens his doom. And hence he is led to enquire, whether the influence of fear might not be substituted in such cases to that of hope with advantage to the patient? This question I shall not presume to answer, but it leads me to say something of the state of the mind in the case just related.

The patient, being a physician, was not ignorant of his danger, which, some melancholy circumstances served to impress on his mind. It has already been mentioned, that his mother and grandfather died of this disease. It may be added, that in the year preceding that on which he himself was attacked, a sister of his was carried off by consumption in her 17th year; that in the same winter in which he fell ill, two other sisters were seized with the same fatal disorder, to which one of them fell a victim during his residence at Bristol, and that the hope of bidding a last adieu to the other was the immediate cause of his journey to Scotland, a hope which, alas! was indulged in vain. The day on which he reached the end of his journey, her remains were committed to the dust! It may be conjectured from these circumstances, that whatever benefit may be derived from the apprehension of death, must in this case have been obtained. The expectation of this issue was indeed for some time so fixed that it ceased to produce much agitation; in conformity to that general law of our nature, by which almost all men submit with composure to a fate that is foreseen, and that appears inevitable. As however the progress of disease and debility seemed to be arrested, the hope and the love of life revived, and produced, from time to time, the observations and the exertions already mentioned.

Wine and beer were rigorously abstained from during six months of the above history; and all the blood which was taken was even to the last buffy." Feb. 3, 1795.

8. Febris scrophulosa. The hectic fever occasioned by ulcers of the lymphatic glands, when exposed to the air, does not differ from that attending pulmonary consumption, being accompanied with night-sweats and occasional diarrhoea.

M. M. The bark. Opium internally. Externally cerussa and bark in fine powder. Bandage. Sea-bathing. See Class I. 2. 3. 21. and II. 1. 4. 13.

9. Febris ischiadica. A hectic fever from an open ulcer between the muscles of the pelvis, which differs not from the preceding. If the matter in this situation lodges till part of it, I suppose, becomes putrid, and aerates the other part; or till it becomes absorbed from some other circumstance; a similar hectic fever is produced, with night-sweats, or diarrhoea.

Mrs. ——, after a lying in, had pain on one side of her loins, which extended to the internal part of the thigh on the same side. No fluctuation of matter could be felt; she became hectic with copious night-sweats, and occasional diarrhoea, for four or five weeks; and recovered by, I suppose, the total absorption of the matter, and the reunion of the walls of the abscess. See Class II. 1. 2. 18.

10. Febris Arthropuodica. Fever from the matter of diseased joints. Does the matter from suppurating bones, which generally has a very putrid smell, produce hectic fever, or typhus? See Class II. 1. 4. 16.

11. Febris a pure contagioso. Fever from contagious pus. When the contagious matters have been produced on the external habit, and in process of time become absorbed, a fever is produced in consequence of this reabsorption; which differs with the previous irritability or inirritability, as well as with the sensibility of the patient.

12. Febris variolosa secundaria. Secondary fever of small-pox. In the distinct small-pox the fever is of the sensitive irritated or inflammatory kind; in the confluent small-pox it is of the sensitive inirritated kind, or typhus gravior. In both of them the swelling of the face, when the matter there begins to be absorbed, and of the hands, when the matter there begins to be absorbed, shew, that it stimulates the capillary vessels or glands, occasioning an increased secretion greater than the absorbents can take up, like the action of the cantharides in a blister; now as the application of a blister on the skin frequently occasions the strangury, which shews, that some part of the cantharides is absorbed; there is reason to conclude, that a part of the matter of small-pox is absorbed, and thus produces the secondary fever. See Class II. 1. 3. 9. And not simply by its stimulus on the surface of the ulcers beneath the scabs. The exsudation of a yellow fluid from beneath the confluent eruptions on the face before the height is spoken of in Class II. 1. 3. 2.

The material thus absorbed in the secondary fever of small-pox differs from that of open ulcers, as it is only aerated through the elevated cuticle; and secondly, because there is not a constant supply of fresh matter, when that already in the pustules is exhausted, either by absorption, or by evaporation, or by its induration into a scab. Might not the covering the face assiduously and exactly with plasters, as with cerate of calamy, or with minium plaster, by precluding the air from the pustules, prevent their contracting a contagious, or acescent, or fever-producing power? and the secondary fever be thus prevented entirely. If the matter in those pustules on the face in the confluent small-pox were thus prevented from oxygenation, it is highly probable, both from this theory, and from the facts before mentioned, that the matter would not erode the skin beneath them, and by these means no marks or scars would succeed.

13. Febris carcinomatosa. Fever from the matter of cancer. In a late publication the pain is said to be relieved, and the fever cured, and the cancer eradicated, by the application of carbonic acid gas, or fixed air. See Class II. 1. 4. 16.

14. Febris venerea. From the absorption of the matter from venereal ulcers and suppurating bones. See Syphilis, II. 1. 5. 2.

M. M. Any mercurial calx. Sarsaparilla? Mezereon?

15. Febris a sanie putrida. Fever from putrid sanies. When parts of the body are destroyed by external violence, as a bruise, or by mortification, a putrefaction soon succeeds; as they are kept in that degree of warmth and moisture by their adhesion to the living parts of the body, which most forwards that process. Thus the sloughs of mortified parts of the tonsils give fetor to the breath in some fevers; the matter from putrefying teeth, or other suppurating bones, is particularly offensive; and even the scurf, which adheres to the tongue, frequently acquires a bitter taste from its incipient putridity. This material differs from those before mentioned, as its deleterious property depends on a chemical rather than an animal process.

16. Febris puerpera. Puerperal fever. It appears from some late dissections, which have been published, of those women who have died of the puerperal fever, that matter has been formed in the omentum, and found in the cavity of the abdomen, with some blood or sanies. These parts are supposed to have been injured by the exertions accompanying labour; and as matter in this viscus may have been produced without much pain, this disease is not attended with arterial strength and hard full pulse like the inflammation of the uterus; and as the fever is of the inirritative or typhus kind, there is reason to believe, that the previous exhaustion of the patient during labour may contribute to its production; as well as the absorption of a material not purulent but putrid; which is formed by the delay of extravasated or dead matter produced by the bruises of the omentum, or other viscera, in the efforts of parturition, rather than by purulent matter, the consequence of suppuration. The pulse is generally about 120 when in bed and in the morning; and is increased to 134, or more, when the patient sits up, or in the evening paroxysm. The pulse of all very weak patients increases in frequency when they sit up; because the expenditure of sensorial power necessary to preserve an erect posture deducts so much from their general strength; and hence the pulse becomes weaker, and in consequence quicker. See Sect. XII. 1. 4.

In this fever time must be allowed for the absorption of the matter. Very large and repeated quantities of the bark, by preventing sufficient food from being taken, as bread, and wine, and water, I have thought has much injured the patient; for the bark is not here given as in intermittent fevers to prevent the paroxysm, but simply to strengthen the patient by increasing the power of digestion. About two ounces of decoction of bark, with four drops of laudanum, and a dram of sweet spirit of vitriol, once in six hours, and a glass of wine between those times, with panada, or other food, I have thought of most advantage, with a small blister occasionally.

Where not only the stomach but also the bowels are much distended with air, so as to sound on striking them with the fingers, the case is always dangerous, generally hopeless; which is more so in proportion to the quickness of the pulse. Where the bowels are distended two drops of oil of cinnamon should be given in the panada three or four times a day.

17. Febris a sphacelo. Fever from mortification. This fever from absorption of putrid matter is of the inirritative or typhus kind. See the preceding article.

M. M. Opium and the bark are frequently given in too great quantity, so as to induce consequent debility, and to oppress the power of digestion.

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ORDO I.

Increased Sensation.

GENUS VII.

With increased Action of the Organs of Sense.

SPECIES.

1. Delirium febrile. Paraphrosyne. The ideas in delirium consist of those excited by the sensation of pleasure or pain, which precedes them, and the trains of other ideas associated with these, and not of those excited by external irritations or by voluntary exertion. Hence the patients do not know the room which they inhabit, or the people who surround them; nor have they any voluntary exertion, where the delirium is complete; so that their efforts in walking about a room or rising from their bed are unsteady, and produced by their catenations with the immediate affections of pleasure or pain. See Section XXXIII. 1. 4.

By the above circumstances it is distinguished from madness, in which the patients well know the persons of their acquaintance, and the place where they are; and perform all the voluntary actions with steadiness and determination. See Sect. XXXIV. 2. 2.

Delirium is sometimes less complete, and then a new face and louder voice stimulate the patient to attend to them for a few moments; and then they relapse again into perfect delirium. At other times a delirium affects but one sense, and the person thinks he sees things which do not exist; and is at the same time sensible to the questions which are asked him, and to the taste of the food which is offered to him.

This partial delirium is termed an hallucination of the disordered organ; and may probably arise from the origin of one nerve of sense being more liable to inflammation than the others; that is, an exuberance of the sensorial power of sensation may affect it; which is therefore thrown into action by slighter sensitive catenations, without being obedient to external stimulus, or to the power of volition.

The perpetual flow of ideas in delirium is owing to the same circumstance, as of those in our dreams; namely, to the defect or paralysis of the voluntary power; as in hemiplagia, when one side of the body is paralytic, and thus expends less of the sensorial power, the limbs on the other side are in constant motion from the exuberance of it. Whence less sensorial power is exhausted in delirium, than at other times, as well as in sleep; and hence in fevers with great debility, it is perhaps, as well as the stupor, rather a favourable circumstance; and when removed by numerous blisters, the death of the patient often follows the recovery of his understanding. See Class I. 2. 5. 6. and I. 2. 5. 10.

Delirium in diseases from inirritability is sometimes preceded by a propensity to surprise. See Class I. 1. 5. 11.

M. M. Fomentations of the shaved head for an hour repeatedly. A blister on the head. Rising from bed. Wine and opium, and sometimes venesection in small quantity by cupping, if the strength of the arterial system will allow it.

2. Delirium maniacale. Maniacal delirium. There is another kind of delirium, described in Sect. XXXIII. 1. 4. which has the increase of pleasureable or painful sensation for its cause, without any diminution of the other sensorial powers; but as this excites the patient to the exertion of voluntary actions, for the purpose of obtaining the object of his pleasureable ideas, or avoiding the object of his painful ones, such as perpetual prayer, when it is of the religious kind, it belongs to the insanities described in Class III. 1. 2. 1, and is more properly termed hallucinatio maniacalis.

3. Dilirium ebrietatis. The drunken delirium is in nothing different from the delirium attending fevers except in its cause, as from alcohol, or other poisons. When it is attended with an apoplectic stupor, the pulse is generally low; and venesection I believe sometimes destroys those, who would otherwise have recovered in a few hours.

M. M. Diluting liquids. An emetic.

4. Somnium. Dreams constitute the most complete kind of delirium. As in these no external irritations are attended to, and the power of volition is entirely suspended; so that the sensations of pleasure and pain, with their associations, alone excite the endless trains of our sleeping ideas; as explained in Sect. XVIII. on Sleep.

5. Hallucinatio visus. Deception of sight. These visual hallucinations are perpetual in our dreams; and sometimes precede general delirium in fevers; and sometimes belong to reverie, and to insanity. See Class III. 1. 2. 1. and 2. and must be treated accordingly.

Other kinds of visual hallucinations occur by moon-light; when objects are not seen so distinctly as to produce the usual ideas associated with them, but appear to us exactly as they are seen. Thus the trunk of a tree appears a flat surface, instead of a cylinder as by day, and we are deceived and alarmed by seeing things as they really are seen. See Berkley on Vision.

6. Hallucinatio auditus. Auricular deception frequently occurs in dreams, and sometimes precedes general delirium in fevers; and sometimes belongs to vertigo, and to reverie, and to insanity. See Sect. XX. 7. and Class III. 1. 2. 1. and 2.

7. Rubor a calore. The blush from heat is occasioned by the increased action of the cutaneous vessels in consequence of the increased sensation of heat. See Class I. 1. 2. 1. and 3.

8. Rubor jucunditatis. The blush of joy is owing to the increased action of the capillary arteries, along with that of every moving vessel in the body, from the increase of pleasurable sensation.

9. Priapismus amatorius. Amatorial priapism. The blood is poured into the cells of the corpora cavernosa much faster than it can be reabsorbed by the vena penis, owing in this case to the pleasurable sensation of love increasing the arterial action. See Class I. 1. 4. 6.

10. Distentio mamularum. The teats of female animals, when they give suck, become rigid and erected, in the same manner as in the last article, from the pleasurable sensation of the love of the mother to her offspring. Whence the teat may properly be called an organ of sense. The nipples of men do the same when rubbed with the hand. See Class I. 1. 4. 7.

* * * * *

ORDO II.

Decreased Sensation.

GENUS I.

Of the General System.

SPECIES.

1. Stultitia insensibilis. Folly from insensibility. The pleasure or pain generated in the system is not sufficient to promote the usual activity either of the sensual or muscular fibres.

2. Taedium vitae. Ennui. Irksomeness of life. The pain of laziness has been thought by some philosophers to be that principle of action, which has excited all our industry, and distinguished mankind from the brutes of the field. It is certain that, where the ennui exists, it is relieved by the exertions of our minds or bodies, as all other painful sensations are relieved; but it depends much upon our early habits, whether we become patient of laziness, or inclined to activity, during the remainder of our lives, as other animals do not appear to be affected with this malady; which is perhaps left owing to deficiency of pleasurable sensation, than to the superabundancy of voluntary power, which occasions pain in the muscles by its accumulation; as appears from the perpetual motions of a squirrel confined in a cage.

3. Paresis sensitiva. Weakness of the whole system from insensibility.

* * * * *

ORDO II.

Decreased Sensation.

GENUS II.

Of Particular Organs.

SPECIES.

1. Anorexia. Want of appetite. Some elderly people, and those debilitated by fermented liquors, are liable to lose their appetite for animal food; which is probably in part owing to the deficiency of gastric acid, as well as to the general decay of the system: elderly people will go on years without animal food; but inebriates soon sink, when their digestion becomes so far impaired. Want of appetite is sometimes produced by the putrid matter from many decaying teeth being perpetually mixed with the saliva, and thence affecting the organ of taste, and greatly injuring the digestion.

M. M. Fine charcoal powder diffused in warm water held in the mouth frequently in a day, as in Class I. 2. 4. 12. or solution of alum in water. Extract the decayed teeth. An emetic. A blister. Chalybeates. Vitriolic acid. Bile of an ox inspissated, and made into pills; 20 grains to be taken before dinner and supper. Opium half a grain twice a day.

All the strength we possess is ultimately derived from the food, which we are able to digest; whence a total debility of the system frequently follows the want of appetite, and of the power of digestion. Some young ladies I have observed to fall into this general debility, so as but just to be able to walk about; which I have sometimes ascribed to their voluntary fasting, when they believed themselves too plump; and who have thus lost both their health and beauty by too great abstinence, which could never be restored.

I have seen other cases of what may be termed anorexia epileptica, in which a total loss of appetite, and of the power of digestion, suddenly occurred along with epileptic fits. Miss B. a girl about eighteen, apparently very healthy, and rather plump, was seized with fits, which were at first called hysterical; they occurred at the end of menstruation, and returned very frequently with total loss of appetite. She was relieved by venesection, blisters, and opiates; her strength diminished, and after some returns of the fits, she took to her bed, and has survived 15 or 20 years; she has in general eaten half a potato a day, and seldom speaks, but retains her senses, and had many years occasional returns of convulsion. I have seen two similar cases, where the anorexia, or want of appetite, was in less degree; and but just so much food could be digested, as supplied them with sufficient strength to keep from the bed or sofa for half the day. As well as I can recollect, all these patients were attended with weak pulse, and cold pale skin; and received benefit by opium, from a quarter of a grain to a grain four times a day. See Class III. 1. 1. 7. and III. 1. 2. 1. and III. 1. 2. 20.

2. Adipsia. Want of thirst. Several of the inferior people, as farmers wives, have a habit of not drinking with their dinner at all, or only take a spoonful or two of ale after it. I have frequently observed these to labour under bad digestion, and debility in consequence; which I have ascribed to the too great stimulus of solid food undiluted, destroying in process of time the irritability of the stomach.

3. Impotentia (agenesia). Impotency much seldomer happens to the male sex than sterility to the female sex. Sometimes a temporary impotence occurs from bashfulness, or the interference of some voluntary exertion in the production of an effect, which should be performed alone by pleasurable sensation.

One, who was soon to be married to a lady of superior condition to his own, expressed fear of not succeeding on the wedding night; he was advised to take a grain of opium before he went to bed, and to accustom himself to sleep with a woman previously, but not to enjoy her, to take off his bashfulness; which succeeded to his wish.

M. M. Chalybeates. Opium. Bark. Tincture of cantharides.

4. Sterilitas. Barrenness. One of the ancient medical writers asserts, that the female sex become pregnant with most certainty at or near the time of menstruation. This is not improbable, since these monthly periods seem to referable the monthly venereal orgasm of some female quadrupeds, which become pregnant at those times only; and hence the computation of pregnancy is not often erroneous, though taken from the last menstruation. See Section XXXVI. 2. 3.

M. M. Opium a grain every night. Chalybeates in very small doses. Bark. Sea-bathing.

5. Insensibilitas artuum. As in some paralytic limbs. A great insensibility sometimes accompanies the torpor of the skin in cold fits of agues. Some parts have retained the sense of heat, but not the sense of touch. See Sect. XVI. 6.

M. M. Friction with flannel. A blister. Warmth.

6. Dysuria insensitiva. Insensibility of the bladder. A difficulty or total inability to make water attends some fevers with great debility, owing to the insensibility or inirritability of the bladder. This is a dangerous but not always a fatal symptom.

M. M. Draw off the water with a catheter. Assist the patient in the exclusion of it by compressing the lower parts of the abdomen with the hands. Wine two ounces, Peruvian bark one dram in decoction, every three hours alternately. Balsam of copaiva. Oil of almonds, with as much camphor as can be dissolved in it, applied as a liniment rubbed on the region of the bladder and perinaeum, and repeated every four hours, was used in this disease with success by Mr. Latham. Med. Comment. 1791, p. 213.

7. Accumulatio alvina. An accumulation of feces in the rectum, occasioned by the torpor, or insensibility, of that bowel. But as liquids pass by these accumulations, it differs from the constipatio alvi, which is owing to too great absorption of the alimentary canal.

Old milk, and especially when boiled, is liable to induce this kind of costiveness in some grown persons; which is probably owing to their not possessing sufficient gastric acid to curdle and digest it; for as both these processes require gastric acid, it follows, that a greater quantity of it is necessary, than in the digestion of other aliments, which do not previously require being curdled. This ill digested milk not sufficiently stimulating the rectum, remains till it becomes a too solid mass. On this account milk seldom agrees with those, who are subject to piles, by inducing costiveness and large stools.

M. M. Extract the hardened scybala by means of a marrow-spoon; or by a piece of wire, or of whale-bone bent into a bow, and introduced. Injections of oil. Castor oil, or oil of almonds, taken by the mouth. A large clyster of smoak of tobacco. Six grains of rhubarb taken every night for many months. Aloes. An endeavour to establish a habit of evacuation at a certain hour daily. See Class I. 1. 3. 5.

* * * * *

ORDO III.

Retrograde Sensitive Motions.

GENUS I.

Of Excretory Ducts.

The retrograde action of the oesophagus in ruminating animals, when they bring up the food from their first stomach for the purpose of a second mastication of it, may probably be caused by agreeable sensation; similar to that which induces them to swallow it both before and after this second mastication; and then this retrograde action, properly belongs to this place, and is erroneously put at the head of the order of irritative retrograde motions. Class I. 3. 1. 1.

SPECIES.

1. Ureterum motus retrogressus. When a stone has advanced into the ureter from the pelvis of the kidney, it is sometimes liable to be returned by the retrograde motion of that canal, and the patient obtains fallacious ease, till the stone is again pushed into the ureter.